Angelite Nurses

College hopes its improvements churn out better prepared grads; some students cry foul
By JESSICA KLIPA
jklipa@bradenton.com 

With a mounting shortage of critically needed nurses, colleges and universities across the nation are struggling to provide sufficient graduates to staff the health care system.

But with that pressure comes the challenge of educating students who succeed in first getting licensed to practice nursing.

In the past few years, Manatee Community College's nursing program has seen a decline in the passing rates among graduates who take the NCLEX - the National Council Licensure Examination - on their first try, records show.

In 2005, 90 percent of MCC nursing students passed on their first try, compared to 69 percent in 2007. The 2007 passing rate was below both the national and state averages of 85.47 percent and 83.22 percent, respectively.

That decline prompted MCC's administration and faculty to make changes in the program's standards.

"It's not fair to the community. It's not fair to the students when they come through a complete program and they're not successful," said Bonnie Hesselberg, MCC's dean for nursing and health professions.

In response to the dropping NCLEX scores, MCC invited nursing education consultants to evaluate the program, to help improve student success in class and on the NCLEX. In August, the Florida Board of Nursing approved the new measures at MCC, based on recommendations from the consultants.

The most significant changes involved increasing the course passing grade from 75 percent to 80 percent and implementing a comprehensive exam students must pass before graduation.

Effective this fall, students will have two chances to pass a standardized test before they can graduate. Previously, students took the test as only a practice to prepare them for the nursing board exam, she said. A strong "predictor" of how well they will do on the NCLEX, the standardized test helps students know where they need to focus on improving. Learning specialists have even been brought in to help students, Hesselberg said.

The new standards have received resounding applause from local hospitals.

"We support this change very strongly because we think it's going to get the outcome we need," said Jan Mauck, vice president and chief nursing officer for Sarasota Memorial Hospital.

Mauck believes that hospitals and educators have an obligation not only to provide the patient with a well-qualified, knowledgable nurse but also must help students choose a career they will enjoy and can succeed in.

"Every program is interested in making sure they have the highest passing rates possible," she said. "You really have to look at what's the standard."

Student concerned

But students in Manatee Community College's nursing program said changing course requirements in midstream is unfair. This week, about 50 of them crowded into a small meeting room at MCC Bradenton to voice concerns to Hesselberg.

While all recognize the drop in passing rate on the NCLEX calls for a change, students said the new standards are unfair considering that many began the program under a separate set of expectations.

Led by Virginia Rossi, who formed a coalition of MCC nursing students, the group said that their future is at stake. Students unable to obtain an 80 percent to pass exams and the course feared their scholarships could be endangered.

Students said they feel added pressure studying for an exam that was once considered a practice test, but is now part of a final grade.

If the standardized test, which helps predict how students will do on the board exams, is used as a tool to pass or fail students, then it looks like the college is trying to weed students out, Rossi said. She also wants to know why the education received at MCC is not sufficient in preparing students for the board exams.

"Would you have felt the need to implement a grade change if students were passing?" she asked Hesselberg.

Rossi and other students asked that they be grandfathered into the former standards, saying they had come too far into the program for change now.

"We're not asking them to lower the bar and strive for mediocrity, we're asking them to be fair," Rossi said.

Another change with the testing measures came about when the standardized testing company Educational Resources, Inc. was bought out by Assessment Technologies Institute. Familiar with the former testing company and the software and information used to prepare for the exam, students now have little time to become accustomed to the new testing style and prepare for an exam that will be worth 25 percent of their final grade in nursing seminar. Fourth-level students, especially, complained that they had just received their books and study materials and had only until Nov. 4 before they took the test. They also wanted to know how it would be determined whether they passed or failed.

When asked by Hesselberg what could be done to help, their answer was "time."

Hesselberg responded to their pleas saying that the changes were meant to help students achieve their goals. If they applied themselves to their work, they would succeed, she said.

"We certainly have not done this to penalize you," Hesselberg said.

Nurses are required to adapt to different situation each day, she said.

"It's not just textbook (knowledge). Boy, would it be nice it if was," she said. "We hope we're giving you some thinking skills."

It's time to study

Of MCC's more than 300 nursing students, not all students protested the changes.

Michael Zimmermann, a fourth-level student who graduates in December, agreed that time is essential. That's why instead of attending the meeting Monday, he spent his time studying in a group. Zimmermann admits that it has taken more effort to adjust to the changes. When he didn't do well on the first exam, he stepped up his game and improved his grade the next exam. The new challenge is a positive one for the students and the program, he said.

"This is not something that they just made up. This is something they put some thought into," he said. "The only thing that can possibly happen is you'll get better."

Michele Riggs, who also attended the study group, had gone to an open forum at the beginning of the semester to vent. She, too, was not happy initially about the new standards but decided she couldn't do much to change them. A mother of two teenagers and assistant to helping her her husband succeed in his business, she had to buckle down and do what it takes to pass the NCLEX.

"Once we swallowed that, then it was like now it's time to stop whining and study," she said.

Since transition is difficult, measures have been taken to start the incoming students out on the new standards like raising the grade point average requirements and giving an entrance exam, Hesselberg said. MCC has also disbanded the wait list for the program. In fall 2008, there were 343 students on the wait list. MCC invited 125 students into the program; about 70 students accepted. The remaining students who met the new standards were asked to reapply, Hesselberg said.

The new standards, she said, are not out of line with other community colleges. After looking into other programs, she discovered that at least eight of the 28 Florida community colleges have 80 an percent or higher as passing grade per course in nursing program. Fifteen have exit exams.

Instruction in courses, she said, varies depending on the instructor. As long as the concepts are taught, instructors may choose to use round-table discussion and others use straightforward lectures, she said.

Improvement on NCLEX scores has been made in the first quarter of 2008, among those who took the NCLEX for the first time from January until March. MCC's passing rate on the NCLEX was 76 percent, but still below the national and state averages of 87.06 percent and 85.68 percent, respectively.

Preparing for the future

Chief nursing officers in the area meet on a regular basis to discuss preparation of nurses. Hospitals spend time and money on training new nurses to care for the patients on the floor, said Chris Malloy, chief nursing officer at Manatee Memorial Hospital.

"One of the things we have all been grappling with is the preparation of students," she said. "This is a national problem. This is not just an MCC problem."

Malloy, who is pleased with MCC's nursing program, believes that "raising the bar" on the standards will help the community and the graduates in the long run. She looks forward to MCC offering the four-year degree programs, which she believes will be a nice "addition" to the existing two-year program opportunity.

"We believe MCC will certainly rise to the occasion. We're very happy about that," she said.

But a decline in performance on the NCLEX among two-year nursing graduates, begs the question: How will students fare if MCC expands to offer a four-year program?

MCC is not "isolated" in having challenges with its graduates passing the NCLEX, which changes every three years, said MCC president Lars Hafner. A change in the NCLEX back in 2007 caused other institutions, which also dipped below the national average pass rate, to reevaluate their nursing program standards, Hafner said.

New standards were addressed prior to Hafner coming to MCC in July, which enables MCC to "shore up" the nursing process and raise the standards for the future.

"What it does is it sets the foundation to offer a quality four-year program," he said. "You want to confront your problems head on, and that's what MCC has done."