SELECTING SUCCESS: ADMITTING ADN STUDENTS WITH THE HIGHEST PROBABILITY OF SUCCESS

Murray State's Digital Commons Murray State's Digital Commons

Murray State Theses and Dissertations Graduate School

2019

SELECTING SUCCESS: ADMITTING ADN STUDENTS WITH THE SELECTING SUCCESS: ADMITTING ADN STUDENTS WITH THE

HIGHEST PROBABILITY OF SUCCESS HIGHEST PROBABILITY OF SUCCESS

Elizabeth Ann Beverly

Follow this and additional works at: https://digitalcommons.murraystate.edu/etd

Part of the Higher Education Commons, and the Other Nursing Commons

Recommended Citation Recommended Citation

Beverly, Elizabeth Ann, "SELECTING SUCCESS: ADMITTING ADN STUDENTS WITH THE HIGHEST

PROBABILITY OF SUCCESS" (2019).

Murray State Theses and Dissertations

. 130.

https://digitalcommons.murraystate.edu/etd/130

This Dissertation is brought to you for free and open access by the Graduate School at Murray State's Digital

Commons. It has been accepted for inclusion in Murray State Theses and Dissertations by an authorized

administrator of Murray State's Digital Commons. For more information, please contact

[email protected].

SELECTING SUCCESS:

ADMITTING ADN STUDENTS WITH THE HIGHEST PROBABILITY OF SUCCESS

Elizabeth A. Beverly

A DISSERTATION

Presented to the Faculty of

The College of Education and Human Services

Department of Educational Studies, Leadership, and Counseling

at Murray State University

In Partial Fulfillment of Requirements

For the Degree of Doctor of Education

P-20 & Community Leadership

Specialization: Postsecondary Leadership

Under the supervision of Dr. Randal H. Wilson, Assistant Professor

Murray, KY

May 2019

Abstract

Declining numbers in healthcare workers are nearing critical levels. In the next few years, more

than a million nursing positions are predicted to be needed, increasing the demand on institutions

to produce quality and competent graduates in health-related fields. Hundreds of potential

students apply for nursing programs each semester, and numerous qualified applicants are denied

admission due to limited space, thus placing emphasis on the selective admissions process.

This study serves to validate current admissions criteria utilized by the nursing program at

Hopkinsville Community College (HCC) to ensure students with the highest probability for

success are admitted. Participants include admitted nursing students (n = 237) from the Spring

2014 through Spring 2017 admission cycles. Analyzed data focused on NLN PAX-RN entrance

exam scores to determine if relationships exist between individual scores and probability for

successful completion of the nursing program, as well as passing the NCLEX-RN on first

attempt.

Limited current research was available for comparison, but results concluded that the NLN PAX-

RN does minimally predict student success. Each of the three individually tested sections on the

NLN PAX-RN were evaluated and Mathematic scores have the highest correlation for predicting

success. Contrary to the current ideology at HCC, no statistically significant relationship was

identified between national percentile scores on the NLN PAX-RN and student success.

Discussion on findings from the study and suggested continued research, provide opportunities

to more effectively assist with closing the growing divide in healthcare.

Keywords: ADN program, student success, admissions criteria, NLN PAX-RN

iii

Acknowledgements

Without the love and support of my family, friends, and colleagues, this accomplishment

would not be possible. To David, my rock and consistent, you will never know how much I love

you. To my kids, Kendel, Rhyan, and Judd, the answer to “Mommy are you finished?” is finally

a yes. They are my heart and reason for life. To my dad for always pushing me to do better, my

mom for all she does, John for setting academic standards ridiculously high, and Hannah for

being my best friend and secret society member; thank you all for everything.

To Ted Wilson, who has been my continual example of academic leadership, I hope to be

half the educator that you are. Thank you for your friendship, even if you do not admit to it. For

collecting the needed data, even when you were beyond busy, Kristi Martin, thank you. Thank

you to all of my colleagues, professors, and teachers who have been a past and present

inspiration.

For the guidance through this process, endless questions, countless emails, and preparing

me to begin my journey as a progressive leader, I say thank you to my dissertation chair, Dr.

Randal Wilson and dissertation committee, Dr. Teresa Clark, and Dr. Mardis Dunham. Your

continual leadership, encouragement, and guidance has led me to this completion and now the

adventure begins.

Table of Contents

Title page …………………………………………………………………………….

Abstract ……………………………………………………………………………....

Acknowledgements …………………………………………………………………..

iii

Table of Contents …………………………………………………………………….

List of Tables ………………………………………………………………………...

vii

Chapter I: Introduction ………………………………………………………………

Purpose of Study ………………………………………………………………….

Research Questions ……………………………………………………………….

Definitions ………………………………………………………………………..

Significance of Study ……………………………………………………………..

Chapter II: Literature Review ………………………………………………………..

Admission Criteria ………………………………………………………………..

Interview scores ……………………………………………………………….

Grade point average …………………………………………………………...

Standardized testing …………………………………………………………...

Community College Nursing Programs …………………………………………..

Kentucky Community Technical College System ………………………………..

Hopkinsville Community College …………………………………………….

Limited Validity of the NLN PAX-RN …………………………………………..

Chapter III: Methodology ……………………………………………………………

Sample Selection ………………………………………………………………....

Participants ……………………………………………………………………….

Admission Criteria ………………………………………………………..……...

ACT scores ……………………………………………………………………

NLN PAX-RN scores …………………………………………………………

Grades …………………………………………………………………………

Data Collection …………………………………….……………………………..

Research Questions ……………………………………………………………….

Analyses …………………………………………………………………………..

Summary ………………………………………………………………………….

Chapter IV: Findings and Analyses ………………………………………………….

Research Questions ……………………………………………………………….

Chapter V: Conclusions and Discussions ……………………………………………

Conclusions ……………………………………………………………………….

Research question 1 …………………………………………………………...

Research question 2 …………………………………………………………...

Research question 3 …………………………………………………………...

Research question 4 …………………………………………………………...

Discussions ……………………………………………………………………….

Practical Implications ....……………………………………………………….....

Limitations of the Study ………………………………………………………….

Recommendations for Future Research …………………………………………..

P-20 Implications …………………………………………………………………

Conclusion ………………………………………………………………………..

References ……………………………………………………………………………

Appendix A: IRB Approval Letters ………………………………………………….

vii

List of Tables

Table 1. Number of ADN Admits Between Spring 2014 and Spring 2017 ………...

Table 2. Fate of Students Admitted into the ADN Program ………………………...

Table 3. ADN Program and NLCEX-RN Results for Admitted Students ………….

Table 4. NLN PAX-RN Percentile Scores of Admitted Students …………..............

Chapter I: Introduction

Purpose of Study

According to the Bureau of Labor Statistics, the nationwide demand for nurses will reach

a critical level in the next five years with over one million positions to fill before 2022 (Bureau

of Labor Statistics [BLS], 2017). Numerous factors contribute to the accelerated disparity of the

current ratio between qualified healthcare workers and patient. Nursing programs on college

campuses have been challenged to support the initiative of providing qualified healthcare

graduates to bridge the gap.

The growing nursing shortage and concerns regarding the inevitable impact on healthcare

has been emphasized in current literature (Blair, 2014; Blitchok, 2018; Snavely, 2016; Young,

2018). Collaborative efforts between the healthcare industry and higher education are struggling

to keep pace with escalating patient demands. Supplemental nursing positons are needed. A

better understanding of what precipitated the emergent nursing crisis by identifying some of the

contributing factors, will support the need for additional nursing programs, graduates, and

positions.

Referring to a specific generation, baby boomers were born following World War II

between the years 1940 to 1964 (Johnstone, 2018). Of the 76 million births in the United States

during these years, 65.2 million were still alive in 2012 (Pollard & Scommegna, 2014). Projected

by 2029 to represent more than one fourth of the population, the approximate 61.3 million baby

boomers have a significant contribution to the aging population and demand for elevated medical

care (Grant, 2016; Jimenez, 2016; Pollard & Scommegna, 2014).

Defined as an incurable and continual illness that can often be medically managed,

chronic diseases or conditions are becoming more prevalent in the aging population (Centers for

Disease Control and Prevention [CDC], 2018). In 2012, nearly half of the reported deaths were

contributed to chronic illnesses, and healthcare professionals predict over 164 million new

patients will suffer from at least one chronic illness by 2025 (CDC, 2018; Partnership for

Solutions, 2004). Considering these numbers, 80% of the population suffers from a chronic

condition and 64% with at least two chronic illnesses which validates the need for additional

nursing care (Jimenez, 2016).

Similar to the aging population of patients, the average age of working nurses is also on

the rise (Jimenez, 2016). Over the next few years, more than one third of the current workforce

in nursing will reach retirement age, meaning over 700,000 retirees must be replaced by 2024

(Grant, 2016). These predicted positions are in addition to the 1.1 million nurses needed to

satisfy growing patient demands.

Health-related programs represented on college campuses across the nation are also a

contributing factor to the expanding shortage witnessed in nursing (Grant, 2016; Jimenez, 2016).

Due to the limited space of classrooms, inability to secure qualified faculty members, and

continuing federal and state budget cuts, nursing programs are restricted on the number of

students admitted each year (American Association of Colleges of Nursing [AACN], 2017).

Despite the fact that nursing is one of the fastest growing career opportunities and the

demand for nurses in the United States is dire, institutions turn away a significant amount of

highly qualified applicants each admission cycle (Blitchok, 2018). Many of the students denied

admission were of the top academic performers at the institution and met all admission criteria

successfully (Blitchok, 2018). In 2014, over 35% of qualified applicants were denied admission

into nursing programs (National League for Nursing [NLN], 2018). For the past 10 years, more

than 30,000 applicants meeting all requirements for nursing programs were rejected (Young,

2018) due to reasons mentioned above by the AACN (2017), specifically the lack of classroom

space and qualified faculty to teach the programs.

In 2014, 78% of nursing programs were forced to deny the admission of qualified

candidates (NLN, 2018). Institutions are challenged to admit applicants with the highest

probability of success within nursing programs. The formidable selection process relies heavily

on the validity of admissions criteria. Identifying the most accurate measure of probable success

in nursing programs has been inconclusively represented in current research.

Hopkinsville Community College (HCC) is dedicated to providing quality education and

graduating competent healthcare professionals. In attempt to support the local and national

demand for nurses, HCC has committed to review the current admissions criteria to ensure the

most accurate indicator of student success is utilized. Current research is inconclusive regarding

which admissions criteria are the best indicators of student success within nursing programs, as

well as in predicting students with the highest probability of first time passing the National

Council Licensure Examination (NCLEX-RN).

Nursing programs implement a variety of admissions criteria and set standards for

acceptance. Depending upon the degree conferred, variations on admission requirements are

noted. Students applying to the Associates Degree in Nursing (ADN) at HCC have specified

requirements that must be met prior to consideration for admission into the nursing program.

Applicants at HCC with all admissions criteria completed are reviewed and considered by an

admissions committee. The decision to admit a student is based heavily upon the candidates

National League for Nursing Pre-Admission Exam (NLN PAX-RN) score, although research

representing the validity of this entrance exam is limited.

Students at HCC are admitted into the ADN program each fall and spring semester, and

of the numerous qualified applicants, approximately 40 candidates are granted admission.

Consistent with the current literature, restricted classroom space and limited available faculty

prevent the admission of additional students at HCC. Currently there are over 300 students vying

for the coveted seats in the ADN program. Of those 300 applicants, approximately 10 students

per semester will be placed on a waiting list, and will be accepted only if an admitted student

decides not to accept the seat. Historically, students admitted into the program confirm their spot,

therefore very few students from the waiting list are accepted. Any student that is not admitted

into the program must go through the application process each admission cycle.

The purpose of the current study is to evaluate the predictive validity of the NLN PAX-

RN when utilized as an admissions requirement. This study will determine the relationship

between overall NLN PAX-RN scores and student success. Likewise, an examination of

individual sections represented on the NLN PAX-RN will be considered to determine if there is a

significant correlation between student success and a specific tested area. Finally, this study will

identify any relationships between admission cutoff scores on the NLN PAX-RN and student

success.

Research Questions

The following research questions and hypotheses will be addressed in this study:

Research question 1: What is the correlation between individual NLN PAX-RN scores

and successful completion of the HCC ADN program?

: There is no correlation between NLN PAX-RN scores and success of students in the

HCC ADN program.

Research question 2: What is the predictive power of the combined three individual

sections represented on the NLN PAX-RN exam and successfully passing the NCLEX-RN on

first attempt?

: There is no combined predictive power of using the three individual sections of the

NLN PAX-RN and passing the NCLEX-RN on first attempt.

Research question 3: What is the correlation between NLN PAX-RN scores of admitted

HCC ADN students and first time pass rate of the NCLEX-RN?

: There is no correlation between NLN PAX-RN scores and first time pass rates of the

NCLEX-RN.

Research question 4: Do students scoring at the 88

national percentage (or above) on the

NLN PAX-RN have a higher first time NCLEX-RN pass rate than students scoring below the

national percentage?

: There is no statistical difference in national percentage scores on the NLN PAX-RN

and first time pass rates of the NCLEX-RN.

Definitions

The following terms and acronyms are used throughout the current study, and have been

defined for clarity.

1. Associate degree in Nursing (ADN): A two-year program, typically taught at community

colleges, that provides the minimal educational requirements for graduates to sit for

certification as a licensed registered nurse (RN).

2. National Council Licensure Examination (NCLEX-RN): State required licensure

examination to become an RN and eligible for employment as a nurse.

3. National League for Nursing (NLN): A national organization that endorses academic

excellence in the field of nursing through professional development opportunities, testing

services, current research, and partnerships to ensure competent and qualified graduates

enter the workforce (NLN, 2018).

4. National League for Nursing Pre-Admission Exam (NLN PAX-RN): An entrance exam

with three tested areas, designed to assist nursing programs in admitting students with a

higher probability of success, and often included in ADN admissions criteria (NLN,

2018).

5. Student success: Students admitted into an ADN program, successfully complete the

nursing program within four semesters, and pass the NCLEX-RN on first attempt.

Significance of Study

Identifying factors to predict student success in nursing programs is critical as the

shortage of available nurses continues to be of growing concern. Qualified applicants are being

denied from programs, thus selecting students with the highest probability of successful

completion of the program and obtaining national certification as a Registered Nurse (RN) is

priority.

Required criteria for the selective admissions process is common practice in numerous

allied health programs. Commonalities in the admission requirements are identified in current

research between varying healthcare programs. Such findings support the need to validate

specific criteria and statistically confirm that admission policies are capable in identifying

potential students with a higher probability for success.

While studies have suggested that a relationship exists between entrance exam scores and

student success, many of the studies are dated and have not been recently reviewed. Studies also

have inconclusive findings, leaving admission committees unsure if instruments used to select

candidates are valid. Ideally, results from this study will determine the strength of the

admissions criteria being utilized at HCC.

Based upon the results of this study, implementation and adoption of best practice during

the admissions process at HCC will assist in predicting student success as measured by

completion of the ADN program within four semesters and first attempt passing of the NCLEX-

RN. By accepting students likely to succeed, HCC will provide qualified and competent nurses

in the workforce to help bridge the growing divide in healthcare. Likewise, admission of these

students will ensure that more admitted students will succeed, thus reducing the overall cost to

both the institution and the students for those who fail to complete the program.

Chapter II: Literature Review

The current critical shortage of nurses in healthcare facilities across the United States,

along with the impact from these declining numbers, is predicted to become worse over the next

few years. More than 1.09 million nurses will be needed to adequately cover patient needs by the

year 2024, meaning an increase in demand of 16% (American Association of Colleges of

Nursing [AACN], 2017). Similarly, a substantial number of nurses in the workforce are

reportedly over the age of 50 and will be retiring within the next 10 years (Snavely, 2016).

Considering this data, over one million nurses will be eligible for retirement by 2024,

multiplying the concerns for the future of healthcare.

Nursing positions have an alarmingly high attrition rate, and numerous causative factors

must be considered as the nursing turnover has reached a critical point. Reportedly one out of

five newly hired nurses leave their job within the first year, and one in three will leave within the

first two years (Blair, 2014). Even more surprising, just over 50% of newly graduated nurses will

leave the medical profession within three years of beginning clinical work (Snavely, 2016). The

high demands of being a nurse, extreme physical and emotional stress, insufficiently staffed

work environments with high nurse to patient ratio, a mismatch between personal and

organizational values, and lack of organizational and leadership support are just a few examples

reported as major contributing factors to the high attrition rate (Blair, 2014; Gillet et al., 2017;

Snavely, 2016).

The mounting shortage in clinical nursing can be also be attributed to numerous

trepidations within nursing programs across the nation. Nearly 60,000 applicants were denied

admission into nursing programs in 2017 due to limited classroom space, clinical availability,

and an inadequate number of faculty members available teach numerous sections of nursing

courses (Kavilanz, 2018). Research on the current nursing faculty shortage highlight the obvious

unbalanced salary offered to nurses in academia versus those in clinical work as a significant

barrier in finding qualified faculty (Nardi & Gyurko, 2013). Despite the demand of nursing

graduates, since 2008 at least 30,000 qualified applicants have been denied admission into

programs (Young, 2018). Considering these constraints and the current state of healthcare,

nursing programs are faced with the daunting task of admitting students who have the highest

probability of success during and after the program.

Success can be defined and represented in many ways depending on, and linked to, a

variety of different factors. In this study, the definition of student success will remain consistent

with the most common definition represented in current literature. The current accepted

definition for success includes successful completion of a nursing program within the appropriate

time frame, and the first time pass rate on the National Council Licensure Examination

(NCLEX-RN) (Schmidt & MacWilliams, 2011). This definition will be used throughout the

study as a measure of program success.

Pass rates on the NCLEX-RN vary from state to state, and each state is required by the

accrediting body and nursing boards to report the pass/fail ratio for the first attempt on the

NCLEX-RN exam. State nursing boards set a minimal benchmark percentage, which is required

by all nursing programs within that individual state to meet in order to remain compliant and in

good status. The state of Kentucky has a higher than average benchmark requirement for passing.

Specifically, nursing programs in Kentucky are expected to have a first time pass rate of 85% or

higher to remain in good standing with the Kentucky Board of Nursing (Kentucky Board of

Nursing [KBN], 2018).

The NCLEX-RN exam is under perpetual review and updated every three years to assure

expected competencies for a newly graduated nurse are accurately evaluated before entering into

the medical field (National Council of State Boards of Nursing [NCSBN], 2018). Individual

questions are continuously reviewed by the National Council of State Boards of Nursing

(NCSBN) to ensure the accuracy and effectiveness of the master question pool (NCSBN, 2018).

The exam is proctored by an approved testing center and administered to students via computer.

According to the NCSBN (2018), the adaptive computerized exam will end when one of the

following occurs: 1. The computer is 95% confident that the student is above the standard pass

rate, 2. The student has taken all of the exam questions and is either found to be above or below

the standard pass rate, or 3. The candidate runs out of time and has or has not reached the

minimum number of required questions, or has reached a minimum number of questions and is

or is not above the standard pass rate.

Nursing programs meticulously vet applicants to ensure admission of students with the

highest probability of succeeding in the program. Failure to succeed has a palpable impact on the

program, the institution, the faculty, the student, and the healthcare field (Tipton et al., 2008).

Extensive research has focused on how to identify appropriate admissions criteria that predict

student success. Conflicting findings are represented in nearly all current literature with no

conclusive evidence in support of the most significant predictor. This gap in identifying effective

admissions criteria supports opportunities for a more focused research opportunity of the specific

criteria currently being utilized in nursing programs.

Admission Criteria

Historically, college and program admission requirements have evolved to represent a

more diverse and talented student population (Beale, 1970). While many academic and non-

academic factors are examined during the admissions process by nursing programs, the three

most common admissions criteria noted in the literature reviewed were interview scores, student

grade point average (GPA), and standardized testing scores. As discussed in detail below,

contradicting findings for each of the three criteria were consistently reported, indicating

uncertainty in the validity of utilizing these criteria for admissions.

Interview scores. Incorporation of interviews has provided programs with representation

of non-academic factors in the admissions process. Even with the support of interviews

represented in current literature, concerns were identified by many groups (Deluca, 2012;

Edwards, Johnson, & Molidor, 1990; McNelis et al., 2010). For example, prior to the interview,

review of all submitted applications is complete and academically strong students have been

identified. With academic markers identified, the likelihood of biased opinions greatly increases

and several studies expressed concerns with utilizing interviews as criteria to admit students due

to this represented biased factor (McNelis et al., 2010).

Another apprehension concerning the usage of interviews was identified by the manner in

which each candidate is rated or scored. Inconsistencies of the rating for interview scores,

committee members represented on the interview panel, and the degree of structure represented

in the interview design all play a role in the validity of using interviews as admissions criteria

(Edwards et al., 1990). Many institutions provide a scale for scoring individual applicants as well

as a list of desired traits or characteristics to improve consistency within the interview process

and assist in deciding admission (Deluca, 2012). However, Deluca (2012) still reported

significant concerns with consistent findings of erratic ratings.

Contrary to the research showing problems with the interviews in the admissions process,

many studies highlighted that interviews increase the diversity of student population represented

in healthcare related programs (Schmidt & MacWilliams, 2011). Statistically, the numbers for

nursing programs and employed nurses show a serious need to improve diversity. Minority

populations in nursing over the past few years have been improving, however are still extremely

underrepresented. In 2000, only 12% of Registered Nurses (RNs) were minority nurses (McNelis

et al., 2010) compared to 24.6% in 2018 (Nursing Statistics, 2018). Minimal diversity within the

healthcare field has been recognized as problematic by numerous associations, institutions, and

research groups.

Gender gaps are also exemplified, with men in the RN field representing only 10.7%

(Data USA, 2018). Limited studies have been focused on the recruitment and representation of

male nurses (Stanley et al., 2016). In an environment historically dominated by women, a shift in

the promotion of gender diversity has been appreciated in current literature (Olson, 2014). Even

with challenges identified for men in nursing, the advantages for male nurses have been utilized

as a recruitment tool for programs and employment (Stanley et al., 2016). Still, the negativity

and stereotypes that surrounds men in nursing hinder male students from pursuing the career

(Rajacich, Kane, Williston, & Cameron, 2013; Stanley et al., 2016).

Cultural, ethnic, and gender diversity increased in some nursing programs from 2% to as

high as 25% after the implementation of interviews as required admissions criteria (McNeils et

al., 2010). Interviews also provide an opportunity to accentuate personality and characteristics

not reviewable or demonstrated through standardized testing or GPA (Trice & Foster, 2008).

While academic factors arguably have solid validity for candidate consideration, non-academic

influences, such as interviews, provide valuable information not represented in academia.

Applicant’s personality and desirable traits such as compassion, empathy, ability to establish and

maintain relationships, authenticity, motivation, and intent are not measurable by a standardized

test, yet provide valuable insight for the admissions committee and can be demonstrated during

interviews (Rosenberg, Perraud, & Willis, 2007).

Despite the sentiment expressed by Rosenberg et al., (2007), incorporating interviews as

a predictor of academic success provided conflicting results in research conducted by the Indiana

University School of Nursing. The research focused on the addition of interviews to admissions

criteria, concluding that the information obtained from interviewing candidates was beneficial,

but agreed more data was needed to conclusively say that interviews helped predict success

(McNelis et al., 2010). Schmidt and MacWilliams (2011), however, concluded that interviews

increased the diversity of selected applicants, however was only slightly predictive of students

that are more likely to drop out of the program as opposed to predicting those more likely to pass

the required NCLEX-RN. Contrary to these findings, several researchers concluded that

interviews do predict the success of students (Alaki, Yamany, Shinawi, Hassan, & Tekian, 2016;

Goho & Blackman, 2009). Research surrounding interviews noted that gender and ethnicity was

shown to have little predictive advantage of overall success; however, the research often noted

that the age of the student and the primary language spoken were found to be significant

predictors of first time pass rates on the NCLEX-RN (Sears, Othman, & Mahoney, 2015).

Review of the current literature provided inconclusive conclusions on the significance of

incorporating interviews as part of the admissions criteria for nursing programs to predict

success. However, all literature reviewed agreed that interviews assisted in improving the

diversity of admitted candidates. Likewise, interviews were consistently deemed useful in the

overall process for admitting students; however, the significance of impact from interviews

varied. Prediction of student success based off of the inclusion of interviews was inconclusive.

Grade point average. The most common predictor of student success utilized during the

nursing program admissions process is the quantitative values from student GPA (Schmidt &

MacWilliams, 2011). Numerous programs considered the overall or cumulative GPA of

applicants prior to entering into the nursing program, while others only considered how students

performed academically in specified prerequisite courses for the GPA consideration. Science and

math courses were the two most common prerequisite course GPAs assessed for admission into

nursing programs. As with the previous research, opposing conclusions regarding the validity of

GPA as a predictor of success were represented in the current literature.

For example, according to findings from Sears et al. (2015), pre-nursing GPA is a

significant predictor of first time NCLEX-RN pass rate. Early research conducted on indicators

of student success within nursing programs recognized cumulative GPA as the most accurate

predictor used by admissions committees when selecting candidates (Daley, Kirkpatrick, Frazier,

Chung, & Moser, 2003). In some studies, a positive correlation was identified between higher

GPAs, successful first time pass rate on the NCLEX-RN, and overall success in the nursing

program (Daley et al., 2003; Feldt & Donahue, 1989). Frith, Sewell, and Clark (2008) found that

higher GPAs were a predictor of passing the NCLEX-RN on the first attempt; whereas. lower

academically performing students were more likely to fail the NCLEX-RN. In research

conducted by Bosch, Doshier, and Gess-Newsome (2012), cumulative GPA was indicated as the

best predictor for NCLEX-RN failure.

Several research groups identified individual course GPAs, specifically Biology and

Chemistry, as more likely to be predictive of student success (Simon, McGinniss, & Krauss,

2013). Terminal grades for Anatomy and Physiology and Pathophysiology were the only two

courses found statistically significant as a predictor of NCLEX-RN success rates by Daley et al.

(2003), where Rancoli, Lisanti, and Falcone (2000) could not conclusively identify specific

science courses as more predictive. Research conducted at Arizona State University identified

students receiving a grade of B or higher in Pathophysiology as significantly more likely to

succeed in the program and on the NCLEX-RN (Herrera & Blair, 2015). In one study, science

specific GPAs were shown to be significant predictors of on-time graduation; however, this

particular study did not examine the impact of GPA on NCLEX-RN pass rates (Seago, Keane,

Chen, Spetz, & Grumbach, 2012).

Contrary to the support of GPA as a predictor of student success, other studies suggested

no relationship between GPA and overall success. For example, a detailed study on predicting

nursing success by Blackman, Hall, and Darmawan (2007) reported that pre-nursing GPA had

minimal predictive validity on overall success in the nursing program. Similarly, Uyehara,

Magnussen, Itano, and Zhang (2007) found no significant correlation between student GPA prior

to entering into the program and first time NCLEX-RN pass rate. Neither Anatomy and

Physiology or Biology I and II were found by Beeman and Waterhouse (2001) to be significant

predictors of student success. These findings were partially repeated by Tipton et al. (2008) who

concluded that GPA of certain specified courses which are required by nursing programs were

useful in predicting NCLEX-RN pass rate; however, they reported that overall GPA was not an

indicator of success.

While prior GPA had significant validity in predicting nursing school success in several

studies, a vast majority of the reviewed literature focused heavily on student GPA while enrolled

in nursing school as the best predictor of NCLEX-RN pass rate. Students with higher GPA in

nursing courses consistently showed a higher pass rate on the NCLEX-RN than did students with

lower GPA (Tipton et al., 2008). Corroborating studies concluded that students with fewer C’s in

nursing courses were more likely to pass the NCLEX-RN on first attempt (Crow, Handley,

Morrison, & Shelton, 2004). Arizona State University examined nursing courses that consistently

have lower academic performance and therefore representing the lowest grades received during

the nursing program and found conclusively that students doing poorly in these classes were

more likely to fail the NCLEX-RN (Herrera & Blair, 2015).

Nationally, the average benchmark for passing nursing courses is 73%, meaning any

student averaging a score below 73% for the final grade will subsequently fail the class and must

reapply to the program for readmission into the semester (Norton et al., 2006). Limited research

could identify an exact nursing school predictive GPA for indicating success, however Frith et al.

(2008) concluded that a GPA of 3.14 was an indicator of success on the NCLEX-RN where a

GPA of 3.07 or lower indicated a higher probability of failure. This small range indicates that

even one grade letter or one course could be the difference between student success or failure on

the NCLEX-RN. To ensure academic preparedness in the nursing program, strong nursing

faculty, clear organization of nursing courses, and effective content delivery are a necessity

(Simon et al., 2013).

Regarding specific courses, some studies have indicated that particular courses within the

nursing program were better predictors of student success, suggesting these courses could

identify the students more likely to fail the NCLEX-RN. Nursing Foundational Principles, often

taught in Nursing I, were found to be highly predictive of student success. Similarly,

Medical/Surgical course grades correctly identified 78.4% of students that failed the NCLEX-RN

(Simon et al., 2013). Other studies supported the importance of Medical/Surgical nursing

courses, as well as added Pathophysiology as a strong indicator (Alameida et al., 2011;

McGahee, Gramling, & Reid, 2010). In one study, Pathophysiology was found to be statistically

a very strong indicator of student success, wherein students receiving a grade of A in the course

were ten times more likely to succeed than students receiving a grade of C (Seldomridge &

DiBartolo, 2004). Students performing academically strong in the first two nursing courses were

consistently found to be more likely to pass the NCLEX-RN upon first attempt (Tipton et al.,

2008). Ukapabi (2008) concurred that Nursing Fundamentals was a solid indicator of student

success, but added Mental Health and Pharmacology as predicative courses. Students with lower

GPA in the first nursing semester were not only more likely to fail the NCLEX-RN, but also

predicted to do poorly or fail the second semester nursing (Blackman et al., 2007).

While some studies disputed exact percentages of predictive GPA and what percentage

constituted a C letter grade, the majority of reviewed literature agreed that nursing GPA was

statistically significant in predicting first time success on the NCLEX-RN. Contrary to these

findings, Uyehara et al. (2007) found no significant correlation between nursing GPA and

predicting NCLEX-RN pass rate. Overall the reviewed literature supported nursing school GPA

to be consistently found as one of the most accurate predictors of student success (Crow et al.,

2004; Daley et al., 2003; Herrera & Blair, 2015; Romeo, 2013; Seago et al., 2012; Sears et al.,

2015; Tipton et al., 2008).

Standardized testing. Considering the current shortage of healthcare workers,

identifying students with a higher probability of completing the nursing program successfully

and passing the NCLEX-RN exam on the first attempt is a high priority for nursing faculty and

their institutions. Standardized testing has been used by nursing programs since the 1930’s

(Shultz, 2010). A variety of entrance exams and standardized tests were identified in the

reviewed literature as currently being used to predict student success including but not limited to:

The Scholastic Aptitude Test (SAT), the American College Test (ACT), the National League for

Nursing Pre-Admission Exam (NLN PAX-RN), the Test of Essential Academic Skills (TEAS),

and the Health Education Systems, INC Exam (HESI).

Despite the popularity of using standardized testing in admissions criteria, concerns were

raised in research conducted by Wang and Yeh (2005). This study emphasized that many

students are not properly prepared academically or emotionally prior to applying for nursing

programs that would require an entrance exam. Their work concluded that the emotional stress of

preparing for and taking an entrance exam could potentially eliminate academically strong

students with a high probability of succeeding from being admitted (Wang & Yeh, 2005).

Emphasis on the high level of test anxiety for nursing students was studied by

Zargarzadeh and Shirazi (2014). Reportedly more than 30% of students admit to having severe

test anxiety (Ejei, Rezaei, & Gholamali, 2011). Nursing students report the limited space for

admission into programs adds to the stress of entrance exams (Beggs, Shields, & Janiszewski-

Goodin, 2011). Elevated levels of anxiety during exams has been linked to loss of concentration,

second guessing cognitive ability, physical illness or discomfort, minimal motivation, and overall

significant decrease in academic performance (Dongfang & Bo, 2017; Enright, Baldo, & Wykes,

2000; Hancock, 2010). Anxiety during entrance exams can result in an eight percent drop in the

score, sparking concerns on the validity of entrance exams (Cassidy & Johnson, 2001; Dongfang

& Bo, 2017).

While disadvantages of standardized testing have been noted, they remain a significant

component of most nursing programs’ admission requirements (NLN, 2018). The following will

briefly discuss each of the most popular standard exams used by ADN nursing program for

admission. A more detailed discussion on the NLN PAX-RN will be emphasized as that

particular exam reflects the purpose of this study.

An assortment of research teams identified the SAT and the ACT as two of the most

common and traditional standardized tests reviewed during the admissions process in many

programs (Crow et al., 2004; Frith et al., 2008; Gallagher, Bomba, & Crane, 2001; Schmidt &

McWilliams, 2011; Wolkowitz & Kelley, 2010). Conflicting research on the validity of

standardized tests offered no conclusive evidence that either of these tests accurately predict

student success. While many groups supported the SAT as a significant predictor of student

success and correlated a high SAT score with passing the NCLEX-RN (Alameida et al., 2011;

Beeson & Kissling, 2001; Rancoli et al., 2000; Stuenkel, 2006), others did not agree with these

findings. Conflicting studies by Beeman and Waterhouse (2001) and Crow et al., (2004)

concluded that SAT scores were inversely related to NCLEX-RN pass rates. Haas, Nugent, and

Rule (2004) concluded that overall SAT scores were not predictive of student success; however,

the Verbal scores alone did predict NCLEX-RN pass rates.

Of the studies discussed above, those in support of the SAT as a predictor of NCLEX-RN

first time pass rates were also in support of the ACT as an indicator of success (Alameida et al.,

2011; Beeson & Kissling, 2001; Rancoli et al., 2000; Stuenkel, 2006). Likewise, Sayles, Shelton,

and Powell (2003) found a strong correlation between higher ACT scores and students passing

the NCLEX-RN on first attempt. The ACT assess English, Math, Reading, Science, and an

optional Writing section of which Higgins (2005) and Sayles et al. (2003) found only Math and

Reading sections to be predictive of NCLEX-RN success. Additionally, at the community

college level, nursing programs found a significant correlation between students scoring low in

Reading sections being more likely to fail the NCLEX-RN (Gallagher et al., 2001).

Contrary to those studies, Tipton et al. (2008) did not support Math or Reading as

indicators for success. Similarly, Lengacher and Kelly (1990) concluded that neither Math nor

English sections of the ACT were significant in predicting student success. Wolkowitz and

Kelley (2010) determined the ACT often reports scores below expected performance, suggesting

the weighted score of each section is not accurately represented by an unweighted composite

score. Many studies supported pre-nursing science courses as indicators of nursing program

success, yet very few standardized tests incorporate a science section, potentially limiting the

validity of standardized tests as a measurement of success (Wolkowitz & Kelley, 2010).

Admissions criteria required by several nursing programs assesses potential candidates by

administering an entrance exam. Unlike the ACT, the TEAS test has a weighted composite

average where English is weighted heavier than math, then reading, and finally science

(Wolkowitz & Kelley, 2010). Support for nursing programs to adhere to a predetermined

benchmark score on the TEAS test as an indicator for student success was emphasized by

Bremner, Blake, Long, and Yanosky (2014). Their findings were similar to those found by

Newton, Smith, Moore, and Magnan (2007) who concluded the TEAS test was a predictor of

early nursing school success, but not correlated to NCLEX-RN pass rates. Research from Ukpabi

(2008) identified the TEAS as a strong predictor of student ability to pass the NCLEX-RN on

first attempt with applicants that score 78 or higher on the TEAS.

Elsevier’s HESI admissions exam incorporated into nursing admission requirements was

found to be significant in predicting first-semester nursing success (Chen & Voyles, 2013).

Consistent with this research Yoho, Young, Adamson, and Britt (2007) reported that the

comprehensive reading score on the HESI was the best indicator of success. More current

research found conflicting results and concluded comprehensive reading was not specifically

correlated with success in the program or on the NCLEX-RN (Chen & Voyles, 2013).

Furthermore, Chen and Voyles (2013) reported all tested sections were observed to be positively

correlated and significant in predicting student success in the first two nursing courses, and the

Math section was found highly significant for nursing Pharmacology courses. Contrary to these

findings, Tipton et al. (2008) found no significant correlation of entrance exam comprehensive

Reading or Math to passing the NCLEX-RN.

While entrance exams have been a primary focus of predicting success, HESI exit exams

have also been studied for validity. The HESI exit exam with a benchmark score of 850 or higher

was identified as a strong predictor of NCLEX-RN pass rate (Barton, Wilson, Langford, &

Schreiner, 2014). Numerous research groups support the addition of HESI exit exams to nursing

programs, concluding the exam is a dominating indicator for NCLEX-RN first time pass rate

(Alameida et al., 2011; Frith et al., 2005; Harding, 2010; Lauchner, Newman, & Britt, 2008;

Morrison, Adamson, Nibert, & Hsia, 2005; Sears et al., 2015;). Substantiating these findings,

Barton et al. (2014) reported the HESI exit exam as accurate as 99.16% in predicting NCLEX-

RN success.

Isolating the most accurate nursing school admissions criteria to predict both successful

and unsuccessful candidates is minimally represented in current literature (Bennett, Bormann,

Lovan, & Cobb, 2016). Much of the represented research uses data to predict students with

higher probability of success, but does not utilize the same data to deduce students with high

probability of failing. Focused on providing quality data to ensure the most accurate information

for programs to utilize during the selective admissions process, the National League for Nursing

(NLN) uses a variety of research methods for continual evaluation of the ability to and process of

predicting student success (Kaufman, 2012).

Since 1987, educators and leaders of the nursing community gather annually to discuss

all collected data and make suggestions to improve the overall training of nurses and enhance

current healthcare practices (Grady & Adams, 2015). The overall mission and vision of the NLN

supports the improvement of nursing programs to ensure quality education and competent nurses

to enrich the inclusive healthcare workforce (National League for Nursing [NLN], 2018). By

providing a plethora of resources, networking, professional development, and grant

opportunities, the NLN (2018) is dedicated to improving higher education and the medical

community.

One of the most common assessment exams required by nursing schools for admission is

the NLN PAX-RN, a tailored exam created by the NLN to assist the admissions process in

predicting students likely to succeed in nursing programs (NLN, 2016). Redesigned in 2016 to

ensure higher validity and better accuracy, the NLN PAX-RN is a computerized exam consisting

of multiple choice questions chosen at random from over 1000 available test bank items to make

every exam a unique and individual test (NLN, 2016). The test was developed as a specific tool

to be utilized by nursing program to predict student success.

As with other standardized exams, the NLN PAX-RN assesses content by scoring three

sections individually as well as computing a weighted overall score (NLN, 2016). The

comprehensive score is calculated into a national percentile for comparisons of all students

across the United States completing that particular NLN PAX-RN exam (NLN, 2016). The exam

does not set pass or fail precedents, instead provides the national comparison to assist individual

programs in gauging academic ability of applicants.

Preparing for the NLN PAX-RN exam can be daunting for potential nursing students. To

aid in this preparation for nursing entrance exams, Swick and Callahan (2016) provide a detailed

breakdown of the content covered on the NLN PAX-RN. Three separate subsections are assessed

in 60 minute increments. Consisting of 40 questions, the Mathematics portion covers topics such

as, but not limited to: Algebra, Geometry, word problems, charts, ratios, percentages, and

fractions. The Science subsection has 60 questions comprised of content from Biology,

Chemistry, Anatomy and Physiology, Genetics, and Development. Finally, the 60 questions on

the Verbal Skills addresses the students’ ability to understand vocabulary, analogies, verbal

reasoning, reading comprehension, spelling, grammar, and root words. (Swick & Callahan,

2016)

To interpret the composite scores ranging from 0 to 200, the NLN provides a computed

percentage from 0 to 99. This percentage is not reporting the number of questions answered

correctly, but instead is calculated from a reference group that recorded raw scores lower than

the individual taking the test (Santa Monica College, 2017). Providing this information allows

students and institutions the opportunity to compare an individual applicant’s performance in

relation to all others testing with the same exam. According to the NLN Testing Services (2016),

a student scoring a 150 on the NLN PAX-RN would be at the 99 percentile. Whereas, a student

scoring a 100 on the same NLN PAX-RN test would be ranked at the 48 percentile (NLN

Testing Services, 2016). Based on the reported national norms, institutions and faculty decide on

a benchmark percentile for applicants to be considered for admissions.

Improving the admissions criteria to more effectively predict student success improves

retention of students and increases graduation rates, therefore affecting the overall numbers of

healthcare workers available to serve patient needs (Bissett, 1995). Nursing programs represent

some of the highest attrition rates in education (Stickney, 2008). While NCLEX-RN pass rates

are used to assess the effectiveness of nursing programs, Giddens (2009) questions the validity of

reporting high NCLEX-RN pass rates when a very low percentage of admitted nursing students

finish the program and take the NCLEX-RN. According to a study on factors that contribute to

attrition, Stickney (2008) emphasizes the need to identify at-risk students during the admissions

process to address and improve the elevated attrition rates. Suggestions on a solution included

pre-admissions entrance exams, specifically the NLN PAX-RN which was found to be the most

accurate predictor of student success (Campbell & Dickson, 1996; Stickney, 2008).

Community College Nursing Programs

To meet the demands and challenges facing current and future healthcare, community

colleges across the nation are struggling to provide adequate enrollment space and qualified

faculty to close the growing gap. For more than 60 years, community colleges provided the

majority of entry-level healthcare professionals in the workforce (Mahaffey, 2002). More than

37% of qualified candidates were rejected from admission into an associate degree in nursing

(ADN) program at community colleges across the United States in 2014 (NLN, 2018). This

number is down from the 45% of students turned away in 2012 (NLN, 2018). Even with a high

percentage of qualified students denied admissions into a program, more than 60,000 students

graduated from an ADN program in 2008 in comparison to the 35,000 that same year that

graduated from a four-year baccalaureate program (NLN, 2018).

Community colleges are important to the healthcare community as they provide quality,

effective, affordable, and accessible education (Skillman, Keppel, Patterson, & Doescher, 2012).

Research specifically focused on community colleges and improving the overall admissions is

reviewed by administrators and faculty to assist in making decisions or implementing program

changes, yet the information and data are often outdated and conflicting (Mahaffey, 2002).

Community college ADN programs are supported by the American Association of Colleges of

Nursing (AACN) and acknowledged as having a significant impact to the medical environment

(AACN, 2017).

In the state of Kentucky, students have an opportunity to apply to 41 different ADN

programs (KBN, 2018). Successful completion of an ADN program requires 65-70 credit hours,

including general education and nursing courses. Typically, programs will be designed to take

students five to six semesters for graduation with the first and often second semester reserved for

general education courses. While there are numerous ways to gauge program success, NCLEX-

RN pass rates is a popular indicator reviewed (KBN, 2018).

Kentucky sets high expectations for ADN graduates with an NCLEX-RN pass rate of

85% or higher which exceeds NCLEX-RN scores (KBN, 2018). Each year, more than 1,000

nursing positions are opened for employment, which means an overall outlook for nursing

positions is predicted at 20% every year (Registered Nursing, 2018). With over 69,000 employed

nurses, Kentucky still feels the impact of the healthcare shortage and predicts an increase in

nursing demand by more than 36% over the next seven years (Patrick, 2017). Kentucky

acknowledged the immediate need to combine efforts between healthcare and higher education

to strategically plan for the future in nursing (Patrick, 2017).

Kentucky Community Technical College System

Serving nearly 875,000 students, 16 community colleges across the state of Kentucky

make up the Kentucky Community Technical College System (KCTCS, 2018). Originally apart

of the University of Kentucky, 14 institutions and 15 technical colleges from Kentucky

Workforce Development were combined in 1998 to establish KCTCS. Now the largest

postsecondary education provider in the state, more than half of graduates in the state of

Kentucky started the college journey with one of the KCTCS community colleges (KCTCS,

2018).

Implementation of a new strategic plan in 2016 focuses on elevated program and

institutional performance and improving affordability, accessibility, and engagement (KCTCS,

2018). Supporting student success, KCTCS (2018) mission and value highlights the

responsibilities of institutions to: be more responsive to students and the community, deliver

information to students with innovative and flexible methods, provide clear communication,

sustain continuous assessment for improvements, and promote diversity.

Each of the KCTCS community colleges offers an ADN program with selective

admissions criteria required of all potential students. Data from individual colleges reported 12

of the 16 colleges required an acceptable entrance exam score for admission into the nursing

program (KCTCS, 2018). Several colleges specifically utilize the NLN PAX-RN for selecting

students. Reportedly, nine out of sixteen KCTCS colleges require the NLN PAX-RN; however,

of those nine colleges, three have an “either/ or policy” and will accept other admissions criteria

such as a high ACT score in place of the NLN PAX-RN (KCTCS, 2018). The HESI entrance

exam was required by two of the sixteen colleges and one other college would accept either the

HESI or the TEAS entrance exam (KCTCS, 2018).

First time pass rates on the NCLEX-RN for all institutions are reported by individual

states’ Board of Nursing. In Kentucky, the Kentucky Board of Nursing maintains records of first

time pass rates for five consecutive years (KBN, 2018). This allows colleges to compare program

effectiveness amongst other two-year institutions as well as four-year universities. Likewise,

reporting the passing rates maintains clear records for the Board of Nursing to track trends in

nursing and assure compliance and good standing of each institution.

First time pass NCLEX-RN results in 2017 supported the high initiative expected by the

state of Kentucky and by KCTCS. Of the six KCTCS colleges that require the NLN PAX-RN for

admission into the nursing program, a range of 13 to 114 represented the number of students per

program taking the NCLEX-RN, with an average at 56.67. Of this particular group of students

that tested, KBN (2018) reported a range of 84.5 to 100 percent first attempt pass rate, with an

average of 91 percent. Three KCTCS colleges will accept the NLN PAX-RN or other admissions

criteria in place of the entrance exam. Of these, a range of 17 to 64 students took the NCLEX-

RN, with an average of 48 students. Reportedly, a range of 88 to 94 percent passed on the first

attempt with an average of 91 percent passing. Requiring an entrance exam other than the NLN

PAX-RN, three KCTCS colleges reported a range of 35 to 67 students, average of 50, testing on

the NCLEX-RN in 2017. From those students, 83 to 97 percent passed with an average of 90.33

percent. Finally, four KCTCS colleges do not use any entrance exam for admissions criteria. Of

these four colleges, a range of 20 to 39 students with the average of 31 were tested. From these

specific colleges, 77 to 100 percent, averaging to 88.75 percent, reportedly passed the NCLEX-

RN on first attempt (KBN, 2018). Despite the diverse range of enrolled number of students, the

average pass rate on the NCLEX-RN was very similar.

Hopkinsville Community College. Specific to the current study, Hopkinsville

Community College (HCC) is one of the sixteen KCTCS colleges. Located in Hopkinsville,

Kentucky, HCC offers associate level degrees, diplomas, and certificates to more than 3,700

students (Hopkinsville Community College [HCC], 2018). Students have the option to pursue

numerous Allied Health programs currently including: Register Nurse, Licensed Practical Nurse,

Medical Assisting, Surgical Technology, Massage Therapy, Emergency Medical Technician,

Paramedic, Respiratory Therapy, Medicaid Nurse Aide, Phlebotomy for Healthcare Workers,

and Medical Information Technology.

Since founded in 1965, institutional values, visions, and overall mission of HCC supports

innovative academic excellence to encourage, prepare, and support student learning.

Hopkinsville is a uniquely diverse college with two main campuses, one in Hopkinsville and the

other located on the Army military base at Fort Campbell, Kentucky. Students have the

opportunity to take courses online, as a hybrid, or in-person to accommodate personal learning

styles and individual schedules (HCC, 2018).

The college is accredited by the Southern Association of Colleges and Schools

Commission on Colleges (SACSCOC), which requires institutional assessments to be conducted

on regular basis (Southern Association of Colleges and Schools Commission on Colleges

[SACSCOC], 2018). Continual assessment ensures a high standard for the quality of education

and overall educational experience. Specific guidelines for institutional effectiveness are

monitored closely with institutional submissions of annual program reports and a five-year site

visit from the accrediting body to emphasize the importance of excellence in higher education

(SACSCOC, 2018).

Along with the four-semester ADN program, HCC also offers an eleven-month practical

nursing program (PN) and a three semester bridge program for licensed practical nurses (LPN) to

complete the required education for an RN (HCC, 2018). Inclusion of an Allied Health division

at HCC in 2017 was implemented to provide a variety of opportunities to students and address

the current healthcare crisis. The ADN program at HCC has consistently remained the largest

and one of the most successful technical programs represented on campus (HCC, 2018).

In 1971, HCC admitted the first group of nursing students. During the initial stages of the

program, the ADN was affiliated with the Pennyrile Regional Associate Degree Program

(PRADP). Sharing instructors, classrooms, curriculums, and resources between HCC and

Madisonville Community College (MCC), the joint program remained functional until 1992

(KCTCS, 2018). While successful in graduating 938 nursing students, the mutual decision to

separate the two college programs dissolved the PRADP and led to individual programs as seen

in other KCTCS sister colleges (KCTCS, 2018).

As a stand-alone program, HCC has graduated on average 45 ADN nursing students with

an Associate of Allied Science in Nursing annually since 1992 (HCC, 2018). Designed to be

completed in five semesters with the first semester set aside for general education courses,

students complete a total of 24 to 30 credits in general education classes and 38 nursing credits to

complete the degree. In 2000, HCC received initial accreditation through the National League for

Nursing Accrediting Commission (NLNAC) and has been held in good standing each year

(HCC, 2018). Now known as the Accrediting Commission for Educating Nurses (ACEN), the

NLNAC granted HCC the maximum term for continuing accreditation of eight years in 2006. As

of 2018, the program remains in continuing accreditation with the next evaluation and site visit

for accreditation scheduled for the Fall 2021 semester (HCC, 2018).

Students are admitted into the ADN nursing program at HCC every fall and spring

semester. Admission into the program depends upon the following: submission of application,

ACT composite score of 20 or higher or a combined SAT score of 940 in Reading and Math,

attendance at an offered Pre-Admissions Conference held by HCC nursing faculty, a minimum

score of 111 on the NLN PAX-RN exam, a GPA of 2.0 or higher, a grade of C or higher in all

Math and Science course pre-requisites (HCC, 2018).

Once admitted into the program at HCC, students are required to pass all nursing courses

with a final letter grade of C or higher. The grading scale for HCC’s nursing program deems a

grade of 75% or higher as a passing score. Any student that does not meet the 75% final grade

will subsequently fail the class and will not be permitted to continue to the next semester. Failing

students are allowed to re-apply into the nursing program as early as the following semester;

however, are not guaranteed a spot. (HCC, 2018).

Of the students admitted into the nursing program, HCC reports the percentage of

students that complete all four semesters successfully without repeating any nursing courses. In

the fall semester of 2014 a total of 58% of students were successful, where in spring 2015 77%

of students admitted passed (HCC, 2018). Fall 2015 reported 49% and spring 2016 had 44% of

nursing students graduate the program. Only 52% of those admitted passed the nursing program

in fall 2016, and in spring 2017 HCC reported 85% of students passed (HCC, 2018). Compared

to other ADN programs in Kentucky, with average graduation rates for all ADN programs at

62.5% in 2016 and 62.6% in 2017, HCC was below average in 2016 but above average in 2017

(KBN, 2018).

Program completion at HCC reflects the national statistics reported in nursing programs,

supporting a higher than normal attrition rate (Merkley, 2015). According to the NLN (2018),

two-year institution nursing programs have experienced a retention rate of 65%. Similarly, one

study reported a national nursing attrition average for ADN programs to be 47%, and suggested

that nursing programs address their admissions process in order to improve attrition rates (Harris,

Rosenberg, & O’Rourke, 2014). Declining numbers of available seats for enrollment into nursing

programs, lack of qualified nursing faculty to teach courses, poor retention of admitted nursing

students, and fewer graduates of ADN programs (AACN, 2017), all validate the need to research

effective admissions criteria to admit those students with the highest probability of success.

Over the last five years, HCC has been successful in graduating competent students and

providing qualified nurses to help bridge the gap in healthcare. In 2013, 51 students from HCC

took the NCLEX-RN and of those tested, 94% passed on the first attempt (KBN, 2018). Of the

51 HCC graduates that tested in 2014, 86% initially passed the NCLEX-RN. The following year,

50 students sat for national certification and 90% passed (KBN, 2018). Due to the high attrition

rates noted in second semester, a change in the breakdown of content lectured during the first

two semesters of nursing was implemented in 2016 (HCC, 2018). On the NCLEX-RN in 2016,

38 students tested with a 97% first time pass rate (KBN, 2018). In 2017, 43 students sat for the

NCLEX-RN exam and 100% of students that took the national certification passed on the first

attempt (HCC, 2018; KBN, 2018).

Limited Validity of the NLN PAX-RN

Current research is very limited regarding validity of the NLN PAX-RN as a predictor for

student success. Support requiring the NLN PAX-RN for selective admissions was represented

in the reviewed literature as an indicator for student success (Briscoe & Anema, 1999; Crow et

al., 2004; Ukpabi, 2008). Strength of indication provided by the NLN PAX-RN was conflicting

in much of the research. Crow et al. (2004) reported a low percentage of nursing programs that

implemented the NLN PAX-RN into admissions criteria found significant ability to predict early

nursing school success. Sayles et al. (2003) concluded that higher Math and Reading

comprehension subsection scores of the entrance exam were a significant indicator of first

attempt NCLEX-RN pass rates, and that the overall composite score is a valid tool for

admissions committees to review when assessing which students are more likely to succeed in

the program.

Concerns with utilizing any standardized testing for selective admissions into nursing

programs have been reported (Randolph, 2017; Tagher, 2017). Randolph (2017) argues that high

pass rates on the NCLEX-RN are not always indicative of a nursing program or intuition’s

efficiency because the test does not examine any skills and addresses only minimal competencies

covered in nursing curriculum. While standardize testing could benefit students by highlighting

academic areas of strengths and weaknesses, these tests are rarely used for content analysis

(Tagher, 2017). Therefore, students often have a negative perspective towards standardize

testing, view such exams as an academic hindrance, and tend to score lower than on program

exams they deem beneficial (March & Robinson, 2015; Tagher, 2017).

In 2012, the National League of Nursing implemented the national fair testing guidelines

in response to growing concerns of using standardized testing in nursing programs to predict

student success (NLN, 2012). The high attrition of nursing students and low graduation numbers

were recognized by the public, institutions, and industries, and the NLN acknowledged the lack

of guidelines or policies for how nursing programs should utilize standardized testing may

contribute to these issues (NLN, 2012). The national fair testing guidelines consists of five major

points including: 1. Faculty are ethically obligated to ensure the tests are consistent and fair to all

students, 2. Faculty must consider assessed skills and abilities that are not included in

standardized testing, 3. Programs should use multiple sources of evaluation, 4. Standardized

testing results must be used to improve the overall program, and 5. Results and how programs

will use standardized testing must be clearly communicated to students (NLN, 2012).

Regardless of the concerns for using standardized testing in nursing, ADN programs

utilize tests such as the NLN PAX-RN entrance exam to admit students. A majority of the

research supporting the validity of using entrance exams was dated and not represented or

recreated in current studies. Recent publications on admissions criteria for nursing schools was

found to support entrance exams, however these studies were focused on the different available

options of entrance exams, and presented without conclusion of which exam is the most accurate

indicator of student success (Liu, Codd, & Mills, 2018). Studies suggest that nursing programs

should examine the admissions process very closely to ensure the predictive validity of tools

used as indicators for selecting applicants (Fowles, 1992; Gallagher et al., 2001).

Obvious gaps in the current literature and concerns regarding the validity of entrance

exams provides a platform for this study to evaluate the NLN PAX-RN as an indicator for

student success. Comparison of overall composite score with each subsection score may provide

insight on the most significant predictor of success. The goal of this study was to provide nursing

programs with current data on the validity of using the NLN PAX-RN in the admissions process

to select candidates with the highest probability of completing the program and passing the

NCLEX-RN on first attempt.

Chapter III: Methodology

Growing concerns in healthcare reflect the need to graduate qualified nurses for

employment. Application pools are filled with qualified candidates, however limited availability

in programs denies admission to hundreds of potential nurses each semester. The purpose of the

study was to determine the validity of Hopkinsville Community College’s (HCC) admissions

policy in the highly competitive Associate Degree Nursing (ADN) program.

This chapter highlights methods utilized during the study to address the research

questions previously detailed in Chapter I. This chapter describes the selection of the sample,

data collection procedures, and the analysis of quantifiable data in order to validate the use of the

NLN PAX-RN entrance exam as a predictor of student success in the nursing school program at

HCC. The goal of this study was to provide selective admissions committees with applicable

results to ensure admittance of candidates with a higher probability of program success.

Sample Selection

The current study examined data collected from HCC nursing program inclusive of

admission cycles from January 2014 through January 2017. The sample specifically included

students that were admitted into the ADN program. Students at HCC are admitted into the ADN

program each fall and spring term, and graduate in four semesters. The sample was limited to

only one of sixteen Kentucky Community and Technical College System (KCTCS) institutions

with the understanding that results could have systematic impact upon similar nursing programs.

Findings from the study could be implemented at HCC and applied to other KCTCS ADN

nursing programs.

The collected data identified HCC nursing students who reported a composite national

percentile score on the NLN PAX-RN, were admitted into the ADN program, successfully

graduated in four semesters, and passed the NCLEX-RN upon first attempt. Considering the

NLN PAX-RN, the study addressed students admitted into the program who scored in the 85

percentile and successfully passed the NCLEX- RN. Selected percentiles were studied based

upon the average NLN PAX-RN scores reported at HCC that resulted in students being admitted.

Likewise, detection of students scoring below the 85

percentile who were admitted into the

nursing program and passed the initial NCLEX-RN attempt will be reviewed.

Participants

The sample included students that were admitted, based upon predetermined admissions

criteria, into the ADN program at HCC during the spring and fall terms from January 2014

through January 2017. A total of 237 students were admitted into the nursing program during

these seven admission cycles. A description of the admitted students for each semester is

provided in Table 1. Required admissions criteria data were provided for all admitted student for

analysis. Following IRB approval from MSU and KCTCS, data were collected from historical

HCC nursing records, and scrubbed of all personal identifiers. Confidentiality was maintained

throughout the duration of the study.

On average 150 applications are submitted for the fall admissions consideration into the

HCC ADN program, and approximately 100 applications are submitted for the spring semester.

During the seven semesters analyzed within this study, an average of 33.86 students were

admitted each semester. The low number of students accepted into the ADN program each

semester is consistent with the reviewed literature (Kavilanz, 2018; Nardi & Gyurko, 2013;

Young, 2018). Factors such as classroom space, qualified faculty, and clinical availability

contribute to the enrollment restrictions.

Table 1

Number of ADN Admits Between Spring 2014 and Spring 2017

Admission Cycle

Spring 2014

Fall 2014

Spring 2015

Fall 2015

Spring 2016

Fall 2016

Spring 2017

Admission Criteria

Eligibility for admission into the HCC nursing program is based upon published criteria,

as detailed below, and is required by all applicants for consideration. Applications that are

incomplete, submitted after the deadline, or that do not meet any portion of the admission criteria

are marked ineligible for acceptance. Applications are reviewed by the Director of Nursing and

the Nursing Administrative Assistant, removing any ineligible applications from the pool prior to

the admissions committee consideration. Potential ADN students are allowed to submit a request

to waive any portion of the admission criteria, and waivers are determined on individual basis.

Required criteria are available on the HCC nursing webpage and in the nursing

department. Academic advisors cover ADN requirements during advising sessions to ensure that

potential students are aware of current standards to apply. Prior to the admission cycle deadline,

students must complete the following criteria for consideration: submit a completed application,

have any official transcript on file, have a minimum of a 20 composite score on the ACT or a

combined score of 940 in Critical Reading and Math on the SAT, attend a Nursing Pre-

Admission Conference, score a minimum of 111 on the NLN PAX-RN, be in good academic

standing at HCC, and have at least a 2.0 GPA with a grade of C or higher in all Math, Science,

and pre-requisite courses.

ACT scores. Of the admitted students during the selected semesters, 227 students

reported ACT scores (M = 22.99; SD = 2.949). Individual scores ranged from a minimum of 19

to a maximum of 33. This requirement was waived for five students, and five students reported

SAT scores in the place of the ACT.

NLN PAX-RN scores. All 237 of the admitted applicants reported NLN PAX-RN scores

which were converted to a national percentile for comparison and consideration. The mean was

the 88

percentile, with a minimum individual score accepted being the 67

percentile and the

maximum reported individual in the 99

percentile. For the selected admission cycles, 75% of

the admitted students scored at the 94

percentile or higher.

Grades. For students admitted into the HCC nursing program, 144 students (60.8%)

successfully passed all four required semesters and graduated the ADN program. The program

had a total of 93 students (39.2%) that were not successful during these semesters. Of the

unsuccessful students, 64 students (68.8%) did not meet the minimum academic grade of a C or

higher required to continue in the program, 14 students (15.1%) chose to withdraw from the

program prior to the final exam due to the impossibility of academic recovery, and 15 students

(16.1%) withdrew due to non-academic related issues. Table 2 summarizes the findings for

students admitted into the HCC nursing program.

Table 2

Fate of Students Admitted into the ADN Program

Admission Cycle

Passed

Failed

WD Failing

WD Non-Academic

Spring 2014

Fall 2014

Spring 2015

Fall 2015

Spring 2016

Fall 2016

Spring 2017

Student success as defined by the current study, includes successful completion of the

ADN program within four semesters and passing of the NCLEX-RN licensure examination on

first attempt. To evaluate the effectiveness of the HCC nursing program in preparing graduates

for eligibility of nursing employment, successful first attempt pass rates of the NCLEX-RN were

analyzed. A total of 131 students took the NCLEX-RN licensure examination during the selected

terms. Of those who took the NCLEX-RN, 119 students (90.1%) passed on first attempt, and 12

students (9.2%) who passed the ADN program at HCC then failed the initial NCLEX-RN. These

data suggest the nursing program at HCC is effectively preparing students for passing the

NCLEX-RN licensure examination.

When considering only the students that were successful in the HCC ADN nursing

program (n = 144), a Chi-square test indicated a statistically significant relationship between

ADN program completion and successfully passing the NCLEX-RN. The Chi-square test

examines the differences between categories within a sample, and accounts for which categorical

variables are responsible for the observed differences (McHugh, 2013). Students who pass the

HCC nursing program have a very high likelihood of being successful on the initial nursing

licensure examination. A summary of these findings are found in Table 3.

Table 3

ADN Program and NLCEX-RN Results for Admitted Students

Admission Cycle

Passed ADN and

Passed NCLEX-RN

Passed ADN but

Failed NCLEX-RN

Spring 2014

Fall 2014

Spring 2015

Fall 2015

Spring 2016

Fall 2016

Spring 2017

Data Collection

Prior to the collection of data, the Institutional Review Boards (IRB) of Murray State

University (MSU) and the KCTCS approved the current study. Historical data were collected

with all personal identifiers removed and confidentiality was maintained throughout the study.

The data were collected from HCC program admission files, NLN PAX-RN records, ADN

course records, and NCLEX-RN records. All statistical analyses utilized the 25

edition of the

SPSS Statistical Software.

Participants included 237 students admitted by an appointed committee to the HCC

nursing program based upon the required NLN PAX-RN entrance exam scores, completed

application, ACT score of 20 or higher, a grade of C or higher in prerequisite courses, and an

overall GPA of 2.0 or higher. Focus was on those students that were successful in their first

attempt at passing the NCLEX-RN for all students graduating in the following terms: Spring

2014, Fall 2014, Spring 2015, Fall 2015, Spring 2016, Fall 2017, and Spring 2017.

Research Questions

In an attempt to explore the overall selective admissions criteria for nursing programs, the

following research questions and hypotheses were addressed in this study:

Research question 1: What is the correlation between individual NLN PAX-RN scores

and successful completion of the HCC ADN program?

: There is no correlation between NLN PAX-RN scores and success of students in the

HCC ADN program.

Research question 2: What is the predictive power of the combined three individual

sections represented on the NLN PAX-RN exam and successfully passing the NCLEX-RN on

first attempt?

: There is no combined predictive power of using the three individual sections of the

NLN PAX-RN and passing the NCLEX-RN on first attempt.

Research question 3: What is the correlation between NLN PAX-RN scores of admitted

HCC ADN students and first time pass rate of the NCLEX-RN?

: There is no correlation between NLN PAX-RN scores and first time pass rates of the

NCLEX-RN.

Research question 4: Do students scoring at the 88

national percentage (or above) on the

NLN PAX-RN have a higher first time NCLEX-RN pass rate than students scoring below the

national percentage?

: There is no statistical difference in national percentage scores on the NLN PAX-RN

and first time pass rates of the NCLEX-RN.

Analyses

To determine if the NLN PAX-RN is an adequate indicator of student success, individual

research questions must be studied statistically. The current study defined student success as

successful completion of the HCC nursing program within the allotted four semesters and

passing of the NCLEX-RN licensure examination on first attempt.

In order to establish if any relationship existed between NLN PAX-RN scores and

success in passing HCC nursing program courses, data were analyzed with a series of point-

biserial correlation and multiple regression. Data were further analyzed to determine if any one

of the three specific sections of the NLN PAX-RN was a more accurate indicator of student

success than the others. The Verbal Ability, Mathematics, and Science sections of the NLN

PAX-RN were evaluated via regression to quantify any relationship between each section and

student success. Multiple regression determines which independent variable or variables best

predicts the dependent variable.

First time pass rates on the NCLEX-RN and individual NLN PAX-RN scores were

compared via a point- biserial coefficient to determine the strength of the relationship is. Data

were analyzed further to determine if the relationship between NLN PAX-RN and NLCEX-RN

pass rates is stronger than the relationship identified in the first research question with NLN

PAX-RN and students passing the nursing courses.

Finally, the national percentage scores from the NLN PAX-RN were examined to

determine if a particular benchmark percentile serves as a defined indicator for student success.

A Chi-square test was utilized to decipher if students scoring at the 88

national percentile or

higher on the NLN PAX-RN were more likely to pass the NCLEX-RN on initial attempt than

students scoring below the 88

percentile. Current admission practices at HCC for the ADN

program identifies a cutoff score based upon the size of the applicant pool as opposed to a

minimal percentile that students are required to obtain for admission.

Summary

Based upon the data collected, the current study analyzed each of the identified research

questions in an attempt to validate the current admission criteria used in predicting student

success. This study provides the opportunity to make results-based recommendations that can

lead to best methods and policies that will identify applicants with the highest probability of

success in the HCC ADN program and initial passing of the NCLEX-RN.

Chapter IV: Findings and Analyses

This chapter presents the findings of this study for each of the research questions and

hypotheses. This study investigated the relationship between the NLN PAX-RN entrance exam,

required for admission into the ADN nursing program at HCC, and student success as previously

defined in Chapter 1. Furthermore, individual sections of the NLN PAX-RN were examined to

determine if a specific section of the NLN PAX-RN was a better indicator of success. Lastly, the

NLN PAX-RN percentile scores of successful students were analyzed to determine if there was a

relationship between an identified benchmark score on the NLN PAX-RN and overall success.

Research Questions

Data were used to analyze the four research questions and hypotheses with the intention

of validating current admissions criteria utilized in the HCC nursing program.

Research question 1: What is the correlation between individual NLN PAX-RN scores

and successful completion of the HCC ADN program?

: There is no correlation between NLN PAX-RN scores and success of students in the

HCC ADN program.

To determine if a relationship exists between NLN PAX-RN scores and students

successfully completing the ADN program, a point-biserial correlation was calculated. A point-

biserial correlation is a specific correlation used to examine possible relationships between a

dichotomous variable (i.e., successful completion of the ADN program) and a continuous

variable (i.e., NLN PAX-RN scores) (Varma, 2006). The point-biserial correlation revealed a

statistically significant relationship between individual NLN PAX-RN composite percentile

scores and successful completion of the HCC nursing program (r

= .222, n = 234, p = .001). A

positive correlation was found, meaning that as NLN PAX-RN percentile scores increase, the

likelihood of passing the ADN program increases as well. The results indicated individual NLN

PAX-RN percentile scores are useful in predicting students likely to successfully complete the

nursing program at HCC. The null hypothesis is rejected.

The results of Research Question 1 suggest that individual NLN PAX-RN percentile

scores and successful graduation from the ADN program have a statistically significant positive

relationship (p =.001). The obtained correlation was weak (r = 0.222), indicating that individual

NLN PAX-RN percentile scores are minimally useful in predicting success in the ADN program.

Research question 2: What is the predictive power of the combined three individual

sections represented on the NLN PAX-RN exam and successfully passing the NCLEX-RN on

first attempt?

: There is no combined predictive power of using the three individual sections of the

NLN PAX-RN and passing the NCLEX-RN on first attempt.

Multiple regression analysis is a valuable tool for determining the predictive power of

several continuous independent variables on a dichotomous dependent variable (Aiken & West,

1991). To determine the best predictor of the dependent variable, a mathematical linear equation

composed of all represented variables is constructed for correlation (Kelley & Maxwell, 2003).

Considering the slope of a line, the independent variables are compared by calculating

how closely each of the variables fit the prediction slope and are reported as R

(McDonald,

2014). Such values are reported between .000 and .100, where .000 shows no relationship

between the variables and .100 shows absolute correlation between the independent and

dependent variable (Kenton, 2018).

Verbal Ability, Mathematics, and Science are the three represented and reported sections

on the NLN PAX-RN. A multiple regression analysis (n = 197) utilizing the Enter method was

performed to evaluate if the individual NLN PAX-RN sections, independently or combined,

significantly predicted the likelihood for passing the NCLEX-RN on first attempt. Collectively,

the individual percentage of NLN-PAX RN scores were significant (F = (3,193) = 5.596, p =

.001) with an R

of .081, meaning that 8.1% of the variance in the data can be explained by the

three variables.

However, of the three individual sections reported on the NLN PAX-RN, only

Mathematics proved statistically significant (p = .001, R

= .053) in predicting success on the

NLCEX-RN. Neither the Verbal Ability (p = .128, R

= .012) and nor the Science (p = .160, R

.025) sections were statistically significant in predicting first attempt success on the NCLEX-RN.

Thus, the null hypothesis is rejected. Mathematics scores are the most significant predictor of

passing the initial NCLEX-RN exam.

Individual NLN PAX-RN Mathematic scores reported (n = 203) for the selected

semesters within the current study ranged from 45 to 98 (M = 76.41, SD = 11.960). To further

evaluate the association between Mathematics and student success, a point-biserial test revealed

a significant relationship between NLN PAX-RN Mathematic percentile scores and successful

passing of the ADN program (r

= .174, n = 201, p = .013). As Mathematics scores on the NLN

PAX-RN increase, the likelihood of passing the NCLEX-RN on first attempt increases as well.

Consideration of individual NLN PAX-RN Mathematics scores would prove beneficial in

admitting students into the ADN program at HCC.

Research question 3: What is the correlation between NLN PAX-RN scores of admitted

HCC ADN students and first time pass rate of the NCLEX-RN?

: There is no correlation between NLN PAX-RN scores and first time pass rates of the

NCLEX-RN.

A point-biserial correlation revealed a statistically significant relationship between

individual NLN PAX-RN composite percentile scores and successfully passing of the NCLEX-

RN on first attempt (r

= .254, n = 220, p < 0.001). A positive correlation was found, meaning

that as NLN PAX-RN percentile scores increase, the likelihood of passing the NCLEX-RN

licensure exam on the first attempt increase as well. The results indicated individual NLN PAX-

RN percentile scores are useful in predicting first attempt passing of the NCLEX-RN. The null

hypothesis is rejected.

Research question 4: Do students scoring at the 88

national percentage (or above) on the

NLN PAX-RN have a higher first time NCLEX-RN pass rate than students scoring below the

national percentage?

: There is no statistical difference in national percentage scores on the NLN PAX-RN

and first time pass rates of the NCLEX-RN.

Of the admitted ADN students at HCC represented in the current study (n = 237), the

mean NLN PAX-RN percentile score was the 88

percentile. The lowest admitted score was at

the 67

percentile and highest admitted score was at the 99

percentile. Current NLN PAX-RN

requirements for admission into the ADN program is a composite score of 111, or the 61

percentile. The lowest reported percentile admitted into the program that was successful in the

ADN program and passed the initial NCLEX-RN was in the 68

percentile. Data from the NLN

PAX-RN scores are represented in Table 4.

Table 4

NLN PAX-RN Percentile Scores of Admitted Students

Admission

Cycle

Number

Admitted

Mean

Percentile

Maximum

Percentile

Minimum

Percentile

Number of Students at the

Percentile or Higher

Spring 2014

Fall 2014

87.47

Spring 2015

87.77

Fall 2015

93.33

Spring 2016

86.28

Fall 2016

88.51

Spring 2017

82.41

To address Research Question 4, a Chi-square test of independence was conducted to

examine the relationship between NLN PAX-RN percentage scores and initial success on the

NCLEX-RN. Chi-square analysis has been historically valuable in determining if an association

of variables exists (Federighi, 1950). There was a statistically significant association found

between the percentile score on individual NLN PAX-RN exams and passing the NCLEX-RN on

the first attempt (X

(58) = 76.713, p = 0.051). Percentile scores above the 88

percentile on the

NLN PAX-RN are a better indicator for passing the NCLEX-RN on first attempt when compared

to those students scoring below the 88

percentile. Thus the null hypothesis is rejected.

Admitting students into the ADN program with an NLN PAX-RN score at the 88

percentile or

higher would increase the likelihood of student success.

Chapter V: Conclusions and Discussions

Conclusions

Several conclusions may be made from analyzing data collected on students in the ADN

nursing program at HCC during the admission cycles including Spring 2014 through Spring

2017. Research questions were designed to evaluate the current criteria utilized to select

applicants for admission into the nursing program.

Research question 1. The first research question was intended to determine if individual

NLN PAX-RN scores predict a higher likelihood of successfully completing the requirements set

forth in the HCC ADN program. The results showed that there was a statistically significant

relationship between these two variables, although this relationship was weak. The NLN PAX-

RN scores are heavily weighted in the determination of admitting students at HCC. This aspect

of entry requirements seems to be defensible, applicants are organized by NLN PAX-RN

entrance exam scores and presented to the Admission Committee for admission consideration.

While applicants are required to meet all predetermined admission criteria, consideration

or discussion of any criteria besides the NLN PAX-RN is not represented in the decision to admit

students into the nursing program. Admission criteria are checked as completing the minimum

requirements, and committee focus on the NLN PAX-RN score is extensive. In the event that

two or more applicants with the same NLN PAX-RN scores are vying for the final admission

seat, prerequisite GPA will typically be the next criteria evaluated for selection.

Based upon analysis of the data, the relationship between NLN PAX-RN scores and

successful completion of the HCC nursing program is a very weak indicator of overall student

success. Of the 93 total students who failed or withdrew from the program, 35 students (37.6%)

scored at the 90

percentile or higher on the NLN PAX-RN.

Research question 2. While the percentile scores for the three individual sections

represented on the NLN PAX-RN are readily available, the nursing admissions committee does

not currently consider these sections in determining admission. The score used to determine

admission for each applicant is the composite scores converted to a national percentile. Data

collected were evaluated to decide if the individual sections were indicative of success on the

NCLEX-RN. The individual Mathematics percentile score was the only section that statistically

predicted success on the NCLEX-RN. Neither Science nor Verbal Ability scores were

significant.

Of the semesters represented in the current study, nearly half of the students with

reported individual NLN PAX-RN sections scored at the 77

percentile or lower in the area of

Mathematics. While findings from this study suggest that individual Mathematics percentile

scores are statistically significant in predicting success on the NCLEX-RN, a benchmark score

was undetermined. Further research to statistically support which percentile score in

Mathematics correlates to a 90% passing of the NCLEX-RN would be helpful.

These findings are of particular interest considering the prerequisite courses required by

HCC for admission into the ADN program include Mathematics, Science, and English. Students

must have a grade of C or higher in selected courses to be considered for admission. Based on

the findings, student success in prerequisite Mathematic courses may provide greater insight on

potential student success.

Comparable findings were witnessed in an internal assessment conducted by the nursing

department that highlighted an obvious lack of basic Mathematical skills, thus hindering students

from succeeding in the program. To address this need, interdepartmental discussions resulted in a

weekly offering of a one-hour tutoring session for nursing students. The session was led by

faculty members in the Mathematics department to assist in homework problems and testing

strategies that involved calculations. Due to a change in schedule, the tutoring was only available

for two semesters.

Research question 3. To better understand if a relationship exists between the NLN

PAX-RN and likelihood for students to pass the NCLEX-RN on first attempt, the study

compared individual NLN PAX-RN percentile scores to NCLEX-RN pass rates. The results

revealed similar findings as the first research question, and found a significant positive

relationship between these variables. The overall goal for students entering into an ADN

program includes passing the NCLEX-RN for licensure and certification in order to be eligible to

enter into the healthcare work field. The HCC nursing admissions committee and nursing faculty

rely on NLN PAX-RN scores to identify students capable of reaching this goal. Of the 119

students that passed the NCLEX-RN on first attempt, 33 students (27.7%) had an NLN PAX-RN

score at the 85

percentile or lower, and 7 students (5.9%) were below the 80

percentile.

The NLN PAX-RN scores are heavily considered during the ADN admission process,

and accepted cutoff percentiles vary each semester based on the application pools. Of the

analyzed semesters, the lowest accepted percentile was in Spring 2017 and was at the 67

percentile. While that particular student was not successful in the program, in the same semester,

a student scoring at the 68

percentile on the NLN PAX-RN was admitted and passed both the

ADN program and the NCLEX-RN on first attempt. Current criteria requires students to have a

composite score of 111 or higher on the NLN PAX-RN for admission consideration, which

correlates to a 61

national percentile rank.

A range of NLN PAX-RN scores from the 67

national percentile to the 99

percentile

was admitted during the seven selected semesters. Overall student success was varied with

respect to NLN PAX-RN scores. Some of the admitted students scoring in the lower national

percentiles on the NLN PAX-RN passed the NCLEX-RN on first attempt, while other students

scoring in the higher national percentiles did not pass the initial NCLEX-RN. Further evaluation

to identify the national percentile score that best correlates to a 90% pass rate on the initial

NCLEX-RN would provide insight for admission committees.

Research question 4. Currently HCC does not require a minimum benchmark percentile

score on the NLN PAX-RN for acceptance into the program. Any student who has taken the

NLN PAX-RN and has met all of the other specified criteria is eligible to apply and considered

for admission. A minimum NLN PAX-RN composite score of 111 score is stated in the

admissions packet, on the HCC nursing webpage, and relayed during advising sessions, however

students with a score lower than 111 can still apply to the ADN program. Of the semesters

studied, no admitted student scored lower than 115 on the PAX-RN. The average score of

students accepted into the program was at the 88

percentile, a 32-point range was represented

with the lowest percentile accepted being at the 67

percentile and the highest at the 99

percentile. Based on the results, the mean percentile was a statistically valuable predictor of

success on the NLCEX-RN.

Despite the suggested composite score of 111 on the NLN PAX-RN, which corresponds

to the 61

percentile, students scoring below the 80

percentile on the entrance exam are highly

encouraged by nursing advisors to retake the NLN PAX-RN for a higher score before applying

to the HCC nursing program. Reasoning behind this suggestion is based upon the ideology and

assumptions that: 1. Students scoring below the 80

percentile are not likely to be admitted in an

admission cycle due to the vast number of applicants, 2. Students scoring below the 80

percentile often fail the ADN program, and 3. Students scoring below the 80

percentile do not

succeed on the initial NCLEX-RN examination. Of the students admitted into the program

during the represented admission cycles, 29 students (12.2%) scored below the 80

percentile on

the NLN PAX-RN. As discussed above, 5.9% of the students successful on the initial NCLEX-

RN exam had scored below the 80

percentile on the NLN PAX-RN, and the admitted student

scoring at the 68

percentile on the NLN PAX-RN was recently successful in passing the

NCLEX-RN on first attempt.

Discussions

Findings from the study are significant in predicting student success, and are as follows:

1. NLN PAX-RN scores are a weak indicator of ADN program success, 2. the NLN PAX-RN

scores are significant in predicting passing the NCLEX-RN on first attempt, 3. the individual

NLN PAX-RN Mathematics percentile score was found to be significant in predicting success on

the NCLEX-RN, and 4. Students scoring at the 88

percentile or higher on the NLN PAX-RN

are more likely to pass the NCLEX-RN on first attempt than students scoring lower than the 88

percentile.

Based upon the results of the current study, HCC can improve their selective admissions

process into the ADN program by prioritizing the entrance components. Applicants with the

highest probability of success, as defined by this study, will report an NLN PAX-RN score at the

percentile or higher, and once a percentile benchmark is established for a Mathematics

score, HCC should consider the individual Mathematics percentile scores for admission.

Consistent with findings from previous research (Fowles, 1992; Gallagher, Bomba, &

Crane, 2001; Liu, Codd, & Mills, 2018) entrance exams offer insight for selecting students with

a higher probability of success. Validation that the NLN PAX-RN is an indicator for student

success is consistent with research conducted by Briscoe and Anema, (1999), Crow, Handley,

Morrison, and Shelton, (2004), Sayles, Shelton, and Powell (2003), and Ukpabi, (2008). Strength

of the correlation between the NLN PAX-RN and student success was consistent with Crow et

al. (2004) who reported NLN PAX-RN scores were a weak indicator of predicting nursing

school success. Considering the increased weight placed upon the NLN PAX-RN scores at HCC

during the admission process, and the findings of a weak correlation to success, HCC should

consider decreasing the weight of the NLN PAX-RN in the admissions selection.

Of the three tested content sections on the NLN PAX-RN, findings from the current

research were inconsistent with earlier studies. Sayles et al. (2003) reported that both

Mathematics and Reading can predict student success. Results for this study indicated only the

Mathematics scores were statistically significant. Currently, the only score on the NLN PAX-RN

that is considered for admission into the ADN program at HCC is the composite score. Based on

the data, HCC should continue to consider the national percentile score on the NLN PAX-RN,

but should also report the Mathematics percentile scores when admitting students. A benchmark

Mathematics percentile score should be determined and considered during admissions.

No previous data were found to compare with the findings of this study in regards to a

specific benchmark score on the NLN PAX-RN being a better indicator of student success.

Individual ADN programs arbitrarily choose a cutoff score for admission, however findings from

this study indicated that the average percentile score reported at HCC during the seven semesters

on the NLN PAX-RN was a better indicator of student success.

Practical Implications

Students in the nursing program are required to complete College Algebra or higher for

eligibility of admission. Based on the current study, Mathematics scores are significant in

predicting overall success. Research on the addition of a first-semester, content-based, remedial

Mathematics course for admitted nursing students with a C in College Algebra may prove

academically beneficial in successful completion of the student. Interdisciplinary coordination

between Nursing and Mathematics to develop and deliver such a course is suggested.

High attrition rates, particularly in the second semester of the ADN program, are

concerning. Evaluation of the current distribution of content delivered during the first and second

semesters may provide insight on reasons that many students are not academically successful in

the program. Second-semester nursing at HCC is focused on the management of patient care and

requires students to utilize critical thinking skills, apply knowledge, and correlate information to

succeed. Students historically struggle with the ability to perform the needed cognitive processes

to answer questions that demand application of content. The addition of Allied Health specific

Anatomy and Physiology, Mathematics, and Psychology courses, embedded with critical

thinking style assignments and exams, designed collaboratively between nursing and general

education faculty may prove beneficial in more effectively preparing students who identify as

pre-nursing. Better preparation academically prior to admission into the nursing program may

alleviate the elevated attrition noted in second semester.

Historically, emphasis on using pre-nursing grade point average (GPA) to predict student

success has been represented in the literature. Of the reviewed literature, findings varied on the

extent that pre-nursing GPA can be used to predict student success, however most studies

concluded that GPA does provide some validity in predicating student success in nursing

programs (Blackman, Hall, & Darmawan, 2007; Bosch, Doshier, & Gess-Newsome, 2012;

Herrera & Blair, 2015; Seago, Keane, Chen, Spetz, & Grumbach, 2012; Sears, Othman, &

Mahoney, 2015). Students applying to the ADN program at HCC are required to have a

minimum pre-nursing GPA of 2.0, which is comparatively low when compared to the 2.5 to 3.0

GPA required by many similar nursing programs. Increasing the minimum GPA requirement to

2.5 may improve the likelihood of admitting students with a higher probability of overall

success.

Research shows a statistically significant relationship between GPA of nursing courses

and overall student success (Alameida et al., 2011; Crow et al., 2004; Herrera & Blair, 2015;

Tipton et al., 2008; Ukapabi, 2008). Students with high academic performance, particularly in

the Nursing Fundamentals course taught in the first semester of nursing, have a statistically

higher probability of completing the program and passing the NCLEX-RN on first attempt

(Blackman et al., 2007; Simon, McGinniss, & Krauss, 2013; Tipton et al., 2008; Ukapabi, 2008).

Based upon these findings, students in the HCC nursing program who receive a grade of C in the

first semester of nursing, should be required to complete a three week accelerated remedial

course before beginning second semester. The course should be designed in modules, developed

by nursing faculty, with the intent to review content obtained in the first semester. To ensure

students remain on track for graduation, fall semester students would complete the mandatory

remedial course during the winter break and spring semester students would complete the course

during the summer break. Students receiving the grade of an A or B in the first semester of

nursing should have the option to complete the course for individual benefit.

The addition of an interview process may prove valuable in identifying students with a

higher probability of student success. Discussions of an interview portion for admission into the

nursing program has been considered at HCC, but not implemented. Interviews will assist in

improving the diversity of students represented in the program and provide perspective on

potential non-academic concerns. Both academic and non-academic factors should be considered

when selecting applicants for admission into the nursing program.

Finally, input during the admissions process from faculty members that teach the required

prerequisite courses could provide valuable insight on applicants being considered for

acceptance into the ADN program. Faculty feedback could potentially be collected via a survey

to be completed by each professor, designed specifically to evaluate the individual applicants.

Responses must be submitted in a timely manner each semester to allow for ample analysis by

the Nursing Admissions Committee for consideration of each candidate. While this particular

mode of participation may be beneficial, a more effective method of soliciting cross-disciplinary

input is suggested. Allowing Algebra, Psychology, and Anatomy and Physiology faculty to serve

on the Nursing Admissions Committee cultivates an environment open to discussion on

individual applicant’s strength and weaknesses in the classroom prior to the decision to admit.

Limitations of the Study

Numerous limitations were identified within the study that will limit generalizability of

the findings. The current study represented a small sample size in each of the seven analyzed

semesters. The data collected focused on students admitted to the HCC nursing program.

According to the NLN (2016) in 2014, 1,092 accredited ADN programs were available for

enrollment. Nearly half of those programs were located in the South or Midwest region of the

United States (NLN, 2016). In the state of Kentucky, 29 ADN programs are available and of

those, the Accreditation Commission for Education in Nursing (ACEN) accredits 17 (KBN,

2018). Thus, the small sample size studied within this research may not represent the total

population of ADN students.

The study did not include all students applying for the HCC nursing program, only those

admitted during the selected semesters. Likewise, the current study did not examine gender, race,

or age of the admitted students. Hundreds of applications are denied consideration due to limited

availability of space within the program. Of those students not accepted, several meet and even

exceed the qualifications for the program. Students who applied, but were not accepted into the

ADN program during the seven semesters were not considered or analyzed in the current study.

Future research including data from all ADN applicants has potential to be proven statistically

valuable.

Prior to the semesters represented within the study, data were not available for analysis.

There has been little to no change in the admissions criteria required for acceptance in the HCC

nursing program since Spring 2014. There was a reported change in the minimal ACT score

requirement during the analyzed semesters from 19 to 20, and therefore ACT scores were not

evaluated in this study. Of the 227 admitted students during this study who reported ACT scores,

only 12 students had a score of 19.

In accordance to requirements set forth by accrediting bodies, only the first attempt of the

NCLEX-RN is reported to the HCC nursing program. Any student passing the initial

examination is considered successful, and any student that fails the first attempt is considered

unsuccessful. Students that fail the first attempt have the opportunity to retake the licensure exam

after a 45-day waiting period. A total of eight attempts each year are possible for persistent

students. Upon passing the NLCEX-RN, regardless of how many attempts, students are eligible

to work as an RN. While acknowledged as both a personal and professional achievement, these

students are never considered a success for the program. Students that pass the NCLEX-RN after

the first attempt and are subsequently employed in healthcare are successful in impacting the

national nursing shortage; however, based on the definition of success within the current study,

these students are considered a failure. No information beyond the first attempt was available for

students that were eventually successful on the NLCEX-RN.

Recommendations for Future Research

Several recommendations for future research were identified. While some

recommendations are outside of the scope of this study, additional and expanded research can

have substantial impact on the nursing program at HCC. Findings from continual research can

potentially be implemented at similarly structured nursing programs across the nation. Future

research can corroborate findings of this study, justify suggestions for improvement, and foster

successful programs.

The findings of this study should be replicated across educational nursing programs at

both the community college and university levels. According to Cai et al. (2018), two optional

methods for replicating educational research can be utilized. The first is called the exact method

of replication, which Cai et al. (2018) concluded to be difficult when considering the diverse

composition of education. The second method is called the conceptual method and openly

accepts slight variations in the research with the goal to test the generalization of other findings

(Cai et al., 2018). Data from other identified community college ADN programs that utilize the

same admissions criteria, would enhance the validity of the findings from the current study. Due

to the complex nature and extreme diversity of classrooms, nursing programs, admission

policies, instructors, and students, future research should attempt to reproduce the findings of this

study.

Upon examination of the data, further research to identify specific contributors to the

attrition rate reported by the HCC nursing program would be of benefit. In the analyzed

semesters, a total of 93 students (39.2%) failed or withdrew from the program. Research should

focus on individual semesters of the nursing program to recognize major personal events or

specific content that led to either the withdraw or failing of students.

Historically, the second semester of nursing at HCC has reported a very high attrition rate

and could be an interest and focus for future researchers. Identifying the most likely reason for

this high attrition rate has proven difficult for nursing faculty and administers. Of the 93 students

that failed out of or withdrew from the ADN program during Spring 2014 through Spring 2017,

84 students (88.3%) were lost in the second nursing semester.

Additionally, of the 46 students admitted in Fall 2017, which were excluded from this

study due to incompletion of the program at the time current study was performed, 16 of the 18

students which have already failed out or withdrew were in second semester. There is a specific

need to improve retention in all college programs. Early detection of possible academic barriers

must be identified and improvements made to increase retention and student success.

Based upon the current literature, a third suggestion for research would be to establish the

significance of non-academic factors in predicting student success. Future research should

determine if non-academic factors play any significant role in identifying applicants more likely

to pass the nursing program and the NCLEX-RN on first attempt. Of the students who withdrew

from the ADN program, 16.1% reported non-academic factors as the cause for leaving. Further

investigation of these barriers will assist to identify potential problems and provide assistance to

specifically address non-academic contributions. Recognition and improvement in such factors

could improve the admissions policy and student success at HCC.

Many ADN programs utilize a point system in the admissions process to assist in ranking

students for program consideration. Students are assigned points in identified categories with top

ranking students endorsed for admission. Many of the point systems included an interview score

to assess the non-academic factors. Further research on the ranking process and validity of such a

system, combined with the findings of this study, may provide enhanced methods for selecting

students with a higher probability of success.

While outside of the scope for the current study, progressive healthcare educators should

focus on improving the represented diversity of admitted nursing students. As reported in the

reviewed literature, gender and ethnic gaps in the nursing field are obvious (Olson, 2014);

however, the findings are contradicting and inconclusive regarding a statistical correlation

between increasing diversity and overall student success in nursing programs (Sears et al., 2015).

Future research on improving recruitment efforts of gender, cultural, and ethnic minorities may

prove beneficial to the program and the institution as a whole.

Finally, further examination of student success in prerequisite courses to determine how

academic preparedness impacts nursing school success would be of substantial benefit. Future

researchers should study grades and academic performance in prerequisite courses, particularly

in Mathematics, to determine if a C average statistically correlates to student success in the

nursing program. Attention should be drawn to the fact that in the prerequisite courses at HCC, a

70% is considered a C grade. However, in the HCC nursing program, students must maintain a

76% or higher to be eligible for continuation. This discrepancy of the grading scale could prove

statistically significant in predicting overall success.

P-20 Implications

The continual evolution of education, combined with the increasing need for healthcare

workers, has provided a platform of opportunity for progressive leaders. Future successes depend

upon the ability of institutions to implement more effective methods in selecting students for

programs with the highest probability of overall success. Research-based suggestions for

improvements validate changes made to current practice.

Transformational educational leaders must support the implementation of more effective

methods and continue further research to identify factors that predict overall student success.

Numerous qualified applicants are denied admission into the HCC nursing program due to

limitations of classroom space, clinical availability, financial constraints, and lack of faculty.

Such enrollment obstructions as these are difficult for programs and institutions to overcome,

and thus solidifies the need for research-based suggestions on improving the selective admissions

process. Innovative methods to increase the likelihood that selected students succeed have

widespread implications.

Earlier identification, progressive advising, and academic preparation of students

expressing an interest in nursing will facilitate stronger applicants with higher probability of

overall success. Institutional and program recruitment efforts must begin prior to high school,

and must be supported at all levels of education. Providing younger generations with the

resources, the tools, and the academic pathways to succeed will assist in constructing a stronger

educational future. Progressive leaders must work collaboratively from birth and beyond,

breaking down current academic silos, to produce qualified, competent, and effective graduates.

Conclusion

Growing demands for healthcare workers have grabbed the attention of higher education

programs. The responsibility to produce qualified and competent employees, helping to bridge

the current divide in healthcare, falls upon institutions like HCC. Large applicant pools of

qualified candidates are denied admission into programs for various reasons, thus selecting

students for admittance with the highest probability of program success is critical. Confirmation

that HCC’s standard practice for admission criteria identifies students more likely to complete

the nursing program and pass the nursing licensure examination validates current methods.

While the admissions methods are statistically significant, the reported correlations are weak,

suggesting room for improvement. Further research may enrich the overall admissions process

into nursing, assist to increase retention, produce more graduates employable in nursing, and

therefore significantly impact the expanding healthcare crisis.

References

Aiken, L. S. & West, S. G. (1991). Multiple regression: Testing and interpreting interactions.

Thousand Oaks, California: Sage Publications.

Alaki, S. M., Yamany, I. A., Shinawi, L, A., Hassan, M. H., & Tekian, A. (2016). Can multiple

mini-interviews predict academic performance of dental students? A two-year follow-up.

Journal of Dental Education, 80, 1376-1383.

Alameida, M.D., Prive, A., Davis, H. C., Landry, L., Renwanz-Boyle, A., & Dunham, M. (2011).

Predicting NCLEX-RN success in a diverse student population. Journal of Nursing

Education, 50, 261-267.

American Association of Colleges of Nursing (AACN). (2017). Fact sheet: Nursing shortage.

Retrieved from http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-

Shortage

Barton, L., Wilson, P., Langford, R., & Schreiner, B. (2014). Standardized predictive testing:

Practices, policies, and outcomes. Administrative Issues Journal Education Practice and

Research, 4, 68-76.

Beale, A. V. (1970). The evolution of college admission requirements. The National ACAC

Journal, 15. 20-22.

Beeman, P. B. & Waterhouse, J. K. (2001). NCLEX-RN performance: Predicting success on the

computerized examination. Journal of Professional Nursing, 17, 158-165.

Beeson, S. & Kissling, G. (2001). Predicting success for baccalaureate graduates on the NCLEX-

RN. Journal of Professional Nursing, 17, 121-127.

Beggs, C., Shields, D., & Janiszewski- Goodin, H. (2011). Using guided reflection to reduce test

anxiety in nursing students. Journal of Holistic Nursing, 29, 140-147.

Bennett, M., Bormann, L., Lovan, S., & Cobb, B. (2016). Preadmission predictors of student

success in a baccalaureate of science nursing program. Journal of Nursing Regulation, 7,

11-18.

Bissett, H.G. (1995). Selective admissions in community college nursing programs: Ethical

considerations. Community College Review, 22, 35-46.

Blackman, I., Hall, M., & Darmawan, G. N., (2007). Undergraduate nurse variables that predict

academic achievement and clinical competencies in nursing. International Education

Journal, 8, 222-236.

Blair, M. (2014, September 4). Nearly one in five new nurses leaves first job within a year,

according to survey of newly-licensed registered nurses. Robert Wood Johnson

Foundation. Retrieved from https://www.rwjf.org/en/library/articles-and-

news/2014/09/nearly-one-in-five-new-nurses-leave-first-job-within-a-year--acc.html

Blitchok, A. (2018, May 8). Top three reasons nursing schools are rejecting applicants in 2018.

Industry. Retrieved from https://nurse.org/articles/reasons-nursing-schools-reject-

applicants/

Bremner, M. N., Blake, B. J., Long, J. M., & Yanosky, D. J. (2014). Setting a benchmark for the

Test of Essential Academic Skills (TEAS) V: Striving for first-semester success in

nursing school. Journal of Nursing Education, 53, 537-540.

Briscoe, V., & Anema, M. (1999). The relationship of academic variables as predictors of

success on the National Council Licensure Examination for Registered Nurses (NCLEX-

RN) in a selected associate degree program. ABNF Journal, 10, 83-84.

Bureau of Labor Statistics (BLS). (2017). Employment projections – 2016-2026. Retrieved from

https://www.bls.gov/news.release/pdf/ecopro.pdf

Cai, J., Morris, A., Hohensee, C., Hwang, S., Robinson, V., & Hiebert, J. (2018). The role of

replication studies in educational research. Journal for Research in Mathematics

Education, 49, 2-8.

Campbell, A. R., & Dickson, C. J. (1996). Predicting student success: A 10-year review using

integrative review and meta-analysis. Journal of Professional Nursing, 12, 47-59.

Cassidy, J. C., & Johnson, R. E. (2001). Cognitive test anxiety and academic performance.

Contemporary Educational Psychology, 27, 270-295.

Center for Disease Control and Prevention (CDC). (2018). Chronic diseases: The leading causes

of death and disability in the United States. Retrieved from

https://www.cdc.gov/chronicdisease/overview/index.htm

Chen, S., & Voyles, D. (2013). HESI admission assessment scores: Predicting student success.

Journal of Professional Nursing, 29, 532-537.

Crow, C. S., Handley, M., Morrison, R. S., & Shelton, M. M. (2004). Requirements and

interventions used by BSN programs to promote and predict NCLEX-RN success: A

national study. Journal of Professional Nursing, 20, 174-186.

Daley, L. K., Kirkpatrick, B. L., Frazier, S. K., Chung, M. L., & Moser, D. K. (2003). Predictors

of NCLEX-RN success in baccalaureate nursing programs as a foundation for

remediation. Journal of Nursing Education, 42, 1-9.

Data USA. (2018) Registered Nurses. Retrieved from

https://datausa.io/profile/soc/291141/#demographics

Deluca, C. (2012). Selecting Inclusive Teacher Candidates: Validity and reliability issues in

admission policy and practice. Teacher Education Quarterly, 39, 7-31.

Dongfang, L., & Bo, X. (2017, March 2). Test anxiety: Perception of American community

college nursing students. Empirical Research in Vocational Education and Training, 9.

Retrieved from https://link.springer.com/article/10.1186/s40461-017-0048-1#citeas

Edwards, J. C., Johnson, E. K., & Molidor, J. B. (1990). The interview in the admissions process.

Academic Medicine, 65, 167-177.

Ejei, J., Rezaei, M. R., & Gholamali, M. L. (2011). The effectiveness of coping strategies

training with irrational benefits (cognitive approach) on test anxiety of students. Procedia

Social Behavioral Science, 30, 2165-2168.

Enright, M., Baldo, T. D., & Wykes, S. D. (2000). The efficiency of eye movement

desensitization and reprocessing therapy technique in treatment of test anxiety of college

students. Journal of College Counseling, 3, 36-48.

Federighi, E. (1950). The use of Chi-Square in small samples. American Physiological Review,

15, 777-779.

Feldt, R.C. & Donahue, J. M. (1989). Predicting nursing GPA and national council licensure

examination for registered nurses (NCLEX-RN): A thorough analysis. Psychological

Reports, 64, 415-421.

Frith, K. H., Sewell, J. P, & Clark, D. J. (2008) Best practices in NCLEX-RN readiness

preparation for baccalaureate student success. CIN: Computers, Informatics, Nursing, 23,

46-53.

Fowles, E. R. (1992). Predictors of success on NCLEX-RN and within the nursing curriculum:

Implications for early intervention. Journal of Nursing Education, 31, 53-57.

Gallagher, P. A., Bomba, C., & Crane, L. R. (2001). Using an admission exam to predict student

success in an ADN program. Nurse Educator, 26, 132-135.

Giddens, J. (2009). Changing paradigms and challenging assumptions: Redefining quality and

NCLEX-RN pass rates. Journal of Nursing Education, 48, 123-124.

Gillet, N., Fouquereau, E., Coillot, H., Cougot, B., Moret, L., Dupont, S.,…Colombat, P. (2017).

The effects of work factors on nurses’ job satisfaction, quality of care and turnover

intentions in oncology. Journal of Advanced Nursing, 74, 1332-1341.

Grady, P. A., & Adams, M. H. (2015). NINR/NLN co-sponsor 2015 national nursing research

roundtable: The nexus practice, research, and education for the health of the nation.

Nursing Education Perspectives, 36, 267-270.

Grant, R. (2016, February 3). The U.S. is running out of nurses. The Atlantic. Retrieved from

https://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/

Goho, J., & Blackman, A. (2009). The effectiveness of academic admission interviews: an

exploratory meta-analysis. Medical Teacher, 28, 335-340.

Haas, R. E., Nugent, K. E., & Rule, R. A. (2004). The use of discriminant function analysis to

predict student success on the NCLEX-RN. Journal of Nursing Education, 43, 440-445.

Hancock, D. R. (2010). Effects of test anxiety and evaluative threat on students’ achievement

and motivation. Journal of Educational Research, 94, 284-290.

Harding, M. (2010). Predictability associated with exit examinations: A literature review.

Journal of Nursing Education, 49, 493-497.

Harris, R. C., Rosenberg, L., & O’Rourke, M. G. (2014). Addressing the challenges of nursing

student attrition. Journal of Nursing Education, 53, 31-37.

Herrera, C., & Blair, J. (2015). Predicting success in nursing programs. Research in Higher

Education Journal, 28, 1-8.

Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates.

Journal of Nursing Education, 44, 541-547.

Hopkinsville Community College (HCC). (2018). Retrieved from www.hopkinsville.kctcs.edu

Jimenez, S. (2016, February 16). U.S. still headed for nurse shortage. Retrieved from

https://www.nurse.com/blog/2016/02/16/u-s-still-headed-for-nurse-shortage/

Johnstone, A. (2018, May 25). Gen when? Who are millennials, baby boomers, and

generation Z? The Sun. Retrieved from

https://www.thesun.co.uk/fabulous/5505402/millennials-baby-boomers-generation-

groups-z-y-x-explained/

Kaufman, K. A. (2012). Findings from the annual survey of school of nursing academic year

2010-2011. Nursing Education Perspectives, 33, 281-282.

Kavilanz, P. (2018, April 30). Nursing schools are rejecting thousands of applicants in the

middle of a nursing shortage. Retrieved from

http://money.cnn.com/2018/04/30/news/economy/nursing-school-rejections/index.html

Kelley, K. & Maxwell, S. E. (2003). Sample size for multiple regression: Obtaining regression

coefficients that are accurate, not simply significant. Psychological Methods, 8, 305-321.

Kenton, W. (2018, July 30). R-squared. Retrieved from https://www.investopedia.com/terms/r/r-

squared.asp

Kentucky Board of Nursing (KBN). (2018). Retrieved from

https://kbn.ky.gov/Pages/default.aspx

Kentucky Community Technical College System (KCTCS). (2018). Retrieved from

https://systemoffice.kctcs.edu/

Lauchner, K., Newman, M., & Britt, R. (2008). Predicting licensure success with a computerized

comprehensive nursing exam: The HESI exam. CIN: Computers, Informatics, Nursing,

26, 4-9.

Lengacher, C. A., & Keller, R. (1990). Academic predictors of success on the NCLEX-RN

examination for Associate Degree nursing students. Journal of Nursing Education, 4,

163-169.

Liu, X., Codd, C., & Mills, C. (2018). Incremental effect of academic predictors on nursing

admission assessment. Nurse Educator, 01, 23-30.

Mahaffey, E. H. (2002). The relevance of associate degree nursing education: Past, present, and

future. The Online Journal of Issues in Nursing. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJ

IN/TableofContents/Volume72002/No2May2002/RelevanceofAssociateDegree.html

March, A. L., & Robinson, C. (2015). Assessment of high-stakes testing, hopeful thinking, and

goal orientation among baccalaureate nursing students. International Journal of Nursing

Education and Scholarship, 12, 1–7.

McDonald, J. H. (2014). Handbook of biological statistics 3

edition. Baltimore, Maryland:

Sparky House Publishing.

McGahee, T. W., Gramling, L., & Reid, T. F. (2010) NCLEX-RN success: are there predictors.

Southern Online Journal of Nursing Research, 10, 208-221.

McHugh, M. L. (2013). The Chi-square test of independence. Biochem Med, 23, 143-149.

McNelis, A. M., Wellman, D. S., Krothe, J. S., Hrisomalos, D. D., McElveen, J. L., & South, R.

J. (2010). Revision and evaluation of the Indiana University School of Nursing

baccalaureate admission process. Journal of Professional Nursing, 26, 188-195.

Merkley, B. R. (2015). Student nurse attrition: A half century of research. Journal of Nursing

Education and Practice, 6, 71-75.

Morrison, S., Adamson, C., Nibert, A., & Hsia, S. (2005). HESI exams: An overview of

reliability. CIN: Computers, Informatics, Nursing, 23, 39-45.

Nardi, D. A., & Gyurko, C. C. (2013). The global nursing faculty shortage: Status and solutions

for change. Journal of Nursing Scholarship, 45, 317-326.

National Council of State Boards of Nursing. (2018). Retrieved from

https://www.ncsbn.org/testplans.htm

National League for Nursing (NLN). (2018). Retrieved from http://www.nln.org/about/mission-

goals

National League for Nursing (NLN). (2016). Retrieved from

http://www.nln.org/newsroom/news-releases/news-release/2016/03/31/new-pre-

admission-exam-(pax)-for-rn-and-pn-applicants

National League for Nursing (NLN) Testing Services. (2016). Retrieved from a

https://www.everettcc.edu/files/programs/health-sciences-public-

safety/nursing/composite_percentile_conversion.pdf

National League for Nursing (NLN). (2012). The fair testing imperative in nursing education.

NLN Board of Governors. Retrieved from http://www.nln.org/docs/default-

source/about/nln-vision-series-%28position-statements%29/nlnvision_4.pdf

Newton, S. E., Smith, L. H., Moore, G., & Magnan, M. (2007). Predicting early academic

achievement in a baccalaureate nursing program. Journal of Professional Nursing, 23,

144-149.

Norton, C. K., Relf, M. V., Cox, C. W., Farley, J., Lachat, M., Tucker, M., & Murray, J. (2006).

Ensuring NCLEX-RN success for first-time test takers. Journal of Professional Nursing,

22, 322-326.

Nursing Statistics. (2018). Retrieved from https://minoritynurse.com/nursing-statistics/

Olson, M. (2014, January). Men in nursing. Western Nurse, 4-5.

Partnership for Solutions. (2004, September 1). Chronic conditions: Making the case for ongoing

care. Johns Hopkins University. Retrieved from

http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf

Patrick, M. (2017, April 10). Kentucky hospitals struggling to find enough nurses; Colleges

working toward finding a solution. Kentucky Health News. Retrieved from

http://www.nkytribune.com/2017/04/kentucky-hospitals-struggling-to-find-enough-

nurses-colleges-working-toward-finding-solutions/

Pollard, K. M., & Scommegna, P. (2014, April 16). Just how many baby boomers are there?

Population Reference Bureau. Retrieved from

https://www.prb.org/justhowmanybabyboomersarethere/

Rancoli, M., Lisanti, P., Falcone, A., (2000). Characteristics of baccalaureate graduates and

NCLEX-RN performance. Journal of New York State Nurses Association, 31, 17-19.

Randolph, P. K. (2017). Standardized testing practices: Effect on graduation and NCLEX pass

rates. Journal of Professional Nursing, 33, 224–228.

Rajacich, D., Kane, D., Williston, C., & Cameron, S. (2013). If they do call you a nurse, it’s

always a ‘male nurse’: Experiences of men in the nursing profession. Nursing Forum, 48,

71-80.

Registered Nursing. (2018). Kentucky RN programs. Retrieved from

https://www.registerednursing.org/state/kentucky/

Romeo, E. M. (2013). The predictive ability of critical thinking, nursing GPA, and SAT scores

on first time NCLEX-RN performance. Nursing Education Perspectives, 34, 248-253.

Rosenberg, L., Perraud, S., & Willis, L. (2007). The value of admission interviews in selecting

accelerated second-degree baccalaureate nursing students. Journal of Nursing Education,

46, 413-416.

Santa Monica College. (2017). Retrieved from

http://www.smc.edu/AcademicPrograms/HealthSciences/Nursing/Pages/--Admission-

Assessment-FAQs.aspx

Sayles, S., Shelton, D., & Powell, H. (2003). Predictors of success in nursing education. ABNF

Journal, 14, 116-120.

Schmidt, B. & MacWilliams, B. (2011). Admission criteria for undergraduate nursing programs.

Nurse Educator, 36, 171-174.

Shultz, C. (2010). High-stakes testing!? Help is on the way. Nursing Education Perspectives, 31,

205.

Seago, J.A., Keane, D., Chen, E., Apetz, J., & Grumbach, K. (2012). Predictors of students’

success in community college nursing programs. Journal of Nursing Education, 51, 489-

495.

Sears, N. A., Othman, M., & Mahoney, K. (2015). Examining the relationships between

NCLEX-RN performance and nursing student factors, including undergraduate nursing

program performance: A systematic review. Journal of Nursing Education and Practice,

5, 10-15.

Seldomridge, L., & DiBartolo, M. C. (2004). Can success and failure be predicted for

baccalaureate graduates on the computerized NCLEX-RN? Journal of Professional

Nursing, 20, 361-368.

Simon, E. B., McGinniss, S. P., & Krauss, B. J. (2013). Predictor variable for NCLEX-RN

readiness exam performance. Nursing Education Research, 34, 18-25.

Skillman, S. M., Keppel, G. A., Patterson, D. G., & Doescher, M. P. (2012). The contributions of

community colleges to the education of Allied Health professionals in rural areas of the

United States. WWAMI Rural Health Research Center. Retrieved from

http://depts.washington.edu/uwrhrc/uploads/RHRC_FR136_Skillman.pdf

Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United

States. Nursing Economics, 34, 98-100.

Southern Association of Colleges and Schools Commission on Colleges (SACSCOC). (2018).

Retrieved from www.sacs.org.

Stickney, M. C. (2008). Factors affecting practical nursing student attrition. Journal of Nursing

Education, 47, 422-425.

Stanley, D., Beament, T., Falconer, D., Haigh, M., Saunders, R., Stanley, K.,…Nielson, S.

(2016). The male of the species: A profile of men in nursing. Journal of Advanced

Nursing, 72, 1155-1168.

Stuenkel, D. L. (2006). At risk students: Do theory grades + standardized testing = success?

Nurse Educator, 31, 207-212.

Swick, S. S., & Callahan, R. (2016). Barron’s nursing school entrance exams, 5

edition.

Hauppauge, New York: Barron’s Educational Services, Inc.

Tagher, G. (2017). Do standardized tests have to be high stakes? Lippincott Nursing Education.

Retrieved from

http://nursingeducation.lww.com/blog.entry.html/2017/10/12/do_standardized_test-

DicQ.html

Tipton, P., Pulliam, M., Beckworth, C., Illich, P., Griffin, R., & Tibbitt, A. (2008). Predictors of

Associate Degree nursing students’ success students. Southern Online Journal of Nursing

Research, 8. Retreived from

http://www.resourcenter.net/images/snrs/files/sojnr_articles2/vol08num01art02.html

Trice, L. B., & Foster, P. H. (2008). Improving nursing school diversity through use of a group

admission interview. AORN Journal, 87, 522-532.

Ukapabi, C. (2008). Predictors of successful nursing education outcomes: A study of the North

Carolina University nursing program. Nursing Research Quarterly, 32, 30-40.

Uyehara, J., Magnussen, L., Itano, J., & Zhang, S. (2007). Facilitating program and NCLEX-RN

success in a generic BSN program. Nursing Forum, 42, 31-38.

Varma, S. (2006). Preliminary item statistics using point-biserial correlation and p value.

Educational Data System, Inc.. Retrieved from

https://jcesom.marshall.edu/media/24104/Item-Stats-Point-Biserial.pdf

Wang, H. F., & Yeh, M. C. (2005). Stress, coping, and psychological health of vocational high

school nursing students associated with a competitive entrance exam. The Journal of

Nursing Research, 13, 106-115.

Wolkowitz, A. A., & Kelley, K. A. (2010). Academic predictors of success in a nursing program.

Journal of Nursing Education, 49, 498-503.

Yoho, M., Young, A., Adamson, C., & Britt, R. (2007). The predictive accuracy of Health

Education Systems, Inc., examinations for associate degree nursing students. Teaching

and Learning in Nursing, 2, 80-84.

Young, S. D. (2018, May 1). Despite shortage, nursing schools reject thousands of applicants.

Consumer Affairs. Retreived from https://www.consumeraffairs.com/news/despite-

shortage-nursing-schools-reject-thousands-of-applicants-050118.html

Zargarzadeh, M., & Shirazi, M. (2014). The effect of progressive muscle relaxation method on

test anxiety in nursing students. Iranian Journal of Nursing and Midwife Research, 19,

606-612.

Appendix A