Social processes influencing nursing students in passing the nursing licensure examination: A grounded theory approach.

AIM: To explore the strategies used by nursing students in passing the nursing licensure examination. DESIGN: This study uses a classic grounded theory design to explore the social processes influencing a nursing license examination. METHODS: Eight graduate students participated in this research study and were interviewed in-depth twice. The Classic Grounded Theory method of Glaser was applied to collect and analyse the data until saturation was reached. RESULTS: The findings revealed that students who passed the nursing licensure examination described the strategies as a preliminary model comprising a core category, Reviewing (Phase 1), which consisted of two sub-categories: Entering Time and Reviewing Styles. Additionally, two other main categories emerged: the Tutoring category (Phase 2) and the Testing Practice category (Phase 3). It was observed that each course (subject) does not necessarily follow a specific order in traversing these phases; they may move back and forth between them until the conclusion of the examination. Furthermore, it was found that the time allocated to Entering Time and completing the three phases significantly influences the successful passing of the nursing licensure examination.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX.

BACKGROUND: The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions. METHOD: A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz. RESULTS: Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions. CONCLUSION: Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum.

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials.

INTRODUCTION: Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination. LITERATURE REVIEW: Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement. DISCUSSION: This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis. CONCLUSIONS: Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

An Overview of Nursing Regulation.

The rules and regulations that govern nursing practice are topics rarely covered in nursing education programs. This article aims to provide a basic understanding of state and federal rules that govern nursing practice; the role and duties of nurse regulatory boards; types of legal actions that nurses may face; and an overview of discipline, complaint, and reporting processes.

An NCLEX-RN Improvement Project: A Study of Student Attributes Associated With Test Success.

BACKGROUND: A school of nursing developed a process to improve graduates' NCLEX-RN scores through a committee tasked with identifying approaches to assist students in passing the NCLEX-RN on the first attempt. METHOD: The process involved: (1) engaging the faculty to use current published evidence; and (2) conducting an anonymous survey of previous graduates to identify the factors associated with NCLEX-RN success in the school's student population. Logistic regression analysis was conducted on a sample of 165 graduates of the program. RESULTS: The analysis of the graduates' psychosocial, academic, and NCLEX-RN preparation attributes compared with NCLEX-RN outcome revealed grade point average was the strongest significant predictor of success. CONCLUSION: The NCLEX-RN success program served to engage the school of nursing faculty. In addition, a study of the program's graduates revealed a predictor of potential student success that can identify students who may need additional support early in the program. [J Nurs Educ. 2024;63(2):102-107.].

Comparative Analysis of NCLEX-RN Questions: A Duel Between ChatGPT and Human Expertise.

BACKGROUND: Artificial intelligence (AI) has the potential to revolutionize nursing education. This study compared NCLEX-RN questions generated by AI and those created by nurse educators. METHOD: Faculty of accredited baccalaureate programs were invited to participate. Likert-scale items for grammar and clarity of the item stem and distractors were compared using Mann-Whitney U, and yes/no questions about clinical relevance and complex terminology were analyzed using chi-square. A one-sample binomial test with confidence intervals evaluated participants' question preference (AI-generated or educator-written). Qualitative responses identified themes across faculty. RESULTS: Item clarity, grammar, and difficulty were similar for AI and educator-created questions. Clinical relevance and use of complex terminology was similar for all question pairs. Of the four sets with preference for one item, three were generated by AI. CONCLUSION: AI can assist faculty with item generation to prepare nursing students for the NCLEX-RN examination. Faculty expertise is necessary to refine questions written using both methods. [J Nurs Educ. 2023;62(12):679-687.].

Effects of the COVID-19 Pandemic on Comprehensive Predictor Scores as Proxy for the NCLEX-RN.

BACKGROUND: Research is needed to examine whether the coronavirus disease 2019 (COVID-19) pandemic affected nursing students' NCLEX-RN pass rate. A decline in the NCLEX-RN pass rate would be detrimental to the nursing workforce, the nursing shortage, and nursing educational programs. This quantitative comparative study analyzed the effect of the COVID-19 pandemic on nursing students' Comprehensive Predictor scores as a proxy for the NCLEX-RN. METHOD: An independent t test was conducted to test for a difference in Comprehensive Predictor scores of nursing students before and during the COVID-19 pandemic. RESULTS: There was no statistically significant difference in Comprehensive Predictor scores before and during the pandemic. CONCLUSION: Because there was no significant change in nursing students' pass rate on the Comprehensive Predictor as a proxy for the NCLEX-RN during the COVID-19 pandemic, the number of new graduate nurses entering clinical practice is expected to remain the same as pre-pandemic levels. [J Nurs Educ. 2023;62(11):638-641.].

An audit of mental health questions on U.S. nursing licensure applications: Evidence to guide urgent action for change.

BACKGROUND: Nurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work. AIMS: This study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States. METHODS: A sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if ≥1 item on the checklist was violated. RESULTS: At least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist. LINKING EVIDENCE TO ACTION: The majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

Course repetition in pre-licensure nursing students: A scoping review.

SIGNIFICANCE OF PROBLEM: Nursing student attrition is a global issue affecting students, nursing programs, and the profession. One group of nursing students at risk for attrition are those that have failed and need to repeat a required nursing course. These students experience academic consequences such as delayed graduation and entry into the workforce, further contributing to the nursing shortage. Unfortunately, current literature about nursing student repeaters remains inadequate, and evidence of support measures is minimal. PURPOSE: This scoping review aims to summarize the literature on course repetition in pre-licensure nursing students and identify gaps in the literature about this population. METHODS: Arskey and O'Malley's (2005) five-step procedure was used as the organizing framework to explore course repetition in pre-licensure nursing students. RESULTS: There were twenty articles relevant for this scoping review. The findings revealed nursing student repeaters are at an increased risk for subsequent failure and attrition. Students experienced shock, sadness, and uncertainty when course failure ensued. Nursing students sought additional help while repeating failed courses, but interventions solely harnessed toward student repeaters can be beneficial. CONCLUSION: Nursing student repeaters are a unique population that requires a multifaceted approach, including academic and non-academic support structures, to ensure they meet the educational standards of the repeated course. Future studies regarding this population should include progression policies' impact on student success and strategies and interventions that create positive outcomes among student repeaters.

Suggestion for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination: a survey-based descriptive study.

PURPOSE: This study aims to suggest the number of test items in each of 8 nursing activity categories of the Korean Nursing Licensing Examination, which comprises 134 activity statements including 275 items. The examination will be able to evaluate the minimum ability that nursing graduates must have to perform their duties. METHODS: Two opinion surveys involving the members of 7 academic societies were conducted from March 19 to May 14, 2021. The survey results were reviewed by members of 4 expert associations from May 21 to June 4, 2021. The results for revised numbers of items in each category were compared with those reported by Tak and his colleagues and the National Council License Examination for Registered Nurses of the United States. RESULTS: Based on 2 opinion surveys and previous studies, the suggestions for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination in this study are as follows: 50 items for management of care and improvement of professionalism, 33 items for safety and infection control, 40 items for management of potential risk, 28 items for basic care, 47 items for physiological integrity and maintenance, 33 items for pharmacological and parenteral therapies, 24 items for psychosocial integrity and maintenance, and 20 items for health promotion and maintenance. Twenty other items related to health and medical laws were not included due to their mandatory status. CONCLUSION: These suggestions for the number of test items for each activity category will be helpful in developing new items for the Korean Nursing Licensing Examination.

Academic Differences in BSN Admission Routes: Implications for Persistence.

BACKGROUND: To increase retention of prelicensure nursing students, several routes are used for admission to nursing programs. Students can be accepted as an early matriculation (EM) student at the point of university admission or they can follow a traditional competitive approach (TR) for admission. METHOD: A retrospective matched cohort study design was used to explore the differences among selected academic variables in two groups of prelicensure undergraduate students (n = 136) in the same program. RESULTS: EM students had significantly lower science grade point averages (GPAs), pre-program GPAs, and junior-level GPAs than TR students. However, there were no significant differences between the two groups in scores on the RN Fundamentals ATI examination, an important predictor of future NCLEX-RN success. CONCLUSION: EM students were as successful as their counterparts on standardized examinations in the first semester of a nursing program. More research is needed to understand program outcomes associated with students entering nursing programs via different routes. [J Nurs Educ. 2023;62(5):302-306.].

LGBTQI+ representation in pre-licensure nursing textbooks: A qualitative descriptive analysis.

BACKGROUND: To improve health equity, nursing curricula should include content specific to the needs of marginalized and underserved communities, such as lesbian, gay, bisexual, transgender, queer, and intersex groups (LGBTQI+). Harmful and absent academic discussions of LGBTQI+ patients lead to provider discomfort and inadequacy in treating this patient population. Nursing schools are well-positioned to increase comfort with LGBTQI+ content as part of pre-licensure curricula. This article presents a systematic evaluation of LGBTQI+ content in nursing pre-licensure textbooks and the nature and quality of the representations. METHODS: A qualitative descriptive analysis of LGBTQI+ content from 14 nursing-specific textbooks required by a pre-licensure degree program at the Johns Hopkins School of Nursing was conducted by a student-led team with faculty oversight. A priori and iterative search terms were used to identify and extract text segments that referenced LGBTQI+ content in each textbook. An iterative codebook was developed, codes were applied, and analysis of the information and context in which the terms were presented was performed. RESULTS: The research team observed gaps and notable patterns in distribution of LGBTQI+ terms and health content areas across the textbooks reviewed. The majority of LGBTQI+ search terms were identified in the following health content areas: social determinants of health, sexual/reproductive health, pediatric sexual & gender diversity, intersectionality, and infectious disease. Based on qualitative descriptive analyses, the data were organized into the following categories: a) Language; b) Medicalization; c) Vague, Incomplete, or Lacking Specificity; and d) Comprehensive Approach. CONCLUSION: Findings highlight the need for increased academic exposure for pre-licensure nursing students regarding the care of LGBTQI+ patients. Thoughtful inclusion of LGBTQI+ content may better foster the delivery of evidence-based care for this patient population. These findings underscore the need for improved nursing curricula to support nurses in delivering affirming care for LGBTQI+ populations.

NCLEX Pass Rates Drop Again.

Remote learning forced by the COVID-19 pandemic may have been a factor.

Strategies to Increase NCLEX Pass Rates: From 68% to 92% in 1 Year.

BACKGROUND: One of the key indicators of a quality prelicensure nursing program is the NCLEX first-time pass rate. NCLEX-RN pass rates have been decreasing over the last several years. PROBLEM: The decrease in NCLEX pass rates suggests that nursing programs analyze their curriculum with the goal of increasing NCLEX scores. APPROACH: One small associate degree in nursing program implemented strategic changes to positively improve NCLEX success, which included curriculum revisions and incorporating a clinical judgment framework. OUTCOMES: By using several innovative strategies, this program increased its first-time NCLEX pass rates by 24%. CONCLUSIONS: The purpose of this article is to provide strategies that significantly increased the NCLEX-RN pass rates within 1 year. With the Next Generation NCLEX's launch in April 2023, nursing programs must be proactive in identifying strategies to prepare students for the NCLEX.

Teaching Social Determinants of Health Through an Unfolding Case Study.

BACKGROUND: The impact of social determinants of health (SDOH) was developed to educate nursing students through the use of an unfolding case study. PROBLEM: SDOH and population health are critical components of prelicensure nursing education. Unfolding case studies are a strategy to develop critical thinking and teach SDOH to nursing students. APPROACH: A model was used to develop the case study including a community assessment, which follows a male veteran and family through life events. Implementation of the unfolding case study took place over 3 consecutive semesters in a community health nursing course. OUTCOMES: This educational activity achieved standardized examination scores, which are intended to assess student preparedness for the National Council Licensure Examination (NCLEX), above the national averages. Student participation was above 90%. CONCLUSION: Unfolding case studies can present realistic scenarios that are useful to teach critical thinking. As the Next Generation NCLEX moves to scenario-based testing, unfolding case studies are a teaching strategy to prepare students.