Abstract
This article presents a nursing faculty department's strategy to empower nursing students identified as being at risk for not passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) on the first attempt while significantly increasing the nursing program's overall first-time NCLEX-RN pass rate. These students were identified as being at risk because of their low scores on standardized assessments with national norms predicting the likelihood of passing the NCLEX on the first attempt. This account details the NCLEX-RN Coaching Partnership as an exemplar to support nursing students’ success through caring relationships with nursing faculty. Faculty coaches offered support, fostered confidence, and maintained accountability with the identified nursing students. The students provided positive feedback regarding the NCLEX-RN Coaching Partnership and ultimately attributed their passing to the coaching relationships. Seven of the eight identified students passed the examination on the first attempt; the overall program's first-time NCLEX-RN pass rate increased significantly from 78% to 90%.
Passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) has far-reaching implications for nursing students, schools of nursing, and the general public. Passing the NCLEX-RN indicates that students have acquired the basic knowledge required for safe nursing practice. Graduates of individual schools of nursing must achieve a cumulative benchmark first-time pass rate on the NCLEX-RN in order for that school to retain accreditation. The intention of licensure is to protect the public and to maintain patient safety (Quinn, Smolinski, & Peters, 2018).
Review of Literature
Nursing literature on coaching has focused on topics related to professional development, nursing leadership, and clinical specialty practice. Few studies have examined the effect of faculty coaching programs on NCLEX-RN success. Brown-O'Hara (2013) investigated the influence of academic coaching on baccalaureate nursing students’ academic success, perceptions of coaching, perceived readiness, and success on the NCLEX-RN. This doctoral dissertation is the only study, which investigated the effect of faculty coaching on NCLEX-RN success. Academic coaching is associated with a high first-time passing rate by students taking the NCLEX-RN. McGann and Thompson (2008) explored factors related to academic success in at-risk senior nursing students who were enrolled in Academic Improvement Strategies, a one-credit course required of students who failed to meet the nursing program's grade requirement of 80%. This study suggested that faculty support and tutoring can contribute to the academic success of at-risk nursing students; however, success on the NCLEX-RN was not specifically addressed. Mondeik (2014) concluded that professional registered nurse tutors can contribute to NCLEX-RN success. Gibbons, Dempster, and Moutray (2011) suggested that peer tutors can improve NCLEX-RN pass rates. The literature on faculty coaching to support student success on the NCLEX-RN remains sparse. There is a need for more research in this area to provide nurse educators with evidence-based teaching strategies.
Purpose of Nclex-Rn Coaching Partnership
The purpose of the NCLEX-RN Coaching Partnership program was to address the NCLEX-RN first-time pass rate of our prelicensure baccalaureate nursing (BSN) program located in a regional public university in the northeastern United States. In order to address the NCLEX-RN pass rate, below the 80% required by the state regulators and the accrediting organization, our nursing faculty created a strategic initiative for student success on the NCLEX-RN. Following the completion of the academic year, we piloted the NCLEX-RN Coaching Partnership to provide guidance and support to students at risk for failing the NCLEX-RN. The program lasted approximately 6 weeks following graduation. Seven faculty members volunteered to serve as faculty coaches. Despite not receiving any monetary compensation, faculty members participated in the program to support the students and the nursing program's success.
Mentoring involves a formal, long-term relationship between a strategically paired mentor and a mentee typically focusing on the attainment of professional goals (Vance & Nickitas, 2014). Coaching represents one component of mentoring (Clarke, 2008). Coaches assist individuals to immediately improve their performance and to enhance their skills through training and instruction (Goldsmith, Lyons, & Freas, 2000). Unlike mentors, coaches provide structured short-term support focused on resolving problems, developing competency, and attaining specific goals (Garvey, Stokes, & Megginson, 2018). Coaching can be more useful than mentoring at the beginning of one's career (Fielden, Davidson, & Sutherland, 2009). The students in our coaching program were just beginning their nursing careers, and they were focused on passing the NCLEX. The coaching program served as a short-term intervention to achieve success on the NCLEX. Coaching was more appropriate than mentoring to enhance students’ test-taking skills and ultimately to become registered nurses. Coaching provided the ideal structure to support our students to pass the NCLEX on the first attempt.
Theoretical Foundation
Swanson's Theory of Caring (1991) was selected as the theoretical foundation for the NCLEX-RN Coaching Partnership. This midrange theory includes five caring processes: knowing, being with, doing for, enabling, and maintaining belief (p. 163). Faculty coaches applied Swanson's caring processes throughout the coaching relationships. Knowing and being with denote striving to understand the meaning of significant life events and being present, both physically and emotionally. The faculty coaches have known the students through prior teaching and advisement. They understand their personal and academic strengths and limitations. Faculty coaches recognize the profound significance of passing the NCLEX-RN. They acknowledge that passing the NCLEX-RN will enable the students to fulfill their dreams of being registered nurses. The faculty coaches are physically and emotionally present to the students through face-to-face meetings, e-mails, text messages, and telephone calls. Doing for corresponds to skillfully intervening with dignity and respect. During individualized sessions, the faculty coaches are doing for the students by developing study plans, reviewing test-taking strategies, and delivering nursing content. They identify resources and suggest plans to remove barriers to success. Enabling and maintaining belief represent supporting the individual's transition through a significant life event while maintaining faith in the individual's ability to successfully transition. Faculty coaches support students through the transition from nursing students to registered nurses. Students commonly have doubts that they will not successfully pass the NCLEX-RN on the first attempt. Faculty coaches maintain hope and optimism that students have the capacity to pass the NCLEX-RN on the first attempt. The faculty act as coaches without compensation, demonstrating caring and commitment to the students and the nursing program.
In keeping with the theme of this issue of Creative Nursing, Cornerstones of Healing: Uncovering Hidden Resources, we discovered the hidden resource of individual nursing faculty members’ willingness to volunteer extra time and energy to enable nursing students to pass the NCLEX-RN on the first attempt. Nursing faculty facilitated success through caring relationships.
Nclex-Rn Coaching Partnership Program
All senior nursing students completed a capstone course focused on standardized testing in the final semester of the nursing program. This course enabled students to identify strengths and gaps in knowledge to prepare for the NCLEX-RN. Eight students consistently scored below benchmark standards and were identified as at risk for failing the NCLEX-RN. During a nursing department meeting, one faculty member proposed the NCLEX-RN Coaching Partnership Program. All faculty members were invited to participate in the program. Seven of eight full-time faculty members volunteered to serve as coaches. Preparation for the coaching program took place during this faculty meeting. Faculty discussed the goals of the program along with the strategies for coaching. They agreed to an emergent design since this was a new initiative. They also agreed to individualize their coaching based on the needs of their particular student(s). Faculty members designated particular students to be assigned to particular faculty coaches based on preexisting relationships, personality styles, and logistics. Coaches then contacted students and formally invited them to participate in the NCLEX-RN Coaching Partnership. All eight students agreed to participate and were contacted to schedule their first meetings.
Coaches encouraged students to utilize the nursing process to analyze questions and eliminate incorrect answers.
During the initial coaching sessions, faculty coaches engaged in honest dialog with their respective students about specific learning needs and established a contract clarifying expectations, confirming priorities, and establishing accountability. Together they created study schedules detailing the hours and days when the students planned to study and take breaks. As part of this plan, students committed to completing an increasing number of practice questions each day. Coaches encouraged students to prioritize studying for the NCLEX-RN from the period immediately following graduation until their scheduled examination. Most students scheduled the NCLEX-RN 4 to 6 weeks after graduation. Faculty coaches and students identified possible barriers to studying; coaches encouraged students to limit working, traveling, and/or engaging in social activities (including social media) as much as possible. To maintain accountability, students and coaches each retained a written copy of the plan. Students and coaches planned to continue the coaching relationship until the students took the NCLEX-RN.
During coaching sessions, faculty members provided individualized instruction. The length of sessions varied from 30 to 60 minutes based on the students’ needs. Some dyads reviewed questions from NCLEX-RN books and Web-based programs. This instruction was not based on clinical content; rather, it focused on utilizing test-taking strategies and reinforcing the process of correctly answering questions. Analyses of questions and the correct response(s) strengthened the students’ knowledge. Coaches encouraged students to utilize the nursing process to analyze questions and eliminate incorrect answers. Students initially completed shorter sets of questions, ultimately building up to answering 265 questions per session. Students completed the questions prior to meeting with their coaches. Prior to the close of each session, a subsequent coaching session was scheduled at a mutually agreed-upon time and location. Accountability was maintained throughout the coaching relationship. Coaches verified that students followed the agreed-upon study plans through text messages, phone calls, and e-mails. The faculty coaches ensured that the fidelity of the coaching program was maintained by regularly communicating as a group through e-mail.
Coaches were available to students between sessions. Since anxiety regarding taking the NCLEX-RN exam is common, some coaches encouraged students to utilize relaxation techniques including slow-paced breathing, guided imagery, and/or meditation. Coaches also encouraged students to maintain self-care, incorporating healthy nutrition, adequate sleep, exercise, and scheduled relaxation between studying sessions. Coaches encouraged students to schedule the NCLEX-RN exam at an optimal time and location for themselves.
The NCLEX-RN Coaching Partnership offered participating students a way to maximize their likelihood of passing the NCLEX-RN on the first attempt and to construct a plan for success. Coaches reiterated that without a comprehensive study plan, students remained at risk for failing the NCLEX-RN. The coaches’ use of retraining changed the perception of the low examination scores that initially identified students as at risk for failing the NCLEX-RN from a threat of impending failure to an opportunity for success.
Results
Both students and faculty shared positive feedback regarding the NCLEX-RN Coaching Partnership. The students appreciated the faculty support and shared that the coaching increased their confidence and readiness for the NCLEX-RN. Students also expressed that the coaching could have been even more beneficial if initiated earlier in their senior year of the nursing program. Faculty coaches expressed satisfaction with the program, describing the coaching relationship as rewarding and worthwhile. Seven of the eight students identified as at risk for failing the NCLEX-RN passed the examination on the first attempt. The remaining student who was not successful on the first attempt passed on the second attempt. The BSN program's first-time NCLEX-RN pass rate for the entire graduating class increased to 90% from 78% the prior year. Both faculty and student participants recommended that the school continues to offer the NCLEX-RN Coaching Partnership to all students identified as at risk for failing the NCLEX-RN.
Challenges
Some challenges surfaced during the coaching relationships. One student did not maintain regular contact with her coach. The coach needed to consistently pursue contact with this student through text messages, e-mails, and telephone calls. Initial goals needed to be reevaluated, and plans needed to be renegotiated. The coach reminded the student of the ultimate goal: to pass the NCLEX-RN on the first attempt.
The coaches’ use of refraining changed the perception of low examination scores from a threat of impending failure to an opportunity for success.
Some students were hesitant to schedule their examinations based on fear of failing. Coaches encouraged these reluctant students to adhere to their daily studying plan ultimately leading up to their scheduled examination dates. Coaches collaborated with students to revise study plans and priorities as needed. Honest dialog allowed the dyads to work through challenges and meet mutually agreed-upon goals to support the students’ success.
Conclusion
The NCLEX-RN Coaching Partnership was developed to improve the first-time pass rate of the students in our nursing program. The program identified students at risk for failing the NCLEX-RN and paired these students with faculty coaches to provide individualized NCLEX-RN preparation plans. The NCLEX-RN Coaching Partnership demonstrated success as illustrated by the improvement in the entire nursing student cohort's NCLEX-RN pass rate from 78% to 90%. This coaching program made a positive impact on the student participants in the NCLEX-RN Coaching Partnership as well as the entire nursing program. Student feedback was unanimously positive, and students attributed their passing the NCLEX-RN on the first try to the coaching program. There is clearly a need to identify strategies to improve the first-time pass rate on the NCLEX-RN. Further research in this area is needed to investigate the impact of faculty coaching on NCLEX-RN success.
Footnotes
Michele M. McKelvey, PhD, RN, is an Assistant Professor of Nursing at Central Connecticut State University in New Britain, Connecticut and practices as a Registered Nurse at St. Francis Hospital and Medical Center in Hartford, CT.
Kerri M. Langevin, MSN, APRN, PC-PNP-BC, is an Assistant Professor of Nursing at Central Connecticut State University in New Britain, Connecticut and practices as a Pediatric Nurse Practitioner in a juvenile detention center.
Leona Konieczyny, DNP, MPH, RN-BC, CNE, is an Associate Professor of Nursing and the department chairperson at Central Connecticut State University.
Jill M. Espelin, DNP, APRN, CNE, PM-HNP-BC, is an Assistant Professor of Nursing at Central Connecticut State University in New Britain, Connecticut and practices as a Psychiatric Mental Health Nurse Practitioner.
Nancy Peer, PhD, RN, CNE, is an Associate Professor of Nursing at Central Connecticut State University in New Britain, Connecticut. Her specialty is MedicaI-Surgica Nursing.
Stacy Christensen, DNP, APRN, CCHP is an Associate Professor of Nursing at Central Connecticut State University in New Britain, Connecticut and practices as a Nurse Practitioner.
Catherine Thomas, DNP, RN, CNE, is an Assistant Professor of Nursing at Central Connecticut State University in New Britain, Connecticut. Her specialties include Critical Care and Medical-Surgica Nursing.