Remediation | The key to success in nursing programs
Remediation THE KEY TO SUCCESS IN NURSING PROGRAMS
Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting
“Nursing school is not like any education I have ever experienced before!”
Most faculty have heard students say this many, many times. And the students are right. Nursing school is not like high school or other undergraduate programs. Nursing curricula cover a wide range of content in a relatively brief period of time and the expectation is that students must not only digest the information, but also learn to apply it in clinical experiences with real patients for whom they are responsible. No wonder nursing students are stressed out and may not do as well in the nursing courses (and examinations) as they have done in previous classes in high school and college. What can nurse faculty do to help students progress successfully through nursing school? How can they provide support for students as they transition to this new way of studying? This paper provides suggestions related to admission processes, orientation for beginning students and identification, as early as possible, of strategies for students who struggle with various areas of the curriculum. It also identifies effective remediation interventions and provides suggestions for coordinating and evaluating the remediation process.
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Admission The Hechinger Report (2017) noted that most colleges enroll students who are not prepared for higher education. While most colleges and universities provide remediation courses to help students make up their deficits early in their college experience, some of these deficits may still be present as they apply to nursing programs. Spots in most nursing programs are at a premium and the nursing shortage is real, so we want to choose students who have the best chance of being successful in nursing school, on the NCLEX®, and certainly in practice. Choosing students who will do well in nursing school through careful, evidence-based admission procedures is critically important for the student and the school. Yet, how can we be sure who are the best candidates? Good grades may or may not give us a complete picture. Given the complex set of skills required to be a nurse, many nursing programs are broadening their admission process to consider qualitative data, too. Insights drawn from interviews, or letters of reference from those who can speak to the students’ abilities, can be extremely helpful in identifying students who don’t stand out based on test scores. This broader perspective can help programs select students with a more diverse set of talents. However, quantitative measures are also important to develop a complete picture. Admission tests designed specifically for nursing programs can give faculty information that can round out a student’s profile. Scores that illustrate the student’s knowledge or skill in science, math, and reading comprehension provide some understanding of the student’s readiness for nursing. Reading comprehension skills are particularly important, because of the breadth of information the student must read and comprehend to be successful. To address both the qualitative and quantitative aspects of a student’s skill set, many programs use a formula for admission, indicating points for each area they consider in the evaluation process, based upon the importance of the measure in describing the aptitudes of the student. Regardless of the criteria chosen, students who meet or exceed established criteria are more likely to be successful in the first year of nursing programs (Mee & Schreiner, 2016). Box A outlines the most common measures used as part of an admission process.
Box A: Criteria for Admission
College GPA
§ § §
High School GPA ACT or SAT Scores
§ GPA in selected courses taken in high school/college § Reference Letters § Interviews § Standardized entrance exam: • Math competency • Vocabulary • Reading competency • Science • Critical Thinking Assessment “No one size fits all nursing programs”
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Ongoing Support Throughout the Program Admitting the “right” students is not enough to ensure student success. Even students who meet or exceed all the criteria established by the program, may struggle in some areas of nursing school. For that reason, remediation processes, often referred to as student success programs which are threaded throughout the course of study provide the most significant support. Mee and Schreiner (2016) define effective ongoing remediation as a structured process which includes multiple modes of instruction consistently implemented throughout the nursing program. Let’s consider an example of a structured process consistently implemented throughout the program. Orientation The first step in this process might include an orientation program for students as they enter the nursing program . All students will benefit from such a program. Content for such an orientation programmight include: § Expectations of the program and reasons for these expectations § Time management strategies § Studying in nursing programs § Strategies for test-taking, both faculty-made and standardized § Availability of support throughout the nursing program Support for “At Risk” Students throughout the Program Identifying students who may be at risk for failure is critical to early intervention. As a first step, students whose scores on standardized admission tests are only slightly above the benchmark established either by the nursing programor the publisher of the standardized test should bemonitored and supported. Such identification often poses an ethical dilemma. Faculty may be concerned that labeling student “at risk” before they have an opportunity to succeed can foster a sense of hopelessness and failure in these students. The faculty play a significant role in managing such a situation, pointing out that most of us have some limitations that can be shored up by learning new strategies. Other students whowill benefit fromongoing support include those whose test scores on faculty-made tests fall below the passing score established by the faculty. Similarly, students who do not meet or exceed the benchmark in standardized specialty tests may benefit from remediation. Equally important, students whose final grade in a course is only points above a passing grade will benefit from such support. At times, those students with significant problems demonstrated in clinical experience may also require remediation. Importantly, students may move in and out of the remediation program as they demonstrate increased competence. For example, a student may do poorly on an early test in a Fundamentals course. As the remediation processes are implemented, the student’s scores on faculty-made tests improve significantly. At this point, this student may not need to continue with the remediation unless they have a drop in scores in a subsequent course(s).
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Specific Remediation Interventions
The specific remediation intervention depends upon the needs of the students. Students may have poor study skills, be spending an inadequate amount of time in study or be prone to wait until the last minute to “cram” for an exam. They may simply have trouble with the kinds of tests nursing faculty write to prepare students for the NCLEX. Conversely, a lack of understanding of the content or inability to translate knowledge appropriate for a clinical situation into a plan of care may have a more lasting negative impact on the student’s success. Table A provides some interventions to address these problems.
Table A: Remediation Interventions to address Student Problems
Student Problems
Faculty Intervention
Guide student assessment of study habits. Encourage students to make a plan for improvement.
Poor study habits .
Have students keep a calendar of time spent in studying, working on projects, jobs, family time, recreation, etc. Assist student to analyze changes to behaviors to enhance the effectiveness of study time.
Poor Time Management
Help students to analyze test items. Encourage students to work individually or in small groups to respond to application or analysis test questions.
Poor Test-Taking Skills
Teach students how to take notes of important content during reading assignments. Give students alternative ways, including digital products that include learning activities such as video clips or diagrams, to learn important material.
Lack of knowledge
Lack of ability to integrate knowledge into clinical practice.
Case Studies, case studies, case studies
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Special Content Sessions
Although many students may do well without ongoing remediation assistance, certain areas of the nursing program are often difficult for many. For example, drug calculations, fluid and electrolyte imbalance and acid-base balance often are stumbling blocks to many students. Analysis of test results often yield other areas of content where students may not do well. Offering special sessions (either optional or required) on topics identified as problematic can be helpful, particularly if the session includes application of the content in a patient scenario.
Coordination of the Remediation Process
A variety of approaches may be used to structure the remediation program. Traditionally, faculty may be responsible for their own students, remediating themwith or without digital support and documenting the results. In some cases, remediation responsibilities for a student may be transferred from one faculty to another as students move from one class or clinical to another. In other cases, students keep the same remediation faculty advisor throughout the course of study, regardless of the classes in which the students are enrolled. To ensure that all students who need remediation receive adequate support, coordination of the remediation process is critical. Several strategies may be used to provide consistency throughout the remediation. One person, either a faculty member or other individual with organizational skills may be assigned to coordinate the process, following up to be sure that students participate in the process and that their needs are being met. This Coordinator is often charged with evaluating the results of the remediation program as a whole. In some cases, the coordinator with the appropriate skills may also do some or all the remediation activities.
Evaluation of the Remediation Program
Remediation or student success programs are time-intensive and thus, expensive, so evaluation of the program to determine the effectiveness is necessary. Increasing the number/percentage of students in any cohort who successfully pass the NCLEX is the ultimate goal of implementing a remediation program. However, how do we know that an increased (or continued satisfactory) first- time pass rate on the NCLEX is influenced by the remediation program? Digging deeper into the evaluation of the remediation program can provide additional information not only about the students’ efforts to increase their knowledge, but also about various compo- nents of the nursing program. While students bear responsibility for improving their own perfor- mance, assessing components of the nursing program by evaluating the remediation program can provide useful information about the program’s effectiveness Table A illustrates how the evaluation of the remediation program can highlight specific areas across the curriculum.
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Table B: The Impact of Remediation Evaluation Results on Nursing Programs
HowMany Students Were:
May Provide Information About:
Admitted in each cohort were identified as “at risk”
The recruiting and/or admission process
Teaching/learning activities regarding content quality of the test questions
Referred because of low grades on faculty-made tests
Referred due to scores on standardized test below benchmark
Curriculum and teaching/learning activities related to the content
Participating in various remediation activities
Coordination of remediation activities
Summary
Supporting students in their successful completion of a nursing program is a core responsibility of nursing faculty. Remediation or student success programs are integral to such success. A coordinated approach offering multiple strategies to meet the needs of a variety of students is key to accomplishing this goal.
References
Burtrynowicz, S. (2017) Most Colleges Enroll Many Students Who are Not Prepared for Higher Education. The Hechinger Report. Community College Higher Education News https://hechingerreport.org/ Accessed 2022. Mee, C., Schreiner, B. (2016) Remediation in Nursing Education Today: Review of the Literature and Considerations for Future Research. Journal of Nursing Regulation. 7 (1) April, 37-45. About the author Susan Sportsman, PhD, RN, ANEF, FAAN , is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas.
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