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PREPARING NURSING & HEALTH PROFESSIONS STUDENTS FOR EDUCATIONAL SUCCESS

Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting

Supporting the timely graduation of nursing and health professions students who can successfully complete licensing or certification requirements and practice safely is a high priority for faculty. Yet multiple factors, some of which the faculty may be able to control, impact the success of students. Implementing strategies early in the students’ education that are most effective in promoting success is key to avoiding poor student performance and attrition before graduation. Two faculty-driven interventions, a discriminating admission policy and early required orientation, can improve retention.

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Discriminating Admission Policies 1. Not every student has the skills to be successful in the health professions, even when they have identified that as their desired career. While faculty have an obligation to admit sufficient students of diverse backgrounds to meet the health care needs of U.S. citizens, it is problematic to admit students who cannot demonstrate the requisite skills for the profession, particularly if the program has insufficient resources to provide relevant remediation. Evaluation of Metrics 2. Historically, most health professions have required some sort of examination that provides quantitative measurements of a student’s understanding of the basic knowledge needed to be successful in their chosen program. Like the SAT and ACT or the Graduate Education Examination (GRE) which evaluate a student’s ability to be successful in college or graduate school, the commercially available nursing and health professions admission tests evaluate knowledge of the basic content needed to build their professional competencies. Typically, they provide a cumulative score plus component scores in English language (reading comprehension, vocabulary, grammar), math, and science (anatomy and physiology, biology, chemistry). The choice of an appropriate program admission examination should be based on the reported reliability and validity of the exam and the correlation of scores with success in the related program. In addition, the extent to which the results of the various components of the exams (e.g., math, reading comprehension) are important to the discipline should be considered. For example, the National Council of State Boards of Nursing (NCSBN) in a groundbreaking, national, mixed-methods study to identify evidence-based quality indicators and warning signs of nursing program performance, found that admission criteria emphasizing a background in the sciences was an indicator of student and program success (Spector, et. al, 2020). In addition to program-specific admission examinations, many schools use other quantitative metrics, such as Cumulative Grade Point Average (CGPA), Cumulative Science GPA, and grade trends to evaluate a candidate’s potential success in the chosen program. When determining the appropriate scores to be selected as a “cutoff” score, reviewing levels chosen by comparable programs can be an initial strategy to identify the required scores. For example, if a number of programs with missions similar to yours require all students to have a 3.0 cumulative GPA, it might be appropriate to choose the same metric as a requirement for admission. As the program develops a history of graduating students, analyzing the level of a metric that is associated with student success in your own program will validate the appropriate criteria to use.

Holistic Admission Review 3. In recent years, administrators, researchers, and faculty have raised concerns that using only metrics to determine students’ readiness for success in a nursing or health professions education program may not give the admission committee sufficient data to predict who will be successful. The question arising from these concerns is, “Do the quantitative metrics adequately represent all of the skills and attitudes that make a nurse or other health professional successful?” Certainly, academic skills are important, but are there other experiences and attitudes that contribute to a compassionate, safe practitioner? As a result of these concerns, nursing and health professions programs began to consider the implementation of a holistic admission review . Artenian, N. et. al. (2017) defines a holistic admission review as “a flexible, individualized way of assessing an applicant’s experiences, attributes, and academic metrics and how the individual might contribute value as a student and future health professional.” Figure 1 illustrates the way in which these characteristics work together to provide a broad picture of the potential of the prospective student Figure 1: Components of a Holistic Admission

ATTITUDES § Resilience

ACADEMIC METRICS § CGPA total/ sciences § Admission test component scores

EXPERIENCE § Health Care Work § Education

§ Integrity § Curiosity § Socio-economic status § Multilingual

HOLISTIC ADMISSION

Adapted from AACN, 2020

To accomplish the positive outcomes of holistic admission review, faculty must commit to this process, which requires significant time to evaluate each candidate. To avoid as much bias as possible in this evaluation, a holistic admission process requires care to quantify the evaluation as much as possible. Table A outlines strategies to reduce the potential reviewer bias in the various approaches to holistic assessment. Table A: Strategies to Reduce Potential Bias in Holistic Assessment

Component of Assessment

Assessment Strategy

§ Resume § Interview Questions: Rubric to evaluate responses § Applicant Essay: Rubric to evaluate essay § Letters of Reference: Rubric to evaluate content relative to criteria

Previous Experience in Healthcare

§ Official Transcripts § Applicant Essay: Rubric to evaluate content relative to criteria of essay

Education Experience

§ Interview Questions to target required soft skills. For example, “Describe a situation where effective communication resolved a potential conflict. In a similar future situation, what would you do differently?” or § “Describe a time you have been part of a team. What did you learn from this experience?”

Soft Skills

Metrics

§ Relevant quantitative data

Required Early Orientation 4. Nursing and health professions programs provide rigorous academics, which often have different expectations than students’ previous academic endeavors. In general, the courses are fast paced, building upon prerequisite knowledge. Importantly, students must learn to use clinical judgment to apply what they have learned in class in clinical situations. The hours in class—and clinical experiences—are long and often stressful. The evaluation process of students’ progression through a nursing or health professions program is also challenging and requires students to adjust to faculty expectations. Faculty develop simulation exercises and challenging clinical situations that require commitment and perseverance and a large dose of “grit.” Faculty-made tests and standardized tests require students to not simply recall information, but also to apply what they have learned in clinical scenarios. Most nursing and health professions faculty can describe many times in their career when students who have just completed an examination remarked, “I have NEVER taken a test like that in other courses. What is the faculty doing—trying to trick us?” Identifying the challenges nursing and health professions students face as they develop the competencies required for safe and successful practice in their disciplines and providing strategies to address these challenges early in the students’ course of study, are key to supporting student success. The course outline below provides an example of such an orientation process. Example of an Early Orientation Process Objectives: At the completion of this orientation process, students will be able to: 1. Implement study skills which emphasize application of knowledge into the provision of safe, effective care in a variety of clinical situations. 2. Use clinical judgment to make decisions that support safe, effective care in a variety of clinical situations. 3. Develop self-care strategies to address test and performance anxiety to ensure the student’s best performance in class, simulation, and clinical scenarios.

Table B

Content

Teaching-Learning Strategies

§ Review of Student Handbook § Questions and Answers

Overview of the program

Characteristics of the successful Nursing/ Health Professions student

§ Presentation by upper classman or new graduate § Presentation by clinical partner

§ Review example of score profile of a standardized admission test § Discuss students’ strengths/challenges and strategies to accentuate strengths and support challenges § Review of ongoing student remediation/supports available to students

Using the student score profile from standardized admission examinations

Study Skills § Relevant quantitative data § Reading § Note-taking § Using clinical scenarios § Application of content § Group vs. individual study time

§ Discussion of effective study skills § Practice: Effective reading Taking notes Application using clinical scenarios

Table B: Continued

Content

Teaching-Learning Strategies

§ What is clinical judgment? § How is clinical judgment developed? § Test-taking strategies § Types of test Items § Use of soft skills Taking care of self § Eating, sleeping, having fun § Reducing anxiety (test, performance) § Stress reduction strategies

§ Discuss clinical judgment § Practice steps of clinical judgment in scenarios § Review types of test questions § Practice answering simple questions § Evaluate scenarios requiring soft skills

§ Discuss program resources to help students take care of self § Presentations from representatives from available resources § Practice stress reduction strategies

As important as an early orientation is to set students up for success, faculty throughout the course of study must reinforce, in an intentional way, strategies presented in this orientation. Thus, all faculty, whether they participate in the orientation or not, must be familiar with the content, allowing them to refer and reinforce these strategies as individuals or groups of students require assistance.

References Artenian, N., Dress, B., Glazer, G., Harris, K., Kaufman, L., Danek, J., Michaels, J. (2017) Holistic Admissions: Strategies for Leaders. Pub Med Central. National Library of Medicine. National Center for Biotechnology Information. https://ncbi.nlm. nih.gov/pmc/articles/PMC5708588/ Accessed 2022. AACN (2020) Promising Practices in Holistic Admission Review. White Paper. American Association of Colleges of Nursing. December. https://www.aacnnursing.org/Portals/42/News/White-Papers/AACN-White-Paper-Promising-Practices-in- Holistic-Admissions-Review-December-2020.pdf Accessed 2022. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. (2006) The rationale for diversity in the health professions: a review of the evidence. http://bhpr.hrsa.gov/healthworkforce/ reports/diversityreviewevidence.pdf . Accessed 2022. Spector, N., Silvestre, J., Alexander, M., Martin, B., Hooper, J., Squires, A., Ojemeni M., (2020) NCSBN Regulatory Guidelines and Evidence-Based Quality Indicators for Nursing Education Programs. Journal of Nursing Regulation. July. 11 (2) Supplement. 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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