The national licensing authority stated its purpose to protect and promote the health of the nation through competent healthcare practitioners based on highest standards and best practices. To this purpose, it became necessary to institute a national nursing licensing examination (NNLE) to test knowledge, skills and attitude for the delivery of competent nursing care (Bruce & Klopper 2017). A heterogeneous profile of nurses from fifty-six nationalities constituted the national nursing workforce while the patient population is homogenous consisting of Muslims and Arab nationals. As the numbers increased of local nurses completing the Bachelor of Science in Nursing program, it became a national leadership prerogative to implement the NNLE to ensure a standard entry level of general nursing competency (Silvestri & Silvestri 2016) for national and international nurses.
2. Leadership Intervention and Outcome
The NNLE blueprint was devised by the national forum of Deans of Nursing to represent the Bachelor of Science in Nursing curriculum. Extensive workshops for subject matter experts (SMEs) were conducted on item writing of multiple-choice questions using methods and experiences gained from Canada and the United States of America’s National Council Licensure Examination (N-CLEX) for registered nurses (Hogan 2018, Silvestri & Sivestri 2016). Vivid examples are shared that demonstrate the range of competency testing of content, contextual, and cultural congruency that embraced the Lower Order Thinking Skills (LOTS) to Higher Order of Thinking Skills (HOTS) of remembering, understanding, applying, evaluating, creating, and synthesizing (Bruce & Klopper 2017, Porter-O’Grady & Malloch 2016, Churches 2009 adaptation of Bloom’s Taxonomy in Ulrich 2012). The NNLE covered nursing fundamentals, medical-surgical, community health, psychiatric nursing, critical care, maternity and pediatric, management and leadership, research, and epidemiology. Testing of these subjects occurred on the three levels of competence, namely practical, foundational, and reflexive (Bruce & Klopper 2017), that will be illustrated in sample NNLE questions that were used in the workshops.
A synopsis of narrative responses is presented from 27 interactive NNLE orientation workshops conducted across four regions of the country over a period of 18 months by the nursing leadership of the national licensing authority. This is provided in tandem with details of the subject content according to the weighting of items for each of the NNLE subject sections that are examined.
3. Leadership Lessons Learnt
It is shown that the faculty approaches to curriculum development, teaching and assessment became a serendipitous focus for the leadership (Iwasiw & Goldenberg 2015). In addition to the NNLE orientation workshop for potential candidates, faculty members required a paradigm shift to embrace the NNLE blueprint concurrent to changing traditional teaching methods to embrace adult principles of learning (Knowles, Holton III, & Swanson 2015). Essential components related to thinking critically, creatively, and practically had to be considered as an approach for readiness of the candidates to take the NNLE (Fink 2003 in Ulrich 2012).
Feedback from the interactive workshops of narrative themes are shared with vivid examples from the interactive workshops that are framed using Fink’s (2003) Taxonomy of Significant Learning (Fink 2003 in Ulrich 2012) relating to clinical-decision making within the context of multiple-choice responses. The major emergent themes included (i) clinical integration of knowledge, (ii) human dimension of caring, (iii) readiness to practice, and (iv) learning how to learn.
It was concluded that faculty required a period of adjustment for readiness to embrace the testing methodology of the NNLE. Further, that communication, cooperation, and collaboration between clinical nursing leadership and academia was vital for optimal NNLE results and outcomes as the new graduates take the NNLE during their twelve-month period of hospital-based clinical nurse internship (residency) program prior to licensing. This emphasis for readiness to take the NNLE was concurrent to recruitment and retention of nurses as it is a national policy mandate that international nurses from the fifty-six countries take the NNLE successfully for issuance of a national nursing license to practice in the country. The key leadership lesson learnt is that a phased approach is required as it was necessary for faculty and clinical leadership to adjust to the new requirement of the NNLE methodology concurrent to new graduate nurses preparing for the NNLE as a licensing requirement.
4. Conclusion
The above feedback has contributed meaningfully to the revision process of the NNLE blueprint and national coordination of logistical examination procedures for implementation during 2019 in addition to further faculty development nationally, committed engagement of clinical leadership, and ongoing robust feedback mechanisms. This historical development in turn will inform the process of national leadership for transformation of the nursing curriculum given that a new paradigm is required to embrace the consequences of inevitable change (Boykin, Schoenhofer & Valentine 2013).