Baccalaureate nursing programs across the country are concerned with attrition rates, which have been reported to be as high as 50 percent in some programs (Harris et al., 2014). Lack of student success is costly to students, families, and the educational institutions, both financially and from a resource perspective. Although admission criteria have traditionally been based upon grade point average (GPA), science GPA, and standardized nursing admission tests, many programs are reevaluating their admission criteria to better predict and promote student success (Van Hofwegen et al., 2019). Isabel Hampton Robb's fundamental theory for the establishment of standardized nursing education standards provides the theoretical construct for this study (Snowden et al., 2014).

The purpose of the research was to determine academic barriers to full admission to our bachelor of science in nursing (BSN) program, which used the Test of Essential Academic Skills (TEAS) preadmission exam. Two research questions were asked: 1) Is overall science GPA a predictor of BSN student success in pathophysiology? 2) Is there a correlation between the overall science GPA and the TEAS science score?

BACKGROUND

Articles published between January 2014 and December 2019 were reviewed to glean documented evidence of academic barriers to student success in baccalaureate nursing programs using the TEAS preadmission exam. Search terms included student success, baccalaureate nursing, academic barriers, attrition, nursing programs, academic predictors, TEAS predictor, nursing admission, assessment, retention, bachelor in science, and BSN. Criteria for inclusion were articles that addressed academic predictors of student success in nursing programs. Eighteen articles obtained did not meet the criteria; six articles were selected for review.

Crouch (2015) conducted a study to assess whether prerequisite GPAs predicted student success in nursing programs. This study found a significant relationship between college prerequisite GPAs and nursing program GPAs, or success in associate degree nursing (ADN) programs. Limitations were noted to be the use of a voluntary sample in one institution, with only three independent variables tested. Lui et al. (2018) explored academic predictors that may be instituted as admission criteria to increase student success. This study examined data on the reading, science, English, and mathematics tests of the TEAS V preadmission exam. The researchers determined that all four content areas should be considered when using TEAS V scores as a portion of admission criteria; use of the composite score was recommended. Dunham and Alameida (2017) conducted a study to determine if the TEAS composite score was a predictor of nursing program outcomes and program outcomes. The composite TEAS score was found to be statistically significant for NCLEX^(R)-RN success, supporting its use as a predictor for success. Noted limitations were the use of one group of schools (community colleges) and one program type (ADN).

Van Hofwegen et al. (2019) conducted a study to examine predictors of success in veterans. It found that TEAS scores were not predictive of nursing program GPAs, graduation rates, or NCLEX-RN pass rates. Students with lower preadmission GPAs were determined to be at increased risk for course failures and lower nursing program GPAs than students admitted with higher GPAs. The findings may be applied to nursing school applicants other than veterans. Tidwell et al. (2018) explored the issues of high attrition rates for nursing schools to determine if insufficient cognitive aptitudes could be a contributing factor. They found that admission criteria often included scholastic standing, science course grades, and preadmission standardized tests and that these criteria may not provide an adequate picture of students' preparedness for the rigor and critical thinking required in nursing. Finally, Kellner (2019) approached the problems associated with nursing shortages, limited numbers of seats available in nursing schools, high attrition rates in nursing programs, and low nurse retention rates. Noting that these problems persist despite the use of vigorous preadmission standardized testing, Kellner surveyed 242 nurses who had graduated from an ADN program in the Northeast between 2012 and 2018. Kellner found that the best predictors of success in nursing programs were nonacademic traits (e.g., good judgment, ethics, professionalism, responsibility, intrinsic motivation). Limitations included the use of graduates from one community college and the self-reporting of traits.

METHOD

This retrospective, quantitative study used BSN admission data for conditionally accepted students. Overall science GPA was calculated by including college algebra, nutrition, statistics, microbiology, anatomy and physiology I and II, and chemistry, using the traditional 4.0 letter-to-numeric conversion scale. Only the first two attempts on courses were included in the overall science GPA. Performance on the standardized TEAS V science subscore was used for data collection; it is numeric and linear in nature. Demographic data included age and gender only. Deidentified data were entered on the data collection tool to allow for consistency in formatting. This study was approved by the Texas A&M University-Texarkana Institutional Review Board.

Retrospective data were collected from existing BSN student enrollment documents located in the department of nursing student files and Degree Works, an electronic degree progress tool. A convenience sample was obtained from admitted student information for the first three cohorts in a new traditional BSN program. Admission data from 79 students were evaluated; as three students withdrew from pathophysiology, 76 students were included in the data analysis: 20 male (26.3 percent) and 56 female students (73.6 percent). Students represented various age groups: under 24 years, 73.6 percent; ages 18 to 20, n = 25, 34.2 percent; ages 21 to 23, n = 30, 39.4 percent; ages 24 to 26, n = 11, 14.5 percent; ages 27 to 30, n = 4, 5.2 percent; and ages 31 to 40, n = 5, 6.6 percent. The data were analyzed using Microsoft Excel. The Pearson correlation coefficient was used to determine the relationship between overall science GPA and pathophysiology completion as well as the relationship between overall science GPA and the TEAS V science subscore.

RESULTS

The mean overall science GPA for the sample was 3.19 (range: 2.53-4.0). The mean TEAS V science subscore was 63.9 (range: 34.0-93.6). There was a weak positive correlation (r = .31) between the TEAS V science subscore and overall science GPA; it was not statistically significant at p = .1. There was a weak positive correlation (r = .38) between overall science GPA and successful completion of pathophysiology; it was not statistically significant at p = .3.

DISCUSSION

This study adds to the divided research on the use of TEAS V subscores and science GPAs as predictors of student success. The lack of correlation supports the research conducted by Lui et al. (2018), which found the composite score to be the best predictor of success. Nursing school admissions criteria should be evaluated annually to determine what best displays a successful student and provide a holistic look during the admission process (Lui et al., 2018). The lack of correlation between the TEAS V science subscore and overall science GPA provides concern regarding the breadth of knowledge evaluated in this section of the TEAS V and the foundational learning provided in prerequisite science courses. Better understanding of the relationship between these two variables is necessary to have a complete understanding of how best to utilize each in the admission process. The lack of research on this correlation is also concerning for nursing programs and presents an opportunity for researchers.

The small sample size and use of only one BSN nursing program's admission data for this study are significant limitations. The inclusion of more university admission data would help increase the generalizability of this study if replicated and would allow for more diversity in the sample.

CONCLUSION

Use of standardized admission exams such as the TEAS V has become common among nursing programs. Best practices for utilizing these components to determine academic preparedness and barriers to receiving full admission to a BSN program are not readily available. To increase the number of BSN-prepared nurses, nursing education must thoroughly evaluate admission criteria. Programs must consider if more cumbersome and stringent admission criteria will increase the number of BSN-prepared nurses. Focusing on identifying at-risk components for applicants and building successful programs to support students may be of greater benefit to the future of our profession. Academic support programs such as academic coaches, supplemental instruction, and peer tutoring have all been shown to assist with success in at-risk students (Freeman & All, 2017). Utilizing these resources, nursing programs could further mitigate the nursing shortage and increase student success.

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