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Factors Influencing Nursing Student Success After Readmission
Teaching and Learning in Nursing 12 (2017) 191–194
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Factors Influencing Nursing Student Success After Readmission Mariann Harding, PhD, RN, CNE ⁎, Mistey Bailey, MSN, RN, Shelly Stefka, MSN, RN Kent State University Tuscarawas, New Philadelphia, OH
a r t i c l e Keywords: Readmission criteria Student success Academic success Academic failure
i n f o
a b s t r a c t This study investigated factors predicting attrition in students readmitted to an associate degree nursing program. The semester a student is initially dismissed and reason for dismissal influenced attrition. Other influences included readmission grade point average, reason for dismissal, taking coursework to raise grade point average, having a history of misconduct, having poor attendance, and failing skills evaluations. Results can be used as a guide to refine readmission criteria. © 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction Students in nursing school are expected to perform at a level that meets established minimum competencies. Unfortunately, every school has students who do not meet performance expectations or find themselves unable to continue schooling for personal reasons, making them subject to readmission policies. Students enter nursing school from diverse social, economic, and education backgrounds. Many are academically unprepared, with poor test-taking skills and a lack of understanding of the rigors of nursing school, making it more difficult for them to learn what they need to know to be successful (Harding, 2012). First-year retention rates support this, with rates about 87% for bachelor of science in nursing programs and 80% for associate degree nursing (ADN) programs (National League for Nursing, 2016). Attrition within nursing programs is problematic for students and to the program for multiple reasons. In addition to contributing to the nursing shortage by reducing the number of new graduates available, it reduces tuition revenue for the program, ineffectively uses financial aid resources, and causes students and families distress and increased costs (Dante, Fabris, & Palese, 2015). Many schools have strict readmission policies for students who have either failed or withdrawn from the program. These policies may place students on warning, probation, suspension, or dismissal from the program. The most common response is to suspend or dismiss these students. However, many of these students want to continue their education. How does one decide if a student should
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ⁎ Corresponding author. Tel.: +1 330 339 3391 (W), +1 330 827 9183 (C). E-mail addresses: [email protected] (M. Harding), [email protected] (M. Bailey), [email protected] (S. Stefka).
have a second chance? What objective criteria can be used to determine if a student will succeed or not, or do such criteria exist? Literature Review There has been some exploration of factors influencing college completion for students who were dismissed for academic or personal reasons. Those who complete after readmission tend to have higher grade point averages (GPAs) and had completed more semesters and credits (Berkovitz & O'Quin, 2006). Little evidence is available that addresses the success of nursing students who have been readmitted following academic dismissal. Studies have identified reliable predictors of success for entry-level nursing students, including entry GPA, standardized entrance examination scores, and number of credits completed prior to entry (Olsen, 2017).Similar evidence exists regarding the likelihood of success after admission, including grades in key nursing courses, program GPA, performance in science courses, and clinical performance (Abele, Penprase, & Ternes, 2013; Dante, Valoppi, Saiani, & Palese, 2011; Harris, Rosenberg, & Grace O'Rourke, 2014). However, it is unknown if these same criteria apply to students after readmission. It is plausible that generalizations about these predictors of success do not apply to students after dismissal for unsatisfactory academic performance or who withdraw for personal reasons. The dismissal and readmission policies at the university studied offer the dismissed student, one who leaves the program for academic or personal reasons, the opportunity to reenter the program at any time, as long as the program is completed within 5 years. Most students reenter the program the next time the required course in the nursing sequence is offered. To meet criteria for readmission, students are required to have a 2.70 GPA on a 4-point scale and submit a readmission application, which is reviewed by a readmission committee. The committee's decision to readmit is based upon review
http://dx.doi.org/10.1016/j.teln.2017.03.004 1557-3087/© 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
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of the student's entire academic record, a written application, and seat availability. The process is often cited as a source of emotional turmoil for students, parents, administrators, and nursing faculty. The faculty perspective here was that incidentally, it appeared that several other factors were related to program completion following readmission. Faculty believed that those students who had not passed multiple skills evaluations had a history of behavior misconduct or were unsuccessful on medication math tests tended not to complete the program. While there had been a few reports of attendance being linked with poor examination grades, faculty believed that a history of multiple absences and episodes of tardiness was directly related to motivation and a student being less likely to complete (Rejnö, Nordin, Forsgren, Sundell, & Rudolfsson, 2017). Students who voluntarily left for personal reasons, although in good academic standing, appeared to be successful upon return. Research regarding personal factors affirms that academically capable students may voluntarily leave school because of family responsibilities, inability to arrange childcare, and having to work to meet financial obligations (Harris et al., 2014; Pitt, Powis, Levett-Jones, & Hunter, 2012). The purpose of this study was to investigate factors influencing program completion in nursing students readmitted to an ADN program. The results of this study will allow administrators and nursing faculty to develop evidence-based readmission policies based on clearly defined criteria that predict a student's likelihood of completing the program. Method Design Data were collected using an archival design from the records of all students readmitted after dismissal between fall 2009 and spring 2015 to an ADN program on a regional campus in northeast Ohio. Dismissal was defined as leaving the nursing program at any time before completion. Students readmitted were tracked from the reentry point until either dismissed a second time or successful, which was defined as program completion. No currently enrolled students were included in the sample. Measures Demographic data obtained included each student's gender and whether the student was a traditional student, licensed practical nurse, or paramedic.Study variables included each student's GPA when initially dismissed and GPA upon readmission to the program; reason for the dismissal—personal or academic, course(s) associated with dismissal, number of semesters completed before the first dismissal, number of semesters out of the program before readmission; midcurricular HESI (MC-HESI) scores; and National Council Licensure Examination-Registered Nurse (NCLEX-RN®) scores for those who completed. Other variables of interest included the number of clinical failures, medication math test failures, skills test failures, attendance, and conduct reports before either dismissal or program completion.
Data were analyzed using Statistical Package for the Social Sciences (SPSS) 22.0 software. Frequencies were used to describe sample characteristics. Correlation coefficients and ttests were used to determine whether statistically significant relationships existed between likelihood of program completion and study variables. Binary logistic regression was conducted to determine which factors most influenced the dependent variable, academic status, which was either program completion or second dismissal. The chosen level of significance (alpha level) for rejection was 0.05.
Findings Of the 107 students for whom complete records were available, 46 (43%) were dismissed a second time, and 61 (57%) completed the program. The gender ratio mirrored practicing nurses, with 95 (88.8%) female and 12 (11.2%) male students. The sample included 98 (91.6%) traditional and 9 (8.4%) advanced standing students who were either paramedics or licensed practical nurses. There was a significant difference between the type of student and program completion (Table 1), with advanced standing students being more likely to complete (χ2= 4.075, p = .044). There were no differences in program completion rates by gender. The reason for dismissal and the semester a student was initially dismissed significantly influenced attrition upon readmission. Here, all students readmitted after withdrawing for personal reasons completed the program (χ 2 = 5.648, p = .019). Of those students, 6 were females, 3 of whom withdrew because of pregnancy. The remaining 4 students, 3 females and 1 male, withdrew because of family responsibilities. No student readmitted after being dismissed the first semester for academic reasons in either the fundamentals nursing course or chemistry completed the program (χ 2 = 37.492 [7], p b .001). Every student readmitted the final semester to repeat the final medical–surgical nursing course completed the program (Table 2). As students progressed through the second and third semesters, the percentage of students completing the program also increased, although the percentage completing after return in the third semester was just over 50% (53.2%). There was no significant difference in program completion rates for those students (n = 21) who failed multiple courses in any one semester (χ[Andrew et al., 2008] .228, p = .63). While there was a difference, although not significant, in entry GPA and MC-HESI scores between those students who completed the program and those who did not, students who completed the program had significantly higher GPAs on readmission (t = 2.023, p = .046) (Table 3). The cohort of students who had to take coursework for three or more semesters to raise their GPA to meet readmission criteria had only a 10% chance of completing the program (χ 2 = 20.741 (4), p b .001). A simple two-factor logistic regression model consisting of GPA on readmission and the semester a student was initially dismissed was statistically significant (χ 2 =
Table 1 Demographic and program completion Factor
Data Collection and Analysis
Program completion Yes n
After obtaining institutional review board permission, a coding sheet for retrieving the archival data was developed. To protect anonymity of archival data, all existing data were assigned an identification number for data collection and evaluation purposes. The master list of students and identification numbers was kept locked in a filing cabinet in the principal investigator's office.
Gender
No %
n
χ(Andrew p et al., 2008)
%
Female 57 60 38 40 3.091 Male 4 33.3 8 66 Student type Traditional 53 54.1 45 45.9 4.075 Advanced standing 8 88.9 1 11.1 Dismissal reason Academic 54 54 46 46 5.648 Personal 7 100 0 0
.079 .044 .019
M. Harding et al. / Teaching and Learning in Nursing 12 (2017) 191–194 Table 2 Semester dismissed and likelihood of program completion Semester dismissed
Program completion Yes
1 2 3 4
n
%
7 17 62 21 107
6.5 15.9 58 19.6
No
n
%
n
%
0 7 33 21 61
0 41.2 53.2 100 57
7 10 29 0 46
100 58.5 46.8 0 43
100.5 [60], p = .001), explaining 81.8% of the variance in program completion rates and correctly classified 88.8% of the students. For the remaining variables, number of clinical failures, medication math test failures, skills test failures, attendance, and conduct, there were significant relationships between attendance, skills test failures, and conduct and program completion. Those who had experienced a conduct issue prior to the first dismissal had only a 12.1% chance of completing the program (χ2 = 10.461, p = .01). Students not completing the program had significantly more absences (M = .5, SD = 1.1) than those who completed (M = .18, SD = .5; t = 2.027, p = .045). Significant results existed regarding skills test failures (t = 2.641, p = .01), with those not completing the program having more skills test failures (M = .41, SD = 1.1) than those who completed (M = .03, SD = .18). Counting each of these variables as an incident, the total incidents for those not completing the program were significantly higher (M = 5.82, SD = 3.9) than those who completed (M = 2.77, SD = .2.9; t = 3.061, p = .003). Of the 61 students who completed the program, 47 (77%) passed the NCLEX-RN® the first time, and 13 (21%) did not pass. At the time of data collection, 1 student had not taken the examination. The 8 advanced standing students who completed all passed the NCLEXRN® the first time. After removing those students from the sample, the traditional student dropped to a 71.7% chance of passing NCLEX-RN® the first time. Implications and Recommendations This study revealed major implications to consider when evaluating the readmission of dismissed students. The fact that no student readmitted after academic dismissal the first semester from the fundamentals nursing course or chemistry completed the program was not surprising. Although program entrance criteria screen for academic ability, it may be that the student who is not successful this early in their schooling is not prepared or able to meet the academic demands of nursing school. The public images of nursing are often skewed, so the student may not have had a realistic assessment of their suitability to nursing or the rigors of nursing school. Some students view nursing as a “hands-on” program and academically are not able to meet the rigors of the science and theoretical content (Andrew et al., 2008).
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Those counseling students considering readmission should assist the student in considering whether to remain in nursing or if their future lies elsewhere. The fact that those students readmitted in the final semester completed the program can be used to refine readmission criteria and assure that appropriate resources are in place to maintain completion rates. Most students reentered the program the next time the required course in the nursing sequence was offered. The low completion rate for those students with a lower readmission GPA or who took additional coursework to raise their GPA were in line with what has been reported about the predictive value of GPA in the general college and nursing student populations. Implementing policies that lower the maximum time allowed to complete a program would make it more difficult for students with low GPAs to be readmitted and reduce student's financial burden associated with continuing to take additional coursework toward a degree that will likely not be realized. The fact that students readmitted after withdrawing voluntarily for personal reasons and advanced standing students being more likely to complete the program was not surprising. Other than female students being more likely to leave for personal reasons, including family responsibilities and pregnancy, no gender differences were found here, affirming research that gender is not associated with academic outcome (Chan et al., 2014). Other studies have declared that advanced standing students have obtained necessary knowledge during their earlier education and with employment that assist them with being successful (Birkhead, Araldi, & Cummings, 2016). As faculty suspected, a general pattern of student behavior emerged that correlated with a decreased likelihood of completing the program. Overall, the poor performance in the skills laboratory, failing skills evaluations or medication math tests, reflect a lack of the necessary knowledge and skills necessary for safe practice, akin to the performance standards in the classroom setting. The issues with behavior and attendance may be related to a number of factors, such as personality, motivation, or an apathetic attitude toward education. Although the 100% NCLEX-RN® pass rate for the advanced standing students was not expected, the 77% first-time pass rate for the cohort in general, and the 71.7% pass rate for the traditional students on the NCLEX-RN® is certainly cause for concern. Administrators and faculty will want to consider how to implement strategies to assist any readmitted students who do complete the program since, in this instance, pass rates are below acceptable standards. This study is not free from limitations. The study results are isolated to a single regional campus in northeast Ohio and may not be applicable to institutions with a different student population.Other than reason for first dismissal, the retrospective design did not allow for consideration of personal factors, such as personality, family obligations, or employment, that could have influenced attrition. Further research should then be undertaken to validate these predictions of program completion and to determine the impact of any changes made to admission and readmission policies. Intervention studies may evaluate how to best influence the success of readmitted students who are identified as being at risk for not completing the program.
Conclusion Table 3 GPA and MC-HESI score differences Academic measure
Program completion Yes M
Entry GPA Readmission GPA MC-HESI
t test
p
No SD
M
SD
3.1187 .33703 3.0596 .28524 .959 .340 3.0244 .28445 2.9302 .19680 2.023 .046 781.40 119.509 749.73 94.052 1.383 .170
Administrators and nursing faculty may find this information useful in further understanding the concept of dismissal and readmission. The study results detail criteria that can readily identify students most likely to be dismissed a second time. This information can be used to refine admission and readmission policies and develop and implement appropriate remediation programs, such as tutoring or mentoring, designed to provide students with resources to support retention and improve the completion rate of readmitted students For those students facing readmission, the results can be used as a guide
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in counseling discussions with administrators and advisors, whose purpose is to help students achieve personal and academic goals. References Abele, C., Penprase, B., & Ternes, R. (2013). A closer look at academic probation and attrition: What courses are predictive of nursing student success? Nurse Education Today, 33(3), 258–261. http://dx.doi.org/10.1016/j.nedt.2011.11.017. Andrew, S., Salamonson, Y., Weaver, R., Smith, A., O'Reilly, R., & Taylor, C. (2008). Hate the course or hate to go: Semester differences in first year nursing attrition. Nurse Education Today, 28(7), 865–872. http://dx.doi.org/10.1016/j.nedt.2007.12.007. Berkovitz, R. A., & O'Quin, K. (2006). Predictors of graduation of readmitted “at risk” college students. Journal of College Student Retention: Research, Theory & Practice, 8(2), 199–214. http://dx.doi.org/10.2190/876B-JF9P-RGFU-9XD6. Birkhead, S., Araldi, M. -J., & Cummings, R. (2016). A model of practical nurse to registered nurse educational articulation: A successful approach to advancing the nursing workforce. Teaching and Learning in Nursing, 11(4), 152–156. http://dx.doi.org/10. 1016/j.teln.2016.07.003. Chan, Z. C. Y., Chan, Y. -t., Lui, C. -w., Yu, H. -z., Law, Y. -f., Cheung, K. -l., ... Lam, C. -t. (2014). Gender differences in the academic and clinical performances of undergraduate nursing students: A systematic review. Nurse Education Today, 34(3), 377–388. http://dx.doi.org/10.1016/j.nedt.2013.06.011. Dante, A., Fabris, S., & Palese, A. (2015). Predictive power of individual factors and clinical learning experience on academic success: Findings from a
longitudinal study. Nurse Educator, 40(3), E1–E6. http://dx.doi.org/10.1097/ NNE.0000000000000132. Dante, A., Valoppi, G., Saiani, L., & Palese, A. (2011). Factors associated with nursing students' academic success or failure: A retrospective italian multicenter study. Nurse Education Today, 31(1), 59–64. http://dx.doi.org/10.1016/j.nedt.2010.03.016. Harding, M. (2012). Efficacy of supplemental instruction to enhance student success. Teaching and Learning in Nursing, 7(1), 27–31. http://dx.doi.org/10.1016/j.teln. 2011.07.002. Harris, R. C., Rosenberg, L., & Grace O'Rourke, M. E. (2014). Addressing the challenges of nursing student attrition. Journal of Nursing Education, 53(1), 31–37. http://dx. doi.org/10.3928/01484834-20131218-03. National League for Nursing (2016). Percentage of qualified applications that were rejected by program type, 2012 and 2014. Retrieved from http://www.nln.org/docs/defaultsource/newsroom/nursing-education-statistics/percentage-of-qualified-applicationsthat-were-rejected-by-program-type-2012-and-2014-(pdf).pdf?sfvrsn=0. Olsen, J. M. (2017). Integrative review of admission factors related to associate degree nursing program success. Journal of Nursing Education, 56(2), 85–93. http://dx.doi. org/10.3928/01484834-20170123-05. Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors influencing nursing students' academic and clinical performance and attrition: An integrative literature review. Nurse Education Today, 32(8), 903–913. http://dx.doi.org/10.1016/j.nedt. 2012.04.011. Rejnö, Å., Nordin, P., Forsgren, S., Sundell, Y., & Rudolfsson, G. (2017). Nursing students' attendance at learning activities in relation to attainment and passing courses: A prospective quantitative study. Nurse Education Today, 50, 36–41. http://dx.doi.org/10.1016/j.nedt.2016.11.025.
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Factors Influencing Nursing Student Success After Readmission Mariann Harding, PhD, RN, CNE ⁎, Mistey Bailey, MSN, RN, Shelly Stefka, MSN, RN Kent State University Tuscarawas, New Philadelphia, OH
a r t i c l e Keywords: Readmission criteria Student success Academic success Academic failure
i n f o
a b s t r a c t This study investigated factors predicting attrition in students readmitted to an associate degree nursing program. The semester a student is initially dismissed and reason for dismissal influenced attrition. Other influences included readmission grade point average, reason for dismissal, taking coursework to raise grade point average, having a history of misconduct, having poor attendance, and failing skills evaluations. Results can be used as a guide to refine readmission criteria. © 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction Students in nursing school are expected to perform at a level that meets established minimum competencies. Unfortunately, every school has students who do not meet performance expectations or find themselves unable to continue schooling for personal reasons, making them subject to readmission policies. Students enter nursing school from diverse social, economic, and education backgrounds. Many are academically unprepared, with poor test-taking skills and a lack of understanding of the rigors of nursing school, making it more difficult for them to learn what they need to know to be successful (Harding, 2012). First-year retention rates support this, with rates about 87% for bachelor of science in nursing programs and 80% for associate degree nursing (ADN) programs (National League for Nursing, 2016). Attrition within nursing programs is problematic for students and to the program for multiple reasons. In addition to contributing to the nursing shortage by reducing the number of new graduates available, it reduces tuition revenue for the program, ineffectively uses financial aid resources, and causes students and families distress and increased costs (Dante, Fabris, & Palese, 2015). Many schools have strict readmission policies for students who have either failed or withdrawn from the program. These policies may place students on warning, probation, suspension, or dismissal from the program. The most common response is to suspend or dismiss these students. However, many of these students want to continue their education. How does one decide if a student should
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ⁎ Corresponding author. Tel.: +1 330 339 3391 (W), +1 330 827 9183 (C). E-mail addresses: [email protected] (M. Harding), [email protected] (M. Bailey), [email protected] (S. Stefka).
have a second chance? What objective criteria can be used to determine if a student will succeed or not, or do such criteria exist? Literature Review There has been some exploration of factors influencing college completion for students who were dismissed for academic or personal reasons. Those who complete after readmission tend to have higher grade point averages (GPAs) and had completed more semesters and credits (Berkovitz & O'Quin, 2006). Little evidence is available that addresses the success of nursing students who have been readmitted following academic dismissal. Studies have identified reliable predictors of success for entry-level nursing students, including entry GPA, standardized entrance examination scores, and number of credits completed prior to entry (Olsen, 2017).Similar evidence exists regarding the likelihood of success after admission, including grades in key nursing courses, program GPA, performance in science courses, and clinical performance (Abele, Penprase, & Ternes, 2013; Dante, Valoppi, Saiani, & Palese, 2011; Harris, Rosenberg, & Grace O'Rourke, 2014). However, it is unknown if these same criteria apply to students after readmission. It is plausible that generalizations about these predictors of success do not apply to students after dismissal for unsatisfactory academic performance or who withdraw for personal reasons. The dismissal and readmission policies at the university studied offer the dismissed student, one who leaves the program for academic or personal reasons, the opportunity to reenter the program at any time, as long as the program is completed within 5 years. Most students reenter the program the next time the required course in the nursing sequence is offered. To meet criteria for readmission, students are required to have a 2.70 GPA on a 4-point scale and submit a readmission application, which is reviewed by a readmission committee. The committee's decision to readmit is based upon review
http://dx.doi.org/10.1016/j.teln.2017.03.004 1557-3087/© 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
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M. Harding et al. / Teaching and Learning in Nursing 12 (2017) 191–194
of the student's entire academic record, a written application, and seat availability. The process is often cited as a source of emotional turmoil for students, parents, administrators, and nursing faculty. The faculty perspective here was that incidentally, it appeared that several other factors were related to program completion following readmission. Faculty believed that those students who had not passed multiple skills evaluations had a history of behavior misconduct or were unsuccessful on medication math tests tended not to complete the program. While there had been a few reports of attendance being linked with poor examination grades, faculty believed that a history of multiple absences and episodes of tardiness was directly related to motivation and a student being less likely to complete (Rejnö, Nordin, Forsgren, Sundell, & Rudolfsson, 2017). Students who voluntarily left for personal reasons, although in good academic standing, appeared to be successful upon return. Research regarding personal factors affirms that academically capable students may voluntarily leave school because of family responsibilities, inability to arrange childcare, and having to work to meet financial obligations (Harris et al., 2014; Pitt, Powis, Levett-Jones, & Hunter, 2012). The purpose of this study was to investigate factors influencing program completion in nursing students readmitted to an ADN program. The results of this study will allow administrators and nursing faculty to develop evidence-based readmission policies based on clearly defined criteria that predict a student's likelihood of completing the program. Method Design Data were collected using an archival design from the records of all students readmitted after dismissal between fall 2009 and spring 2015 to an ADN program on a regional campus in northeast Ohio. Dismissal was defined as leaving the nursing program at any time before completion. Students readmitted were tracked from the reentry point until either dismissed a second time or successful, which was defined as program completion. No currently enrolled students were included in the sample. Measures Demographic data obtained included each student's gender and whether the student was a traditional student, licensed practical nurse, or paramedic.Study variables included each student's GPA when initially dismissed and GPA upon readmission to the program; reason for the dismissal—personal or academic, course(s) associated with dismissal, number of semesters completed before the first dismissal, number of semesters out of the program before readmission; midcurricular HESI (MC-HESI) scores; and National Council Licensure Examination-Registered Nurse (NCLEX-RN®) scores for those who completed. Other variables of interest included the number of clinical failures, medication math test failures, skills test failures, attendance, and conduct reports before either dismissal or program completion.
Data were analyzed using Statistical Package for the Social Sciences (SPSS) 22.0 software. Frequencies were used to describe sample characteristics. Correlation coefficients and ttests were used to determine whether statistically significant relationships existed between likelihood of program completion and study variables. Binary logistic regression was conducted to determine which factors most influenced the dependent variable, academic status, which was either program completion or second dismissal. The chosen level of significance (alpha level) for rejection was 0.05.
Findings Of the 107 students for whom complete records were available, 46 (43%) were dismissed a second time, and 61 (57%) completed the program. The gender ratio mirrored practicing nurses, with 95 (88.8%) female and 12 (11.2%) male students. The sample included 98 (91.6%) traditional and 9 (8.4%) advanced standing students who were either paramedics or licensed practical nurses. There was a significant difference between the type of student and program completion (Table 1), with advanced standing students being more likely to complete (χ2= 4.075, p = .044). There were no differences in program completion rates by gender. The reason for dismissal and the semester a student was initially dismissed significantly influenced attrition upon readmission. Here, all students readmitted after withdrawing for personal reasons completed the program (χ 2 = 5.648, p = .019). Of those students, 6 were females, 3 of whom withdrew because of pregnancy. The remaining 4 students, 3 females and 1 male, withdrew because of family responsibilities. No student readmitted after being dismissed the first semester for academic reasons in either the fundamentals nursing course or chemistry completed the program (χ 2 = 37.492 [7], p b .001). Every student readmitted the final semester to repeat the final medical–surgical nursing course completed the program (Table 2). As students progressed through the second and third semesters, the percentage of students completing the program also increased, although the percentage completing after return in the third semester was just over 50% (53.2%). There was no significant difference in program completion rates for those students (n = 21) who failed multiple courses in any one semester (χ[Andrew et al., 2008] .228, p = .63). While there was a difference, although not significant, in entry GPA and MC-HESI scores between those students who completed the program and those who did not, students who completed the program had significantly higher GPAs on readmission (t = 2.023, p = .046) (Table 3). The cohort of students who had to take coursework for three or more semesters to raise their GPA to meet readmission criteria had only a 10% chance of completing the program (χ 2 = 20.741 (4), p b .001). A simple two-factor logistic regression model consisting of GPA on readmission and the semester a student was initially dismissed was statistically significant (χ 2 =
Table 1 Demographic and program completion Factor
Data Collection and Analysis
Program completion Yes n
After obtaining institutional review board permission, a coding sheet for retrieving the archival data was developed. To protect anonymity of archival data, all existing data were assigned an identification number for data collection and evaluation purposes. The master list of students and identification numbers was kept locked in a filing cabinet in the principal investigator's office.
Gender
No %
n
χ(Andrew p et al., 2008)
%
Female 57 60 38 40 3.091 Male 4 33.3 8 66 Student type Traditional 53 54.1 45 45.9 4.075 Advanced standing 8 88.9 1 11.1 Dismissal reason Academic 54 54 46 46 5.648 Personal 7 100 0 0
.079 .044 .019
M. Harding et al. / Teaching and Learning in Nursing 12 (2017) 191–194 Table 2 Semester dismissed and likelihood of program completion Semester dismissed
Program completion Yes
1 2 3 4
n
%
7 17 62 21 107
6.5 15.9 58 19.6
No
n
%
n
%
0 7 33 21 61
0 41.2 53.2 100 57
7 10 29 0 46
100 58.5 46.8 0 43
100.5 [60], p = .001), explaining 81.8% of the variance in program completion rates and correctly classified 88.8% of the students. For the remaining variables, number of clinical failures, medication math test failures, skills test failures, attendance, and conduct, there were significant relationships between attendance, skills test failures, and conduct and program completion. Those who had experienced a conduct issue prior to the first dismissal had only a 12.1% chance of completing the program (χ2 = 10.461, p = .01). Students not completing the program had significantly more absences (M = .5, SD = 1.1) than those who completed (M = .18, SD = .5; t = 2.027, p = .045). Significant results existed regarding skills test failures (t = 2.641, p = .01), with those not completing the program having more skills test failures (M = .41, SD = 1.1) than those who completed (M = .03, SD = .18). Counting each of these variables as an incident, the total incidents for those not completing the program were significantly higher (M = 5.82, SD = 3.9) than those who completed (M = 2.77, SD = .2.9; t = 3.061, p = .003). Of the 61 students who completed the program, 47 (77%) passed the NCLEX-RN® the first time, and 13 (21%) did not pass. At the time of data collection, 1 student had not taken the examination. The 8 advanced standing students who completed all passed the NCLEXRN® the first time. After removing those students from the sample, the traditional student dropped to a 71.7% chance of passing NCLEX-RN® the first time. Implications and Recommendations This study revealed major implications to consider when evaluating the readmission of dismissed students. The fact that no student readmitted after academic dismissal the first semester from the fundamentals nursing course or chemistry completed the program was not surprising. Although program entrance criteria screen for academic ability, it may be that the student who is not successful this early in their schooling is not prepared or able to meet the academic demands of nursing school. The public images of nursing are often skewed, so the student may not have had a realistic assessment of their suitability to nursing or the rigors of nursing school. Some students view nursing as a “hands-on” program and academically are not able to meet the rigors of the science and theoretical content (Andrew et al., 2008).
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Those counseling students considering readmission should assist the student in considering whether to remain in nursing or if their future lies elsewhere. The fact that those students readmitted in the final semester completed the program can be used to refine readmission criteria and assure that appropriate resources are in place to maintain completion rates. Most students reentered the program the next time the required course in the nursing sequence was offered. The low completion rate for those students with a lower readmission GPA or who took additional coursework to raise their GPA were in line with what has been reported about the predictive value of GPA in the general college and nursing student populations. Implementing policies that lower the maximum time allowed to complete a program would make it more difficult for students with low GPAs to be readmitted and reduce student's financial burden associated with continuing to take additional coursework toward a degree that will likely not be realized. The fact that students readmitted after withdrawing voluntarily for personal reasons and advanced standing students being more likely to complete the program was not surprising. Other than female students being more likely to leave for personal reasons, including family responsibilities and pregnancy, no gender differences were found here, affirming research that gender is not associated with academic outcome (Chan et al., 2014). Other studies have declared that advanced standing students have obtained necessary knowledge during their earlier education and with employment that assist them with being successful (Birkhead, Araldi, & Cummings, 2016). As faculty suspected, a general pattern of student behavior emerged that correlated with a decreased likelihood of completing the program. Overall, the poor performance in the skills laboratory, failing skills evaluations or medication math tests, reflect a lack of the necessary knowledge and skills necessary for safe practice, akin to the performance standards in the classroom setting. The issues with behavior and attendance may be related to a number of factors, such as personality, motivation, or an apathetic attitude toward education. Although the 100% NCLEX-RN® pass rate for the advanced standing students was not expected, the 77% first-time pass rate for the cohort in general, and the 71.7% pass rate for the traditional students on the NCLEX-RN® is certainly cause for concern. Administrators and faculty will want to consider how to implement strategies to assist any readmitted students who do complete the program since, in this instance, pass rates are below acceptable standards. This study is not free from limitations. The study results are isolated to a single regional campus in northeast Ohio and may not be applicable to institutions with a different student population.Other than reason for first dismissal, the retrospective design did not allow for consideration of personal factors, such as personality, family obligations, or employment, that could have influenced attrition. Further research should then be undertaken to validate these predictions of program completion and to determine the impact of any changes made to admission and readmission policies. Intervention studies may evaluate how to best influence the success of readmitted students who are identified as being at risk for not completing the program.
Conclusion Table 3 GPA and MC-HESI score differences Academic measure
Program completion Yes M
Entry GPA Readmission GPA MC-HESI
t test
p
No SD
M
SD
3.1187 .33703 3.0596 .28524 .959 .340 3.0244 .28445 2.9302 .19680 2.023 .046 781.40 119.509 749.73 94.052 1.383 .170
Administrators and nursing faculty may find this information useful in further understanding the concept of dismissal and readmission. The study results detail criteria that can readily identify students most likely to be dismissed a second time. This information can be used to refine admission and readmission policies and develop and implement appropriate remediation programs, such as tutoring or mentoring, designed to provide students with resources to support retention and improve the completion rate of readmitted students For those students facing readmission, the results can be used as a guide
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