Nursing program acceptance criteria

1. Nursing program acceptance criteria Connie J. Frisch Doctoral Candidate

2. problem • AD mobility nursing programs lack evidence for designing effective admission criteria for nursing program acceptance related to student success as measured by retention and NCLEX-RN pass rates.

3. purpose • To determine which AD mobility nursing program admission criteria are associated with students’ retention rate and first-time passing of NCLEX-RN.

4. Brief review of literature • Little consensus regarding predictors of nursing students success in the literature as measured by passing of NCLEX-RN; findings include: • Nursing theory course grades (Lengacher & Keller, 1990); • Nursing clinical course grades (Lengacher & Keller, 1990); • Cumulative GPA (Daley et al., 2003; Horkey, 2015; Mills et al., 1992); and • Success in science course pre-requisites (Herrera & Blair, 2015; Horkey, 2015; Seago et al., 2008; Uyehara et al., 2007; Wolkowitz & Kelly, 2010).

5. Brief review of literature • Very little research has been done on AD mobility nursing students; • LPNs have typically taken all their non-nursing pre-requisites prior to admission to the mobility nursing program (Yates and Sandiford, 2013); • Some consistency noted in the literature regarding nursing student success in science courses and retention and first-time passing of NCLEX-RN, (Herrera and Blair, 2015; Uyehara et al., 2007; Wolkowitz & Kelly, 2010); • Predictive criteria may be clearer among AD mobility nursing students than among other groups of nursing students.

6. Theoretical framework • Tinto’s theory of retention (Tinto, 1987, 1993): • Rewarding encounters result in integration; • Greater integration leads to meeting goals and achieving success; • Learning communities or cohort models increase retention; and • Emphasis on importance of faculty interaction with students.

7. Theoretical framework • Shelton’s model of nursing student retention (Shelton 2003, 2012): • Perceived faculty support; • Self-efficacy; and • Outcome expectations.

8. Research questions 1. Are students’ demographic variable associated with their retention in an AD mobility nursing program? 2. Are there relationships among the admissions criteria (variables) used in AD mobility nursing programs and nursing students’ success in completing the program? 3. Are the student retention factors of perceived faculty support, self-efficacy, and outcome expectations related to students’ retention in an AD mobility nursing program? 4. Are there relationships among the admission criteria (variables) used in AD mobility nursing programs and nursing students’ success in passing the NCLEX-RN examination on first attempt?

9. hypotheses 1. There will be a positive correlation between one or more student demographic indicators related to retention in an AD mobility nursing programs. 2. There will be a positive correlation between one or more variables (admission criteria) and retention rates of students graduating from AD mobility nursing programs. 3. There will be a positive correlation between one or more student retention factors of perceived faculty support, self-efficacy, and outcome expectations related to student retention of AD mobility nursing programs. 4. There will be a positive correlation between one or more variables (admission criteria) and first-time passing of NCLEX-RN licensing examination for graduates from AD mobility nursing programs.

10. method • Population; 320 possible, 265 actual; 95% confidence level reached with sample of 175; 224 beginning sample, 190 final sample; • Instruments (retention instruments measured at end of first semester and final semester of nursing courses) • Demographics; (measured once) • Perceived faculty support scale (24 items); • Self efficacy for self regulated learning scale (11 items); and • Outcomes expectations questionnaire (14 items). • Data collection • Independent variables: Admission criteria • Dependent variables: Retention, NCLEX-RN

11. Analysis • Cronbach’s alpha coefficient • Determine reliability of the instruments • (Perceived Faculty Support 0.94; Self-Efficacy 0.83; Outcome Expectations 0.87) • Chi-square • Examine the relationship between two categorical variable that contain two or more levels in each • Pearson Correlation coefficient • Examine the relationships between the admission criteria (Prerequisite GPA, Practical Nursing GPA, TEAS, NACE and Math test scores) and • Retention and • NCLEX-RN passing on first attempt. • Logistic Regressions • Demographic values and retention • Items within each of three retention instruments and retention

12. analysis • Logistic regressions analysis is multiple regression with an outcome variable that is categorical (in this case binary [retained – yes or no) and predictor variables are continuous or categorical (predicting probability or odds of Y occurring [retained] given the value of X [measurement of retention items]).

13. analysis • None of the institutions participating in the study utilized all five measures of admission criteria therefore, I needed to conduct a series of bivariate correlations to separately test whether there were significant relationships between the admissions criteria variables and students retention. • Pearson’s correlation • Spearman’s correlation • I conducted a Pearson’s correlation with the admission criteria variables (pre-requisite GPA, PN GPA, TEAS, NACE and math test) to determine if there was a positive correlation between one or more admission criteria and NCLEX-RN passing on first attempt.

14. Results • Hypothesis #1: There will be a positive correlation between one or more student demographic indicators related to retention in an AD mobility nursing program. • Students who had mothers with a higher level of education had significantly improved odds of retention (Exp(B) = 1.84, p = 0.05). • One demographic indicator was found to be positively related to retention therefore Hypothesis 1 was partially supported.

15. Results • Hypothesis #2: There will be a positive correlation between one or more variables (admission criteria) and retention rates of students graduating from AD mobility nursing programs. • The results suggestion there is a small positive relationship • between the variable of Practical Nursing GPA and retention (r = .20; p < 0.05), and • between the variable of perquisite GPA and retention (r = .24, p < 0.01). • Hypothesis 2 is supported • Of interest, there is also a small (nearing medium) positive relationship between Prerequisite GPA and TEAS test (r = .26, p < .05) and Prerequisite GPA and Practical Nursing GPA (r = .26, p < 0.01). • (r in Pearson Correlation indicates strength of relationship between variables; 0.10 = small effect; 0.30 = medium effect; >0.50 = strong effect).

16. interpretation • Hypothesis #3: There will be a positive correlation between one or more of the student retention factors of perceived faculty support, self-efficacy, and outcome expectations related to students’ retention in AD mobility nursing programs. • Perceived Faculty Support* • Self-Efficacy* • Outcome Expectations* • *(each measured at end of first semester and last semester of nursing courses)

17. Interpretation • p-value represents statistical significance, 0.05 to 0.01; • Exp(B) (Exponential Beta)represents the odds ratio which is an indicator of the changes in the odds resulting from a unit change in the predictor in logistic regression (Field, 2013). If the odds ratio is greater than 1, it indicates that as the predictor increases, the odds of the outcome occurring also increase.

18. Perceived Faculty Support • The results suggested that at the end of the FIRST SEMESTER, students who perceived their faculty • Acknowledge when student have done well (Exp(B)) = 0.41, p = .04); • Give helpful feedback on student assignments (Exp(B)) = 0.41, p = .05); and • Demonstrate confidence in their abilities (Exp(B) = 2.64, p = .05) • have increased odds of graduating. • The results suggested that at the end of the SECOND SEMESTER, students who perceived their faculty • Listen to student (Exp(B) = 12.25, p = .04) • have increased odds of graduating.

20. Self-Efficacy* • The results in the FIRST SEMESTER suggested that when students believe they can finish assignments by deadlines, (Exp(B) = 1.96, p = .01) there is an associated increase in the odds the student will graduate. • The results in the SECOND SEMESTER suggested that when students believe they can finish assignments by deadlines, (Exp(B) = 3.87, p = .01) there is an associated increase in the odds of retention. • (*Self-efficacy is defined as self-control over motivation, behavior and environment).

21. Outcome expectations* • There were no outcome expectation survey items in the FIRST SEMESTER significantly associated with students’ retention. • In the SECOND SEMESTER the results suggested that there is an associated increase in the odds of retention when • Students don’t worry about their ability to deal with death (Exp(B) = 3.58, p = .02); and • They believe that the public does not have a low opinion of people in the nursing profession (Exp(B) = 3.10, p = .01). • (*Half of the outcome expectations items were reversed worded and needed to be reverse coded).

22. The results suggest that four perceived faculty support items, one self-efficacy item, and two outcome expectation items were found to be positively correlated with retention; • Hypothesis 3 is supported.

23. Nclex-RN • Hypothesis #4: There will be a positive correlation between one or more variables (admission criteria) and first-time passing of NCLEX-RN licensing examination for graduates from AD mobility nursing programs. • The results suggested there was no relationship found between admission criteria and passing of NCLEX-RN on first attempt . • Hypothesis 4 was not supported. • There is also a small (nearing medium) positive relationship between Prerequisite GPA and TEAS test (r = .26, p < .05) and Prerequisite GPA and Practical Nursing GPA (r = .26, p < 0.01).

24. Conclusions – Limitations • Each colleges’s admission criteria was different, none of the five had all the admission criteria variables; • One college had to reschedule data collection related to weather; • For one college, the data collection was after a final examination when all students would be on campus.

25. Conclusions – Implications for Research • I could have included PN GPA for all the colleges (even though not all used this) from existing student data; • Studying whether the variable of English as second language correlates to nursing student success as measured by retention would be helpful; • Suggest investigating the relationship between student retention/graduation and NCLEX-RN success; • Faculty support is a repeating supportive component of student retention. Consider research related to implementation of nursing faculty development for promotion of perceived faculty support across the curriculum; • Consider combining both qualitative and quantitative measures for admission criteria that may be more predictive of nursing student success.

26. Conclusions – Implications for Theory TINTO • Tinto’s theory of retention was supported in this study through GPA correlation to nursing student retention, and the importance of faculty support and faculty involvement through correlation to four perceived faculty support items positively related to retention. • All AD mobility nursing programs in this study were a cohort model which aligns with Tinto’s theory of retention through learning communities. SHELTON • Shelton’s retention model was supported in this study through one demographic variable, four perceived faculty support, one self-efficacy and two outcomes expectancy survey items.

27. Conclusions – Implications for Practice • Consider Practical Nursing GPA as an admission criterian; • Consider using pre-requisite GPA as an admission criterian rather than a standardized admission test, or carefully consider weighting rubric points for these items; • Identify students at risk for success as early as possible and work with identified students to develop plans to assist the students in meeting their educational goals; • Collect formative and summative data concerning student’s perceptions of faculty support; • Review curriculum to be sure it is addressing possible students worries regarding ability to deal with death and their thoughts about public opinion of the nursing profession; • Nursing faculty professional development should be directed towards developing and implementing best-practices for student support including how to • acknowledge that students have done well, • give helpful feedback on student assignments, • demonstrate confidence in students, and • listen to students.

28. Questions, comments, discussion

29. references • Daley, L. K., Kirkpatrick, B. L., Frazier, S. K., Chung, M. L., & Moser, D. K. (2003). Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation. Journal of Nursing Education, 42(9), 390-398. • Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). London, England: Sage. • Herrera, C., & Blair, J. (2015). Predicting success in nursing programs. Research in Higher Education Journal, 28(5), 1-8. • Horkey, E. (2015). It’s not all academic: nursing admissions and attrition in the United States. Nursing Reports, 5(1), 29-31. • Lengacher, C. A., & Keller, R. (1990). Academic predictors of success on the NCLEX-RN examination for associate degree nursing students. Journal of Nursing Education, 29(4), 163-169.

30. references • Mills, A. C., Sampel, M. E., Pohlman, V. C., & Becker, A. M. (1992). The odds for success on NCLEX-RN by nurse candidates from a four-year baccalaureate nursing program. Journal of Nursing Education, 31(9), 403-408. • Seago, J. A., Wong, S. T., Keane, D., & Grumbach, K. (2008). Measuring attributes of success of college students in nursing programs: A psychometric analysis. Journal of Nursing Measurement, 16(3), 184-200. • Shelton, E. N. (2003). Faculty support and student retention. Journal of Nursing Education, 42(2), 68-76. • Shelton, E. N. (2012). A model of nursing student retention. International Journal of Nursing Education Scholarship, 9(1)(1), 1-16. • Tinto, V. (1987). Leaving college: Rethinking the causes and cures of student attrition. Chicago, IL: University of Chicago Press.

31. references • Tinto, V. (1993). Leaving college: Rethinking the causes and cures of student attrition (2nd ed.). Chicago, IL: University of Chicago Press. • Tinto, V. (1999). Taking retention seriously: Rethinking the first year of college. NACADA Journal, 19(2), 5-9. • Tinto, V. (2000). What have we learned about the impact of learning communities on students? Assessment Update 12(2), 1. • Uyehara, J., Magnusses, L., Itano, J., & Zhang, S. (2007). Facilitating program and NCLEX-RN success in a generic BSN program. Nursing Forum, 42(1), 31-38. • Wolkowitz, A. A., & Kelley, J. A. (2010). Academic predictors of success in a nursing program. Journal of Nursing Education, 49(9), 498-503. • Yates, L., & Sandiford, J. (2013). Community College Nursing Student Success on Professional Qualifying Examination from Admission to Licensure. Community College Journal of Research and Practice, 37, 319-332.