Journal of Nursing Education

The articles prior to January 2013 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

Research Brief 

Prescription for Success in an Associate Degree Nursing Program

Tanya Lynn Rogers, MS, APRN, BC

Abstract

In the midst of a national nursing shortage and a demanding health care environment, nursing programs must prepare more nurses by facilitating student success from admission to program completion to licensure. The purpose of this qualitative study is to explore the factors that contribute to student success in associate degree nursing programs and on the NCLEX-RN®. Six seniors and three faculty members were interviewed, and a document analysis was conducted. Emergent themes were categorized as student related, collaborative, and curriculum related. These themes included, but were not limited to, the need for support systems, motivation, health care experience, critical thinking skills, prioritization of roles and responsibilities, diligent study habits, and faculty involvement. Recommendations for practice and research are discussed in this article.

Abstract

In the midst of a national nursing shortage and a demanding health care environment, nursing programs must prepare more nurses by facilitating student success from admission to program completion to licensure. The purpose of this qualitative study is to explore the factors that contribute to student success in associate degree nursing programs and on the NCLEX-RN®. Six seniors and three faculty members were interviewed, and a document analysis was conducted. Emergent themes were categorized as student related, collaborative, and curriculum related. These themes included, but were not limited to, the need for support systems, motivation, health care experience, critical thinking skills, prioritization of roles and responsibilities, diligent study habits, and faculty involvement. Recommendations for practice and research are discussed in this article.

Ms. Rogers is Associate Professor of Nursing, Fairmont State University, Fairmont, West Virginia.

The author has no financial or proprietary interest in the material presented herein.

Address correspondence to Tanya Lynn Rogers, MS, APRN, BC, Associate Professor of Nursing, Fairmont State University, 57 Bastille Lane, Fairmont, WV 26554; e-mail: Trogers1@fairmontstate.edu.

Received: June 10, 2008
Accepted: February 04, 2009
Posted Online: February 04, 2010

Nursing programs face a multitude of challenges in the midst of the complex health care environment. Despite limitations in resources, many programs have increased enrollment to offset a national nursing shortage. Increasing the number of students admitted will not help overcome challenges alone. To increase the workforce, students must be able to complete the program and achieve licensure. Accrediting agencies recognize this need, as programs are held accountable for retention rates and NCLEX-RN® pass rates (National League for Nursing Accreditation Commission, 2006).

Often, as programs attempt to increase the number of students, attrition also increases (Symes, Tart, & Travis, 2005), and achieving retention goals becomes more difficult (Carr, 2008). In attempts to improve retention, NCLEX-RN results may decline. At the same time, programs that focus on improving NCLEX-RN scores risk higher attrition rates. The true challenge is identifying ways to increase both retention and NCLEX-RN pass rates. The purpose of this qualitative study is to explore the factors that contribute to success in program completion and on the NCLEX-RN in an associate degree nursing (ADN) program. The guiding research questions were:

  • What contributes to student success in program completion and on the NCLEX-RN?
  • What are the experiences of successful nursing students?

Literature Review

Identifying factors that contribute to success has been complicated because many of the studies published have pointed to different factors for success or have contradicted the findings of previous research. This may be related to the variability in students, nursing programs, and the methods with which this issue has been studied. This variability makes it difficult for researchers to draw sound conclusions, replicate studies, or predict success (Bissett, 1995; Davenport, 2007; Gallagher, Bomba, & Crane, 2001; Waterhouse & Beeman, 2003). However, some education research findings are consistent with the findings from this study.

Method

Setting

This study was conducted at a state university, a public institution in a rural area. The ADN is entry level, yet an RN-to-baccalaureate nursing (BSN) completion program is also offered. The university’s nursing student population is predominantly White, and women currently outnumber men in the ADN program at least five to one. The population is diverse in terms of socioeconomic status, age, and life experiences. The School of Nursing admits approximately 96 new students annually. The retention rate is approximately 80%, and the NCLEX-RN first time pass rate is approximately 89%.

Participants

Consistent with the guiding research questions, successful graduates who passed the NCLEX-RN and professors who are experienced in working closely with successful students were chosen to participate in the study. Graduates were chosen based on exemplary academic and clinical performance in the program, their nursing test scores, and successful completion of the program and licensure requirements on the first attempt. They also continued their education in the BSN completion program. Traditional and nontraditional students, a licensed practical nurse (LPN), and students of both genders were selected.

Professors who were selected had more than 10 years of experience, intense contact with ADN students, and experience with students at different levels of the program. Pseudonyms were used to protect anonymity. Amanda is an ADN instructor who team teaches the medical-surgical courses. Brooke is experienced in LPN transition, pediatrics, and BSN completion. Cathy teaches Fundamentals of Nursing and maternal and newborn care and works closely with students on study skills, testing strategies, and math competencies.

Data Collection

Following institutional review board approval and informed consent from participants, data were collected in semistructured, open-ended, and face-to-face interviews. Sessions were audiotaped to preserve the accuracy and richness of the data. Pseudonyms were created for all participants to maintain confidentiality. Sample interview questions are provided in Table 1.

Sample Questions

Table 1: Sample Questions

A document analysis was conducted to triangulate interview data. The analysis focused on information communicated to students regarding factors affecting success and recommendations for students to facilitate their own success. Reviewed documents included School of Nursing information brochures, course packets, required textbooks and resources, and admission policies. Web sites for the National Council of State Board of Nursing, Pearson Vue, and School of Nursing and the 2008 NCLEX-RN Examination Candidate Bulletin published by the National Council of State Board of Nursing were also reviewed.

Data Analysis

Comparisons were made within and across cases, and all of the interviews were triangulated with the document analysis. Data were analyzed, coded, and categorized, and emergent themes were identified based on actual participant responses.

Results

Overview

Instructors and students had similar beliefs regarding factors that contribute to success. Participants were in strong agreement that no one factor guarantees success and that a combination of factors may play a different role among different students. None of the participants cited prenursing academic achievement as an important factor although the document analysis revealed a heavy emphasis on academic achievement. Therefore, this omission was clarified with the last four students and instructor interviewed. They indicated that the competitive admission process brings in students of similar academic backgrounds, so they believed there were other factors contributing to success.

Emergent Themes

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.

Recurring Themes Among Participants

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.

Limitations

This study was limited to one ADN program; yet nursing programs face similar challenges, and graduates from every entry-level nursing program in this country are held to the same standards for licensure. However, nursing programs should recognize the characteristics and needs of their populations (McLaughlin, 2008).

Successful graduates were chosen for this study to highlight a prescription for success. The perspectives of those who were not successful, at least on the first attempt, are not represented in this study. Also, the framework for this study did not focus directly on identifying barriers to success; however, the participant responses also included ways to overcome those barriers.

Recommendations

The findings of this study are consistent with recommendations in the current nursing literature. The following practice and research recommendations reflect the perspectives of the participants and the state of the current research.

Practice

Collaboration. Faculty members should make efforts to mentor students and form trusting professional relationships. Positive feedback and encouragement help students achieve their goals and also help nurture the internal motivation necessary for their success (Davenport, 2007; McLaughlin, 2008; Sayles & Shelton, 2005; Sayles, Shelton, & Powell, 2003).

In addition to collaboration with faculty members, students should also be encouraged to form networks, establish support systems, and mobilize resources (Bissett, 1995; Davenport, 2007; Keane, DiMattio, & Gaudet, 2002; Leufer, 2007; McLaughlin, 2008; Symes et al., 2005). Students must also learn to balance socialization and academic endeavors (Carr, 2008; Keane et al., 2002).

Students. Participants did not cite prenursing academic achievement as a determinant of success in nursing. Admission policies that balance academic achievement and subjective data may better predict student success (Bissett, 1995).

Nursing programs should emphasize health promotion for nursing students (Gardner, Deloney, & Grando, 2007; Sayles & Shelton, 2005). One instructor and four graduates emphasized the role of rest and nutrition in success. Students, as well as patients, must attend to their physiological needs first.

Students, who are new to the health care environment or who need to improve critical thinking skills, may be encouraged to work in health care while attending nursing school. Participants believed these experiences contribute to growth and success.

Curriculum. Nursing programs can continue to perfect curricula that prepare students for the NCLEX-RN and the challenging workforce by constructing and administering examinations that mimic the format of the licensure examination and encouraging students to practice the questions. Faculty members can be better mentors if they are prepared to help students think critically through the test questions and their clinical implications (Davenport, 2007; Keane et al., 2002).

Faculty members must consider ways in which to improve classroom learning. Both instructors and students in this study recognized that a lecture-focused classroom environment does not stimulate critical thinking. Higher level thinking must be modeled and practiced in every nursing course (Gardner et al., 2007; Keane et al., 2002; Leufer, 2007; McLaughlin, 2008; Sayles & Shelton, 2005).

Research

More can be investigated regarding the subjective nature of the predictability of success. Work can be conducted to validate this qualitative data and also to explore the role of these findings in admission and curricular policy decisions. It would be valuable to compare the findings from this study to those of a qualitative study involving students who were not successful either in program completion or on the NCLEX-RN.

Another viewpoint to be investigated is the connection between the data in this study and the academic achievement backgrounds of the students involved in the study. A comparison of the participants’ academic backgrounds and the backgrounds of unsuccessful students may also add insight to the results of this study.

Conclusion

This study explored factors that influence nursing program completion and NCLEX-RN success using qualitative methods. Despite a lack of consistency in the quantitative research, the findings of this study supported the observations and published recommendations of nursing education experts. This study also presented factors not commonly found in the research, such as personal well-being, rest, and nutrition.

Challenges that are universal to nursing programs exist, but it is important for each nursing program to assess the specific needs of the program and its students and develop a plan to address those needs (Davenport, 2007; Keane et al., 2002; Sayles & Shelton, 2005; Sayles et al., 2003; Symes et al., 2005). This study described factors influencing success that can be applied to common goals and challenges in nursing programs across the country. It also served as an example of how faculty and administrators can explore factors influencing success in their own programs.

References

  • Bissett, H. (1995). Selective admissions in community college nursing programs: Ethical considerations. Community College Review, 22(4), 35–46. doi:10.1177/009155219502200406 [CrossRef]
  • Carr, G. (2008). Changes in nurse education: Delivering the curriculum. Nurse Education Today, 28, 120–127. doi:10.1016/j.nedt.2007.03.011 [CrossRef]
  • Davenport, N. (2007). A comprehensive approach to NCLEX-RN success. Nursing Education Perspectives, 28, 30–33.
  • Gallagher, P., Bomba, C. & Crane, L. (2001). Using an admissions exam to predict student success in an ADN program. Nurse Educator, 26, 132–135. doi:10.1097/00006223-200105000-00015 [CrossRef]
  • Gardner, E., Deloney, L. & Grando, V. (2007). Nursing student descriptions that suggest changes for the classroom and reveal improvements needed in study skills and self-care. Journal of Professional Nursing, 23, 98–104. doi:10.1016/j.profnurs.2006.07.006 [CrossRef]
  • Keane, K., DiMattio, N. & Gaudet, C. (2002). Education news. Nursing success in a community college. Nursing Education Perspectives, 23, 110–111.
  • Leufer, T. (2007). Students’ perceptions of the learning experience in a large class environment. Nursing Education Perspectives, 28, 322–326.
  • McLaughlin, B. (2008). Retention issues: What can we do?Teaching and Learning in Nursing, 3, 83–84. doi:10.1016/j.teln.2008.02.003 [CrossRef]
  • National League for Nursing Accrediting Commission. (2006). Accreditation manual with interpretive guidelines by program type for postsecondary and higher degree programs in nursing. New York: Author.
  • Sayles, S. & Shelton, D. (2005). Student success strategies. The ABNF Journal, 16, 98–101.
  • Sayles, S., Shelton, D. & Powell, H. (2003). Predictors of success in nursing education. The ABNF Journal, 14, 116–120.
  • Symes, L., Tart, K. & Travis, L. (2005). An evaluation of the nursing success program: Reading comprehension, graduation rates, and diversity. Nurse Educator, 30, 217–220.
  • Waterhouse, J. & Beeman, P. (2003). Predicting NCLEX-RN success: Can it be simplified?Nursing Education Perspectives, 24, 35–39.

Sample Questions

Student Interviews

What was the experience of being an advance nursing degree (ADN) student like for you? What was easy? What was difficult?

Was there ever a point when you needed to change to move toward your goals? If so, please describe what you did to change.

From your perspective, what contributed to your success in the nursing program?

What do you believe contributed to your success on the NCLEX-RN® examination?

Some of your classmates were not as successful. What do you think you did that was different?


Instructor Interviews

From your perspective, what contributes to ADN students’ success in program completion?

What do you believe contributes to ADN students’ success on the NCLEX-RN?

Some students are more successful than others. In what ways do you think successful students’ experiences in the program are different than the experiences of students who are not as successful?

In what ways have your experiences with successful and unsuccessful students differed?

Recurring Themes Among Participants

ThemesFaculty
Students
AmandaBrookeCathyDianeEllenFeliciaGraceHollyIsaac
Student related
  MotivationXXXXXXXXX
  Critical thinking skillsXXXXXXX
  Testing skillsXXXXX
  Active participationXXXX
  Growth and maturityXXXX
  Organization skillsXXXXXX
  Health care experienceXXXXXXX
  Prioritization of roles and responsibilitiesXXXXXX
  Study habitsXXXXXXX
  Rest and nutritionXXXX
  Ability to manage life events and extreme stressXXXX
Collaborative
  CommunicationXXXXXXXX
  Support systemsXXXXXXX
  Faculty involvementXXXXXXXXX
Curriculum related
  Teaching methodsXXX
  Program examinationsXXXXX
  Practice questionsXXXXXX
  NCLEX-RN® workshops and coursesXXXXX
Authors

Ms. Rogers is Associate Professor of Nursing, Fairmont State University, Fairmont, West Virginia.

The author has no financial or proprietary interest in the material presented herein.

Address correspondence to Tanya Lynn Rogers, MS, APRN, BC, Associate Professor of Nursing, Fairmont State University, 57 Bastille Lane, Fairmont, WV 26554; e-mail: .Trogers1@fairmontstate.edu

10.3928/01484834-20091022-03

Sign up to receive

Journal E-contents