By the year 2010, there is a projected need for a million new and replacement nurses throughout the United States.1 As the shortage of nurses continues to threaten the healthcare society, it is important to identify new and innovative programs to attract new students.2 According to the American Association of Colleges of Nursing,3 schools of nursing are attempting to meet this challenge by creating new programs to accelerate nursing education without compromising the integrity and quality of the nursing program.

In response to this challenge, Auburn University School of Nursing implemented the Accelerated Nursing Degree Program in 1993. The Accelerated Nursing Degree Program is designed to enable students with degrees in other fields to complete the professional nursing curriculum in 3 semesters and 1 summer term of full-time study instead of the 5 semesters required for traditional students.

Since the inception of the Accelerated Nursing Degree Program, faculty believed these students were more successful academically and on the National Council Licensure Examination for Registered Nurses (NCLEXRN) than traditional students. There was much interest in determining if this belief was true and, if so, factors that explain this.

A study was developed to determine if there is a significant relationship among selected variables and success on the NCLEX-RN licensure exam in the traditional nursing students and accelerated nursing degree students and also if there were significant differences in the academic achievement of accelerated and traditional nursing students in selected variables and NCLEX-RN performance. Variables studied included science grade point average (SGPA), Health Education Systems Inc. (HESI), specialty exam scores (pediatric, maternity, medical surgical, and psychiatric), Exit HESI exam scores, and nursing clinical course grades.

Review of Literature

Many studies4-13 attempted to identify predictors of success on the NCLEXRN for the traditional nursing student; however, studies focusing on accelerated students are rare.7,14 The review of research for this study focused on the academic achievement of the traditional and the accelerated student related to variables maintained in a computerized data bank on all students in the school of nursing. The variables can be grouped into 3 categories: grade point average (GPA), number of Cs, Ds, and Fs in nursing courses, and assessment exams. A review of research on the success of both groups of students on the NCLEX-RN was also examined.

Research studies have examined various calculation of GPA and found that GPA can be predictive of NCLEXRN results. For example, one study found that the best predictor of success on the NCLEX-RN is GPA at graduation. 5 GPA at the end of the sophomore year and at the end of the junior year has also been found to be a predictor of success.6 Further, traditional students who passed the NCLEX-RN had significantly higher biology GPAs than students who failed the NCLEX-RN.5,7-11 Sophomore GPA, nursing GPA, and senior GPA were predictors of success on the NCLEX-RN in one study.11 These studies all focused on traditional students; further study is needed to determine whether GPAs are a factor in the success of the accelerated student.

Nursing course grades is another factor found to be significant in determining the success of traditional students.1,4,5,7,12,13,15 In one study,12 a significant relationship was found between the student's grades in certain nursing courses (psychiatric mental health nursing, maternity nursing, pediatric nursing, adult health nursing I and II, and nursing care of the critically ill) and success on the NCLEX-RN. Another finding was that the risk of failure on the NCLEX-RN increased with the number of C (or lower) grades obtained in nursing theory courses. In another study,13 nursing theory courses at the junior and senior years had a strong correlation with success on the NCLEX-RN exam. Another researcher7 found that students with no grades of C or below had a 97% chance of success on the NCLEX-RN, whereas those with 3 or more Cs, Ds, or Fs only had a 51% chance of being successful.

Research4,8,9,12,13,16 suggests that assessment tests are predictors of success on the NCLEX-RN. Some studies4,9,12,13,16 found the Mosby Assesstest to be a predictive exam. Some studies8,11 found that a high score on the NLN Comprehensive Achievement Test contributed significantly to performance on NCLEX-RN, whereas another study12 found that there was a significant relationship between the student's scores on NLN specialty tests (psychiatric, maternity, pediatric, and the adult) and success on the NCLEX-RN. Other research17-21 indicated that the Exit HESI exam developed by Health Education Systems is a predictor of success on the NCLEX-RN. For all groups of students, the Exit HESI was determined to be 99.49% accurate in predicting success on the NCLEX-RN exam when given in monitored situations.

There is a lack of research on specialty assessment tests and their ability to predict NCLEX-RN success. There were no studies found that specifically addressed the predictive ability of assessment tests in accelerated students.

One study7 suggests that nontraditional second-degree students (older than age 23) were more likely to be successful on the NCLEX-RN than traditional students. In this study, accelerated students had a success rate of 96%, whereas traditional students had 88.3% passage. One study compared the performance of students in an accelerated baccalaureate nursing program for college graduates and a traditional nursing program.14 A comparison of 29 traditional students with 27 accelerated nursing students was completed. The accelerated students completed the program in 13 months. The accelerated students performed better with a 90% success rate on the NCLEX-RN as compared with the traditional students with a 70% success rate.

Clearly, the predictors of NCLEX-RN success vary from school to school. Also, there is very little known about the performance of accelerated students. It was important for faculty in our school to determine predictors for our students, particularly the accelerated group.

Methods

Sample

A sample of convenience of nursing students at one university was used. All students, both accelerated and traditional, who graduated, took the NCLEX-RN, and whose results were received between December 2000 and December 2004 were included in the sample. A total of 224 participants were included. Tables 1 and 2 show the sample groups and demographic data.

Table 1. Sample Groups

Table 2. Demographic Data

Variables

The dependent variable used in this study was the outcome (pass or fail) on the NCLEX-RN exam. Independent variables included SGPA, HESI specialty exam scores (pediatric, maternity, medical surgical, and psychiatric), the Exit HESI exam scores, and the number of Cs in the nursing clinical courses. These variables were used as both predictors of success and measures of academic achievement in this study.

Prior to admission, all students took principles of biology, human anatomy and physiology I and II, general microbiology, and fundamentals of chemistry. The grades of these courses were averaged to compute a SGPA. The HESI specialty exams are administered at the end of each semester in which the student has taken the course, whereas the Exit HESI exam is administered at the end of the program after all courses are completed. Only nursing courses that had a clinical component were included in the study.

Design and Procedure

A retrospective correlational design was used in this study. Simple means and standard deviations were used at the descriptive level to make observations and describe certain aspects of the data. Correlational analyses, t test, and chi-square analyses were performed on the SGPAs, HESI exams, and the number of Cs in the nursing courses to determine whether there was a difference in these factors for those students who passed the NCLEXRN and those students who failed the NCLEX-RN. To determine the difference in the academic achievement of students from the accelerated baccalaureate nursing program and students from a traditional nursing program, a 1-way analysis of variance was performed. Because of the wide variation in the number who passed the NCLEXRN (n = 202) and for those students who failed the NCLEX-RN (n = 22), homogeneity variance test was conducted for each test and the separate variance formulas were used for those scores that were found to be significant. Finally, logistic regression analyses were performed to search for a model to help predict outcome on the NCLEX-RN.

Results

NCLEX-RN Success

Although students in the accelerated program have a higher passing rate (92.3%) than the traditional students (89.5%), there was no statistically significant difference in the NCLEX-RN pass rates for the 2 groups ([chi]² = 0.347, P = .388).

Science Grade Point Average

An independent-samples t test was computed to determine if there was a significant difference in the SGPA of the students who passed the NCLEXRN and those who failed (see Table 1). The mean average SGPA for the traditional students who passed the NCLEX-RN was significantly higher at 3.02, whereas the mean average SGPA for those who failed was 2.73. The mean average SGPA for the accelerated student who passed the NCLEXRN was 3.17, whereas the mean average SGPA for those who failed was also lower at 2.62; however, there was no significant difference found.

HESI Specialty and Exit Exam

There was a significant difference found in the maternity, medical surgical, psychiatric, and pediatric HESI specialty exam and the Exit HESI exam in the traditional students; however, the only significant finding for the accelerated student was the Exit HESI exam (Table 3).

Table 3. Comparison of Traditional and Accelerated Students who Passed and Failed the NCLEX-RN

Number of Cs in Clinical Courses

This study found that all students, accelerated and traditional, who make fewer Cs in nursing clinical courses, have a greater chance of passing NCLEX-RN. Students who made no Cs had a 95% success rate on the NCLEX-RN, whereas students who make 4 Cs had only a 50% chance of passing NCLEX-RN. A statistical significance was found in the difference in the number of Cs for both the accelerated and the traditional students who passed the NCLEX-RN and those who failed (Table 3).

Relationship of NCLEX-RN to Independent Variables

Correlational analysis was used to measure the strength of association between the results of the NCLEX-RN and each of the predictor variables. The medical surgical HESI specialty exam, the Exit HESI exam, and the number of Cs in clinical courses were significantly correlated with the NCLEX-RN results for the accelerated students. The highest correlation was the Exit HESI exam (r = 0.419, P = .002), however, the number of Cs was also highly correlated (r = -0.346, P = .012) as well as the medical surgical specialty HESI (r = 0.292, P = .036).

For traditional students, the SGPA, medical surgical and maternity specialty HESI, the Exit HESI, and the number of Cs in clinical courses were significantly correlated with the NCLEX-RN results. The highest correlation was the Exit HESI (r = 0.274, P = .006). All of the specialty HESI exams, maternity HESI exam (r = 0.205, P = .007), medical surgical HESI (r = 0.211, P = .005), psychiatric HESI (r = 0.181, P = .017), and the pediatric HESI exam (r = 0.186, P = .015) were correlated to success on the NCLEX-RN. The number of Cs in clinical courses (r = 0.197, P = .009), as well as SGPA (r = 0.183, P = .016), was significantly correlated to success.

Academic Achievement of Traditional and Accelerated Students

A 1-way analysis of variance was performed for each independent and dependent variable to determine whether there was any difference in the academic achievement of students from the 2 programs. The accelerated students were found to be significantly better on the psychiatric HESI (F1,219 = 8.247, P = .010), the pediatric HESI (F_1,219 = 20.16, P = .000), and the Exit HESI (F_1,219 = 9.589, P = .002). There was no significant difference in the medical surgical HESI or SGPA. Levene's test of homogeneity of variances was significant for the psychiatric HESI exam, P = .023, and the number of Cs in clinical nursing courses, P = .004, therefore an independent t test was computed to determine whether there was a significant difference between the psychiatric HESI scores and the number of Cs in clinical nursing courses for the accelerated and traditional students. Equal variances were not assumed. Results of the t test for psychiatric HESI exam (t_103.58 = 3.394, P < .001) and the number of Cs in clinical nursing courses (t_116.29 = -4.645, P < .001) indicated a statistically significant difference.

Linear regression was used to assess predictors of success on the NCLEX-RN for all students, accelerated and traditional. This technique tests the effect of each variable in the model on the success of passing the NCLEX-RN while controlling the other variables. Because the specialty exams are subtests of the Exit HESI, they were omitted from the analysis. The overall model with 3 predictors resulted in an R² of 0.109 (F = 8.947, P = .000). This model is summarized in Table 4. Upon examining the variables in the first model, only the Exit HESI exam was found to contribute significantly toward the prediction of success on the NCLEX-RN. This model predicted 99.5% of students who would pass, but only 9% of those who would fail.

Table 4. Predictors of Success on the NCLEX-RN

A second more restricted model was evaluated that did not include the Exit HESI because it is not given until the last semester. Faculty was interested in knowing if there were predictors that could be analyzed across the curriculum. The second model resulted in an R² change of 0.068 and an F change of 8.100, and did show a significance in the SGPA (P < .05) and the number of Cs in clinical courses (P < .05). Although significant, these variables represent limited additional explanation of students who will fail (only 6%).

Discussion

With the current nursing shortage, it is clear that this accelerated group of students should be encouraged to enter the nursing profession. They have valuable knowledge and skills from their previous education and a maturity and level of experience to deal effectively with multiple disciplines. In 15 months, these students can complete the nursing major and enter the workforce. In this nursing program, there is an 88% retention rate in the accelerated program.

The findings of this study indicate that when selecting students into nursing programs, admission committees should look very carefully at the SGPA. This was significant for both accelerated and traditional students. Students who have a low SGPA coming into the program and make Cs on nursing clinical courses during the program should be advised on test taking strategies and assisted to identify whether test anxiety or other deterrents are the reason for the Cs. Since the Exit HESI exam was found to be predictive of success on the NCLEX-RN, it should be considered when providing for interventions in the program. Presently in this university, students who are unsuccessful on the Exit HESI exam are counseled and given specific assignments based on their weaknesses.

These findings suggest that academic variables do account for some of the student's success. Identification of at-risk students should begin early in the nursing program with scrutiny of the SGPA, followed by the number of Cs the students make and scores on the HESI exams or other assessment exams being offered.

Although there was no significance found in the success on the NCLEX-RN of the traditional and the accelerated degree students, the accelerated students did have a higher pass rate than the traditional students. Students in the accelerated program are more mature and function at a higher level in the clinical setting. This study did, however, reveal that the accelerated students were more successful than the traditional students on the psychiatric HESI, the Exit HESI, and the pediatric HESI. One other study had indicated that there was no significant difference in passing rates or assessment tests.22

Overall, the results corroborate the findings of previous studies for the traditional students and indicate that it is possible to predict the success of accelerated degree nursing students in a baccalaureate degree nursing program.

Given the findings of this study, more studies need to be completed on the accelerated student as this is a highly successful group who can contribute to nursing quickly after beginning the program. The findings of this study are unique and significant. The uniqueness of these findings relates to the accelerated nursing degree graduate. This study shows that the accelerated graduate is just as successful as, and more often more successful than, the traditional student. An increase in accelerated programs could help to reduce the nursing shortage by graduating nurses at a more rapid pace.

References