Improving NCLEX – RN results at Muskingum University

Starting With

the End in Mind

Located in east-central Ohio in the Village of New Concord Chartered in 1837 as Muskingum College Presbyterian Heritage Noted for Liberal Arts education

Muskingum University Department of Nursing

Pre-licensure program track started fall 2008 RN to BSN program track started spring 2009 Pre-licensure graduates (first class) in 2012 RN-BSN graduates (first group) in 2011 Approved by the Ohio Board of Nursing Accredited by The Commission on Collegiate Nursing Education (CCNE)

NCLEX-RN results

2012 – 17 graduated – 8 passed first attempt 47% 2013 – 7 graduated – 3 passed first attempt

• (one graduate did not take NCLEX until 2014) 50%2014 – 23 graduated – 18 passed first attempt 78%2015 – 11 graduated – 10 passed first attempt 90%

Goal #1

Improve NCLEX-RN results for currently enrolled seniors – 95% of the national average and beyond

The How

Selected ATI summer 2013• Consultants reviewed nursing syllabi for placement of ATI remediation

and proctored assessments across the sophomore, junior and senior nursing courses

• Faculty developed an integration strategy for all levels of currently enrolled students

Integration Plan: Sophomores (2013-2016)

TEAS ExamNURS 225

Orientation to ATI – “Getting Started” video Nurse Logic 2.0 Assigned ATI Readings and Skills video Practice Assessments –with required remediation (see rubric) Form A (1st

assessment) RN CMS Fundamentals Proctored Assessment (see rubric) Form B

Integration Plan: Juniors (2013-2015)

NURS 350 Nurse Logic 2.0 – Plus ATI Orientation “Getting Started” video Assigned ATI Readings and review materials, skills, lab videos and

Pharmacology Made Easy 2.0 & Dosage Calculation Tutorials 2.0 Practice Assessment – RN TMS align with course content (see rubric) –

Fluid, Electrolyte & GI Proctored Assessment – RN CMS Fundamentals (see rubric) Form B

Integration Plan: Seniors (2013-2014)

NURS 460ATI Orientation “Getting Started” videoATI Reading and ReviewPractice Assessment – Community Health (see rubric) Form B RN CMS Community Health Proctored Assessment (see rubric) Form B

Seniors cont.

NUR 490 Comprehensive Predictor Form B All

Classes Maternal/Newborn Practice Assessment

(see rubric) Maternal/Newborn Proctored

Assessment (see rubric) Pediatric Practice Assessment (see

rubric)

Pediatric Proctored Assessment (see rubric)

Mental Health Practice Assessment (see rubric)

Mental Health Proctored Assessment Med-Surg Practice Assessments (see

rubric) Cardiovascular Gastrointestinal

Seniors cont

Endocrine Respiratory Neurosensory & Musculoskeletal Renal & Urinary Fluid/Electrolytes/Acid-Base Perioperative RN NCLEX Final

RN Comprehensive Assessment Practice (see rubric)

RN Comprehensive Predictor (see rubric) ATI Based Individual Plan for Students

NCLEX Review Course

ATI RubricATI Assigned Practice Assessment*

Remediation (Active Learning) 

ATI Proctored Test

Remediation  

Points Possible(course total 10 points)Weight (or %) varies by individual course

Score 90-100% **see Remediation below

Proficiency level 3 - 4 pts

**see Remediation below

10/10

Score 80-89% **see Remediation below

Proficiency level 2 - 3 pts

**see Remediation below

9/10

Score 70-79% **see Remediation below

Proficiency level 1 - 2 pts

**see Remediation below

8/10

Score below 70% **see Remediation below

Below Proficiency level 1 - 2 pts

**see Remediation below

7/10

ATI Remediation Rubric cont

* ATI Practice Assessment will be specified (A or B)

**RemediationRemediation must include at least two bullet points (handwritten) for each item missed during the assessment (each ‘topic to review’). Remediation is awarded Pass or Fail credit only, NO partial credit. No late assignments accepted for points. Remediation will be considered as entrance criteria for future course or ATI exams or assessments.

Implemented Virtual ATI (VATI)

Enroll in VATI program Complete the 2013 comp predictor Watch VATI getting started video Complete enrollment survey Complete all customized learning

activities on time as identified by VATI coach

Complete proctored assessments per VATI coaches’ recommendation

Wait for the VATI coach to give the “green light” to take NCLEX

Take NCLEX within 3 weeks of “green light”

Program Cost = $

VATI cont

o To be reimbursed students must:• Pay fees up front to Muskingum• Enroll in VATI program• Complete all customized learning activities on time as identified

by the prescribed ATI plan• Wait for the “green light” from ATI before taking NCLEX• Schedule the NCLEX exam within the 3 week window after

receiving the “green light”

Implemented Virtual ATI (VATI) cont

VATI Coach/Program 

   Coach develops individual plan based on comp predictor results Coach facilitates student’s progress by providing individualized

support Coach provides a calendar to guide student’s daily review of material Reviews are individualized and tailored as the student progresses,

special focus is given to topic areas that need more attention Coach gives “green light” when student is ready to take NCLEX

Implemented Virtual ATI (VATI) cont

Muskingum Coach

Meet with students and watch VATI video Facilitate VATI start-up after enrollment survey complete Monitor student progress weekly and foster student participation and

engagement Work with students regarding optimal testing Collaborate with VATI coach and provide additional student assistance

with content weaknesses Verify “green light” with VATI coaches to optimize student success on

NCLEX

Implemented Virtual ATI (VATI)

cont

* NCLEX pass rate is 97.5%

when students wait to receive

the “green light” from the VATI

coach

VATI Results

2014 graduates – 78% passed on first attempt• 22 of 23 registered• 17 of 22 completed VATI and received the “green light”• 14 of 17 passed NCLEX on first attempt (82%)• 5 did not wait on green light; 3 passed and 2 failed (60%)

VATI Results cont

2015 graduates – 90% passed on first attempt• 10 of 11 registered• 8 of 10 completed VATI and received the “green light”• 8 of 8 passed NCLEX on first attempt (100%)• 2 did not wait on green light; 1 passed and 1 failed (50%)

Other Strategies Implemented

oSenior students attended 3 day live review on campus (ATI)

oElective nursing course spring semester on NCLEX preparation; 5,000 – 6,000 questions with remediation

oComprehensive predictor in the spring semester (ATI)

oProvided faculty development using ATI consultants

• Item writing

• Teaching strategies

Other Strategies Implemented cont

o Implemented a process to evaluate item discrimination and item difficulty on nursing exams

o Assessed nursing course content using the NCSBN blueprint and ATI content

o Increased the use of low, moderate and high fidelity simulation strategies in the lab

o Incorporated computer based testing in all nursing courses with NCLEX focus

The Work Continues…

2015 - Implementing curriculum revisions for incoming freshman partially based on ongoing assessment of ATI comprehensive predictor and proctored assessment results