A major challenge in the nursing education system is to assist nursing students to be successful in the program and on the National Council of Licensing Examination for Registered Nurses (NCLEX-RN). Nursing schools have a critical responsibility for contributing to the nation’s need for more qualified nurses in order to reduce the impact of the nursing shortage, and maintaining first-time NCLEX-RN pass rate at or above the national average. The AACN reports show that as the Baby Boomers age and retire, the need for more health care and professional nurses increases in the US (AACN, 2014). In order to meet the increasing demand for professional registered nurses, nursing educators in the nursing school are responsible to enroll and educate sufficient students to be successful on the NCLEX-RN. A hospital-based nursing school in the northeastern region of the US has experienced a decline in NCLEX-RN pass rates since 2008. The reason for the low pass rate from 2008 to 2013 was unclear. The accreditation status of the school was in jeopardy as the accreditor agency evaluated the school’s first-time pass rate in 2013. The reason for the low pass rate from 2008 to 2013 was unclear. A study conducted by Chen and Lo (2015) on student satisfaction, affirmed the importance of studying the student experiences for better program accountability. Charalampous and Kokkinos (2014) supported that since the education focuses on students, their perspectives are fundamental aspects for program effectiveness. To understand student self-regulated behaviors, learning approaches and other factors that impact their academic outcomes, the student perspectives on learning and preparing for NCLEX-RN were explored.
The purpose of this qualitative multiple case study was to explore nursing student experiences on NCLEX-RN including learning styles and approaches. Liew, Sidhu, and Barua (2015) stated that the learning approaches and styles in individual students vary and their learning needs are different from one to other. There have been studies regarding learning styles among nursing students to improve the teaching styles and the curriculum (AlKhasawneh, 2013; Andreou, Papastavrou, & Merkouris, 2014). However, studies conducted on learning styles used by nursing students in preparation for NCLEX-RN are scarce. Kolb’s experiential learning theory was the framework for the study to predict the preferred learning style for nursing students in preparation to NCLEX-RN. Kolb proposed in ELT that “Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38). Kolb’s ELT has four learning styles including diverger, assimilator, converger and accommodator where “the diverger learns through concrete experience, the assimilator uses reflection and observation, the converger utilizes abstract conceptualization, and the accommodator learns through activities” (Poore & Cullen, 2014, p. 245).
In reviewing studies that used Kolb's learning styles, the most regularly revealed learning styles for nursing students were accommodator and diverger (Fleming, 2008; Hallin, 2014; Kolb, 2000). Kolb (1984) emphasized students identify their preferred learning style so that they can progress as an effective learner. Since the diverger learns through concrete experience and the assimilator uses reflection and observation, these styles cannot be excluded fully from nursing students’ learning process. Therefore, this study also focused on identifying the preferred learning styles used by nursing graduates to prepare for NCLEX-RN in-depth and find out whether the findings are in agreement with theory propositions or contrast (Aneshensel, 2012; Baškarada, 2014). A purposive sampling method was used to recruit participants. Interviews were concluded when saturation of data was achieved. The final sample for the study was nine nursing graduates as three cases defined by the year of graduation from 2011 to 2013. Kolb’s experiential learning theory was the framework for the study and Kolb’s Learning Style Inventory (LSI) was used to explore learning styles.
Eight major themes were emerged from the study: (a) a study plan is an important learning approach for NCLEX-RN; (b) constant practice of NCLEX-RN style questions and answers is a helpful learning approach; (c) note taking and summarizing is an effective learning approach for NCLEX-RN; (d) staying focused is a learning approach for NCLEX-RN preparation; (e) commitment to study is crucial while preparing for NCLEX-RN; (f) students need to watch and think (Assimilating) while learning for NCLEX-RN; (g) students learn by doing and thinking (Converging ) for NCLEX-RN and (h) students learn by feeling and watching (Diverging) while preparing for NCLEX-RN.
As an implication to theory, the results extended Kolb’s ELT by revealing that some nursing students learn by watching, when others learn by doing, feeling or thinking. This study results confirmed that the nursing graduates gain knowledge by watching, thinking, feeling and doing and transform that knowledge in to new knowledge mostly by thinking during NCLEX-RN preparation. The study finding also support that the most preferred learning style for nursing students during NCLEX-RN preparation was assimilating or watching and thinking style. The recommendations for practice included (a) support nursing students to take a deeper learning approach, (b) plan mandatory study strategy seminars, (c) establish a NCLEX-RN review center, (d) include higher cognitive level questions on the course examinations, (e) support the student after graduation by extending the NCLEX-RN review center, and (f) identify student preferred learning styles. Recommendations for future research included (a) a quantitative correlational study to examine the major themes, (b) a mixed method study to explore nursing students learning styles and NCLEX-RN outcome, and (c) a quantitative comparative study of student learning approaches, learning styles and NCLEX-RN outcomes in multiple nursing programs.