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Why the NCLEX® Must not be the ONLY Barometer to Assess the Health of Your Program

By November 17, 2016June 8th, 2023No Comments

Nursing programs live or die by the current or recent pass rates of the NCLEX® licensure examination.

If NCLEX® pass rates are 90% or greater, your program is assumed to be in excellent shape and no need for change is required.

If NCLEX® pass rates are too low, or trending in the wrong direction, this is cause for concern, or your program may be at risk for an intervention by your state board of nursing.

But though NCLEX® first time pass rates are the current “gold standard” of the health of nursing programs, is too much weight put on this one benchmark?

I believe the answer is yes and though NCLEX® pass rates are important, there is something much more important that evaluates the true health and state of a nursing program.

Have they successfully implemented the three essential paradigm shifts required to transform nursing education outlined in Educating Nurses: A Call for Radical Transformation.

Putting First Things First

A concept based curriculum is not what was prescribed by Patricia Benner and the researchers of the Carnegie foundation to bring needed change.

Instead pause, reflect and determine if your program has implemented three simple shifts advocated by Educating Nurses to bring needed change and transformation to your program.

Regardless of what type of curriculum your program uses or what your current or past NCLEX® pass rates are, STOP and determine how consistently your faculty at every level are implementing consistently the following paradigm changes required to TRANSFORM nursing education.

This is ground zero and is the foundation of evaluation that accurately determines the true state of the health of your nursing program.

The following three SHIFTS outlined in Educating Nurses will lay the foundation for not only needed transformation, but also lead to NCLEX® success!

Remember that the essence of the NCLEX® is that it is a test that evaluates if students can contextualize content to practice and think like a nurse using the skill of clinical reasoning.

With each step honestly reflect and determine if you and your colleagues are CONSISTENTLY doing the following:

  1. SHIFT from covering decontextualized knowledge and content (textbook) to CONTEXTUALIZING classroom content so it is situated in clinical practice (at the bedside) so students can see why the content is RELEVANT.
  2. SHIFT from sharp separation of classroom and clinical teaching to greater INTEGRATION of classroom theory and clinical content (see prior blog Why Learning Must Be Active).
  3. SHIFT from an emphasis of critical thinking to an emphasis on CINICAL REASONING. Clinical reasoning is the ability of the nurse to think in action and reason as a situation changes over time by capturing and understanding the significance of clinical trajectories and grasping the essence of the current clinical situation (Benner, Sutphen, Leonard, & Day, 2010). See prior blog WHY Clinical Reasoning is Foundational to Practice.

Questions that Determine True Health of Your Program

Use the following reflection questions to evaluate the health and foundation of your program and HOW content is taught:

1. Contextualize Content

  • Do you provide a “hook” to contextualize ALL content taught to the bedside?
  • Do you use stories in every lecture from your own practice to illustrate important principles from the textbook?

2. Bring Clinical to Class

  • Do you use practical tools such as case studies to bring clinical realities to class with each lecture?
  • Do you implement teaching strategies in every lecture that require students to USE and APPLY knowledge so students are NOT passive sponges absorbing content?

3. Emphasize Clinical Reasoning

  • Do you deeply understand the essence of clinical reasoning and how to integrate this nurse thinking skill in your class and clinical settings?
  • Do you consistently use active learning tools such as case studies that allow students to practice the thinking of clinical reasoning?

Read the Book

Have you read Educating Nurses: A Call for Radical Transformation? Though I was an early adopter of these paradigm shifts in 2011, it is never too late to see yourself the essence of the research findings of the Carnegie foundation.

I encourage department leaders to buy at least three copies and make this book available to your faculty to provide the WHY of change that is often difficult to realize in nursing education. This journey will bring not just bring change, but transformation to your program!

Simply Change the Way you Teach

Would it surprise you to realize that in order to bring needed and lasting change and transformation to your program no curriculum change is required.  Simply change the way you teach your current content (Benner, Sutphen, Leonard, & Day, 2010)!

I do not completely understand the current obsession and emphasis of transitioning to a concept based curriculum (see prior blog on clinical reasoning based curriculum).

Curriculum change of any kind requires an incredible amount of time, energy as well as pain! I am concerned that educators are obsessing about the wrong thing.

In Closing

Do not be complacent if your NCLEX® pass rates are above average. Regardless of the current state of your program’s NCLEX® pass rates, adopt the motto of the Home Depot and “never stop improving!”

Do not allow the NCLEX® alone to define your program’s health, but assess and reflect how well are you and your program implementing these three shifts of change from Educating Nurses.

Lay this foundation FIRST, and then you can be confident that you have a program that will not only get your graduates to pass a test, but more importantly, are preparing them for real-world clinical practice!

ACTION Steps from Today’s Blog

  1. Share this blog with your colleagues and have them reflect to determine if they could do things differently to bring needed change.
  2. Purchase or obtain a copy of Educating Nurses: A Call for Radical understand the WHY of change. My resources provide the HOW to bring needed change.
  3. Review my clinical reasoning case studies for topics you teach or download a complementary case study on sepsis below to see for yourself how easy it can be to take that first step of needed change!
  4. I am available to schedule a  conversation so I can better understand your unique situation, and help you bring needed change. Simply click the link!

What do you think?
How do you define success in your program?
Comment below and let the conversation begin!

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

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