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April, May, June 2010

ANA\C The Nursing Voice • Page 5

Nursing Education

New Nurse Testing Standard Raises Bar

NLN Annual Survey of Schools of Nursing

Joanie Alston Lovelace, MBA, RN, NHA, resident services administrator at Barclay Friends in West Chester, PA., believes that “a test score does not always reflect the knowledge level of an individual.” “The new nurses coming out of school today are very ‘book’ smart, however they lack the hands-on experience of the ‘old’ school nurses,” says Lovelace. “There needs to be more clinical time incorporated into the learning process. The new nurses also are not truly prepared for what they will face in a new position. In school, they have maybe three patients to take care of in their last year of school and when they are in the work setting they could have as many as 15.”

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Judy Dodge of the Indiana Heart Hospital has mixed feelings about raising the passing standard of the NCLEX. “I do feel that 75 questions don’t seem like enough to cover all the processes and diseases that one learns over the course of their education. I realize one cannot cover everything, but it just seems like such a very small sample,” she says. The higher standard is the result of NCSBN’s regular plans to reevaluate the test and passing standard every three years to ensure both stay current and reflect the care nurses will give their patients. Lovelace, Nappi, and Dodge believe that changing the passing standard is only part of the solution, and is one of the many steps the nursing profession should take to safeguard the patients.

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The majority of prelicensure programs are “highly selective.” Almost two thirds of ADN and diploma programs (62 and 60 percent, respectively) were “highly selective”—a designation earned by those programs that accept fewer than half of all

Demand for admissions continues to outstrip supply. Nearly one quarter (23.4 percent) of US nursing programs of all types reported receiving more qualified applications than could be accepted in 2008. Among prelicensure programs, there was considerably more unmet demand for admissions; more than 119,000 qualified applications—or 39 percent of all qualified applications—were turned away from prelicensure programs in 2008.

The amount of care required by hospitalized patients seems to grow every year, and many nurses in the field question whether recently-graduated nurses are sufficiently prepared to take on the demanding task. Josephine Nappi, MA, RN, director, nursing professional development for nursing education at Memorial Sloan-Kettering Cancer Center, in New York, NY, agrees there is an added amount of care needed for those who are hospitalized. “Our patient acuity rises daily, our aged population presents additional challenges, and at the same time knowledge and technology increase exponentially. Individuals new to our profession must translate what they have learned in their basic nursing programs into practice rapidly,” says Nappi.

The National Council of State Boards of Nursing (NCSBN) considers this a major issue and recently raised the passing standard on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to ensure new nurses are sufficiently ready to take on the growing needs of sicker patients. The higher passing standard was voted on in December 2009 and will go into effect on April 1, 2010. Nurses will be granted a passing grade with a -0.16 as opposed to a -0.21.

Notable findings from the 2009 NLN Annual Survey of Schools of Nursing include as the recession hits, the expansion of educational capacity stalls as insufficient faculty is the major constraint to the expansion of post- licensure programs. Since the 1950s, the NLN has conducted an annual survey of all nursing programs in the United States, gathering key statistics including admissions, enrollments, graduations, student demographics, and numbers of faculty (New York, NY—February 9, 2010).

The 2009 annual survey was administered from May to September 2009 to obtain 2007-2008 data. In announcing the results, NLN CEO Dr. Beverly Malone pointed out some of the new topics addressed by the 2009 survey. “These data are critical to tackling challenges related to the nursing education workforce and nursing education capacity. Recent additions include unused educational capacity, constraints on expanding admissions, faculty vacancies and recruitment, and the impact of faculty shortages on educational capacity.”

Findings include:

Key statistics reflect slowing growth. Expansion in the number of prelicensure RN programs ground to a near halt between 2007 and 2008, with the nation adding only 15 additional programs, a less than 1 percent increase. In addition, in a surprising turnaround, annual admissions to prelicensure nursing programs fell and enrollments were flat for the first time in at least six years. Graduations did increase significantly in 2008, a lagging effect of an upsurge in admissions between 2003 and 2005.

applicants. Fewer baccalaureate programs (39 percent) fell into that category.

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    Shortages of faculty and clinical placements constrain growth. Among schools that did not accept all qualified applicants, postlicensure programs were much more likely to cite a shortage of faculty as the main obstacle to expansion. Prelicensure programs reported that lack of clinical placement settings were the biggest impediment to admitting more students.

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      Postlicensure programs are much more likely to report that adding faculty would expand admissions capacity. Almost three quarters of RN-BSN programs, over two thirds of master’s programs, and over half of doctoral programs projected that filling all faculty vacancies would positively impact admissions. By contrast, only 41 percent of prelicensure RN and only 29 percent of LPN/LVN programs anticipated that full staffing would allow for expansion.

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    Some seats still go unfilled. Just under one in 10 US nursing programs (9.8 percent) reported unfilled vacancies for new student admissions. Of those schools with unfilled spots, 44 percent attributed the vacancy rate to a lack of qualified students; 19 percent stated that “lack of affordability” or “high cost of education” was the main obstacle to student recruitment.

Observed NLN president Dr. Cathleen Shultz, “Nursing Data Review will be invaluable to decision-makers, organizations, and individuals interested in data reflecting the state of nursing education. It will serve a critical role in models designed to project the magnitude of the future registered nurse workforce. The League appreciates the survey responses provided by literally thousands of nursing school deans, directors, chairpersons, program administrators, and their hardworking staff members, without whom this valuable data source could not have been created.”

Please note: NLN research data is available to all on the NLN website. NLN DataView(tm) , at www.nln.org/ research/slides/index.htm, features slides and tables from key NLN data reports as PDFs, MS PowerPoint(tm) slides, MS Excel(tm) charts, and JPG images.

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