Impact of a Digital Intervention on Perceived Stress, Resiliency, Social Support, and Intention to Leave Among Newly Licensed Graduate Nurses: A Randomized Controlled Trial.

BACKGROUND: The nursing shortage has been deemed a public health crisis as the turnover rate of newly licensed graduate nurses (NLGNs) continues to grow. One of five NLGNs are leaving the profession due to work dissatisfaction and feelings of inadequacy, risking patient safety. METHOD: A prospective, randomized controlled trial evaluated the impact of a 6-week digital intervention (text messaging) on NLGNs' self-reported stress, resiliency, sense of support, and intention to leave their jobs, organization, and profession. Messages to the experimental group (n = 10) conveyed emotional, esteem, and networking support, and messages to the control group (n = 11) were medical facts. RESULTS: The digital intervention in the form of medical facts increased the control group's sense of social support. Stress, resilience, and intention to leave their jobs, organizations, or profession did not change for either the control or experimental group. CONCLUSION: A digital intervention, such as text messaging, potentially can increase NLGNs' sense of support during their first year of hire. [J Contin Educ Nurs. 2021;52(8):367-374.].

Perceived stress, physiological stress reactivity, and exit exam performance in a prelicensure Bachelor of Science nursing program.

Objectives High-stakes exams are a source of chronic stress that may adversely affect nursing students' thinking, behavior, and overall health. The purpose of this study was to explore the relationships of perceived stress, physiological stress reactivity, and exit exam performance. Methods A within-subjects design allowed measurement of perceived stress, salivary cortisol, and salivary alpha amylase in pre-licensure nursing students under two different conditions: a high-stakes exit exam and a low-stakes homework assignment. Results Perceived stress and salivary alpha amylase were significantly higher after the high-stakes exam compared to the homework condition. Perceived stress after the exam was correlated with lower exam score. Conclusion Study findings suggest that in response to a high-stakes exam, prelicensure nursing students experience high levels of perceived stress coupled with sympathetic activation but not activation of the hypothalamic-pituitary adrenal axis.

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology.

BACKGROUND: People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. PURPOSE: The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. METHODS: A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. RESULTS: Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. CONCLUSIONS: The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.

Gender Differences and Similarities in Accelerated Nursing Education Programs: Evidence of Success From the New Careers in Nursing Program.

AIM: The aim of the study was to examine the profile of male students in accelerated nursing education programs (ANEPs) focusing on key demographic, educational, and outcome variables and compare male and female students on these variables. BACKGROUND: Though ANEPs have proliferated over the last two decades, there has been little study of students enrolled in these programs and, consequently, the role ANEPs could play in enhancing nursing workforce diversity. METHOD: This study is a secondary analysis of data collected from 3,502 students who participated in the Robert Wood Johnson Foundation New Careers in Nursing Program from 2008 to 2016. RESULTS: ANEP completion and NCLEX-RN success rates were strong overall. Male and female ANEP students differed on several dimensions often associated with academic success, differences that have relevance for purposes of teaching, research, and program planning. CONCLUSION: ANEPs could be an effective mechanism for increasing the gender, racial, and ethnic diversity of the nursing workforce.

Quality of nursing schools in the Philippines: Trends and evidence from the 2010-2016 Nurse Licensure Examination results.

BACKGROUND: The quality of undergraduate nursing programs offered by higher education institutions (HEIs) in the Philippines is usually evaluated using Nurse Licensure Examination (NLE) results. PURPOSE: To describe NLE trends in 2010 to 2016, compare low- and high-performing HEIs, and examine the association of HEIs' characteristics with NLE passing rate. METHODS: NLE and HEI data were collected from two Philippine government agencies. Descriptive statistics were used to present NLE trends, while multiple linear regression was used to determine the association of HEI characteristics with NLE passing rate. DISCUSSION: There was a downward trend for NLE takers and passers from 2010 to 2016. Regression results showed that location, size, type, year of establishment, and student-faculty ratio were associated with NLE passing rate. CONCLUSION: HEIs should consider decreasing their student-faculty ratio to improve NLE performance. Relevant government agencies should take measures to improve most HEIs' NLE performance in the Philippines.

Senior NCLEX-RN Coaching Model: Development and Implementation.

BACKGROUND: A host of interventions have been used to improve NCLEX outcomes, yet scant evidence exists to show the influence of academic coaching on pass rates. PURPOSE: To improve NCLEX confidence/readiness and pass rates in a baccalaureate nursing program, an NCLEX Coaching Model was developed and implemented. METHOD: Senior students were paired with faculty for 6 weeks of NCLEX coaching. Students self-assessed strengths, risk factors, and challenges related to NCLEX preparation. Coaches and students co-developed the NCLEX Preparation and Success Plan using standardized NCLEX predictor scores. Success plans represented individualized preparation strategies focused on specific NCLEX Client Needs categories. RESULT: National Council Licensure Examination confidence/readiness scores improved significantly, and first-time NCLEX pass rates improved slightly after coaching. CONCLUSION: An NCLEX Coaching Model can build student confidence/readiness and promote NCLEX success among nursing students. Peplau's Theory of Interpersonal Relations was useful in guiding development and implementation of a coaching model.

Student Profile Characteristics as Predictors of Success: Nontraditional and English as an Additional Language Students in a Prelicensure BSN Program.

This study examined the extent to which selected student profile characteristics predict success for a sample of prelicensure BSN students at a Midwestern university. The results indicated that both nontraditional students and students with English as an additional language are less likely to experience early program success and on-time completion while nontraditional students were more likely to experience National Council Licensure Examination (NCLEX-RN®) success. Results from the study were used to develop interventions specifically designed to promote success in diverse student populations at the research site.

A comparative analysis of NCLEX pass rates: Nursing health human resources considerations.

AIMS: To examine performance differences among different writers of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) examination in Canada; to compare Canadian and U.S. writer pass rate data; and to identify if changes in the Canadian nursing workforce can be related to the introduction of NCLEX-RN. BACKGROUND: In January 2015, the entry-to-practice licensing examination changed from the Canadian Registered Nurse Examination to the NCLEX-RN, and pass rates declined. METHODS: This comparative analytic study examined NCLEX-RN pass rate data for 2015, 2016 and 2017 using publicly available data. The Canadian data were compared with that from U.S. nurses taking the examination. RESULTS: Overall year-end pass rates among Canadian writers appeared to improve significantly in 2016 (95% to 96.3%, p < 0.001, from 2015 to 2016) but declined again from 96.3% to 90.4% in 2017 (p < 0.001). Pass rates remain significantly lower for first attempt Canadian writers compared to first attempt U.S. writers (2015: 69.7% vs. 84.5%, p < 0.001). CONCLUSIONS: The change in licensing examination had a major impact on pass rates for new graduates entering the nursing profession and potentially the number of new nurses entering the profession in Canada immediately after graduation. IMPLICATIONS FOR NURSING MANAGEMENT: A loss of entry-level workers to the nursing profession in Canada affects workforce management strategies, particularly with respect to worker shortages.

Voices Raised: The NCLEX-RN Experience in Canada.

The journey to this issue on the National Council Licensure Examination (NCLEX) began when the CJNL editorial director received two unsolicited NCLEX-focused manuscripts for consideration to publish. Adding to the growing body of articles and news stories published about the NCLEX since its 2015 implementation in Canada, the two papers revealed that the NCLEX-RN remains a controversial and unresolved issue for our profession. CJNL has long published special issues to focus attention on specific topics. Such focused publication creates a convenient repository of knowledge and information about a given subject, facilitating deeper exploration of the issue and serving as a historical reference point for the topic going forward. This issue continues that tradition by presenting 10 papers that discuss the NCLEX from the perspectives of researchers, policy makers, educators, students and a coalition of nurses that is vigorously advocating for remedies to address the disproportionately adverse impact of the NCLEX on students and especially on francophone writers. As CJNL's editor for policy and innovation, I was asked to serve as guest editor for this issue, and it has been my privilege to do so.

Predictors of Success in the NCLEX-RN for Canadian Graduates.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) has been the nursing licensure exam in most Canadian jurisdictions since 2015. Nursing faculty across the country have invested considerable effort into understanding the NCLEX-RN, so they could help to prepare students to be successful in the exam. A retrospective study was conducted at one Canadian university to identify predictors of success on the NCLEX-RN. Findings revealed that the strongest predictors of success were a grade point average of >3.5 and a course grade in the community development course. The strong predictive value of the community development course was unexpected, and this suggests that content specifically related to acute care may not play as heavy a role in the NCLEX-RN outcome as previously expected. It is possible that students' higher levels of cognitive abilities, such as application, analysis and synthesis of nursing knowledge, play a larger role in the exam outcome than content-specific knowledge.

A Closer Look at the Introduction of the NCLEX-RN in Canada.

In 2015, the nursing faculty across most of Canada were informed by provincial nursing regulators that the America-based National Council Licensure Examination-Registered Nurse (NCLEX-RN) was going to replace the Canadian Registered Nurse Examination for our nursing students to become registered as nurses. This change in the exam has presented a number of challenges to both faculty and students as they transitioned from a Canadian exam for the Canadian context to an exam that was originally formulated for nursing registration in the United States. This manuscript examines the differences in the Canadian and American healthcare systems; explores the variations in Canadian and American nursing practice and education; outlines concerns surrounding the use of standardized testing that panders to corporate interests, encourages "teaching to the test" and is costing nursing programs and nursing students considerable resources; and explores the controversy surrounding the validity of the NCLEX-RN in both Canada and the United States. This manuscript asks Canadian nursing leaders, educators, clinicians and researchers to question why Canadians have taken on this exam when Americans themselves state that this exam "gives a false and incomplete picture of practice readiness."

The Forgotten: The Challenges Faced by Francophone Nursing Candidates following the Introduction of the NCLEX-RN in Canada.

In 2015, the traditional paper-and-pencil entry-to-practice exam in Canada was replaced by a computer-adaptive testing exam, the American National Council Licensure Examination for Registered Nurses (NCLEX-RN). As there are two official languages in Canada - English and French - the NCLEX-RN was translated to French. Although initially the pass rates for anglophone writers with the NCLEX-RN were lower than with the previous Canadian licensing exam, their pass rates have now increased. By contrast, francophone writers have continued to have lower pass rates, and a decreasing number of candidates are choosing to write the exam in French. A lack of access to French language preparatory resources is being reported by francophone graduates as one of the contributing factors. Canadian nursing regulators report that they are not responsible for ensuring that candidates have access to preparatory materials. However, given the bilingual culture and heritage in Canada, there is a responsibility to ensure equitable access to preparatory resources to ensure success on the licensing exam. This paper raises alarm about the decreasing number of francophone graduates writing the NCLEX-RN in French and the ongoing delivery of safe, quality nursing care to francophone patients by nurses proficient in the French language.

The NCLEX-RN as an Entry-to-Practice Exam in New Brunswick: The Rocky Road Story of Francophone Candidates to the Nursing Profession.

This article describes the experience of adopting the NCLEX-RN as an entry-to-practice exam among francophone baccalaureate nursing students in New Brunswick, Canada. The journey between 2012 and now has been difficult, and nursing leadership was necessary to inform key stakeholders regarding the inequities faced by francophone nursing students and to bring about change. Here is a description of the arduous work done by a group of concerned nurses (active and retired) to advocate for the rights of francophone nursing students.

The Canadian Nursing Students' Association and its Advocacy for a Culturally Competent Entry-to-Practice Exam.

The Canadian Nursing Students' Association (CNSA) is the national voice of Canadian nursing students. Its goal is to increase the legal, ethical, professional and educational aspects of nursing, which are an integral part of the profession. The association is actively dedicated to the positive promotion of nurses and nursing as a whole. Since the implementation of the NCLEX-RN, CNSA has worked extensively to support nursing students as they write this entry-to-practice examination. On national and provincial platforms, CNSA has implored stakeholders to engage in an inclusive dialogue that results in increased support for nursing students with regard to the NCLEX-RN.

Emotional Intelligence Relates to NCLEX and Standardized Readiness Test: A Pilot Study.

BACKGROUND: Understanding what factors contribute to NCLEX-RN success is critical to nursing programs. Emotional intelligence is one factor that warrants investigation. PURPOSE: The purpose of our study was to examine emotional intelligence, measured via the Mayer-Salovey-Caruso Emotional Intelligence Test 2.0, to 2 standardized measures of nursing student performance: the Kaplan Nursing Assessment Test (NAT) and NCLEX-RN success. METHODS: A descriptive, cohort design with 2 data collections times points (n = 53) evaluated the contribution of emotional intelligence to NAT and to NCLEX-RN success, while controlling for age. RESULTS: Emotional intelligence global scores were significantly related to both NAT and NCLEX-RN. Understanding emotions branch was a significant predictor of NAT. Perceiving emotions and understanding emotions branches were both significant predictors of NCLEX-RN. CONCLUSIONS: Results suggest that enhancing nursing curriculum to include training in perceiving and understanding emotions may be beneficial in augmenting student success.

Exploring NCLEX Failures and Standardized Assessments.

BACKGROUND: Nurse educators seek valid and reliable tools to assist in early identification and intervention for students at-risk of NCLEX-RN failure. PURPOSE: The purpose of this cross-sectional study was to use principal component analysis to explore relationships within standardized assessment (SA) scores from a sample of students who failed the NCLEX-RN on the first attempt. METHODS: Standardized assessment scores were collected from prelicensure programs between 2009 and 2016 (n = 296). Mixed modeling sought to reveal SA scores that represented redundancy or duplication. RESULTS: The principal component analysis found 2 distinct components emerging from the 8 SAs included in the study, signifying duplication in the content assessed. Within these 2 components, maternal newborn and pharmacology had the strongest correlations among the SA scores. CONCLUSIONS: Discovering those SAs that assess similar content and have the strongest correlations can provide additional information for decision making when implementing these tests throughout the nursing curriculum.

Adaptive Quizzing Improves End-of-Program Exit Examination Scores.

BACKGROUND: A third of nursing schools use a standardized, end-of-program exit examination requiring minimum passing scores for student progression. Student failures on high-stakes tests have negative implications for students and schools of nursing. Adaptive quizzing has increased grades, graduation rates, and NCLEX-RN passing rates and reduced test anxiety in nursing students. PURPOSE: To diminish the negative effects of high-stakes testing and increase standardized exit examination scores, an undergraduate nursing program incorporated customized adaptive quizzing for nursing students in their final nursing course before graduation. METHODS: End-of-program exit examination scores were compared in a preintervention cohort of students and postintervention cohort assigned individualized adaptive quizzing. RESULTS: Statistically significant increases in end-of-program exit examination scores were evident in groups of students completing the customized adaptive quizzing assignments. CONCLUSION: The use of tailored adaptive quizzing increased exit examination scores, supporting the implementation of customized assignments for remediation.

Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks.

BACKGROUND: In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. METHODS: We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file. RESULTS: Based on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles. CONCLUSIONS: Publicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.

National Licensure Exam for Brazilian Nurses: why and for whom?

OBJECTIVE: To analyze critically the reasons for regulating a National Licensure Exam for Brazilian Nurses (NLEXB-N). METHOD: Qualitative study with secondary source applying the critical discourse analysis to situate context and intertextuality in the establishment of a new social practice. We analyzed data from legal documents regulating the National Licensure Exam of other professions in Brazil, the Educational Census, the Survey of Brazilian Nursing Profile and global nursing literature. RESULTS: Four themes were explored: Brazilian experiences with this exam; nursing experiences in other countries; effects of the exam on the examinees; NLEXB-N in Brazil: what purposes could we present? FINAL CONSIDERATIONS: The National Licensure Exam for Brazilian Nurses is a measure of individual accountability that increases social injustice, inequality and inequity. We must pay attention to the consequences of its application, based on evidences produced in the area.