National American University is a for-profit university with several campuses throughout the US. The South Dakota campuses in Sioux Falls and Rapids City offer a pre-licensure Bachelor of Science in Nursing program, which is accredited by the Commission on Collegiate Nursing Education.
National American University’s Nursing Program Chair for South Dakota campuses discusses how her faculty’s optimized use of HESI and EAQ across campuses improved its NCLEX® pass rate.
When Dr. Lori Bork, RN, MSN, PhD, CCRN, joined National American University in 2016 as the program chair for its two School of Nursing campuses in South Dakota, she set her sights on improving its struggling NCLEX® scores.
“When I started, NCLEX scores were in the 50s,” Bork said. “NAU had been on interim status since the beginning of the program with the Board of Nursing in South Dakota because they had never been able to get their NCLEX scores above the 75% pass rate for two consecutive years. I certainly had a huge interest in making sure that we rose our NCLEX scores significantly.”
However, it would prove to be a challenge. Bork’s campuses in Sioux Falls and Rapid City are 375 miles apart but are viewed as one combined group for the NCLEX. Because of this, she knew it would be crucial for both campuses to operate in the same way and work together.
Mapping the Curriculum and Implementing Changes
NAU was using HESI Case Studies, Patient Reviews, and Elsevier Adaptive Quizzing when Bork joined the program, but they were being used inconsistently or not at all. Bork decided the first step to getting the program back on track would be to map the curriculum to identify areas that were potentially over- or under-emphasized. To her surprise, the curriculum was in pretty good shape.
“Once the curriculum mapping was complete, then we really worked on mapping EAQ to each individual course, mapping the case studies to each individual course, and mapping the patient reviews to each individual course,” Bork said.
NAU began using EAQ for fundamentals and med-surg in the beginning of the program and incorporated EAQ for the NCLEX-RN into the fourth quarter.
Next, Bork reviewed their exams. During this time, NAU was using ATI; however, Bork felt it was time to switch to HESI.
“I thought if we’re going to use a lot of these Elsevier products, then it probably makes the most sense to use HESI Specialty Exams also,” Bork said. “So, I really championed for using HESI and, luckily, we were able to do that.”
Bork also added HESI/Saunders Online Review to the last quarter when students complete their practicum. Students are required to complete the review modules available in HESI/Saunders Online Review, which Bork said allows them to stay fresh on their test-taking skills.
With these various changes and additions implemented, NAU’s NCLEX scores revealed it was paying off.
“We ended up with an 83% overall NCLEX pass rate, which was the highest pass rate NAU ever had at the South Dakota campuses in the five years that they had a nursing program,” Bork said. “We really thought at that point, we’re on to something.”
Setting the Bar High with HESI
When NAU switched to HESI, Bork explained her program set the benchmark score for all HESI Specialty Exams at 900 and implemented strict HESI testing policies.
“We’ve had 18 students test, and about 13 or 14 of those have passed on 75 questions,” Bork said. “I think that says a lot about expecting 900.”
As far as HESI policies, NAU places a strong emphasis on exam preparation. For instance, if students have not prepared for their HESI exam, then they are not allowed to test.
“Students are required to complete the practice tests and the practice exams for each specialty exam,” Bork said. “They have to reach a 95%. If they don’t reach a 95%, then they’re not allowed to test. If they don’t complete it, then they’re not allowed to test.”
Bork has implemented a HESI remediation policy as well. Regardless of how a student scores on HESI, every student is required to complete a minimum of four hours of remediation. Additionally, to identify areas of weakness earlier in the program, faculty use a spreadsheet to track students’ HESI scores, the number of times they took each HESI exam, and their scores from HESI/Saunders Online Review.
“So many of us who have taught for years would always go, ‘Oh gosh, this student is really struggling’ when they got to the end of the program,” Bork said. “’I wonder what we should do with him/her?’ Well, by then, it’s too late. Frankly, we look at these spreadsheets and if we see a student consistently having to test twice to get above the benchmark, we talk to them. We ask them if they’re struggling with the technology, with the test taking, and what else they can do to prepare?”
At the end of the program, Bork explained that they do not release students’ grades until they have met with faculty to determine a study plan based on their individual spreadsheet.
“When you set that expectation really high, I think students understand what you’re telling them to do is in their best interest,” Bork said.
Optimizing with EAQ
Since Bork’s initial changes to the program, she has worked with her faculty to continually optimize and improve their use of Elsevier products and make additional changes where they see fit.
For example, they decided to attach a grade to the HESI Saunders Online Review and EAQ completion. Since implementing this, Bork said it has helped students see the value of these tools.
“When you establish that culture early and you establish that expectation early, students buy in to it,” Bork said. “It’s so funny, now we have junior students that are asking if we’ll wipe their EAQ clean so they can start over again.”
Bork explained that 78% of a student’s grade is testing and the remaining 22% comes from assignments, which are typically EAQ.
“We always tell students, one of the reasons you should care about EAQ is if you plan to go on further to grad school, you have to have a certain GPA and this is a way to really help your GPA,” Bork said. “Plus, it’ll help your NCLEX success by doing this.”
Faculty have also incorporated EAQ into clinical. Bork explained that in the seventh quarter, students work with a case manager for five to six hours in the morning and then afterwards are required to write a paper and complete the case management section in EAQ.
“When students are in clinical and they’re seeing these things, then they can get those questions that apply to what they’ve already done, it makes it more palatable for them to want to do it,” Bork said. “They realize, ‘Oh, I just saw this during clinical and now I’m getting a question about it.’”
Collaborating Across Campuses to Gain Faculty Buy-In
Bork, who has her doctorate degree in online learning, loves technology and has been able to convey its importance to her faculty.
“I see the value of technology in the way students learn,” Bork said. “It’s all there for you and it’s all tailored to the book. You can choose what you think your students need. There’s just so much value to not having to spend time developing, and instead choosing what will make my students more successful.”
Bork said she has been fortunate to have faculty that have bought in to using the technology and embrace it by collaborating across campuses. However, if they are going to be trying something new, Bork is sure to provide appropriate training.
“It’s interesting because two weeks before every quarter, my faculty are on the phone with each other going, ‘OK, we’re going to do this’ or ‘let’s tweak this,’” Bork said. “Whoever is teaching the same courses at each campus, they get on the phone and talk and discuss.”
Advice for Faculty
Bork highly recommends mapping tools to courses to make it less overwhelming for faculty. By doing this, faculty will know ahead of time where they will be using the tools. Additionally, she said it is important to make sure faculty can partner with a mentor who knows the products and can answer questions.
“One of the things that I think has made us successful is using all of the products, all at the same time, all together,” Bork said. “That, I think, has been the big difference. We haven’t left anything out.”