It is imperative for nursing programs to admit students who can successfully complete the educational program and also attain success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN(R)). Failure to admit students who can achieve success affects the student, the nursing program and academic institution, employers, and society, as well as qualified students who were not admitted to the program. Underwood, Williams, Lee, and Brunnert (2013) stated that the loss of the student "wastes a sought-after student position" (p. S38). Failure to succeed in the nursing program affects students both financially and emotionally (Griffiths, Patastrat, Czekanski, & Hagan, 2004; Roa, Shipman, & Carter, 2011); for academic institutions, especially those with public funding, the impact on graduation and retention rates leads to financial loss (Granting Resources and Autonomy for Diplomas Act, 2014). NCLEX-RN pass rates also affect approvals by the state's governing body for RNs and accrediting bodies for the nursing program. When a pass rate does not meet the state's standard, the program will be placed on conditional approval, which can lead to loss of accreditation or even closure.
For all these reasons, a need exists in associate degree nursing programs to research admission criteria and the relationship to program completion and NCLEX-RN success. The purpose of this study was to understand whether the admission criteria of the HESI Admission Assessment (HESI A2(R)) composite score and preadmission science and math course grades are predictors of completing the nursing program in two years and passing the NCLEX-RN on the first attempt.
The theoretical framework for the study utilizes Bandura's (1994) theory of self-efficacy, which provides insight into how individuals believe in the ability to plan and perform actions that are necessary to achieve a self-defined desired outcome. Bandura's theory and the four processes that influence self-efficacy are applicable to nursing students. Once students are admitted into the program, their motivation and self-efficacy levels continually develop and increase, leading them to achieve their goal of becoming a nurse through academic success and successful passage of the licensure exam.
METHOD
A retrospective, descriptive correlational research design was used for the study. This design enabled the investigation of the relationship between the independent variables (HESI A2 composite score, preadmission science and math grades) and the dependent variables (program completion and NCLEX-RN success). The study, conducted in a nonresidential community college AD program, involved a review of academic records from previous admission groups. The population for the study consisted of students admitted into the nursing program from fall 2009 through fall 2012. Licensed practical nurses admitted via the nursing program's LPN-RN track were excluded. The total sample consisted of 245 students.
The data collection process began after institutional review board approval was received. Data were collected by the researcher from students' academic records. The data collected included admission criteria (HESI A2 composite score and preadmission science and math grades), year admitted to program, year completed the program, and NCLEX-RN passage. The review of records followed ethical considerations to ensure student anonymity and the protection of data. Data were analyzed using the SPSS program version 23. A significance level of p < .05 was used to determine statistical significance for the research questions and hypotheses in the study.
RESULTS
Students in the sample ranged in age from 19 to 58 years (average 28.58 years). Most students were Caucasian (82.4 percent) and female (78.4 percent). Of the total sample, 97 students (34.5 percent) completed the program in two years; 165 students (67.3 percent) passed the NCLEX-RN on the first attempt.
A statistically significant relationship was found, t(178) = 2.565, p = .011, between HESI A2 scores and successful passage of the NCLEX-RN on the first attempt. Statistically significant relationships were found, [chi]2(n = 245, df = 2) = 17.35, p < .001, between completion in two years and preadmission science grade, and program completion in two years and HESI A2 composite scores, t(243) = 2.382, p = .018. Results indicated no statistically significant relationship, [chi]2(n = 175, df = 2) = 0.820, p = .664, between preadmission math grades and success on the NCLEX-RN.
DISCUSSION
Bandura's theory of self-efficacy includes four efficacy-activated processes that influence self-efficacy beliefs: cognitive, motivational, affective, and selection. Each applies to the present study. The cognitive and selection processes involve selecting a career path and establishing the goal of becoming an RN. To achieve this goal, students took prerequisite courses prior to applying for admission to a nursing program; students must attain a grade of "C" or higher in these classes to be eligible for admission and must take a standardized nursing admission exam. Their motivational processes were apparent in their persistence in achieving the goal of admission by completing required courses and attaining a passing score on the admission exam, no matter the obstacle. Student motivation increased upon acceptance into the nursing program and completing courses successfully. Affective processes were associated with the emotional reactions of students. No matter the amount of stress they experienced in their studies, the majority of students in this study proceeded through the curriculum and attained the goal of completing the program in two years, with NCLEX-RN passage on the first attempt.
The student population in the study consisted of a majority of Caucasian women in their late twenties. For this population, findings revealed that the admission criteria were related to completion of the program and successful NCLEX-RN passage. The findings also support a relationship between HESI A2 composite score and program completion and NCLEX-RN passage. Preadmission science grades had a statistically significant relationship with program completion; students with higher grades were more likely to complete the program in two years. Miles (2006) and Seago, Keane, Chen, Spetz, and Grumbach (2012) found science grade point average to be a statistically significant predictor of program success.
It is noteworthy that science grades did not have a relationship with NCLEX-RN success. Fewer than half the students for this study had to retake the science course to achieve admission to the nursing program. Yet, this grade, whether A, B, or C, did not predict NCLEX-RN success, a finding not supported by Seldombridge and DiBartolo (2004). For this sample, there was no statistically significant relationship between preadmission math grades and program completion and NCLEX-RN success. Further research on math grades is needed.
Bandura's theory is evident in the accomplishments of students in the sample who completed the nursing program. To attain the goal of becoming an RN, students completed prerequisites, passed the nursing admission exam, were admitted to the nursing program. For this study, 180 students successfully passed all nursing classes, and of these students, 91.7 percent passed the NCLEX-RN on the first attempt, demonstrating that self-efficacy can continuously evolve even in the face of obstacles. Within the established time frame, students persevered to pass the NCLEX-RN on the first attempt, and their goals were achieved.
The study had several limitations. First, it was limited to one nursing program in the Southeast, and findings should not be generalized to other populations and academic settings. Second, not all students in the study had a preadmission math course grade; they were not required to take the class due to their score on ACT or an equivalent standardized exam. Third, not all students took preadmission math and science courses at the same institution or took these courses only once. Several students repeated these courses, and the last recorded grade was used for the study.
CONCLUSION
Because of the expected shortage of nurses within the next five years, it is imperative for nursing programs to admit students who will be successful in completing the program and passing the NCLEX-RN. Thus, it is essential that nursing programs review their admission criteria to determine whether current components utilized can ensure that students will complete the program and pass the NCLEX-RN. This study examined criteria currently utilized by nursing programs for admission: a standardized nursing admission exam composite score and prerequisite courses. It was found that the HESI A2 composite score and the preadmission science course grade were significant in determining students' success in completing the nursing program and passing the NCLEX-RN. Similar results were not found for preadmission math course grades.
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