Greater emphasis will be given to teaching strategies that improve clinical reasoning once changes in the NCLEX-RN test plan take place in 2022 and faculty development with proven strategies needs to begin now (Dickison, Haerling, & Lasater, 2019). Evidence shows that faculty teaching strategies can promote higher level thinking and improve development of students’ clinical judgement (Cassum, Gul, & Profetto-McGrath, 2015; Cook, Stroup, & Harrington, 2019; Oliver, et al. 2018). Given that Cassum, Gul, and Profetto-McGrath (2015) determined that faculty need to make time for students to think and not just focus on the content, a standardized testing education program (STEP) was developed to make that time. The aim of this quality improvement (QI) project was to raise clinical judgement scores on the Assessment Technologies Institute (ATI) tests taken by senior nursing students using evidenced-based teaching strategies.
Methods:
Two faculty co-developed STEP to help students practice thinking through NCLEX-RN style test questions. All senior-level students were invited to participate. The 10-week thirty-minute program was offered fall and spring semesters. Session topics included general test-taking strategies, with the major focus on development of thinking. Teaching strategies included brief sessions, Socratic questions and faculty dyad conversation to model reasoning. All strategies were chosen to facilitate student recognition and analysis of cues in order to prioritize hypothesis and generate solutions.
Results:
Thirty-nine of 77 (51%) senior-level students participated in one or more STEP sessions. Three examinations were used to compare critical thinking means between participants and non-participants of STEP: 1) content mastery series (CMS) exam for Nursing Care of Children (pediatric) (taken prior to beginning STEP); 2) CMS for Medical Surgical Nursing (taken during STEP); and 3) Comprehensive Predictor (taken after STEP). On average, those who participated in STEP (M=56.46, SD=7.45) had significantly lower (p=.003) critical thinking scores on the pediatric examination than non-participants (M=62.55, SD=9.78). The medical surgical nursing examination revealed a non-significant difference (p=.06) in critical thinking between participants (M=62.28, SD=9.51) and non-participants (M=66.43, SD=10.02). Likewise, a stronger non-significant difference (p=.310) was found for the Comprehensive Predictor critical thinking scores between participants (M=69.50, SD=7.92) and non-participants (M=71.40, SD=8.46).
Conclusion:
The goal of faculty development is to support or enrich the work of nurse educators. Lang (2016) and Brown, Roedinger, and McDaniel (2014) emphasize the use of teaching practices and strategies that trigger learning. With peer support, faculty can develop their skills to teach higher level thinking in students to prepare new graduates to provide safe, competent nursing care. This QI project demonstrates how faculty peer collaboration led to improved ATI clinical judgement scores for students who participated in STEP. Peer collaboration, practice, partnership of faculty and support of administration were needed to develop STEP and the use of evidence-based teaching strategies to provide at-risk students an opportunity to practice thinking in a novel environment.