PREDICTORS OF NURSING GRADUATES' PERFORMANCE IN LICENSURE EXAMINATION
by
HERMANITO B. CONSAD II, RN, MSN
[email protected] Palawan State University Puerto Princesa City, Palawan, Philippines FRANCES MURIEL L. TUQUERO, Ph. D. Palawan State University Puerto Princesa City, Palawan, Philippines Abstract This study is aimed to determine the relationship of the grades of nursing professional subjects, grades of tool subjects in the board exam rating of nursing graduates from Palawan State University from 2007 to 2009. The study tried to predict the variables that can help improve the rating in the Nurse Licensure Examination of PSU Bachelor of Science in Nursing graduates in the future. The descriptive-correlational and ex-post facto method of research was employed in the study. Random sampling was used to select the subjects. English courses and Microbiology with Parasitology in tool subjects while Primary Health Care 11 (PHC11) and Nursing Care Management 100 (NCM 100) in nursing core subjects have significant predictive relation in board examination rating. Students’ proficiency in the nursing and tool subjects should be aimed to ensure better chances of passing the nurse licensure examination.
Keyword: Licensure examination predictors, performance predictors, nursing education
Introduction Quality nursing education is very crucial since nurses are stewards of health. The theories that nursing students learn in school are their weapon to effectively manage their patient's health. Nursing schools, therefore, should impose the highest standard possible in order to produce the best nurses not only in terms of theoretical foundation but as well as their skills developed. Not so long ago, from 1981 to 1990 only 36 schools were given approval and recognition by the Philippine government to offer a nursing program. Soon after the western countries open up their doors to foreign nurses, nursing schools proliferated like mushrooms. From 1991 to 2003, there were already 237 schools offering the nursing program, a staggering 558% increase compared to the previous decade (Baldago, 2004). The proliferation of these nursing schools greatly affected the quality of nurses being produced. The Palawan State University College of Nursing and Health Sciences (PSU-CNHS) first offered the nursing program in the school year 2003-2004. The College of Nursing and Health Sciences (CNHS) then was under the College of Sciences. In the school year 2006-2007, CNHS was established as a separate college. Its first dean, Professor Violeta R. Yadao limited its door only to few "best" enrollees considering that the College then had limited classrooms and clinical instructors to accommodate students. In a span of a decade from 1997 to 2006, there were 250,127 total board takers who took the Nurse Licensure Examination and 49.3% or 123,433 successfully became registered nurses. However, in just four years, from 2007 to 2010, the number of board exam takers rose to 278% or a total of 695,949 and only 33.05% or 229,984 successfully became registered nurses (abbaphilippines.com, 2011). In April 2007, the University graduated the first batch of the nursing program and in December of the same year, 55 took the licensure examination for nurses, 54
successfully became registered nurses. However, since then, the passing rate of the University, although way above the national passing rate continues to decline. In 2011, it got its lowest passing rate ever at 48.58%. This scenario is synonymous with the national arena, passing rate continuous to decline. Nursing schools whose board examination performance of their graduates is less than 2/3 of the national passing rate will face closure. This move to closely monitor the performance of nursing schools by the Commission on Higher Education (CHED) is stipulated in CHED Memo 14 series of 2009 article XI. Several studies have been conducted to predict the performance of nursing graduates in the Nurse Licensure Examination. In the study of Neri (2008), academic performance in the nursing core subjects as well as the clinical performance, guided review performance, and in-house review performance were used as her basis in predicting the performance in the board exam. She concluded that Nursing Licensure Examination passers are usually those students who are performing well in their academics in both classroom and clinical exposure and in in-house reviews. Furthermore, passers have higher intellective profile compared to non-passers. Ong, Bañico, and Palompon (2012) in their study using College Entrance Examination performance on IQ test, nursing aptitude test, composite score of science, math and English tests, college grade point average and pre-board examination performance concluded that these variables have correlations with licensure examination performance. However, grade point average and pre-board examination were the only variables significantly predicted the licensure examination performance. Moreover, Garcia (2012) in his study found out that general point average in Microbiology and Parasitology and performance in Nursing Board Examination review where the best predictor for board examination performance. Navarro et al (2011) in their study employing college admission
test, Nursing Aptitude Test, and academic performance concluded that these are significant predictors of performance in the Nursing Board Examination. Furthermore, in the study of Lacubtan and Juan (2011) using general weighted average (GWA) and Nursing Aptitude Test (NAT) as correlational variables to licensure examination performance revealed that both variables are significantly correlated with the performance of the graduates in the licensure examination for nurses. Stuenkel (2006) found in his study that graduates with better grades in pharmacology, maternal-child, mental health, community, pathophysiology, medical-surgical, and leadership have a greater chance of passing the NCLEX examination. He concluded that those with a higher average in those subjects have a greater chance of passing the said examination. Daley, Kirkpatrick, Frazier, Chung and Moser in their study in 1999 and 2000, found two variables that correlated with NCLEX success: final course grade for a senior medical-surgical nursing course and cumulative program grade point average (GPA). Using students' records from 1991 to 2001, Haas, Nugent, and Rule (2004), noted that students who passed the NCLEX have GPA which is 0.3 higher than those who failed. However, Giddens and Glockner (2005) in their study employing critical thinking as a predictor of passing the NCLEX noted that said variable is reliable as predictor only to those who passed the examination but not for those who failed. Mcgahee et. al. (2010) noted that the main variable that predicts NCLEX success is the proficiency in theoretical foundations and pathophysiology. Furthermore the authors explained that there is no single variable that can be a predictor in passing the They further noted that nursing education is multi-dimensional and that no single class or experience will stand alone, courses build upon prior learning experiences, and students
must use knowledge and skills from each course in the final analysis. In addition, Beeman and Waterhouse (2001), in their study regarding the predictor of passing the National Council Licensure Examination (NCLEX) examination noted that the most common predictor of failures in the licensure exam are grades. According to the authors, higher grades in pathophysiology and other nursing core subjects correlate with success in the same licensure examination. Moreover, Mcgahee et al (2010), Bonmass, Monnie and Kowalski (2010) studied the relationship between Nursing Entrance Test and Educational Resources and they found out that students who passed the National Council Licensure Examination (NCLEX) have scored significantly higher in the standardized exam like the College Admission exam and the Nursing Entrance Examination. Theoretical Framework Shewart’s Theory of Prediction states, “A phenomenon will be said to be in control when, through the use of past experience, we can predict at least within limits, how the phenomenon may be expected to vary in the future. Here it is understood that the prediction within limits means that we can state, at least approximately, the probability that the observed phenomenon will fall within given limits” (Shewart, 1931). Predicting student’s performance to perform well in any given exam is a big help not only to the student him/herself but as well as to the institution he/she represented. Necessary adjustments can be made once the parameters are set. However, unlike production where quality can be easily controlled, factors affecting student performance vary. In this study, the factors considered is the academic performance of graduates in nursing core subjects and selected tool subjects. As suggested by Shewart’s Theory of Prediction, factors that will be found to have significant relationship with the performance in the
licensure exam can be used as predictors of the likely outcomes or partly explain the licensure exam results. However, because of the type of study (which is correlational not experimental) these factors/predictors cannot be consciously considered as the very causes of passing or failing in the exam. Individuality of the students is a factor that is hard to predict. What complicates more is the fact that predicting is not aimed at 100 percent accuracy as this is not about producing a product out from a machine. It is about producing graduates that will at least perform positively that is to pass the board exam for nurses. Shewart’s theory is primarily designed for production purposes where variables can be easily predicted and can easily be controlled. The individuality of the subjects may vary and there may be other factors that closely relate and affect their performances. Objectives The objective of this study was to determine the predictors of graduates' performance in the Nurse Licensure Examination Rating of Palawan State University BS Nursing graduates of batches 2007 to 2009. Methodology This study used the descriptive-correlational ex-post facto method. Systematic random sampling was employed to select the graduates. The graduates of batches 2007 to 2009 of the BS Nursing program of Palawan State University-College of Nursing and Health Sciences were the respondents of the study. Multiple regression, frequency & percentage, weighted mean were the statistical tools used. The null hypothesis (H0) was tested at .05 level of significance.
Results and Discussions Table 1 Graduate's Performance in
Tool Subjects and Nursing Core Subjects n=77 Tool Subjects Math EngAve Biosci13 Biosci14 Overall Rating
Mean Rating 2.3117 1.9356 2.2727 2.0584 2.1446
Interpretation Average Highly Satisfactory Average Satisfactory Satisfactory
Core Subjects PHC11 PHC12 NCM100 NCM101 NCM102 NCM103 NCM104 NCM105 Overall Rating
Mean Rating 2.0126 1.8481 2.0875 2.1309 2.2121 2.1071 2.1318 1.9731 2.0629
Interpretation Satisfactory Highly Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Highly Satisfactory Satisfactory
Legend: Average Grade equivalent to 3.0-2.26 or 75 to 82.99 Satisfactory Grade equivalent to 2.25 to 2.01 or 83-85.99 Highly Satisfactory Grade equivalent to 2.0 to 1.76 or 86-88.99 Outstanding Grade equivalent to 1.75 to 1.26 or 89-91.99 Excellent Grade equivalent to 1.25 to 1.0 or 92-100 Source: Palawan State University Grading System
The data in Table 1 shows the performance of nursing graduates in the tool and nursing core subjects based from their general weighted average. The performance of the graduates in both tool subjects and nursing core subjects were categorized as satisfactory. By performance, in both the tool and nursing core subjects based from the data presented, it can be said that majority of the nursing graduates of Palawan State University performed satisfactorily. Table 2 Graduates' Performance in the Licensure Examination for Nurses n=77 NLE Performance Nursing Practice I Nursing Practice II Nursing Practice III Nursing Practice IV Nursing Practice V NLE Rating
Mean Rating 81.7403 79.6234 77.7532 76.5325 80.0519 79.0000
Legend: Average Satisfactory Highly Satisfactory Outstanding Excellent
75-82.99 83-85.99 86-88.99 89-91.99 92-100
Interpretation Average Average Average Average Average Average
The above data presents the performance of the graduates per test in the licensure examination for nurses. The overall performance of the graduates is rated as Average. Table 5 Predictors of Nursing Board Examination Rating Tool Subjects Multiple Regression Result Summary Model Summary *R Adjusted R2 .523a .233 ANOVA F Sig. 6.778 .000 Coefficients Predictor Significance Variable (p < 0.05) Math .181 EngAve .002 Biosci13 .812 Biosci14 .011 *Legend: Value of r (R) Interpretation/Relationship -0.5≤ r ≤0.5 Weak -0.8< r < -0.5 or 0.5 < r < 0.8 Moderate r ≤ -0.8 or r ≥ 0.8 Strong *(Jay L. Devore, Probability and Statistics for Engineering and the Sciences, Eighth Edition, 2012) Math -College Algebra EngAve-GWA of Communication Arts, Skills and Composition, Speech and Oral Communication, and Writing for Academic Purposes Biosci13-Anatomy and Physiology Biosci14-Microbiology with Parasitology
Table 5 summarizes the multiple regression results. The model of the four predictors produced R = .523, F (4, 72) = 6.778, p < .05 (Sig. =.000). As seen above, the group of tool subjects has a moderate positive (R=0.523) correlation with the NLE rating. This implies that graduates with higher grades in the tool subjects have higher NLE Rating. Furthermore, graduates with lower grades in tool subjects have lower NLE rating. The Adjusted R Square suggests that 23.3% variability of the NLE rating is explained by the tool subjects. The Coefficients shows the individual relationships of the tool subjects to the NLE Rating. As can be seen above EngAve (p=0.002) and Biosci14 (p=0.001) are the two tool subjects that made the most impact in the model to predict the outcome of the graduate's NLE Rating.
The data shows that tool subjects have a significant relationship with the NLE Rating. It can be assumed that better grades in the tool subjects predict passing rating in the Nurse Licensure Examination. The tool subjects that have significant influence to the model are EngAve and Biosci14. The results relate the data from the National Council for Licensure Examination (NCLEX) as cited by the Oklahoma State Board of Nursing and California Board of Nursing that proficiency in English as a second language and Microbiology & Parasitology have significant role in passing the NCLEX licensure examination. This also relates the result of the study conducted by Garcia (2012) that general point average in Microbiology and Parasitology are best predictors in Nurse Licensure Examination performance. Furthermore, the results of this study affirm the study of Beeman and Waterhouse (2001) that grades are the common predictors in the licensure examination, that higher grades correlate with passing the NCLEX examination. Table 6 Predictors of Nursing Licensure Rating Core Subjects Multiple Regression Result Summary Model Summary *R Adjusted R2 .541 .219 ANOVA Coefficients
F 3.667 Predictor Variable PHC11 PHC12 NCM100 NCM101 NCM102 NCM103 NCM104 NCM105
Sig. .001 Significance (p < 0.05) .574 .043 .019 .837 .738 .745 .393 .098
*Legend: R (r) -0.5≤ r ≤0.5 -0.8< r < -0.5 or 0.5 < r < 0.8 r ≤ -0.8 or r ≥ 0.8
Interpretation/Relationship Weak Moderate Strong
*(Jay L. Devore, Probability and Statistics for Engineering and the Sciences, Eighth Edition, 2012)
PHC-Primary Health Care; NCM-Nursing Care Management
Table 6 shows the summaries of multiple regression results of nursing core subjects and NLE rating, the model produced R = .541, F (8, 68) = 3.667, p < .05 (Sig. =.001). As seen above, the group of core subjects has a positive correlation with the NLE rating. This indicates that graduates with higher grades in the nursing core subjects have higher NLE Rating. Furthermore, graduates with lower grades in nursing core subjects have lower NLE rating. The Adjusted R Square suggests that 22% variability of the NLE rating is explained by the effects of nursing core subjects. The Coefficients show the individual relationships of the nursing core subjects to the NLE Rating. As can be seen above, PHC12 (p=0.043) and NCM100 (p=0.019) are the two core subjects that made the most impact in the model to predict the outcome of the graduate's NLE Rating. The data shows that nursing core subjects have the significant relationship with the NLE Rating. It can be assumed that better grades in the nursing core subjects predict better rating in the Nurse Licensure Examination. The nursing core subjects that have significant influence to the model are PHC12 and NCM100. The results relate with the data from the study of Stuenkel (2006), Daley, Kirkpatrick, Frazier, Chung and Moser (1999, 2000), Haas, Nugent, and Rule (2004), Beeman and Waterhouse (2001), the Oklahoma State Board of Nursing, and California Board of Nursing that better grades in nursing subjects have significant role in passing the NCLEX licensure examination. Furthermore, the results of this study affirms the study of Neri (2008), Navarro et al (2011), Ong, Bañico, and Palompon (2012), that students with better grades in nursing subjects have better chance of passing the Philippine Nursing Licensure Examination. Furthermore the results of this study support the study of Beeman and Waterhouse (2001) that
grades are the common predictors in the licensure examination and that higher grades correlate with passing the licensure examination.
Conclusions and Recommendations Nursing graduates of Palawan State University College of Nursing batches 2007 to 2009 are performing satisfactorily in their tool and nursing core subjects. In the Nurse Licensure Examination, the performance of PSU-CNHS Nursing graduates are way above the national passing rate. The findings of the study strongly suggest that there is a significant positive correlation between the tool and nursing core subjects and the rating of the graduates in the Nurse Licensure Examination. Statistical analyses show that higher grades in tool and nursing core subjects lead to higher rating in the Nurse Licensure Examination. On the other hand, lower rating in the tool and nursing core subjects lead to lower rating in the Nurse Licensure Examination. This means that the NLE rating of the graduates can be explained by the relationship of the tool and nursing core subjects. English and Microbiology with Parasitology are the tool subjects while Primary Health Care 11 and Nursing Care Management 100 are the nursing core subjects that best predict the performance of the graduates in the Nurse Licensure Examination. The result of the study is in congruence with the previous study conducted by Neri (2008), Navarro et al (2011), Ong, Bañico, and Palompon (2012) that better grades in the nursing subjects have better chance of passing the Philippine Nurse Licensure Examination. Moreover, the result of the study also relates the studies of Stuenkel (2006), Daley, Kirkpatrick, Frazier, Chung and Moser (1999, 2000), Haas, Nugent, and Rule (2004), Beeman and Waterhouse (2001), the Oklahoma State Board of Nursing, and the California Board of Nursing that better grades in nursing subjects have significant role in passing the NCLEX licensure examination. Furthermore, the results of this study affirms the
study of Beeman and Waterhouse (2001) that grades are the common predictors in the licensure examination, that higher grades correlate with passing the licensure examination. Despite the result of the study pinpointing strong relationship to two nursing core subjects namely Primary Health Care 11 and Nursing Care Management 100 with the licensure rating, it is highly recommended that nursing students should be proficient in all nursing core subjects because the content of Nurse Licensure Examination covers all the concepts and not just on the two core subjects mentioned. High proficiency leads to better performance in the licensure examination as what the statistical data suggest. For Microbiology with Parasitology, proficiency in this tool subject is equally important as it discusses on microorganisms that cause diseases. Theoretical proficiency in microorganisms that cause diseases may help examinees’ comprehension in the interaction of humans to microorganism and the development of diseases. For the English subject, students’ comprehension should be developed since 100% of the licensure question is written in English. Answering correctly the licensure examination questions depends on the examinee’s comprehension. Better performance in English resulted to better rating in the licensure examination as what the result of this study suggest. The level of English proficiency in both writing and speaking, as well as comprehension, may also become part of the admission requirements of incoming and transferee nursing students to PSU. Entrants with weaknesses in this aspect can further be assisted during their stay in the University. Alternatively, for those who have a low score in English in the entrance examination may be admitted in the College but is required to undergo English proficiency class. It has been done before when English O is required to be taken by incoming freshmen whose English rating in the entrance exam is low or failing, such program may be revived. The College may also keep the evaluation record and monitor the students' progress to make sure that once they graduate, their English proficiency is satisfactory.
For Palawan State University, this study can be duplicated in other colleges whose graduates have to take licensure examination to help predict their performance and make ways and means to increase their chance of passing such examination. For future researchers who want to pursue the same line of inquiry, it is suggested that admission score, NAT score, high school general average, Competency Appraisal performance, and review class performance including mock board examination will be included as variable to be evaluated. Lastly, it is suggested that despite the findings of this study that the nursing core subjects Primary Health Care and Microbiology with Parasitology to have high correlations with the passers of the board licensure examination it should be noted that the content of the Philippine Nurse Licensure Examination varies every exam period, thus, nursing students/graduates are advised to be proficient in all nursing core subjects to have a greater chance of passing rather than concentrating on the subjects found out to have high correlations. The PRC-BON had issued resolution pertaining to the scope of the licensure exam, thus, these pointers must be given emphasis especially during review classes.
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