Success on the NCLEX-RN® has widespread ramifications for students, nursing schools and employers. The stakes are high related to first time pass rates and review of the literature verified that student preparation for entry into practice is of great concern to nurse educators and schools nationally and globally (Wells, 2003; Higgins, 2004; Crow et al 2004; Davenport, 2007; Siffert & McDaniel, 2007; and Carrick, 2011); graduating seniors, and employers (Beeman, P., & Waterhouse, J. ,2003; Spencer, J., 2006; Pine, 2007;Silvestri, L., Clark, M. & Moonie, S., 2013; Atemafac, J., 2014).
The purpose of this retrospective correlational pilot study was twofold. The first was to determine which characteristics of a standardized NCLEX –RN® Review Course impact NCLEX-RN® success. Are the characteristics, class size, course placement, mandatory attendance, and confidence level associated with NCLEX-RN® success? The second purpose was to describe the positioning within the curriculum of the standardized NCLEX Review Course and its relationship to the timing of the Exit Exam. Findings contribute to the identification of those variables that contribute to success on NCLEX-RN® when participating in an NCLEX® Review Course. Knowing which factors may contribute to success is helpful to schools of nursing in the formulation of innovative curriculum design to support nursing student success in the NCLEX-RN®.
There is limited research on the effect of standardized review courses on successful NCLEX-RN® or standardized exam outcomes. Success is a complex phenomenon. Corrigan-Magaldi, Colalillo, & Molloy, (2014); Crow (2004) and Ashley and O’Neill (1991) found review courses to be one of the statistically significant interventions for NCLEX® success. Requiring mandatory attendance at review courses seems to be a successful strategy (Mills, et al, 2001; Norton, et al, 2006). Ross, et al, (1996) identified that low participation at optional attendance standardized review courses resulted in lower standardized test scores. Lack of confidence was cited as a factor influencing NCLEX failure (Farquhar, 2014) while high self-efficacy expectations showed a positive correlation with NCLEX success (Silvestri, 2010; Silvestri, Clark & Moonie, 2013). While it is difficult to isolate class size from other variables, such as ineffective teaching methods and impact on grades or achievement, the educational literature suggests mixed results on class size and impact on grade or achievement (Robb, 2012; Hattie, 2009; Kokkelenberg, Dillon, & Christy, 2008; Arias & Walker, 2004; Mitchell & Beach, 1990).
Methods:
This exempt study was approved by the IRB of Texas Woman’s University Protocol #17690. A retrospective correlational research design was used and the DV was measured by first time passage of NCLEX-RN®. The independent variables included: a) required attendance at a standardized review course, b) class size, c) positioning of standardized exit exams (E2), d) timing of the course in relation to graduation, and e) confidence. The standardized NCLEX-RN® Review course emphasizes memory retrieval by reviewing key concepts related to commonly occurring disorders and health needs. It highlights mental rehearsal by helping the students practice critical thinking and test taking strategies and analysis and builds confidence through faculty/student interaction and repetition to support retention. In order to achieve these purposes, the students who attended the standardized NCLEX-RN® Review Course answered a post-course questionnaire measuring satisfaction and confidence. Deans or Directors were invited to respond to two questionnaires: demographic and scoring tool.
Results:
Results revealed that mandatory attendance is associated with statistically significant higher scores on a standardized E2 (p<.01). A chi-square test of independence demonstrated no difference in NCLEX success between those required to attend a LRC and those who were not required (X (1, N=746) = .1783, p=.674). Students attending courses with smaller class sizes (<60 students) scored significantly higher on the Exit Exam ( X= 919.1) than those attending larger classes (>60 student) (X =831.5). There was no difference in NCLEX outcomes. The percent of students passing NCLEX was the same regardless of class size (X2 =.003, p=.958). Students passed NCLEX at statistically higher rates when the standardized exams were offered after the review course rather than before the review course (p=<.01). The timing of the review course conferred benefit on NCLEX outcomes. More students passed NCLEX when the course was offered 1-9 weeks prior to graduation compared to students who attended a review the week of graduation or 12 weeks before graduation (1, N= 497) (X2=29.22, p<.01). There was a statistically significant improvement in self-reported confidence among students enrolled in the standardized review course.
Conclusion:
While limited research is available to determine the effectiveness of strategies used to improve NCLEX-RN success, a comprehensive standardized review course is appropriate to help students understand the testing process, develop test-taking skills, increase content knowledge, improve critical thinking abilities, and gain confidence. Future research is recommended on identifying confounding variables associated with class size and intent to prepare post-graduation