Emerging themes fell into three major categories. Factors related to either student qualities and skill sets, collaboration with others, or the nursing curriculum. The occurrences of themes in the interviews of each participant can be found in Table 2.
Table 2: Recurring Themes Among Participants
Student-Related Themes. Student-centered themes included motivation; academic abilities, such as critical thinking, test-taking, and study skills; organization; prioritization of roles and responsibilities; the ability to manage life events and extreme stress; and health care experience.
All of the students interviewed thought that getting good grades, specifically A’s, was important. Ellen, a traditional student, stated, “[The program] is easier if you like it,” and Grace, another student, stated that “my conscience makes me do my best.” When discussing why other students may not have been as successful, Ellen projected that those students “have to really want nursing.”
When discussing the importance of problem solving, Diane, an LPN student, mentioned the difficulty of “moving from a knowledge base to thinking critically.” Ellen, who began her nursing education right out of high school, stated that although she had done well in school up to that point, she “[did not] know how to think before.” This information confirms the continued need for nursing programs to seek to admit students with critical thinking ability and to assist students in fully developing that skill.
The document analysis and interviews emphasized the possession of test-taking abilities. Isaac, a non-traditional student, stated, “[It is] all about being able to take tests.” Grace described test-taking ability as a trait, as “some people just [are not] test takers.” Faculty members recognize the link between theory and clinical performance; however, according to Amanda (an instructor), all of the participants in this study thought that “[students] may be excellent in clinicals, but have trouble because they have [problems] taking tests.”
Students and faculty also commented on the importance of skill in managing stress, complex circumstances, multiple roles and responsibilities, and personal well-being. One might expect that results would include an emphasis on prioritization, time management, and personal growth; however, the emphasis on personal well-being, specifically rest and nutrition, was an unexpected finding from the researcher’s perspective. Nurses are taught that physiologic needs are the most basic and essential to human needs, but often nursing students try to perform in the most demanding circumstances, without fulfillment of those needs. Ellen indicated that until she started eating right and sleeping more, she was performing well below her potential.
Collaboration-Related Themes. According to the participants in this study, successful students collaborate with others. Students rely on support systems that may include religion, finance, family, and friends. Communication with faculty members and the level of faculty involvement with students were also cited as important factors for success.
The document analysis revealed that students are told to see instructors if they have below a grade of C at any time in the program. Amanda expressed that students have to participate and ask questions. Cathy stated, “students need at least one person to talk to [in the program].” Ellen, a student, commented that “I went to my instructors’ offices a lot” and “our instructors know us by name.”
Curriculum-Related Themes. Finally, the framework and implementation of the nursing curriculum were referenced within the interviews and document analysis. Amanda spoke of the ineffectiveness of lecture as the only teaching method and the inability of faculty to “teach it all.” Students and faculty thought that innovative teaching methods and carefully constructed course examinations could facilitate success in both program completion and on the NCLEX-RN.
Throughout the program, in the classroom and with required textbooks, students were given practice questions to prepare for the NCLEX-RN. Course examinations and standardized assessment examinations were designed to mimic the NCLEX-RN, and students emphasized their role in helping them to prepare. Students also expressed that completing practice questions and attending NCLEX-RN workshops and courses were instrumental to their success on the NCLEX-RN examination.