THAT TIME YOU WERE IN THE PERFECT STORM OF NCLEX FAILURE
HOW YOU CAN NAVIGATE YOUR WAY TO SUCCESS FOR A STRONG FUTURE
It was a perfect storm, recalls Jennifer Lloyd, DNP, MSMIT, FNP, CNL, RN, former Director/Assistant Professor of Nursing for the University of Lynchburg (now V.P. Clinical Excellence and CNIO, Centra Health). A confluence of events had resulted in an NCLEX pass rate of 67% among the University of Lynchburg nursing school’s 2014 graduates — a historic low for a program that routinely achieved 100 percent — or close to it.
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“It certainly wasn’t what I anticipated,” says Dr. Lloyd, new to her position at the time. “Looking back, there were a lot of factors impacting our NCLEX performance; leadership transition, faculty turnover, and the NCLEX test had changed the year before.
“Our scores weren’t acceptable to the college, so we immediately began working on a NCLEX success plan.”
Around that time, in the fall of 2014, Lloyd received a visit from two members of her ATI Nursing Education team who gave her a grounding in ATI’s portfolio of capabilities.
Although the school had been using various products from ATI, they were treated as “add-ons” to the curriculum, rather than being fully integrated, which lessened their effectiveness. Additionally, the available analytics and data on student progress which could have helped the faculty anticipate the 2014 results, weren't understood or utilized fully.
“I spent that summer looking for common themes,” says Jean St. Clair, PhD, RN, former dean, Health Sciences and Human Performance and Professor of Nursing. “It was clear we should have been paying attention to the ATI (proctored assessment) scores, which were indicators of how our students were going to do. Those scores should have been a red flag for us.”
Dr. Lloyd also had an in-depth conversation with ATI Solutions Support Nurse Educator Judi Dunn, MSN, RN, about the school's urgent, short-term need to prepare current seniors — who were already well into the 2014-2015 academic year — for their boards and the longer-term need for sustainable program success.
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"When I got off the phone with Judi, I went to our dean and said, 'We're going to be fine,'" says Dr. Lloyd.
Dunn's initial meetings with administration and faculty set the positive and productive tone that would characterize the partnership. The ATI team began by focusing on two key areas — ramped-up NCLEX preparation for the class of 2015 seniors and developing faculty to transition to a more effective and student-centered active-learning environment.
Products including ATI's Capstone Content Review, Customized Live Review, Virtual ATI, and others were incorporated to prepare the seniors for their boards in May. Strategies such as identifying academically at-risk students and focused remediation in critical content areas of Pharmacology and Adult Medical-Surgical helped close the gap between students' knowledge and what they would need to know for the NCLEX. That plan was deployed over the fall and into the spring of 2015.
COMMITTING TO NURSING PROGRAM SUCCESS
Concurrently, the Lynchburg faculty went through customized workshops and training designed to help them transition from the traditional "stand-up-and-lecture" model to a more active-learning environment. The new model focused on developing students’ clinical reasoning skills and caused them to come to class prepared. (Prepared students more actively participate in the learning experience, rather than those who just listen to a lecture.) One of the key tenets of the training was assuring inclusion of the breadth of the NCLEX test plan and QSEN competencies, as opposed to teaching to the textbooks.
"We knew that we had to change the way we taught," recalls Dr. St. Clair. "My biggest fear was that we would overwhelm our faculty with too much, and that we would lose a lot of educators. Many of them were already new, and now we were going to something that was completely different than what they had been used to."
But the concerns proved unfounded, and the return from winter break brought a welcome surprise.
"Over break, our entire faculty had completely revamped their courses into an active-learning format," says Dr. Lloyd. "This was without any prodding from us. They were so inspired by the notion of not having to stand up and be constricted by PowerPoint slides. We told them, 'You have so much knowledge you can share and stretch the students.'"
"They've done a remarkable job," adds Dr. St. Clair. "They were excited to see change in students and excited to see results. To have a brand new faculty totally willing to do this was amazing."
By early 2015, as the partnership gained traction, Lynchburg officially moved to ATI's Complete Partnership, a package that would offer the school access to nearly every resource in the ATI product portfolio, along with an open door to the experts within ATI to help develop a customized approach to help the school achieve its goals.
Drs. St. Clair and Lloyd met with students to explain why the major changes were being implemented, to engage them in the new way of learning, and explain how the changes would better prepare them for NCLEX and, subsequently, to become nurses. For the seniors facing boards in just a few months, remediation and courses that drew on critical thinking, emphasized effective clinical decision-making, and reinforced the NCLEX content resonated — particularly after a weekend ATI Live Review session.
"They weren't pleased to have to [attend the review on a weekend]," Dr. Lloyd says, "but afterwards, when they looked at their results and better understood their gaps, they thought it was amazing. They knew what they had to work on to pass."
TURNING THE CORNER TOWARD BETTER NURSING PROGRAM OUTCOMES
Dr. St. Clair says, “There’s a great sense of approachability. If I need something, I can call and get a good and an honest answer. It has not always been what I wanted to hear, but if you truly want to move your program, you have to accept the hard answers.
The work of the seniors and faculty paid off with Lynchburg's class of 2015 achieving a 100% first-time pass rate on the NCLEX. In addition, the school experienced 0% faculty attrition for the academic year, and its student retention remained high; for the 2015-2016 academic year, 98% of students remained in the program.
"As it turns out for us, one year of major NCLEX downturn was the best thing that could have happened," says Dr. St. Clair. "It forced us to realize that we needed to change and do the painful work to make our program better.
"Traditionally in nursing, you go through the curriculum, then intensive review, and hope you can get it in students' heads enough to remember," she adds.
"The ATI approach is to assess them continuously and remediate in the areas they don't know before they move forward. It's a different approach — much more beneficial for students."
SUSTAINABLE SUCCESS FOR YOUR NURSING PROGRAM
Moving forward, Lynchburg continues to leverage the tools of the Complete package to the fullest, including the analytics and measurement resources. Through tools like the proctored assessments and Comprehensive Predictor, the faculty is able to see how students perform compared to the benchmark and identify content gaps, which can then be addressed through focused work.
The team has also worked with ATI to customize data collection and evaluation processes. They used tools such as ATI Pulse, along with a customized dashboard. The dashboard permits Complete Partners to access real-time evaluation of students’ program progress toward meeting course and program objectives.
"I'm a very big believer in a systematic approach to success," Dr. Lloyd says. "ATI's reports and data are objective. They allow us to understand what we need to be delivering in courses. We can also look back through data and see where content gaps are. It's not used to point fingers, but always to improve the program."
In addition to the tools themselves, the nursing leadership team at Lynchburg continues to call on the expertise of their ATI counterparts.
She adds, “Working with the ATI team gave me a sense of relief and confidence we were on right road.”
WHAT IS THE ATI COMPLETE PARTNERSHIP?
Working with a nursing program, ATI develops a blueprint, identifying the resources and solutions needed to meet student, faculty, and program goals. ATI teammates then develop a seamless integration plan and conduct Insight Reviews to create mutual accountability between our program and yours.
As an ATI Complete Partner, a nursing program receives:
- Insight reviews
- Quick, effective deployment
- Training and integration of your new resources
- Policy development
- Robust data, such as KPIs and student usage metrics
- Faculty development.
Learn more at: ATItesting.com/educator/solutions/complete
