Strategies for Success: A Crisis

Management Model for

Remediation of At-Risk Students

Anita C. Reinhardt, PhD, RN

Teresa Keller, PhD, RN

Linda Summers, PhD, RN

Pamela Schultz, PhD, RN

The start: N490 - Opportunity for

Success: BSN Undergraduates

Anita C. Reinhardt, PhD, RN

Tenna R. Schumacher, MSN, RN

Pamela Schultz, PhD, RN

Project

• Student’s Program success or failure

• Remediation course (N490 - Opportunity for

Success)

• Presentation at Western Institute of Nursing

Conference (Spring 2011)

Rational/Background

• Schools are adopting the HESI exit exam as a

benchmark for progression (Nibert, Young, &

Britt, 2008).

• Students at risk for successful completion in

nursing programs have been shown to benefit

from a focused remediation course.

Nibert, A. T., Young, A., & Britt, R. (2008). The HESI Exit Exam: progression benchmark and remediation guide... reprinted with permission

from Nurs Educ 2003;28(3):141-145. Nurse Educator, 70S-774.

Rational/Background

• Research shows that the content of successful

remediation courses varies, but most feature

common strategies to help students become

successful.

• These strategies include faculty mentoring,

test-taking strategies, and self-directed student

activities.

The Approach

• Crisis Management for At-Risk Students

(Elders, 2008)

– Assess the individual and the problem

– Plan the intervention

– Implement the intervention

– Resolution of the Crisis

– Anticipatory planning

Elders, D. (2008). Theory and intervention. In K. Fortinash & P. Holoday Worret (Eds.), Psychiatric/Mental

Health Nursing (4th ed.). St. Louis, MO: Mosby-Elsevier.

Setting

• The BSN program is situated within a college

of a land-grant University in the southwest

southern border of the USA.

• The undergraduate BSN program admits 48

students each semester for a four semester

program and is accredited by CCNE.

• The standardized testing products used for the

program is offered by HESI.

Setting

• Prior to admission to the program, students are tested to indicate baseline assessment of basic knowledge gained from prerequisite courses required of BSN undergraduate students.

• During the program various levels of ongoing knowledge are accessed and a HESI Exit exam is required prior to clinical placement in the preceptorship that is a culminating immersion clinical experience.

Sample

• Thirteen (13) students in danger of program

dismissal.

• The sample included 7 female, 6 males with a

mean group age of 29 (range 23-41).

• The cohort ethnic mix: 4 Anglo, 7 Hispanic, 1

Asian, and 1 African American.

Sample

• Some students had taken the Exit HESI exam

as many as 9 times without success.

• The minimum passing grade was 850 out of

1200 per HESI guidelines.

• Students took the HESI Exit Exam as part of

their final culminating nursing course while

enrolled in the remediation course.

Planning the Intervention

• Review of the literature; development of

evidence table

• Discussion with course faculty leaders and the

BSN and Program Director

• Discussion with peers

• Assess current practice for at-risk students

Intervention Design

• A retrospective project design was used to

review pre-existing student test data from

HESI exams

• Develop the independent-study outcomes for a

course offered in Spring Semester 2010.

• IRB approval was obtained from NMSU for

post hoc analysis.

The Course

• Students in danger of program dismissal due to

repeated HESI failure were enrolled in a

remediation course designed around

– faculty engagement and mentoring,

– focused reviews and self -assessment,

– self-directed student content assessment with

review plan, and

– student engagement with their own learning

process.

The Course

• In addition, students were provided an

opportunity for individual test-taking

counseling to assess study techniques and

offered alternative study methods.

Course Objectives

Upon successful completion of the course, the

student is expected to be able to:

• Perform a self-evaluation for areas of strength

and challenges in professional performance

• Mobilize areas of emotional and academic

strength to support successful performance

Course Structure• Duration: 15 weeks

• Class time: 3 hrs per week in face-to-face

classroom

• Engagement:

– Mandatory attendance

– Assessment on-line of self esteem

– Self-developed plan of review based on areas of

weakness found in previous HESI attempts

– Required participation in group discussions

Course Structure

• Instruction format:

– Socratic questioning and discussion

– Practice tests

– Test reviews

– Power Point presentation in weak content area that

included a teaching plan with pre-post test and self

evaluation of the presentation

– Registration and weekly progress reports of an

external review program

Implementing the Intervention

• The N490 course was taught for the first time

in Spring of 2010, with the purpose to

determine if an evidence-based remediation

course lead to improved student outcomes,

including success with a program-required exit

HESI exam and ultimate first-time success on

the NCLEX-RN licensing exam.

Results • All students successfully completed the

remediation course and passed the HESI Exit Exam enabling them to complete the preceptorship and the BSN program.

• NCLEX-RN first-time pass rate was 92% with 12/13 student results reported.

• Only 1 of these student failed the NCLEX-RN on their first attempt. As last to report, this person was finally successful on their 2nd attempt. Now, the cohort has a 100% pass rate.

Anticipatory Planning• Implement changes to the program

– Pathophysiology became a pre-requisite course

– Curricular review of BSN program objectives

implemented

– Continuation of the N490 course for any student at-

risk (having failed a Nursing course).

– Focused support (counseling or referral) of at-risk

students

• Minimum Admission HESI composite score level

set by department

Conclusion

• The Crisis Intervention Model assisted in our

approach to the development of the focused

remediation.

• A focused remediation course with engaged

faculty involvement supports positive student

outcomes and the production of qualified BSN

graduates prepared to take and pass the

NCLEX-RN examination successfully.

What’s next?

• Presentation – WIN 2011 (done)

• Publish – JNE 2012 (done)

• Expand – Ongoing work to analyze data and

present WIN 2012 (done) and another article

this time to Nurse Educator journal about use

of HESI admission scores and student progress

and outcomes (in final draft)

• All scholarly work!

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