Predicting Success on the National Council Licensure Examination-Registered Nurse: Another Piece of the Puzzle FOTI, MA,
IGNATIA
RN*
and SANDRA DEYOUNG,
A retrospective correlational study was conducted at a state-supported bachelor’s degree nursing program to determine variables that predict success on the National Council Licensure Examination-Registered Nurse (NCLEX-RN). Data were collected from 1985 through 1999 on a sample of 298 students. The independent variables studied were: grade point average (GPA) overall, GPA In the major, GPA in science, Scholastic Aptitude Test (SAT) verbal and quantltatlve scores, National League for Nurslng (NLN) Comprehensive Baccalaureate Achievement Test scores, and Mosby Assess Test scores. The outcome variable was the NCLEX-RN. Pearson correlations indicated the Mosby Assess Test, overall GPA and GPA in the major, NLN Achievement Test, and SAT verbal to be of moderate predictive value. Multiple regression analysis indicated that the most useful combination of predictors was the Mosby Assess Test, SAT verbal, and overall GPA. The results support the value of a program at this school designed to increase students’ verbal abilities. (Index words: NCLEX-RN; Predicting NCLEX; State board licensing examination; Success In nursing school) J Prof Afurs 7:99-104, 1991. Copyright 0 by W.B. Saunders Company
must
be taken
academic
failure are known, ardize or predict National
T ment,
heightened retention,
of nurses
educators’
in our country
concerns
for years, and many students educational
these students
deficits are going
stu-
figures may persist
who do enroll will come
that
must
be addressed
if
to succeed in their nursing
education. Nursing programs must retain the students they recruit to offset the decreasing pool of students enrolling
in nursing
if the numbers
of students
from departments
programs
of nursing
retained
nationwide.
But
and graduating
are to be increased,
steps
tAssociate Professor and Chairperson, William Paterson College, Wayne, NJ. Address correspondence and reprint requests to Dr DeYoung: Department of Nursing, William Parterson College, Wayne, NJ 07470. Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0702-0011$03.00/0
Jofim[
of Professional
Nming,
of success for the
Paterson
of variables
graduates
ning interventions
College
variables
in
that could
were studied.
that predict
success for
of this college will help in plan-
for at-risk
students.
Review of Previous Research
A substantial
number
in an attempt ination.
of studies has been conducted
to identify
Research
findings
that contribute
indicating
non.
Predictor
science,
variables
that
for success on the national
tion,
and
grade point on American
variables
nature
include
science
many
of the phenome-
grades
courses;
averages (GPA); College
as
exam-
have demonstrated
the complex social
function
licensure
to success on the examina-
scores on the Scholastic
verbal
Aptitude Tests
in nursing,
entry
and exit
and quantitative Test (SAT); scores
(ACT);
performance
on
National League for Nursing Achievement Tests (NLN); and most recently, scores on the Mosby Assess Test. Many of the studies using
*Assistant Professor, WilliamPaterson College,Wayne,NJ.
William
NJ. Single and multiple
the nursing
jeop-
Examination-Registered
help predict success on this examination
variables
recruit-
and academic success of nursing
dents. The present low enrollment with
about
has
Factors that
must be identified.
at The
The identification
at risk of
their progress
success in college and on the
focuses on correlates
NCLEX-RN Wayne,
to support
Licensure
Nurse (NCLEX-RN) This study
place students
or misguided.
student
Council
and appropriate
at the right time.
that
attempts
may be inadequate
RN-/-
adequate
provided
the factors
predictors HE SHORTAGE
to ensure
support
Unless
EDD,
the
(SBTPE).
State After
were performed
Board 1982,
Test
Pool
the outcome
in the 1970s Examination
variable
NCLEX-RN, which replaced the SBTPE. expect the predictors for both examinations
was the
One would to be sim-
ilar, because the universe of basic nursing knowledge sampled by the exams has changed relatively little in those years. Among the studies that have been conducted,
Vol 7, No 2 (March-April), 1991: pp 99-104
there 99
100
FOTI AND DEYOUNG
is a lack of any consistent ables.
However,
considerable nursing
support.
GPA,
the most 1984;
Jenks,
Grades
single
courses,
& Bausell,
Duffy,
1986;
Quick,
Sharp,
1984;
Whilley,
& Halpin,
& Paquet,
& Coonrod,
1981; Outtz, Krupa,
1986; Yocom & Scherubel,
1989;
1979; Payne & 1985;
Woodham
& Taub,
1985). SAT scores (espe-
cially verbal) were also found to be useful predictors (Dell & Halpin, Coonrod,
1984; McKinney,
1988;
Whitley,
Outtz,
1979;
1985; Woodham
those who studied eral found
Small, Quick,
& Taube,
them to contribute
&
Krupa,
&
Tests, sev-
moderately
to predic-
tion of state board exam success (Baldwin,
Mowbray,
& Taylor,
1968; Brandt,
Melcolm,
Venn,
& Bausell,
Various subscores moderate Perez,
& Schumann,
1981;
1966;
Seither,
value
Sharp,
(Aldag
1984).
& Rose,
The newest
1983;
Studies
to strong predictor
success on the NCLEX-RN
to date have
(Jenks, Selekman,
1989; McKinney,
Small, O’Dell,
of
Bross, & Coon-
the
combination
seems to be unique success for nursing
students
the predictive faculty
Paterson
baccalaureate-granting Of special interest
this of
of the Department
focused on assessing
SAT scores
therefore
all cal-
the SAT were done on a sample of
Data were obtained the NCLEX manner potential
from student
score reports.
in a
and confidentiality.
The
to ensure anonymity predictive
variables
all, GPA in the major, and quantitative),
records and from
All data were handled studied
were: GPA over-
GPA in science,
NLN
Baccalaureate
SAT (verbal Achievement
faculty. . . have long believed that reading and verbal abilities relate to success in the nursing program . , .
Courses included courses,
nutrition,
in the GPA in the major were all
psychology
and statistics.
courses,
GPA
lated from grades in anatomy microbiology, outcome
chemistry
variable
science courses,
in science was calcu-
and physiology
courses,
courses,
and genetics.
The
in each case was the NCLEX-RN
of Nursing
and verbal abilities curriculum. and improving
was conducted.
in the predictive
r) were calculated
combinations
of predictors
relate to sucskills for
were also in-
value of the NLN Baccalau-
reate Achievement Test as opposed to the Mosby Assess Test, because both tests were being administered to the senior class each year.
plain the variance
coefficients
for each predictive
prowas
design was used. Pear-
correlation
was performed
In fact, a program
The faculty
correlational
moment
sion analysis
have long be-
reading
A retrospective son product
with the NCLEX
majors had already been put into place when
this study
on only 149 students;
involving
Col-
value of the SAT verbal score, since the
cess in the nursing
terested
the predictors
at William
New Jersey.
lieved that reading
nursing
variables
school settings,
to determine
a state-supported
gram in northern
of predictor
to individual
study was undertaken lege,
year.
score.
1988).
Because
culations
nursing
predictive
tool is the Mosby Assess Test.
rod,
were available
year but before the first
in the sophomore
1980).
shown this test to be a moderate & Paquet,
course
of the ACT exams have had low to
predictive 1977;
Hastie,
after the freshman
nursing
Test score, and Mosby Assess Test score.
O’Dell,
1986). Among
the NLN Achievement
program
149.
1988; Mel-
& Whitley,
1986;
or
appear to be
(Dell
Bross,
O’Dell,
vati-
have received
in nursing
predictors
Selekman, Small,
calm, Venn,
of predictor
variables
and entry and exit GPA,
stable
McKinney,
pattern
some single
score. In addition,
multiple
to determine
in NCLEX
scores. Previous
they do not reflect the complexity Multiple
regression
the dependent
along regres-
the best
that could be used to ex-
have shown that while single predictors
several independent
(Pearson
variable
of the real world.
can help to explain variables
studies
can be useful, the reality of
simultaneously
affecting
variable.
Scores of all students
were also plotted
variable graphs to determine
on two-
the range of scores in the
predictor variables associated with success on the NCLEX. These graphs help the researcher to visualize, for example, minimum sample scores on SAT verbal compatible with a passing score on NCLEX.
Methodology Results The sample consisted of 298 nursing students who were graduated in the 4 years between 1985 and 1988, including students who transferred into the
Pearson correlations yielded some sizable statistically significant relationships between predictor vari-
PREDICTING
ables
SUCCESS
and
101
ON THE NCLEX-RN
the NCLEX.
Chief
among
the NLN
Baccalaureate
was .5 1. The second highest between
the overall
GPA
Achievement
and the NCLEX
between
coefficient
GPA
quantitative
in science and the NCLEX
Outcome Variable
Predictor Variables
The SAT
NCLEX-RN
Mosby Assess SAT verbal Mosby Assess SAT verbal GPA overall
and SAT
Multiple
regression
useful combination
(Table
analysis indicated
of predictors
sess Test, SAT verbal,
and overall GPA. This variable
was that of just the Mosby Assess Test an R* of .46 (Table
with
of further
predictor
added
graphs yielded
of individual
on which
the NCLEX
and who scored between but
percentile
no student
a
1,600 score, that of
There were four students
percentiles, 42nd
in passing
(score below rank on
who failed the
the 32nd and 42nd
who scored
above
research,
can help
41.39
.OOOl
score of over 440 were
the NCLEX.
Selekman,
the
and in previous
scores on the Mosby Assess Test
to predict Brass,
ney, Small, O’Dell,
results.
1,6OO), most scored below the 2 1st percentile NCLEX
published Uenks,
all individual
some interesting
l), it can be seen, by drawing
who failed
the Mosby.
.49
Analysis of Data
alone
line from the NCLEX
the students
.OOOl
Based on the data in this study
pre-
at the graph of the Mosby Assess Test (Fig
55.99
to the regres-
complex.
The two-variable
horizontal
.46
Test
with an SAT verbal
2). The
value and would
computations
scores were plotted and NCLEX
variables
no predictive
scores needlessly
looking
P
an R2 of .49. The second best
make mathematical
When
students successful
combination
sion equation
F
that the most
was the Mosby As-
yielded
and SAT verbal
Test
RZ
1).
combination
dictive
NCLEX-RN
and the NCLEX were very low and therepredictions
Multiple Regression Prediction of the NCLEX-RN Based on Two and Three Predictor Variables
and be-
was .46. The correlations
fore not useful in making
addition
2.
TABLE
Test
(. 59) were
correlations
tween GPA in the major and the NCLEX. verbal correlation
is the
of .66. In com-
Mosby Assess Test, with a correlation parison,
these
success
on the NCLEX
& Paquet,
& Coonrod,
1989; McKin-
1988). A Pearson r of
.66 means that 43 per cent of the variation scores can be accounted
for by the variability
on the Mosby Assess Test. Paterson
College,
it appears
For students that
above 42 would be highly predictive NCLEX.
in NCLEX
This makes the Mosby
useful screening
device in predicting
at risk of failing
the NCLEX-RN.
in scores
at William
a percentile
rank
of success on the Assess Test a very students
who are
on the Mosby Assess Test failed the
NCLEX . Plotting
of the overall GPA with NCLEX licensure
scores indicated NCLEX
that
most
students
who failed the
had a GPA below 2.7 (Fig 2). There were
only three unsuccessful
students
with GPAs between
2.9 and 3.2, and none with a GPA above 3.2. The graph
depicting
the relations
verbal scores and the NCLEX
TABLE
1.
Predictor
between
SAT
(Fig 3) shows that all
Pearson Product Moment Correlations of Predictor Variables and the NCLEX-RN Variables
Based on the data in this study and in previous pub&hed research, scores on the Mosby Assess Test alone can help to predict success on the NCLEX . . .
The addition increases
Pearson r
R2
P
Mosby Assess Test GPA overall GPA major NLN Achievement Test SAT verbal GPA science
.66 .59 .59 .51 .46 .2a
SAT quantitative
.15
.43 .35 .35 .26 .21 .oa .02
.OOOl .OOOl .oooi .OOOl .OOOl .OOOl .06
of more variables,
predictability.
gest that 49 per cent of the variation can be understood
however,
clearly
Data from this sample in NCLEX
in terms of the combined
sugscores
variabil-
ity of the Mosby Assess Test, SAT verbal score, and overall GPA. The 6 per cent difference in variability between the Mosby Assess Test alone (43 per cent) and the combination of Mosby, SAT verbal, and GPA (49 per cent) make it worthwhile to use all three predictors. A multiple regression equation using these
FOTI AND DEYOUNG
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* w s
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u
(I
+
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+ + + +
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ill38
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+
SYlas cl
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h
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w
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f.m
u
(I* E
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us
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aa”us u uwa Ii*
0
es
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A
*ti 64
u
f.l
64 *Ian
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&QU
Ia
binpI
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UC
s
w4
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s
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J*
suiuuU~
E
+s
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+ + + + + * + + + * + + + +
s
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u u
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Figure 1. Plot of licensure + score and Mosby Assess _+___-__+-____-+--_~_-_+-_____+__-___+-____-*-____-+-_____+__-___+-_____+_-____+_~.___+______+__~___+_ 0.w 4.07 0.IY 0.21 0.98 Cl.35 Cl.92 0.w 0.56 0.63 0.70 0.77 0.09 0.w ‘*” Test. A, 1 observation MOSBY PERCENT
+ + + +
(OBS); B, 2 OBS; etc.
Ia
+ + +
u
+ :
li
+
”
+
*
Ii : +
(I
b
:
+ +
II E
L)
*
c :
LI(y*IW
: 0
Ll(leta *IaItanw
fi 011
*a*ahE81)(1
:
+ *
CI
I)iMsw
s
at4
*fi ECcIcyI(u~ & u (Ila(Ih Ia * PI LI
w
n
+
IId :
+ +
LI
rtWE
63 SW
*co
(r
cab*Y ~
u
L,
us
L( * &I
E
111 *
w
(I
UC
**
(18
co
SM
*
Ia
M Ir
II
*
*
”
u
Ii
u
II u
*
(1 6i
ta
m
(I
u
u
0
6%E
(luuu !a
0
UP h
cu
ss su
#aah
*
SW ams*IcI s&&u MC, u 6 8 EL) 6 LI
ret
u
IfI
ChslU 64
II
u
s&u
*
*
LI* dlb E(1 E
lab
*
* IId
* LI
0
u
Ia
*
aa
0
ti
a
*
+ * l
+ + + + + + +
a
+
: +
__+________~+_______-_+___~---_-+_---_____+-________+---__~~..____~_____-_-_ '--------;~,-------;f, 2.8 2.2 2.Y i-.c 3.0 3.2 3.4 3.6 1.0 w*
variables can be used to predict scores on the NCLEX: Y’ = a + b, X, In this
equation,
Y’
individual
+ b, X, is the
student
+ b, X3
predicted
value
for
Flgwe 2. Plot of licensure score and GPA overall. A, 1 OBS; B, 2 OBS; etc. Seventeen OBS had missing values.
NCLEX; a is the intercept constant; b,, b,, and b, are the regression coefficients for the variables Mosby Assess Test, overall GPA, and SAT verbal; and X, to X, are the scores on those respective variables (Munro, Visintainer, & Page, 1986).
103
PREDICTING SUCCESS ON THE NCLEX-RN
a
Figure3. Plot of licensure score and SAT verbal. A, 1 OBS; B, 2 OBS; etc. One hundred fifty-five OBS had
;;co
: +
17CB
: .
pi Y
7E0 i
9
:
500 i .r~l___r~,._.I~,___E~~._.~~~-_.~~~ ._....._._+.._..+____-*-__--+_____*_____+ ____ _~_____*_____1-____~____-~____*-_____+ ____ _&_ l
missing values.
Thus,
if a William
Paterson
in the 50th percentile
College student
scored
on the Mosby Assess Test, and
reading
rate below 220 are referred
Academic
Support
for an academic
had an overall GPA of 3.4 and a verbal SAT of 4 10,
gram called LEAP (Learning
the predicted
Program).
licensure
score would be 1,87 1, a pass-
ing score. The prediction
of an actual score might
more reassuring
to a student
or she is likely
to pass. The student
however, that this prediction, not be a certainty
realize,
like most others, would in NCLEX scores. Still, a
this high is a useful predictor
the student
must
since the R2 of .49 accounts for only
about half of the variability correlation
be
than just saying that he
some guidance
and can give
in preparation
for the
NCLEX. Another
way of looking
two-variable
at the three predictor profile indicated
graphs (Figs l-3). The student
the NCLEX
percentile
These
and test-taking
Reading
Sack
Yourman
the computer
The entire program
Many students the LEAP program plete the computer they had a problem
should
receive attention.
into
work.
academic
Discussion
constellation
that SAT verbal scores are a part of the of predictors
for the NCLEX gives more
weight to the Department of Nursing’s emphasis on reading skills. Nursing students at William Paterson College are tested with the Nelson-Denny Reading Test before they begin the sequence of nursing courses. Students who score below the fifth stanine on vocabulary and reading comprehension or who have a
tional motivator
the NCLEX,
of the LEAP program.
that
would translate
performance.
in getting
did not
skills or that increas-
skills not only in passing
also in passing The finding
time
Some did not believe
with reading
data from this study, which support verbal
the Cen-
only and did not com-
speed and comprehension
improved
over a one-
attending
before the present the seminars
is one who scores below the 2 1st
dents who fit this picture
is conducted
on
to the
who were referred to the Center for
attend or attended
ing reading
The coun-
selections
of 1 hour per week.
vari-
and an overall GPA below 2.7. Stu-
Speed-
program.
the reading
semester time frame with students
on the Mosby Assess Test, has an SAT ver-
bal below 440,
also use the
disk that will be most helpful
in the
at risk of
in note-
Developmental
assigns
pro-
comprehension,
They
Course ( 1984) computer
for
Assistance
seminars
techniques.
selor in the Center student.
attend
skills, reading
and stress-reduction self-paced
enhancement
Enhancement
students
ter for a minimum
ables is to consider the student failing
taking
to the Center
Perhaps
the importance college
the of
courses but
can be used as an addistudents
to take advantage
It may help them
to see this
extra work as a useful tool in assisting them toward their future career goals. The Mosby Assess Test is presently administered in the beginning of the senior spring semester, and based on the findings of this study, it will continue to be used at that time. The students will be apprised of
104
FOTI AND DEYOUNG
their scores along with an interpretation in predicting
of the scores
pass or fail on the NCLEX.
The results
of the Mosby Assess Test also will be calculated the multiple
regression
equation
score based on this trio of variables
NCLEX
Seniors who are
judged to be at risk of NCLEX failure will be directed into individual
remedial
weakness diagnosed
work based on the areas of
in the Mosby Assess Test. A state
board review course will also be recommended. Further
research into the reliability
tion formulas
will be ongoing
of our predic-
and should
the success of
into
will also be shared
to the students.
to predict
students.
Summary
along with the SAT
verbal score and overall GPA. The predicted with and explained
authors to refine their ability
help the
The ability grants
to predict
success on the NCLEX-RN
a school some control
over the academic
out-
comes of its students.
As a result of the identification
of predictive
in this study,
variables
College
Department
mitted
to increasing
ically
at-risk
through
of Nursing
William
is even more com-
the verbal abilities
freshman
and
LEAP and will require
Paterson
of its academ-
sophomore
students
all senior students
to
take the Mosby Assess Test.
References Aldag, J. & Rose S. (1983). Relationship of age, American College Testing scores, grade point average, and state board examination scores. Remrcb in Nursing and He&h, 6, 69-73. Baldwin, J. P., Mowbray, J. K., & Taylor, R. G. (1968). Factors influencing performance on state board test pool examinations. Nursing Rarearch, 17, 170- 172. Brandt, E. M., Hastie, B., & Schumann, D. (1966). Predicting success on state board examinations. Nursing Research, 15, 62-69. Dell, M. A., & Halpin, G. (1984). Predictors of success in nursing school and on state board examinations in a predominantly black baccalaureate nursing program. Jotic nal of Nming Bducation, 23, 147-150. Jenks, J., Selekman, J., Bross, T., & Paquet, M. (1989). Success in NCLEX-RN: Identifying predictors and optimal timing for intervention. Journal of Nursing Education, 28, 112-118. McKinney, J., Small, S., O’Dell, N., & Coonrod, B. A. (1988). Identification of predictors of success for the NCLEX and students at risk for NCLEX failure in a baccalaureate nursing program. Journal of ProfersiomzlNursing, 4, 55-59. Melcolm, N., Venn, R., & Bausell, R. B. (198 1). The prediction of state board test pool examinations scores within an integrated curriculum. Journal of Nursing Education, 20, 24-28.
Munro, B. H., Visintainer, M. A., & Page, E. B. (1986). Statistical tnethodrfor health care ruearch (p. 93). Philadelphia: Lippincott. Outtz, J. H. (1979). Predicting the success on state board examinations for blacks. Journal of Nursing Education, 18, 35-40.
Payne, M. A., & Duffey, M. A. (1986). An investigation of the predictability of NCLEX scores of BSN graduates using academic predictors. Journal of ProfarJionalNursing, 2, 326-332. Perez, T. L. (1977). Investigation of academic moderator variables to predict success on state board of nursing examinations in a baccalaureate nursing program. Journal of Nursing Education, 16, 16-23.
Quick, M. M., Krupa, K. C., & Whitley, T. W. (1985). Using admission data to predict success on the NCLEX-RN in a baccalaureate program. Journal of Professional Nursing, 1, 364-368.
Sack, A., & Yourman, J. (1984). Sack Yourman Developmental Speed-Reading Course (5th ed.). (1984). Baltimore: College Skills Center. Seither, F. F. (1980). Prediction of achievement in baccalaureate nursing education. Journal of Nursing Education, 19, 28-36.
Sharp, T. G. (1984). An analysis of the relationship of seven selected variables to state board test pool examination performance of the University of Tennessee, Knoxville, College of Nursing. Journal of Nursing Education, 23, 5763. Whilley, M. P., & Chadwick, P. L. (1986). Baccalaureate education and NCLEX: The causes of success. Journal of Nursing Education, 25, 94- 10 1. Woodham, R., & Taube, K. (1986). Relationship of nursing program and success on the NCLEX-RN examination for licensure in a selected associated degree program. Journal of Nursing Education, 25, 112- 117. Yocom, C. J., & Scherubel, J. C. (1985). Selected preadmission and academic correlates of success on state board examinations. Journal of Nursing Education, 24, 244-249.
IGNATIA
RN*
and SANDRA DEYOUNG,
A retrospective correlational study was conducted at a state-supported bachelor’s degree nursing program to determine variables that predict success on the National Council Licensure Examination-Registered Nurse (NCLEX-RN). Data were collected from 1985 through 1999 on a sample of 298 students. The independent variables studied were: grade point average (GPA) overall, GPA In the major, GPA in science, Scholastic Aptitude Test (SAT) verbal and quantltatlve scores, National League for Nurslng (NLN) Comprehensive Baccalaureate Achievement Test scores, and Mosby Assess Test scores. The outcome variable was the NCLEX-RN. Pearson correlations indicated the Mosby Assess Test, overall GPA and GPA in the major, NLN Achievement Test, and SAT verbal to be of moderate predictive value. Multiple regression analysis indicated that the most useful combination of predictors was the Mosby Assess Test, SAT verbal, and overall GPA. The results support the value of a program at this school designed to increase students’ verbal abilities. (Index words: NCLEX-RN; Predicting NCLEX; State board licensing examination; Success In nursing school) J Prof Afurs 7:99-104, 1991. Copyright 0 by W.B. Saunders Company
must
be taken
academic
failure are known, ardize or predict National
T ment,
heightened retention,
of nurses
educators’
in our country
concerns
for years, and many students educational
these students
deficits are going
stu-
figures may persist
who do enroll will come
that
must
be addressed
if
to succeed in their nursing
education. Nursing programs must retain the students they recruit to offset the decreasing pool of students enrolling
in nursing
if the numbers
of students
from departments
programs
of nursing
retained
nationwide.
But
and graduating
are to be increased,
steps
tAssociate Professor and Chairperson, William Paterson College, Wayne, NJ. Address correspondence and reprint requests to Dr DeYoung: Department of Nursing, William Parterson College, Wayne, NJ 07470. Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0702-0011$03.00/0
Jofim[
of Professional
Nming,
of success for the
Paterson
of variables
graduates
ning interventions
College
variables
in
that could
were studied.
that predict
success for
of this college will help in plan-
for at-risk
students.
Review of Previous Research
A substantial
number
in an attempt ination.
of studies has been conducted
to identify
Research
findings
that contribute
indicating
non.
Predictor
science,
variables
that
for success on the national
tion,
and
grade point on American
variables
nature
include
science
many
of the phenome-
grades
courses;
averages (GPA); College
as
exam-
have demonstrated
the complex social
function
licensure
to success on the examina-
scores on the Scholastic
verbal
Aptitude Tests
in nursing,
entry
and exit
and quantitative Test (SAT); scores
(ACT);
performance
on
National League for Nursing Achievement Tests (NLN); and most recently, scores on the Mosby Assess Test. Many of the studies using
*Assistant Professor, WilliamPaterson College,Wayne,NJ.
William
NJ. Single and multiple
the nursing
jeop-
Examination-Registered
help predict success on this examination
variables
recruit-
and academic success of nursing
dents. The present low enrollment with
about
has
Factors that
must be identified.
at The
The identification
at risk of
their progress
success in college and on the
focuses on correlates
NCLEX-RN Wayne,
to support
Licensure
Nurse (NCLEX-RN) This study
place students
or misguided.
student
Council
and appropriate
at the right time.
that
attempts
may be inadequate
RN-/-
adequate
provided
the factors
predictors HE SHORTAGE
to ensure
support
Unless
EDD,
the
(SBTPE).
State After
were performed
Board 1982,
Test
Pool
the outcome
in the 1970s Examination
variable
NCLEX-RN, which replaced the SBTPE. expect the predictors for both examinations
was the
One would to be sim-
ilar, because the universe of basic nursing knowledge sampled by the exams has changed relatively little in those years. Among the studies that have been conducted,
Vol 7, No 2 (March-April), 1991: pp 99-104
there 99
100
FOTI AND DEYOUNG
is a lack of any consistent ables.
However,
considerable nursing
support.
GPA,
the most 1984;
Jenks,
Grades
single
courses,
& Bausell,
Duffy,
1986;
Quick,
Sharp,
1984;
Whilley,
& Halpin,
& Paquet,
& Coonrod,
1981; Outtz, Krupa,
1986; Yocom & Scherubel,
1989;
1979; Payne & 1985;
Woodham
& Taub,
1985). SAT scores (espe-
cially verbal) were also found to be useful predictors (Dell & Halpin, Coonrod,
1984; McKinney,
1988;
Whitley,
Outtz,
1979;
1985; Woodham
those who studied eral found
Small, Quick,
& Taube,
them to contribute
&
Krupa,
&
Tests, sev-
moderately
to predic-
tion of state board exam success (Baldwin,
Mowbray,
& Taylor,
1968; Brandt,
Melcolm,
Venn,
& Bausell,
Various subscores moderate Perez,
& Schumann,
1981;
1966;
Seither,
value
Sharp,
(Aldag
1984).
& Rose,
The newest
1983;
Studies
to strong predictor
success on the NCLEX-RN
to date have
(Jenks, Selekman,
1989; McKinney,
Small, O’Dell,
of
Bross, & Coon-
the
combination
seems to be unique success for nursing
students
the predictive faculty
Paterson
baccalaureate-granting Of special interest
this of
of the Department
focused on assessing
SAT scores
therefore
all cal-
the SAT were done on a sample of
Data were obtained the NCLEX manner potential
from student
score reports.
in a
and confidentiality.
The
to ensure anonymity predictive
variables
all, GPA in the major, and quantitative),
records and from
All data were handled studied
were: GPA over-
GPA in science,
NLN
Baccalaureate
SAT (verbal Achievement
faculty. . . have long believed that reading and verbal abilities relate to success in the nursing program . , .
Courses included courses,
nutrition,
in the GPA in the major were all
psychology
and statistics.
courses,
GPA
lated from grades in anatomy microbiology, outcome
chemistry
variable
science courses,
in science was calcu-
and physiology
courses,
courses,
and genetics.
The
in each case was the NCLEX-RN
of Nursing
and verbal abilities curriculum. and improving
was conducted.
in the predictive
r) were calculated
combinations
of predictors
relate to sucskills for
were also in-
value of the NLN Baccalau-
reate Achievement Test as opposed to the Mosby Assess Test, because both tests were being administered to the senior class each year.
plain the variance
coefficients
for each predictive
prowas
design was used. Pear-
correlation
was performed
In fact, a program
The faculty
correlational
moment
sion analysis
have long be-
reading
A retrospective son product
with the NCLEX
majors had already been put into place when
this study
on only 149 students;
involving
Col-
value of the SAT verbal score, since the
cess in the nursing
terested
the predictors
at William
New Jersey.
lieved that reading
nursing
variables
school settings,
to determine
a state-supported
gram in northern
of predictor
to individual
study was undertaken lege,
year.
score.
1988).
Because
culations
nursing
predictive
tool is the Mosby Assess Test.
rod,
were available
year but before the first
in the sophomore
1980).
shown this test to be a moderate & Paquet,
course
of the ACT exams have had low to
predictive 1977;
Hastie,
after the freshman
nursing
Test score, and Mosby Assess Test score.
O’Dell,
1986). Among
the NLN Achievement
program
149.
1988; Mel-
& Whitley,
1986;
or
appear to be
(Dell
Bross,
O’Dell,
vati-
have received
in nursing
predictors
Selekman, Small,
calm, Venn,
of predictor
variables
and entry and exit GPA,
stable
McKinney,
pattern
some single
score. In addition,
multiple
to determine
in NCLEX
scores. Previous
they do not reflect the complexity Multiple
regression
the dependent
along regres-
the best
that could be used to ex-
have shown that while single predictors
several independent
(Pearson
variable
of the real world.
can help to explain variables
studies
can be useful, the reality of
simultaneously
affecting
variable.
Scores of all students
were also plotted
variable graphs to determine
on two-
the range of scores in the
predictor variables associated with success on the NCLEX. These graphs help the researcher to visualize, for example, minimum sample scores on SAT verbal compatible with a passing score on NCLEX.
Methodology Results The sample consisted of 298 nursing students who were graduated in the 4 years between 1985 and 1988, including students who transferred into the
Pearson correlations yielded some sizable statistically significant relationships between predictor vari-
PREDICTING
ables
SUCCESS
and
101
ON THE NCLEX-RN
the NCLEX.
Chief
among
the NLN
Baccalaureate
was .5 1. The second highest between
the overall
GPA
Achievement
and the NCLEX
between
coefficient
GPA
quantitative
in science and the NCLEX
Outcome Variable
Predictor Variables
The SAT
NCLEX-RN
Mosby Assess SAT verbal Mosby Assess SAT verbal GPA overall
and SAT
Multiple
regression
useful combination
(Table
analysis indicated
of predictors
sess Test, SAT verbal,
and overall GPA. This variable
was that of just the Mosby Assess Test an R* of .46 (Table
with
of further
predictor
added
graphs yielded
of individual
on which
the NCLEX
and who scored between but
percentile
no student
a
1,600 score, that of
There were four students
percentiles, 42nd
in passing
(score below rank on
who failed the
the 32nd and 42nd
who scored
above
research,
can help
41.39
.OOOl
score of over 440 were
the NCLEX.
Selekman,
the
and in previous
scores on the Mosby Assess Test
to predict Brass,
ney, Small, O’Dell,
results.
1,6OO), most scored below the 2 1st percentile NCLEX
published Uenks,
all individual
some interesting
l), it can be seen, by drawing
who failed
the Mosby.
.49
Analysis of Data
alone
line from the NCLEX
the students
.OOOl
Based on the data in this study
pre-
at the graph of the Mosby Assess Test (Fig
55.99
to the regres-
complex.
The two-variable
horizontal
.46
Test
with an SAT verbal
2). The
value and would
computations
scores were plotted and NCLEX
variables
no predictive
scores needlessly
looking
P
an R2 of .49. The second best
make mathematical
When
students successful
combination
sion equation
F
that the most
was the Mosby As-
yielded
and SAT verbal
Test
RZ
1).
combination
dictive
NCLEX-RN
and the NCLEX were very low and therepredictions
Multiple Regression Prediction of the NCLEX-RN Based on Two and Three Predictor Variables
and be-
was .46. The correlations
fore not useful in making
addition
2.
TABLE
Test
(. 59) were
correlations
tween GPA in the major and the NCLEX. verbal correlation
is the
of .66. In com-
Mosby Assess Test, with a correlation parison,
these
success
on the NCLEX
& Paquet,
& Coonrod,
1989; McKin-
1988). A Pearson r of
.66 means that 43 per cent of the variation scores can be accounted
for by the variability
on the Mosby Assess Test. Paterson
College,
it appears
For students that
above 42 would be highly predictive NCLEX.
in NCLEX
This makes the Mosby
useful screening
device in predicting
at risk of failing
the NCLEX-RN.
in scores
at William
a percentile
rank
of success on the Assess Test a very students
who are
on the Mosby Assess Test failed the
NCLEX . Plotting
of the overall GPA with NCLEX licensure
scores indicated NCLEX
that
most
students
who failed the
had a GPA below 2.7 (Fig 2). There were
only three unsuccessful
students
with GPAs between
2.9 and 3.2, and none with a GPA above 3.2. The graph
depicting
the relations
verbal scores and the NCLEX
TABLE
1.
Predictor
between
SAT
(Fig 3) shows that all
Pearson Product Moment Correlations of Predictor Variables and the NCLEX-RN Variables
Based on the data in this study and in previous pub&hed research, scores on the Mosby Assess Test alone can help to predict success on the NCLEX . . .
The addition increases
Pearson r
R2
P
Mosby Assess Test GPA overall GPA major NLN Achievement Test SAT verbal GPA science
.66 .59 .59 .51 .46 .2a
SAT quantitative
.15
.43 .35 .35 .26 .21 .oa .02
.OOOl .OOOl .oooi .OOOl .OOOl .OOOl .06
of more variables,
predictability.
gest that 49 per cent of the variation can be understood
however,
clearly
Data from this sample in NCLEX
in terms of the combined
sugscores
variabil-
ity of the Mosby Assess Test, SAT verbal score, and overall GPA. The 6 per cent difference in variability between the Mosby Assess Test alone (43 per cent) and the combination of Mosby, SAT verbal, and GPA (49 per cent) make it worthwhile to use all three predictors. A multiple regression equation using these
FOTI AND DEYOUNG
+ + + + + + +
44
+ +
Ii Ii
+
+ +
+ +
* w s
”
u
(I
+
a
+
L)
+ +
+
u
M
cl&i*
/ui c
Ia*
+ + + +
Y
sci *
+ +
* *
+ +
fl(l
ill38
uena + a + *Ia
+
SYlas cl
s/w
6! Ia EU
6.4
h
Ia
-&s*
w*
w&u *(I* *i!& Ii
uu s MB/I cl s-r) w Baa LyIlj bl “I P SIU BS 64 &.awa 6 yu s*au(Iu P *ae * ~ (1
w
* *
f.m
u
(I* E
*
a
us
uu
aa”us u uwa Ii*
0
es
Ii
M
* *
A
*ti 64
u
f.l
64 *Ian
*
*
&QU
Ia
binpI
u(1
UC
s
w4
LI
s
Ii (1
*
64
*
J*
suiuuU~
E
+s
Ia
+
P
+ + + + + * + + + * + + + +
s
s
u u
Y
Ii
6
Ll Ii
* *
a
u
(1
(I Ia
(I
*
Figure 1. Plot of licensure + score and Mosby Assess _+___-__+-____-+--_~_-_+-_____+__-___+-____-*-____-+-_____+__-___+-_____+_-____+_~.___+______+__~___+_ 0.w 4.07 0.IY 0.21 0.98 Cl.35 Cl.92 0.w 0.56 0.63 0.70 0.77 0.09 0.w ‘*” Test. A, 1 observation MOSBY PERCENT
+ + + +
(OBS); B, 2 OBS; etc.
Ia
+ + +
u
+ :
li
+
”
+
*
Ii : +
(I
b
:
+ +
II E
L)
*
c :
LI(y*IW
: 0
Ll(leta *IaItanw
fi 011
*a*ahE81)(1
:
+ *
CI
I)iMsw
s
at4
*fi ECcIcyI(u~ & u (Ila(Ih Ia * PI LI
w
n
+
IId :
+ +
LI
rtWE
63 SW
*co
(r
cab*Y ~
u
L,
us
L( * &I
E
111 *
w
(I
UC
**
(18
co
SM
*
Ia
M Ir
II
*
*
”
u
Ii
u
II u
*
(1 6i
ta
m
(I
u
u
0
6%E
(luuu !a
0
UP h
cu
ss su
#aah
*
SW ams*IcI s&&u MC, u 6 8 EL) 6 LI
ret
u
IfI
ChslU 64
II
u
s&u
*
*
LI* dlb E(1 E
lab
*
* IId
* LI
0
u
Ia
*
aa
0
ti
a
*
+ * l
+ + + + + + +
a
+
: +
__+________~+_______-_+___~---_-+_---_____+-________+---__~~..____~_____-_-_ '--------;~,-------;f, 2.8 2.2 2.Y i-.c 3.0 3.2 3.4 3.6 1.0 w*
variables can be used to predict scores on the NCLEX: Y’ = a + b, X, In this
equation,
Y’
individual
+ b, X, is the
student
+ b, X3
predicted
value
for
Flgwe 2. Plot of licensure score and GPA overall. A, 1 OBS; B, 2 OBS; etc. Seventeen OBS had missing values.
NCLEX; a is the intercept constant; b,, b,, and b, are the regression coefficients for the variables Mosby Assess Test, overall GPA, and SAT verbal; and X, to X, are the scores on those respective variables (Munro, Visintainer, & Page, 1986).
103
PREDICTING SUCCESS ON THE NCLEX-RN
a
Figure3. Plot of licensure score and SAT verbal. A, 1 OBS; B, 2 OBS; etc. One hundred fifty-five OBS had
;;co
: +
17CB
: .
pi Y
7E0 i
9
:
500 i .r~l___r~,._.I~,___E~~._.~~~-_.~~~ ._....._._+.._..+____-*-__--+_____*_____+ ____ _~_____*_____1-____~____-~____*-_____+ ____ _&_ l
missing values.
Thus,
if a William
Paterson
in the 50th percentile
College student
scored
on the Mosby Assess Test, and
reading
rate below 220 are referred
Academic
Support
for an academic
had an overall GPA of 3.4 and a verbal SAT of 4 10,
gram called LEAP (Learning
the predicted
Program).
licensure
score would be 1,87 1, a pass-
ing score. The prediction
of an actual score might
more reassuring
to a student
or she is likely
to pass. The student
however, that this prediction, not be a certainty
realize,
like most others, would in NCLEX scores. Still, a
this high is a useful predictor
the student
must
since the R2 of .49 accounts for only
about half of the variability correlation
be
than just saying that he
some guidance
and can give
in preparation
for the
NCLEX. Another
way of looking
two-variable
at the three predictor profile indicated
graphs (Figs l-3). The student
the NCLEX
percentile
These
and test-taking
Reading
Sack
Yourman
the computer
The entire program
Many students the LEAP program plete the computer they had a problem
should
receive attention.
into
work.
academic
Discussion
constellation
that SAT verbal scores are a part of the of predictors
for the NCLEX gives more
weight to the Department of Nursing’s emphasis on reading skills. Nursing students at William Paterson College are tested with the Nelson-Denny Reading Test before they begin the sequence of nursing courses. Students who score below the fifth stanine on vocabulary and reading comprehension or who have a
tional motivator
the NCLEX,
of the LEAP program.
that
would translate
performance.
in getting
did not
skills or that increas-
skills not only in passing
also in passing The finding
time
Some did not believe
with reading
data from this study, which support verbal
the Cen-
only and did not com-
speed and comprehension
improved
over a one-
attending
before the present the seminars
is one who scores below the 2 1st
dents who fit this picture
is conducted
on
to the
who were referred to the Center for
attend or attended
ing reading
The coun-
selections
of 1 hour per week.
vari-
and an overall GPA below 2.7. Stu-
Speed-
program.
the reading
semester time frame with students
on the Mosby Assess Test, has an SAT ver-
bal below 440,
also use the
disk that will be most helpful
in the
at risk of
in note-
Developmental
assigns
pro-
comprehension,
They
Course ( 1984) computer
for
Assistance
seminars
techniques.
selor in the Center student.
attend
skills, reading
and stress-reduction self-paced
enhancement
Enhancement
students
ter for a minimum
ables is to consider the student failing
taking
to the Center
Perhaps
the importance college
the of
courses but
can be used as an addistudents
to take advantage
It may help them
to see this
extra work as a useful tool in assisting them toward their future career goals. The Mosby Assess Test is presently administered in the beginning of the senior spring semester, and based on the findings of this study, it will continue to be used at that time. The students will be apprised of
104
FOTI AND DEYOUNG
their scores along with an interpretation in predicting
of the scores
pass or fail on the NCLEX.
The results
of the Mosby Assess Test also will be calculated the multiple
regression
equation
score based on this trio of variables
NCLEX
Seniors who are
judged to be at risk of NCLEX failure will be directed into individual
remedial
weakness diagnosed
work based on the areas of
in the Mosby Assess Test. A state
board review course will also be recommended. Further
research into the reliability
tion formulas
will be ongoing
of our predic-
and should
the success of
into
will also be shared
to the students.
to predict
students.
Summary
along with the SAT
verbal score and overall GPA. The predicted with and explained
authors to refine their ability
help the
The ability grants
to predict
success on the NCLEX-RN
a school some control
over the academic
out-
comes of its students.
As a result of the identification
of predictive
in this study,
variables
College
Department
mitted
to increasing
ically
at-risk
through
of Nursing
William
is even more com-
the verbal abilities
freshman
and
LEAP and will require
Paterson
of its academ-
sophomore
students
all senior students
to
take the Mosby Assess Test.
References Aldag, J. & Rose S. (1983). Relationship of age, American College Testing scores, grade point average, and state board examination scores. Remrcb in Nursing and He&h, 6, 69-73. Baldwin, J. P., Mowbray, J. K., & Taylor, R. G. (1968). Factors influencing performance on state board test pool examinations. Nursing Rarearch, 17, 170- 172. Brandt, E. M., Hastie, B., & Schumann, D. (1966). Predicting success on state board examinations. Nursing Research, 15, 62-69. Dell, M. A., & Halpin, G. (1984). Predictors of success in nursing school and on state board examinations in a predominantly black baccalaureate nursing program. Jotic nal of Nming Bducation, 23, 147-150. Jenks, J., Selekman, J., Bross, T., & Paquet, M. (1989). Success in NCLEX-RN: Identifying predictors and optimal timing for intervention. Journal of Nursing Education, 28, 112-118. McKinney, J., Small, S., O’Dell, N., & Coonrod, B. A. (1988). Identification of predictors of success for the NCLEX and students at risk for NCLEX failure in a baccalaureate nursing program. Journal of ProfersiomzlNursing, 4, 55-59. Melcolm, N., Venn, R., & Bausell, R. B. (198 1). The prediction of state board test pool examinations scores within an integrated curriculum. Journal of Nursing Education, 20, 24-28.
Munro, B. H., Visintainer, M. A., & Page, E. B. (1986). Statistical tnethodrfor health care ruearch (p. 93). Philadelphia: Lippincott. Outtz, J. H. (1979). Predicting the success on state board examinations for blacks. Journal of Nursing Education, 18, 35-40.
Payne, M. A., & Duffey, M. A. (1986). An investigation of the predictability of NCLEX scores of BSN graduates using academic predictors. Journal of ProfarJionalNursing, 2, 326-332. Perez, T. L. (1977). Investigation of academic moderator variables to predict success on state board of nursing examinations in a baccalaureate nursing program. Journal of Nursing Education, 16, 16-23.
Quick, M. M., Krupa, K. C., & Whitley, T. W. (1985). Using admission data to predict success on the NCLEX-RN in a baccalaureate program. Journal of Professional Nursing, 1, 364-368.
Sack, A., & Yourman, J. (1984). Sack Yourman Developmental Speed-Reading Course (5th ed.). (1984). Baltimore: College Skills Center. Seither, F. F. (1980). Prediction of achievement in baccalaureate nursing education. Journal of Nursing Education, 19, 28-36.
Sharp, T. G. (1984). An analysis of the relationship of seven selected variables to state board test pool examination performance of the University of Tennessee, Knoxville, College of Nursing. Journal of Nursing Education, 23, 5763. Whilley, M. P., & Chadwick, P. L. (1986). Baccalaureate education and NCLEX: The causes of success. Journal of Nursing Education, 25, 94- 10 1. Woodham, R., & Taube, K. (1986). Relationship of nursing program and success on the NCLEX-RN examination for licensure in a selected associated degree program. Journal of Nursing Education, 25, 112- 117. Yocom, C. J., & Scherubel, J. C. (1985). Selected preadmission and academic correlates of success on state board examinations. Journal of Nursing Education, 24, 244-249.
