Purpose: This study sought to analyze standardized assessment scores from multiple sources representing a variety of commercial vendors. The purpose of this cross-sectional study was to use principal components analysis to explore relationships within standardized assessment scores from a sample of students who failed NCLEX-RN on the first-attempt.The aim was to explore the relationships among the SA scores in a sample from students failing NCLEX-RN on the first attempt. This appears to be the first study to use this statistical approach to analyze SA scores across multiple vendors and multiple programs of nursing.
Methods: Mixed modeling sought to reveal SA scores that represented redundancy or duplication.Principal Component Analysis (PCA) was employed as an exploratory technique to analyze the scores to acquire new insight into NCLEX-RN failure for future hypothesis testing. Standardized assessment (SA) scores were collected from prelicensure programs between 2009 and 2016 (n=296). The SA scores were provided by multiple sources, including 10 programs of study and one commercial vendor in the US. The sample of first-attempt SA scores were matched across vendors to the 10 content-specific areas, 1) fundamentals of nursing care, 2) pediatrics, 3) maternal/newborn or obstetrics, 4) pharmacology, 5) adult medical-surgical, 6) mental health/psychiatric nursing, 7) leadership, 8) community and 9) nutrition along with the comprehensive end-of-program assessment. Inclusion criteria for the sample were (a) completion of a prelicensure program of nursing; (b) completion of a minimum of three of the eight SA retained ; and (c) recorded failure of NCLEX-RN on the first attempt. SA scores were merged into an Excel file and then transformed to Z-scores.
Results and Discussion: The structure of the rotated loading values, represented as correlations, found that six of the original SA correlated strongly on component #1, contributing the most, overall, to the variation in the SA scores for first-attempt NCLEX-RN failures. Component #1 represented content related to fundamentals of nursing care, maternal/newborn, pediatrics, mental health, leadership, and the end-of-program comprehensive examination. Component #1 is especially related to maternal/newborn (r = 0.85) even more so than the comprehensive predictor (r = 0.78). This is an interesting finding given one might expect the comprehensive predictor to load the strongest since it is thought to represent all the content expected for NCLEX-RN preparation. The remaining two content-specific assessments – pharmacology and adult medical-surgical – correlated strongly on component #2 and contributed greatly to the overall variation in the scores suggesting the assessments contained redundant or duplicated content. The principal component analysis found 2 distinct components emerging from the 10 SA included in the study signifying duplication in the content assessed. Within these 2 components, maternal newborn and pharmacology were found to have the strongest correlations among the SA scores.
Some nursing programs are now opting to administer a reduced number of SA to decrease the testing overload and mental fatigue that students can experience. Selection of SA is largely dependent upon faculty preference as the evidence to identify the best SA to include in the program of study which seems to be absent in the literature. The quest for early identification of students at-risk for NCLEX-RN failure has resulted in an increased number of assessments and exams students are expected to complete. Students are reporting “too many standardized assessments” are administered throughout the nursing program. Selection decisions for using standardized assessments should be evidence-based to assess students’ performance compared to national standards. Faculty have an ethical responsibility to ensure tests are fair and based upon the best available evidence.
Conclusions:The findings of this study are the first in the literature to explore the utility of using PCA to analyze SA scores from students who failed NCLEX-RN on the first attempt. This is also the first study to collect and analyze SA scores from multiple prelicensure nursing programs from across the US using a variety of commercial vendors.The extensive literature surrounding student performance on NCLEX-RN shows strong evidence to support the ability to predict success. Yet, the decades of studies have yielded little evidence to correct the problem as current trends in national pass rates have remained in the 80% range for a number of years. Discovering those SA that assess similar content and have the strongest correlations can act as a catalyst for change and inform decision making when implementing standardized assessments throughout the nursing curriculum. Creating collaborations in research serves to connect and expand the professions to provide the best quality education for future nurses.