The current trend in health care is a demand for registered nurses prepared at the bachelors or graduate level (AACN, 1999). Enrollments in registered nurse (RN) to bachelor of science in nursing (BSN) programs in the nation's nursing schools decreased by 3.3 percent from fall of 1997 to fall of 1998 (Berlin, Bednash, Hosier, 1999). The Division of Nursing of the U.S. Department of Health and Human Services (1996) predicts that by the year 2010 the rising demand for bachelor or graduate level prepared RNs will soon surpass the supply. Despite the apparent predicted need for RNs with a bachelors degree there have been and continue to be barriers to obtaining further education for RNs returning to school (Creasia, 1989; Home, 1993; Mannion et al., 1993, Messmer, Miller, Spruck, 1994). Validation of prior nursing knowledge or nursing crédit transfer has been identified as one of the major obstacles that RNs face during the admission process (Creasia, 1989; Mannion et al., 1993).
Academic policies for validating prior nursing education vary. leacher-prepared examinations, standardized examinations, portfolio, case-by-case analysis, programto-program articulation agreements, transitional courses and direct credit transfer are validation methods (Arlton & Miller, 1987; Zusy, 1986; Strachota, 1989). Challenge examination is the most common method of validation used by academic institutions (Rapson, 1990). The American Association of Colleges of Nursing (AACN) Task Force on Educational Mobility reports that 73% (n = 128) of respondents, to a member school survey related to educational mobility for RN to BSN programs, continue to validate previous nursing learning by standardized examinations (Rice, 1997). RNs returning to school question the need to validate knowledge previously gained through academia. Many institutions accept direct transfer credit for sciences and liberal arts courses taken at the associate level but use other methods of validation for nursing credit. RNs see this discrepancy in the admission process and fear of taking challenge examinations as deterrents to returning for further education.
Identifying alternative methods of validating nursing knowledge for returning RNs that are not seen as punitive, without compromising educational integrity, may ease the transition and increase the number of students returning for a bachelors degree. The purpose of this study was to determine which variables can be used in lieu of challenge examinations to validate lower division undergraduate nursing credit for RNs returning for a BSN.
Studies have examined a number of variables as predictors for success in RN to BSN programs. Some of the variables studied were found to be predictive of success but the results varied. Rapson et al. (1990) found no significant differences in success among three different methods of articulation (examination, transition courses, and direct transfer). While McHugh (1991) reported that students admitted under direct articulation procedures appear to be successful in the BSN program. Challenge examination scores are reported as correlating positively with success in BSN programs (Kearney, 1991; Yang & Noble, 1990; Kroll, 1990). Type of basic nursing preparation (Kroll, 1990), length of time since basic preparation (Kroll, 1990), employment status (Yang & Noble, 1990; Kroll, 1990), enrollment status, age, race, and sex were found to have no significant relation to BSN success. Kearney (1991) found that GPA from ADN programs was significantly related to success at the BSN level and Kroll (1990) reported no significance between these two variables. However, Kroll (1990) did find a positive correlation between GPA on prerequisite courses in the BSN program and success in the program.
The findings of these studies must be used carefully when determining admission and articulation criteria because the samples were drawn from populations that were already accepted and enrolled into BSN programs (Kearney, 1991; Rapson et al., 1990; Yang & Noble, 1990; Kroll, 1990; McHugh, 1991). This suggests that the participants had already met admission criteria that may have predicted their success in a bachelors degree awarding program. Populations in many of the studies were confined to specific geographical locations (Kearney, 1991; Rapson et al., 1990; Kroll, 1990; McHugh, 1991).
Two studies examined variables that predict achievement on the challenge examinations. The ACT-PEP and NLN Mobility Profile II exams are the most commonly used standardized examinations for validation of lower division nursing credit (Arlton & Miller, 1987). McHugh (1991) found a direct relationship between 419 participant's ADN GPA and ACT-PEP composite scores. Significant positive relationships were shown between ADN GPA and length of time since graduation from ADN programs and mean score on the NLN Mobility Profile II battery by Kearney (1991). Participants from diploma awarding basic nursing programs showed significantly higher mean scores on the NLN Mobility Profile II battery than participants from ADN programs (Kearney, 1991). The investigators concluded that using ADN GPA as a discriminator for validating previous nursing knowledge might be defensible.
Participants in the studies were homogenous to specific areas (Kearney, 1991; McHugh, 1991) and were already accepted into BSN upper division courses (Kearney, 1991). Both studies (Kearney, 1991; McHugh, 1991) examined composite mean scores on the standardized batteries and did not look at the possibility of students achieving differently on the separate exams within the battery. The scarcity of data comparing standardized validation examinations and variables that can be used in place of challenge exams demands further study in this area.
Providing data that may ease the mobility process for returning RNs will increase enrollments and provide communities with nurses educated at the BSN level. The following research hypotheses were explored in this study:
1. RNs with a GPA = or >2.5 from their initial associate degree nursing program will have a higher passage rate on the NLN Mobility Profile II examinations than RNs with a GPA <2.5.
2. RNs from associate degree programs will show no difference in performance on the NLN Mobility Profile II examinations when compared to RNs from diploma programs.
3. RNs from NLN accredited nursing programs will show a higher percentue score on the Mobility Profile II examinations than RNs from nonaccredited nursing programs.
4. There will be a positive relationship between length of time since initial nursing program and percentile scores on the NLN Mobility Profile II examinations.
A convenience sample was taken from records of all registered nurses who took any portion of the NLN Mobility Profile II examination at Dominican College of Blauvelt, New York, between November 1989 and June 1997. Inclusion criteria for the records included: (1) recorded results on any portion of the NLN Mobility H examination; (2) identity of initial nursing program and date of graduation. Participante had not taken any nursing courses at Dominican College and did not have to be enrolled in the College. The criteria for inclusion used in this study were met in 276 records. Participants ranged in age from 20 to 62 years [mean (M) = 37.6, standard deviation (SD) = 8.1]; 98% percent were female. The initial nursing program for 72% of the sample was associate degree (AD) and 28% were from diploma programs. Participant records were coded and identifying information was kept in a secure environment.
A descriptive, correlational design with record review methodology was used. Data were collected from transfer evaluations, current transcripts, challenge examination information sheets, and original result reports from the NLN Mobility Profile II examinations. Data collected included: participant demographics (age, sex), initial nursing program information (name, location, type, date of graduation, NLN accreditation status and final GPA), and percentile score for each of NLN Mobility Profile II examinations taken.
The dependent variable in this study was the NLN Mobility Profile II examinations. The Nursing Mobility Profile II consists of four parts: care of the adult client, care of the client during childbearing, care of the child, and care of the client with mental disorder. Results provided by NLN (1997) Testing Services include a decision score (a standard score with a mean of 100 and a standard deviation of 20), a normalized percentile "indicates the percentage of individuals in a reference group who would customarily obtain lower decision scores" (National League for Nursing, 1997, p. 4), and an advisory score (percentage of questions answered correctly) for each of the four examinations. Individual institutions are encouraged to aet their own passage rate based on curricula that is being challenged (National League for Nursing Test Service, 1997). For this study, an exam was considered passed if the participant achieved at the fortieth percentile or better as established by Dominican College. Each portion of the Mobility Profile II was explored separately.
Data were grouped into two categories for examination of GPA. A GPA cutoff of 2.5 was used because this is the GPA used in criteria for acceptance into the upper division nursing program at Dominican College. Diploma graduates records revealed inconsistent reporting of final GPA and were therefore not analyzed. Type of program and type of exam data were treated as subgroups for purposes of analysis.
The Statistical Package for Social Sciences/PC+ was used to analyze the data to determine relationships among various variables and passage of the NLN Mobility Profile II examinations. Summary statistics were used for study variables as appropriate including mean, standard deviations, and percentages. Differences between groups were evaluated using cross tabulation and chi square tests. Group means were compared using Student ¿-test. Pearson r was used as the correlation coefficient. A .05 level of significance was set for all statistical procedures.
GPA Related to NLN Mobility Profile II Passage
Data from ADN graduate records were used to study the relationship of final GPA to NLN Mobility Profile II Passage. The number of cases varies for each exam because not all students took all of the exams. Results revealed a significant difference in the mean GPA between the group that achieved greater than the fortieth percentile and the group that did not achieve at the fortieth percentile for all four exams: care of the adult (M = 2.99 vs. 2.42); care of the client with mental disorder (M = 3.01 vs. 2.57); care of the client during childbearing (M = 3.04 vs. 2.55); and care of the child (M = 3.02 vs. 2.36).
Participants with a GPA equal to or greater than 2.5 had significantly higher mean percentile scores than those participants with a GPA less than 2.5: care of the adult (M = 85.3 vs. 71.7); care of the client with mental disorder (M = 67.7 vs. 57.2); care of the client during childbearing (M = 67.2 vs. 51.6); and care of the child (M = 71.3 vs. 52.6).
Results showed a significant positive association between GPA groups (Group I GPA <2.5; Group II GPA >2.5) and frequency of passage for the care of the client with mental disorders (79.5% vs. 92.1%); care of the client during childbearing (71.4% vs. 93.8%); and the care of the child exams (78.6% vs. 97.9%). The care of the adult exam did not show a significant association between GPA from initial program and passage rate. These results support the first hypothesis for three of the four examinations.
Type of Initial Program Related to NLN Mobility Profile II Performance
The mean score on the NLN Mobility Profiles tended to be higher for associate graduates than diploma graduates for each of the four examinations. However, no statistically significant difference in mean scores was revealed. These results support the second hypothesis.
Program Accreditation Statue Related to NLN Mobility Profile II Scores
A significant difference in scores related to program accreditation status was found. This analysis included both diploma and associate graduates. RNs from NLN accredited initial programs had significantly higher scores on three of the four NLN Mobility Profile II exams than RNs from unaccredited programs (mental: M = 67.2 vs. 36.1; childbearing: M = 65.6 vs. 48.4; child: M = 68.7 vs. 56). Participants from NLN accredited programs had a higher adult exam mean score, but the difference was not statistically significant (p = .053). The third hypothesis was supported by these results for all of the examinations except the care of the adult.
Length of Time Since Initial Nursing Program and NLN Mobility Profile II Scores
Scores on the NLN Mobility Profile II examinations were correlated with the length of time since graduation from the initial nursing program for both diploma and AD graduates. Results for the care of the child exam showed a significant inverse correlation (n = 262, r = -.13, p = .13) between length of time since initial program and examination scores. Care of the adult and care of the client during childbearing correlated inversely with length of time since initial program (-.07, -.01). A positive correlation (.01) was obtained for care of the client with mental disorders and length of time since initial program. The fourth hypothesis was not supported with these results.
This study was undertaken to identify variables that may be useful in validating nursing knowledge for RN to BSN students. The variable that showed the strongest relationship to passage of challenge examinations was GPA from initial AD nursing program. These findings are consistent with other studies (Kearney, 1991; McHugh, 1991). Findings indicate that AD RNs with a GPA of 2.5 or greater have a strong likelihood of achieving at the fortieth percentile or greater on standardized challenge examinations. The sample was not limited to any particular ADN program. Based on this data RN to BSN programs should consider using AD GPA as a validation criterion in place of challenge examinations. The dilemma of how to validate diploma graduates remains, since nursing courses were not taken for college credit and final grades are reported in a variety of manners.
Accreditation status of the initial nursing program showed a strong association with passage of challenge examinations. This finding reaffirms the value of accreditation processes for nursing programs and gives RN to BSN programs another alternative variable to use in validating nursing credit.
Type of nursing program, diploma or associate degree, was not shown to make a difference in challenge exams scores. This finding could provide some valuable information for the ongoing discussion on how to validate diploma graduates' previous knowledge. If no differences in scores on validation exams are found, then possibly validation criteria should be the same for both populations. These results conflict with research that found diploma graduates scored higher on standardized challenge examinations than associate graduates (Kearney, 1991). The similarities and differences in these two populations should be studied further considering the inconsistent findings in the literature.
A limitation of the study is that participants were all from a similar geographic area. However, they did have diverse backgrounds in relation to their initial nursing program, age, and GPA, The diploma graduate subgroup was smaller in size than the associate degree subgroup, as was the nonaccredited subgroup in relation to the accredited subgroup.
Further studies are needed to identify variables that can be used to facilitate transition for RNs returning to school. Use of GPA, as a validation criterion appears to be promising for associate degree applicants. NLN accreditation of diploma schools may be a possible variable to use for validation of knowledge of diploma graduates. This variable needs to be explored further with other populations. Discovering ways to decrease the barriers to mobility for RNs returning for their BSN continues to be a challenge for educational institutions.
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