Closing the Loop UNLV School of Nursing BSN Program

1. Closing the LoopUNLV School of NursingBSN Program Susan Kowalski, RN, PhD November 6, 2008 Academic Assessment Symposium

2. Our 8 program outcomes are based upon our faculty selected 8 core concepts. The core concepts are aligned with the Essentials of Baccalaureate Education (AACN).

3. Each semester 2 program outcomes are evaluated. • According to our program assessment plan, each program outcome has 3-4 types of assessment measures. • These include: NCLEX results, ERI standardized test scores, various surveys, clinical evaluations by faculty/preceptors and rubric scored capstone papers. • Use of standardized exams and NCLEX allow for comparison with national norms and used for several of our program outcomes and are an important part of our analysis and decision making process. Assessment Plan

4. Uses Bloom’s Taxonomy with the majority of items written at the application level or higher since the practice of nursing requires application of knowledge, skills and abilities. Content of the examis organized into 4 major client needs categories: • Safe and Effective Care Environment • Management of Care • Safety and Infection Control • Health Promotion and Maintenance • Psychosocial Integrity • Physiological Integrity • Basic Care and Comfort • Pharmacological and Parenteral Therapies • Reduction of Risk Potential • Physiological Adaptation The NCLEX Exam

5. Content is also divided into 4 major fundamental nursing processes which are then integrated throughout the client needs categories. • Nursing Process– the scientific problem-solving approach to care that includes assessment, analysis, planning, implementation and evaluation. • Caring – the interactions between nurse and client in an atmosphere of respect and trust. This is a collaborative environment where the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes. • Communication and Documentation– the verbal/nonverbal interactions between the nurse and client, the client’s significant others and other members of the health care team. Client care is validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care. • Teaching/Learning – the facilitation of the acquisition of knowledge, skills and attitudes promoting behavior change.

7. Table IV-B.2 Performance on NCLEX-RN Licensure Examination of Baccalaureate Graduates • National first time pass rates • 2005 87.2% • 2006 88.1% • 2007 85.5% • Nevada first time pass rates • 2005 81.2% • 2006 85.1% • 2007 81.1% • UNLV SON first time pass rates • 2005 79.8% • 2006 83.9% • 2007 82.9% Use of NCLEX Scores allow for trending of classes over time and comparison with state and national means. UNLV has 3 graduating classes each year (48-56 graduates per class).

8. The ERI exams give us important feedback that is helpful in identifying specific content areas of our curriculum that may need improvement. • We use the exams for evaluation, and for teaching. As part of the ERI total testing program students receive practice tests, remediation for weak areas, and have monitored exams that are 10% of their course grade. Use of ERI Exams

9. Fundamentals • Maternal Child Nursing • Gerontological Nursing • Medical Surgical Nursing • Pharmacology • Mental Health Nursing • Critical Thinking • Therapeutic Communication • Community Nursing • Critical Care Nursing • Pre-RN Assessment • RN Assessment • MOCK NCLEX (Computer Adaptive Test) Exams given throughout programfor learning – and evalution.

10. Example: Program Outcome #1 • Utilize the nursing process as a framework for nursing practice, incorporating critical-thinking skills. • Critical Thinking Exam (3rd semester) • RN Assessment Exam (prior to graduation) – sections on Nursing Process and Critical Thinking Exams matched to Program Outcomes –

11. Spring 2008 ERI RN Assessment exam = no = No risk = At risk = High risk

12. You can imagine how distraught the faculty was when viewing the class composite results for the Spring 08 graduating class – RN Assessment test. • An immediate decision was made based on this data to implement a 4 day NCLEX Prep course. Addition of Face to Face NCLEX prep course.

15. ERI standardized exams are given throughout all levels – we are presently meeting with other testing programs which will give more specific remediation to the student. • 75% average on exam policy implemented – Ability to perform well on exams is essential for passing the NCLEX. • Competitive admissions (points for NET test, selected science and math grades). Our data indicated that students with scores below the national mean on the NET were most often unsuccessful in the program or unable to be successful on the NCLEX. • 4 day NCLEX face to face review session for Spring and Summer 08 students – and will be continued. This replaces a previous on-line review course. Changes related to testing

16. To increase skills in critical thinking and clinical judgment as used in the nursing process we have implemented use of simulation in every level. • A simulation team with members from each level are involved in the writing of scenarios and running the scenarios – our goal is to have simulation up to 10% of the clinical experience in each clinical course. Implementation of Simulationas a Teaching Method

17. Required PDAs for all students (based on survey from students and faculty after pilot study with optional use). • Use of I-clickers in class – (survey) • Implementation of on-line math calculation course in Level I (survey) Changes in use of Information Technology

18. Based on feedback from ERI tests, we have incorporated more application of pharmacology throughout the curriculum (to augment the 2 patho-pharm courses presented in level 1 and 2), especially in the clinical area. • We have fine tuned content throughout the curriculum. Changes in Content

19. 2004 – Last Revision (from 5 semesters to 4 semesters) Spring 2009 Curriculum Revision Planned