Journal of Nursing Education

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Relationship of Nursing Program Predictors and Success on the NCLEX-RN Examination for Licensure in a Selected Associate Degree Program

Ruth Woodham, RN, MSN; Kurt Taube, MA

Abstract

ABSTRACT

This ex post facto correlational study sought to determine the relationship of selected admission criteria and performance in the integrated nursing major didactic courses of an associate science in nursing degree program as predictors for performance on the licensing examination for registered nurses. A significant positive relationship at .01 with NCLEX was individually demonstrated with all of the seven ASN nursing courses and with SAT verbal scores. Not significant were age at graduation from the program, high school class rank percentile, and SAT math scores. Multivariate regression weights derived from an equation using course grades of 104 graduates were used to predict NCLEX scores. The predicted scores correlated strongly (n=. 78551, p<.001) with the actual scores. Ten predicted and actual scores were provided for demonstration.

Abstract

ABSTRACT

This ex post facto correlational study sought to determine the relationship of selected admission criteria and performance in the integrated nursing major didactic courses of an associate science in nursing degree program as predictors for performance on the licensing examination for registered nurses. A significant positive relationship at .01 with NCLEX was individually demonstrated with all of the seven ASN nursing courses and with SAT verbal scores. Not significant were age at graduation from the program, high school class rank percentile, and SAT math scores. Multivariate regression weights derived from an equation using course grades of 104 graduates were used to predict NCLEX scores. The predicted scores correlated strongly (n=. 78551, p<.001) with the actual scores. Ten predicted and actual scores were provided for demonstration.

The primary concern of nursing education is the implementation of knowledge in such a manner that the nursing student can become a competent, accountable, and effective professional in nursing practice. The nursing license makes it possible for a nurse to practice his or her profession legally. The current cognitive licensing measurement of minimum, safe nursing practice is the National Council Licensure Examination for Registered Nurse Licensure (NCLEX-RN). This examination which replaced the State Board Test Pool Examination (SBTPE), was administered for the first time on July 13 & 14, 1982 (NLN Perspective, 1981). The NCLEX-RN is an integrated licensure examination organized in a nursing process framework (Saxton, Pelikan, Nugent & Weedleman, 1982). The comprehensive minimum passing score for the exam is 1600.

The midwestern Associate of Science in Nursing Degree Program selected for this study has had a reputation for preparing graduates who have successfully passed the SBTPE on first attempt. Statistical data from June 1968 through February 1982 are on file in the office of the Associate Dean of the program to support this claim (Applegate, 1983). The data record the scores of 1,480 candidates over 32 testing periods. The percentage of candidates represented in each of these testing periods who successfully passed ali five subscores on first attempt was consistently above 90%. The eventual successful pass rate in all five subscores on subsequent attempts for the 1,480 candidates was 100% for all the original test periods except June 1970, January 1972, and July 1974. Four candidates of 1,480 were not successful. Two had not passed on repeat, one person's status was uncertain, and one person was reported as deceased before repeat.

The highly successful SBTPE performances of past graduates appeared to support beliefs that program performance measures might have been indicators of success with the original RN licensure examination. With the introduction of a new licensing examination, and with ongoing revisions and refinements in the programs admission criteria and curriculum, a study to examine the relationship of selected program predictors and success on the NCLEX-RN examination was undertaken.

The ASN Program in this study is located in an urban metropolitan area within a core campus of a major midwestern state university. The student body on the campus represents the third largest student body in the state. Multiple sections of support courses make program planning for the nursing students more flexible in terms of selecting elective courses or planning for multiple goals. The School of Nursing offers, in addition to the ASN Degree, BSN, MSN, and DNS degrees.

The students in the ASN program have been a heterogeneous population in terms of age, sex, and ethnicity. A ten-year admission profile completed in 1979 and updated in 1983 indicated a wide age range with a continuing trend toward an adult learner population. The largest single age category in the 10-year profile was 20-24 (32.9%) (Self-Evaluation Report, 1983). A significant number of students were married and were parents of dependent children. A majority required some financial aid. Many maintained part-time employment. The educational background and work experiences of the students in the study were diverse. A number of students completed some college work and a few had associate, baccalaureate, and masters degrees in other fields.

Admission to the nursing program occurs in both the fall and spring semesters on the campus. At the time of this study three admission routes were available to the students. Records were reviewed for graduating high school seniors, who wished to directly enter the nursing major, for students in University Division of the university who chose to enter the university and complete some general education and/or pre-requisite nursing courses before applying to the School of Nursing, and for students in a special university guided study program whose high scool records indicated that they might need special help to meet the challenge of higher education. Criteria for all groups for admission to the School of Nursing included:

1. Graduation in the upper half of high school with a minimum high school transcript of 3 units of English, 1 unit of laboratory science, 1 unit of algebra, and an additional 8 units in English, language, mathematics, science or social studies. Grades lower than C in these listed courses may have resulted in a remediation requirement.

2. Achievement of reasonable SAT or ACT examination as established by the Associate Degree faculty. (SAT criteria were math 400 and verbal 400.) It should be noted that the Associate Degree Program accepts the university policy that requires SAT scores for admission only for students who have graduated from high school within two years of application to the university. Because of the emerging trend of adult learners applying to the nursing program, statistical data for SAT scores is incomplete for the sample used in this study

3. Admission to support courses while enrolled in the University Division does not guarantee admission to the nursing major. Admission therefore is on a competitive basis for a limited number of positions.

4. Other guidelines in reviewing student records include a minimum 2.0 on a 4,0 scale for all college work completed with 15 credit hours of courses relevant to nursing having priority. Pre-requisite support courses for the ASN program include Human Anatomy (5 credit), Human Physiology (5 credit), Microbiology and Laboratory (4 credit), Psychology as a Social Science (3 credit), Life Span Development (3 credit), Principles of Sociology (3 credit), Guided Elective in Sociology (3 credit), and Elective (3 credit) and English (3 credit).

A record review of the total 107 graduates for the graduating classes of May 1982, December 1982, and May 1983 was undertaken to determine the relationship of selected admission criteria and performance in the integrated nursing major didactic courses of an associate science in nursing degree program as predictors for performance on the licensing examination for registered nurses. Nursing major course grades were also used in an equation to predict NCLEX scores of graduates from 104 of the 107 records reviewed. Three records were incomplete. Two records were without actual NCLEX scores and one record did not have one course grade recorded.

Multiple entrance routes to the nursing major plus the heterogeneity of the pre-nursing college educational backgrounds of students did not lend the college courses outside of the nursing major amenable to this study. Although SAT scores were used in the correlation study, these were not used in the prediction equation. Data were incomplete for SAT scores (71 out of 107). Because a significant number of students were adult learners at the time of this study and continue to increase in numbers with future admissions, obtaining data from the SATs for a prediction study was and will continue to be illusive.

The grading scale used by the ASN Program for nursing major didactic courses is 91-100% = A, 83-90% = B, 75-82%=C. All scores below 75% are considered not passing for nursing major courses. The course must be repeated for credit towards graduation. Receiving less than 75% in two nursing courses results in dismissal from the program. In the event that records revealed a repeat in one course because of less than 75%, the first grade recorded was used. From 748 first-time course grades observed for the 107 students, only eight first-time failing grades were noted. Only one of these, a 69, fell below 72%.

Data gathered for this study included age at graduation from the nursing program, high school class rank percentile, SAT verbal scores, SAT math scores, percentage scores for each of seven ASN nursing major didactic courses, and NCLEX scores. Correlation of each independent variable with NCLEX scores was computed using the Regression and Pearson Correlation sub-program of the Statistical Package for the Social Sciences (SPSS).

SAT math scores for associate degree students in this program have been analyzed previously by faculty. Dexter and Applegate (1980) cite a study correlating students' high school algebra grades, geometry grades and math SAT scores with their performance in various areas of the nursing program. They concluded that "above a certain minimum (in our case 350 to 400) there was no evidence that higher SAT scores predicted greater achievement within the nursing program" (pg. 53).

The total number of graduates for the three graduating classes reviewed in this study was 107. Information for all variables for all 107 records was incomplete, and this may have influenced some of the calculations used in this study. Ages were reported for all 107 graduates. High school percentile was available for 95 graduates. Seventyone SAT verbal and math scores were reported. All course grades were reported for total N with the exception of A151 which reported 106 grades. One student was exempt from this course during matriculation. NCLEX scores were reported for 105 candidates. Two people in July 1983 chose not to have their scores reported to the educational institution. Testing dates involved were July 13 & 14, 1982; February 1 & 2, 1983; and July 12 & 13, 1983.

Table 1 records the mean, standard deviation, and range for each variable with the number of cases (n) for the total sample. Individual course grades were reported to the nearest whole percentage. As reported previously, a grade of less than 75% is considered a failing score, and the student must repeat the course before continuing in the nursing major. In the event that records revealed repeats in courses, the first grade recorded was used. Age of the population for the study was reported at time of graduation and indicated an emerging trend toward an increase in age for students who choose the ASN program.

Table

TABLE 1MEAN, STANDARD DEVIATION, RANGE OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES (n) FOR TOTAL SAMPLE

TABLE 1

MEAN, STANDARD DEVIATION, RANGE OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES (n) FOR TOTAL SAMPLE

The high school percentile mean of 73 for this ASN population confirms that the program is selective in admission and attracts students who have demonstrated achievement in their high school performance. The mean percentile for the campus as a whole was 60 for entering students in Spring 1985. All interpretations must be tempered by the fact that the sample represents only those who graduated. The assumption might be made that the admission data for those who successfully completed the program would exceed the data for the total group upon admission (total group to include unsuccessful and successful students). The means for both SAT verbal and math scores when available support the criteria for ASN admission and are compatible with state and national means. The range, however, is quite wide. The State Department of Public Instruction, Division of Educational Information and Research, reports that the 1982-1983, verbal and math SAT mean scores for the state in which the university in this study is located were V=410, M=454 and the national mean scores for the same period were V=425 and M=468. Means for the nursing major course grades were surprisingly homogeneous throughout the program. All AlOO level course numbers represent first-year nursing courses. Highest means were recorded for A151, Introduction to Nursing and A155, Evolving Life Cycle. A151 is the only nursing major course which spans a complete semester (15 weeks). All subsequent courses are presented in seven-anda-half-week modules. Means were toward the lower end of the B range for second year courses with the exception of A265 which reported an 81 mean or C. Again these means would be somewhat reduced if they included the scores of students who did not complete the program. The average NCLEX score for total sample was 2223.39.

Table

TABLE 2MEANS AND STANDARD DEVIATIONS OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES FOR THREE GRADUATING CLASSES

TABLE 2

MEANS AND STANDARD DEVIATIONS OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES FOR THREE GRADUATING CLASSES

Table 2 records the mean and standard deviation for all variables and NCLEX by graduating class. The mean NCLEX scores for the three ASN graduating classes reviewed in this report were 2204.29 (May 1982 graduates), 2200.86 (December 1982 graduates), and 2261.92 (May 1983 graduates). National statistical data for the NCLEX examinations for the December 1982 and May 1983 graduates, reveals that these ASN means are higher than the national means for all three types of programs that are eligible for the examination for RN licensure. The national data released by the State Board of Nursing Registration and Nursing Licensure for the state indicated that in February 1983, 2239 Diploma graduates, 4182 Degree (BS) graduates, and 7,604 Associate Degree graduates took the examination for the first time. Mean scores for each group were Diploma, 2023.2; Degree, 1995.5; and AD, 2010.6. In July 1983, the number of first-time candidates was 9,570, Diploma; 19,423, Degree; and 33,823, AD. Mean scores for this group were Diploma, 2015.4; Degree, 1959.5; and AD, 2026.0 (Statistical Report, 1983).

Course grades for the three classes were in the B range with the exception of A265. All three groups averaged a C for this course. A265 is a three-credit hour course offered in a seven-and-a-half-week module. The course provides knowledge of biopsychosocial concepts relative to adaptive/ maladaptive responses of patients to interferences with the needs of oxygen/carbon dioxide exchange and fluid balance. Course content contains considerable pathophysiology of the respiratory and cardiovascular systems. Reading assignments are lengthy and contain difficult concepts. Students view this course as one of the most difficult hurdles in their nursing education.

Table 3 indicates that all nursing didactic course grades for the three graduating classes reflected a significant positive relationship at the 1% level with NCLEX scores. Also significant at 1% were SAT verbal scores. Not significant at the 1% level were age, high school percentile and SAT math scores.

All course grades for A151, A153, A155, A261, A263, A265, A267 as well as the SAT verbal score correlated positively with NCLEX (p<.001 in all cases). It must be noted that a positive correlation does not imply causation. It is possible that other variables such as IQ, motivation, completion of college courses other than nursing courses, work experience in a health care setting, and life experiences also may have impacted on the course grades, the SAT verbal scores, and the NCLEX scores. No linear relationship (p<.01) was observed between age, high school percentile, or SAT math scores and NCLEX scores. The relationship between course grades and NCLEX scores appeared strong enough to be considered highly predictive.

Since it was the intent to show the relative impact of nursing major course performance on NCLEX scores, only nursing major course grades were used in computing multiple regression weights. These weights computed from the course grades of 104 graduates, are presented in Table 4 along with course grades and predicted and actual NCLEX scores for a representative cross section of 10 graduates.

Table

TABLE 3PEARSON r CORRELATIONS OF INDEPENDENT VARIABLES WITH NCLEX FOR TOTAL POPULATION WITH LEVEL OF SIGNIFICANCE IDENTIFIED AT 1%

TABLE 3

PEARSON r CORRELATIONS OF INDEPENDENT VARIABLES WITH NCLEX FOR TOTAL POPULATION WITH LEVEL OF SIGNIFICANCE IDENTIFIED AT 1%

The average difference between the predicted and actual NCLEX scores for the 10 students sampled was 123.5, which is less than half of the standard deviation of the total sample of actual NCLEX scores obtained (SD=277.94). For the 10-student sample, the mean NCLEX score was 2253.3 and the mean predicted NCLEX score was 2251.6. Two important points need to be considered when interpreting multiple regression data. First, small or negative weights do not imply small or negative correlation coefficients. Often the variance predicted by one variable will be predicted by others as well. Therefore, the relative impact of the variable may be lessened. A regression equation provides a means of prediction, not interpretation. Second, most correlational methods can never imply cause and effect. It is known that A predicts B, not that A causes B.

Multiple r refers to the correlation of the weighted sum of independent variables (in this case, the course grades) with the dependent variable (in this case, the NCLEX score). Multiple r = .78551 (p_<.001) for the entire sample of graduates. This weighted sum accounted for over HaIf(R2 = .61703) of the variability in NCLEX scores. The correlations for each course with NCLEX ranged from .51147 to .66746 (R2 - .26160 to .44550). An aggregation of course data should be, and indeed is, much more predictive of success on the NCLEX exam than any one piece of data. It may be inferred that cumulative grade point average would also correlate positively with NCLEX, but this was not used in prediction due to the relative imprecision of these data. Only five scores were possible for each course, compared to the larger range of percent scores obtainable.

The marked difference between multiple r and simple r reflect the integrated curriculum cf the ASN Degree Program. This was supported by the high (r = .5115 to .7434, p<.001 in all cases) correlations between course grades noted in this sample. Some questions addressed in the study were:

Table

TABLE 4NCLEX SCORES, COURSE GRADES, AND PREDICTED NCLEX SCORES FOR TEN RECENT ASN GRADUATES COMPUTED FROM MULTIVARIATE REGRESSION WEIGHTS

TABLE 4

NCLEX SCORES, COURSE GRADES, AND PREDICTED NCLEX SCORES FOR TEN RECENT ASN GRADUATES COMPUTED FROM MULTIVARIATE REGRESSION WEIGHTS

1 . Would score performance on the NCLEX be as strong for graduates of the program as performance had been with SBTPE?

2. Does the current ASN integrated curriculum prepare students for an integrated examination?

3. Can NCLEX-RN performance be predicted using admission criteria and/or program performance measures?

NCLEX scores for three graduating classes who took the inaugural examination and two examinations following the first testing period indicated that the graduates of this selected ASN program collectively scored very well. Minimum passing score is 1600. ASN NCLEX mean scores for the first three testing periods of the exam were 2204.29, 2200.86, and 2261.92. These mean scores were well above the minimum passing score and also above the state and national mean scores for the second and third administrations of the exam. The highest NCLEX score reported for 105 graduates was 3,000. The lowest score reported for 105 graduates was 1560. This score and one other score of 1584 were the only non-passing scores on first attempt for the first three testing periods of NCLEX. Two students elected not to have their scores reported to the school.

It appeared that the graduates of the program had little difficulty in performance on the integrated examination for the first three testing periods. Records of licensure examination scores are kept for each graduating class of the program. A repeat record review in the near future or on a continuous three- to five-year basis for the purpose of correlation studies to determine predictability of program variables with NCLEX is recommended.

Only nursing major didactic courses were reviewed for this study. A similar correlation which incorporates required general education course grades could also be done, although this data would be less controlled because of transfer credit and the tendency for students to complete general education courses over an extended time frame before applying to the nursing major.

It has neither been the intent of faculty nor indeed the goal of the curriculum to teach to the licensure examination, however because success on this exam is the final determinant of legal nursing practice, it seems prudent to monitor the results. In addition to the variables identified, a variety of educationally related factors may influence a graduates performance on the standardized, national test for registered nurses. Some of these factors which have played an important part in the history of the ASN program have been reasonable admission criteria for the nursing program which has in turn resulted in quality student performance, faculty with outstanding academic credentials that have included courses in teaching and evaluation at the university level plus extensive clinical practice in their areas of expertise, continual review, evaluation, and refinement of the curriculum under the guidance of a qualified faculty curriculum coordinator, and emphasis on the understanding and utilization of the problem solving approach nursing process) throughout the nursing curriculum.

An additional influence on NCLElX performance may be the impact of a Board Review Program conducted for each graduating class by faculty who are chosen by a student committee for their knowledge and expertise in their field of nursing. This review which was originally available only to the associate students of the program has been judged so successful by students that it has enlarged to include BSN graduates of the school plus area graduates of other programs. The ASN program in this study has also had the advantage of being located within a strong senior university system. All co-requisite, supporting courses offered have provided an excellent background in the sciences and liberal arts. The extent of the influence of these factors on the success of ASN graduate performance has doubtless been marked, though unmeasured in this study.

The high performance of the graduates during the first three NCLEX testing periods indicates that the ASN integrated curriculum prepares students for the integrated examination. Both NCLEX and the curriculum rely heavily on utilization of the nursing process, which may be a critical similarity. Conceptual threads are probably another strength.

Of all course variables, the two highest correlations were for A267 (r = .66756) and A263 (r = .66452). A151 course grades correlated third highest with NCLEX scores (r = .65741). All concepts for the program are introduced in A151 as overview material and are built upon in subsequent courses. The A263 course content focuses on concepts of communication interaction and interpretation and on concepts associated with chronic problems which influence achievement, sexuality, and affiliation needs. In A267 the emphasis is on biopsychosocial concepts related to adaptive/maladaptive responses of persons with need interferences associated with nutrition and elimination. Graduates have indicated that a more conceptual approach to course content has prepared them to adapt information to a variety of similar situations on standardized examinations.

Table 4 - which records a sample of 10 students' NCLEX scores, course grades, and predicted NCLEX scores computed from multivariate regression weight - indicates a very close correlation between overall course performance and predicted and actual NCLEX scores. The data indicate that outstanding achievement in the program, for this particular sample, predicts outstanding NCLEX performance. Average achievement predicts average NCLEX scores.

An integrated program which introduces major concepts in the beginning nursing course and builds upon these concepts in succeeding courses apparently has prepared graduates of this Associate of Science in Nursing Degree Program for successful achievement in the first three testing periods of the NCLEX for Registered Nurses. Educational factors which historically have influenced the eleven variables identified for correlation with NCLEX may be influenced by changes brought on by challenges to nursing education in the decade of the '80s. Continual monitoring of NCLEX scores with the variables identified in this review plus correlation studies with required general education courses should help faculty measure the effectiveness of the curriculum in the preparation of students for licensure. Although this study was confined to predicting success with NCLEX, successful nursing practice "within a humanistic and scientific framework cannot be measured by the results of only one cognitive measurement. It is hoped that graduates of the ASN Program receive a solid foundation that prepares them for beginning entry level practice within a structured health care setting. The success of their practice and the contributions that they make to the health care industry will depend upon a lifelong, individual commitment to learning.

References

  • Applegate, M. (1983). Siate board test pool statistics, 1968-1983. Unpublished raw data. Indiana University School of Nursing.
  • Dexter, P. & Applegate, M. (1980). How to solve a math problem. Journal of Nursing Education, 19(2), 49-53.
  • NLN Perspective. (1981). Nursing and Health Care, 11(6), 333.
  • Saxton, D.F., Pelikan, P.K., Nugent, P.M., & Weedleman, S.R. (1982). Mosby's assess test St. Louis: C.V. Mosby Co.
  • Self evaluation report, Vol. I: Narrative. (1983). Associate of Science in Nursing Degree Program, Indiana University School of Nursing.
  • Statistical report of the registered nurse licensure examination. (1984). Form 783, Administration July 12-13, 1983 by Indiana State Board Nursing Registration and Nursing Education. Unpublished raw data.

TABLE 1

MEAN, STANDARD DEVIATION, RANGE OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES (n) FOR TOTAL SAMPLE

TABLE 2

MEANS AND STANDARD DEVIATIONS OF VARIABLES AND NCLEX SCORES WITH NUMBER OF CASES FOR THREE GRADUATING CLASSES

TABLE 3

PEARSON r CORRELATIONS OF INDEPENDENT VARIABLES WITH NCLEX FOR TOTAL POPULATION WITH LEVEL OF SIGNIFICANCE IDENTIFIED AT 1%

TABLE 4

NCLEX SCORES, COURSE GRADES, AND PREDICTED NCLEX SCORES FOR TEN RECENT ASN GRADUATES COMPUTED FROM MULTIVARIATE REGRESSION WEIGHTS

10.3928/0148-4834-19860301-07

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