Using a Capstone Course to Increase Standardized Test Scores And Predict Future Success in the RN –NCLEX Nursing Exam

Edward King

1. Background On Standardized Testing In The Nursing Curriculum

There are certain required courses within the RN Nursing Curriculum. These courses are Nursing of Fundamentals Practice, Nursing Care of the Childbearing Family 1and 2, Pharmacology, Nursing Care of the Adult 1 and 2, Nursing Care of the Client with Mental Illness, and Nursing Trends and Issues.

The RN Program at Hostos Community College utilizes the Standardized Testing Package from ATI Testing Inc. There is a standardized test given to the students at the end of each course enabling the instructor as well as the students, to measure test scores against the average obtained by other nursing programs throughout the nation.

The ATI Tests are graded using Proficiency Levels. These levels are:

Below level 1: Scores below the Proficiency Level 1 standard can be considered below minimum expectations and can be of significant risk in this content area.

Level 1: Scores meeting the Proficiency Level 1 standard can be considered to meet the absolute minimum expectations for performance in this content area.

Level 2: Scores meeting the Proficiency Level 2 standard can be considered to exceed most expectations for performance in this content area.

Level 3: Scores meeting the Proficiency level 3 standard can be considered to exceed most expectations for performance in this content area.

(ATI Testing.com).

The instructor can use these levels to interpret and compare the student’s progress to similarly situated nursing students throughout the country in the same course. The student’s actual grade is discernable to either be above or below the national or program mean. The national mean compares their grade to all nursing students and the program mean compares their grade to other RN students in a community college. Therefore, when a student is below Level 1, they are well below the program mean and the exam readily identifies the materials needed to be studied so their grade can be improved to a higher level evidencing a knowledge of the subject matter.

A research study that examined 589 RN graduates between 2003 and 2009 indicated, “that scores on the ATI RN Comprehensive Predictor were positively, significantly associated with first-time pass success. Students in jeopardy of failing the NCLEX-RN on their first attempt can be identified prior to graduation and remediation efforts can be strengthened to improve their success.” (Alameida, et al., p.1). Therefore, this work was intended to provide a brief review of past testing, as well as incorporate the current ATI Standardized Tests to identify the students predicted ability to pass the RN-NCLEX Licensure examination on their first attempt.

Nursing Trends and Issues is the last Nursing Course taken by each graduating RN student. I wanted to include the ATI Leadership Test within the Nursing Trends and Issues Syllabus because the course examines the role of the Registered Nurse as a leader within the healthcare team. Also, the content of the ATI Leadership Test reflects approximately 40% of the RN-NCLEX Examination based on Client Management and Infection Control. (NCSBN.com).

I had utilized the ATI Leadership Test when I had taught this course in two prior semesters. The students had obtained passing results, coming very close to the National mean in one course and exceeding it in another. (See Graph 2, NUR 320 courses labelled A and B).

2. Rationale For A Pilot Program To Incorporate The Ati Leadership Material And Testing In Nur 320

In the Spring, 2015, I was asked to teach NUR 320 by the Interim Nursing Coordinator, Professor Hamide Laucer. At that time, I identified the low score on the RN Comprehensive Predictor achieved by a prior graduating class which was 1.8% below the Mean National Average. The class only had 12 of 22 students projected to have better than a 56% chance of passing the RN-NCLEX Licensure Exam. This standardized test is used to predict passing rates on the RN-NCLEX Examination used for licensure in New York State. Ultimately, this class did have a large number of failures on the first time RN-NCLEX Licensure examination.

Refer to Graph 1,

I wanted to initiate a pilot program to determine if a score increase on the RN Comprehensive Predictor could be achieved by the graduating class of June, 2015.

It was my theory that including the ATI Leadership subject material, along with a quick review of the ATI Nursing Fundamentals and Pharmacology Tests, would have a positive impact on the RN Comprehensive Predictor. I based this theory on results I had achieved using the Leadership ATI Test with the graduating classes taught in two prior semesters. See Graph 2.

Prior to teaching Nursing Trends and Issues 320 in the Spring, 2015 semester I received permission from the Allied Health Chairperson, Dr. Charles Drago and the Interim Nursing Coordinator, Professor Hamide Laucer, to start the pilot program. At the conclusion of the pilot program, the RN Comprehensive Predictor was 1% above the Mean National Average, and had 16 of the 17 students projected to have better than a 56% chance of passing the RN-NCLEX Licensure Exam. Ultimately, all the students in this class passed the first time RN-NCLEX Licensure examination.

While the use of an ATI review within NUR 320 cannot be considered the only factor leading to an increased score on the RN Comprehensive Predictor, I think it certainly cannot hurt the students in the course. A review of graph 1 indicates that when the ATI review was used in NUR 320 with the ATI Leadership Examination, the number of students scoring at the bottom of the RN Comprehensive Predictor (56% or below chance of passing the RN-NCLEX) was reduced from ten (10) students to one (1) or two (2) students. This is a dramatic improvement for the students at the bottom of the class who need this remediation the most.

As to the rest of the students, the class average was also raised to at least meet the national mean.

Therefore, based on two separate classes, it seems possible to increase the results obtained on the RN Comprehensive Predictor for a graduating class when ATI materials were reviewed within NUR 320. See Graph 1.

Upon examining the results of the earlier ATI Leadership Examination for the class with 4 failures, it was evident that the class mean was a few points below the national mean. Therefore, I looked at the ATI curriculum, knew I had to revise some lesson plans, and planned to move the ATI Leadership Examination up in the semester as opposed to waiting near the end. My theory was that the graduating seniors had less of an attention span at the end of their final semester.

Thereafter, independent of this work in the Spring, 2015, Nursing Trends and Issues was designated a Capstone Course. The Office of Academic Affairs invited me to participate in a summer long semester to work on the syllabus for this course. The results of this work are detailed in the next section.

1. Results From Updating The Nur 320 Syllabus In The Summer, 2015 Title V Capsatone Seminar

During the Summer, this seminar was led by Sarah Brennan, the Vice President for Academic Affairs, and Silvia Reyes, the Title V Director.

I worked on the Title V Capstone Seminar with Professors Natasha Yannacanedo from Drama, and Marta Rivera from Criminal Justice to improve the syllabus

in NUR 320. Incorporating these ideas, the writing assignments, student presentations and standardized testing were incorporated into the syllabus.

As a result of these changes to NUR 320, several positive results can be reported:

1. The General Education requirements were identified as being met by the students as they did their presentations for Sarah Brennan.

2. The class which had consistently tested below the national mean on their ATI standardized tests was able to improve all their ATI standardized tests to meet or exceed the national mean.

3. Their RN Comprehensive Predictor compares very favorable to other classes. The number of students scoring at 56% or less chance of passing the RN-NCLEX Examination on the first attempt were reduced to only two students from a high of 10 students in a preceding class that did not utilize the ATI Leadership or ATI review within Nursing Trends and Issues.

It is my belief, that if time permitted a retest of these two students would have increased their grades since Nursing care of the Adult 2 had not yet been completed at the time the RN Comprehensive Predictor Comparison was given to the class.

I thank my colleagues and the Office of Academic Affairs for the opportunity to participate in this Capstone Seminar and believe it greatly improved the student performance within the course as a result of the work done with the seminar leaders and the other professors.

Graph 1: RN Comprehensive Predictor Comparison
Predicted Probability of Passing the RN-NCLEX

Graph 2: Comparison of ATI Leadership Test results in Nursing trends & Issues

•This class mean does not include the increased scores from the three retests who originally were at a Level <1.

Graph 3: Nursing Fundamentals Test for Graduating Class of 12-2015

Explanation of Retest in NUR 320

•* < Level 1This student retesting in NUR 320 was a voluntary retest who had level 1 on her first attempt but wanted to try again for a higher grade.

•* Level 1: This student had < Level 1, retested to a level 1.

•* Level 2: As to these two students, one had been absent for the ATI Test and one was retesting who had < Level 1.