Education Interventions to Pass NCLEX

[barb4575]

I am curious what other educators are doing specifically to prepare students to pass the NCLEX. There seems to be some conflict regarding whether the BSN faculty want to teach students to critically think or pass NCLEX. To me, what's the difference? If they critically think, they should pass the NCLEX and vice versa. There are so many test banks out there to prepare students to take the NCLEX and was wondering which ones you have reviewed and preferred? I have found some questions online for free and have brought them into class and asked the students too. They love doing it as it makes them feel...well, I am right on target.

The bottom line is that if they graduate with a BSN and fail the NCLEX, then they won't practice. I don't see how educators could not be concerned with their pass rates.

I am most concerned that they are prepared to work on the floor and this is my greatest focus. Students love to learn psychomotor skills and if they don't feel comfortable with them, then they are unconfident in their delivery of care. I bring the critical thinking in with the skills as well along with developing their confidence level.

Thanks for your input,

Barbara

[VickyRN, MSN, DNP, RN]

An EXCELLENT article on getting the most miles out of your classroom instruction (and preparing the students for the NCLEX examination):

Herman, J.W. (2002). The 60-second nurse educator: creative strategies to inspire learning. Nursing Education Perspectives, 9/1/2002

TODAY'S NURSE EDUCATORS serve multiple roles in the classroom. We are mentors, sages, entertainers, information jugglers, motivators, and more. One of our primary goals is to inspire. Through our connections with our students, we hope they will develop greater motivation and a greater capacity to learn, remember the information we impart and think about its relevance, and essentially "turn on" to learning.

The strategies presented in this article can be integrated into large classrooms, small classes, and clinical learning experiences. An inherent message is that content that is presented and reinforced in a fun manner will have a greater likelihood of being learned, and creating environments that celebrate learning will enhance nursing education (1).

We all face obstacles to using creative methods in the classroom, including lack of preparation time and insufficient class time, our own teaching style habits, the divergent learning styles of students, and the perceived need to cover all the content in class. The strategies presented here are quick, easy to implement, and transferable to a wide range of teaching topics and settings. It is important to remember that "shared perspectives, shared knowledge, and shared experiences are key foundational building blocks of creativity" (2, p. 675). Creating an atmosphere that promotes sharing and establishes rapport with students enhances learning and makes it memorable.

The Large Classroom Teaching in a large room with more than 50 learners offers significant challenges. The physical distance between teacher and learner can lead to an impersonal atmosphere in which the teacher does not know the learners, and the learners do not know one another. In larger classrooms where it is difficult to see all participants, it may be difficult to engage all the learners (3).

Strategies that increase student comfort, personal interpretation of content, and learning in large classrooms include in-lecture short methods, case studies, and in-class quizzes and tests. In-lecture innovations are quick, easy exercises or experiences that stimulate interest, build rapport, and reinforce concepts. While delivering information in a lecture format, the instructor can intersperse activities and ideas that grab the student's attention. (See Table 1.)

Case studies and scenarios are commonly used in nursing education. Rich clinical anecdotes, the drama of the human experience, and the practical nature of nursing knowledge all contribute to the value of this method. Case studies can be as brief or as extensive as time and abilities permit. Several types of cases are introduced in Table 2.

The in-class quizzes and test questions in Table 3 are important for reinforcing content. Students themselves, especially seniors facing the NCLEX exam, often request test items to be discussed in class. They are useful for testing knowledge, gaining a glimpse into test formats and content, and identifying learning needs.

The instructor should caution the class to wait for a signal before giving the answer. Students who are slower readers or need to think about test options find it frustrating to have peers answer a question before they find the answer.

These strategies may be implemented in large classrooms to enhance traditional lectures. Well-planned in-lecture innovations, case studies, and quizzes and test questions provide diversion, opportunities to assess student learning, tools to serve as memory builders, and reinforcement of key concepts.

Small Classes The definition of a small class varies with the environment. In some academic settings, a small class consists of no more than 10 students. In others, classes with fewer than 50 students are considered small. Generally, small groups of 20 to 30 students offer a great number of teaching advantages.

Working with a small group can be an enjoyable and effective teaching experience. By engaging learners and employing cooperative learning and problem-based techniques, teachers may perceive that they are in the most fertile ground for educational enhancements (4). However, challenges remain. Some students are reluctant to participate even in smaller groups, and the dynamics of the group may present some negative aspects.

While a cohesive group may encourage active learning, the dynamics of some groups discourage participation and the spirit of inquiry. A teacher who is able to assess group attitudes and needs can enhance group function through the use of learning interventions such as the ice-breakers, group exercises, and cooperative activities found in Table 4.

Teaching nursing research and scholarly appreciation is frequently a challenge for nurse educators. The need to make research understandable, relevant, useful, and enjoyable is necessary to develop future nurse scientists and enhance nursing care and client outcomes. Whether taught as a separate course or incorporated throughout the curriculum, research concepts are often taught in smaller groups. Several methods that may enhance learning are listed in Table 5.

Clinical Teaching Clinical teaching is undoubtedly one of the most rewarding venues in nursing education. It also offers significant challenges due to the intensity of the environment, the potential for large clinical groups, and the varying needs of students. Instructors grapple with the balance between teaching students and providing valid evaluation. Fostering independence in students is always tempered by the need to maintain control and organization within the group.

Several strategies can enhance clinicals and postconferences to create valuable learning experiences. The innovative strategies and enjoyable learning experiences in Table 6 can help both students and faculty balance the stress and frustration associated with clinical instruction (5). Teaching critical thinking, priority setting, and the application of theory are integral to nursing education. Ultimately, the clinical setting is where the practice of nursing is learned, and novice nurses grow and develop.

The Pros and Cons Creativity interfaces with content and the teacher's knowledge when ingenuity and imagination are used to design teaching strategies. Innovation and humor can drive home points and enhance retention (6), and the use of cartoons, film clips, and carefully expressed anecdotes can help change the pace of the traditional lecture, place content on a human plane, and demonstrate to students an enjoyment of teaching and sharing (7,8).

There are, however, disadvantages as well as advantages to the use of these strategies. On the positive side, these strategies appeal to different learning styles, stimulate students to attend to information, and, by making concept connections, facilitate the transition from one topic to another. The disadvantages arise from the risk inherent in each strategy. Some student's may not understand the significance or application of content, some may misconstrue meanings, and others may consider methods childish. Methods may "crash and burn" if students feel ill prepared for the activity or prefer passive learning methods.

To enhance effectiveness, creative 60-second strategies should be dealt in appropriate doses, casually added to content, and not forced or overused. Using them involves preparation time and class time. It is best to start with a few methods and adapt them to one's personal teaching style. The activities offered in this article can serve as a springboard for the development of new exercises.

Like any other skill, integrating new teaching strategies into one's instructional style demands a willingness to take risks, stretch one's imagination, and practice. To enter a realm where learning is active, fun, and memorable, and encourage students to respond positively to the experience, educators may want to remember this quotation from William Butler Yeats, "Education is not the filling of a pail, but the lighting of a fire" (9, p. 35).

Key Words Clinical Teaching--Creative Teaching Strategies--Nursing Education--Student Learning

TABLE 1.

IN-LECTURE INNOVATIONS

Why are you here? Open the class with the

question, "Why are you here?" Responses to this

question allow instructors to compare their own

goals with those of their learners and gear content

to student needs. Sharing of class plans sets boundaries

about what will and will not be covered and

clarifies expectations.

Short clips Show movie segments, commercials,

or clips from television shows to reinforce concepts.

Health care shows offer positive and negative

portrayals of nursing, medicine, client perspectives,

and key issues. Popular videos bear poignant

messages for today's TV generation. Rapport is

enhanced and information retained when content

relates to the learner's frame of reference. Even

greeting cards and comic strips provide humorous

ways to emphasize key information.

Stories Lay, business, parenting, or news literature

can enhance the relevance of key concepts.

Children's books may be used to develop an

appreciation of the universal nature of health

care issues and priorities. Nurses and students

instinctively cling to "war stories" and clinical

anecdotes to capture attention and reinforce

information. Telling brief, current, and well-spaced

stories may entice learners to attend to

content and establish priorities. Several publications

provide rich anecdotes to augment nursing

content (6,7,10).

What's the big deal? A common source of

frustration for many nursing students is setting

priorities and selecting initial, key nursing

actions. Many students are shocked to find that

all four options on a multiple choice exam represent

correct answers, with their role being to

delineate the most correct answer. Implement

this strategy by asking, "What's the big deal?"

after teaching a concept. Focus on clinical scenarios,

cultural and spiritual priorities, and personal

experiences by asking this question and

having students discuss priorities and the impact

of health problems on clients.

Jigsaw This strategy by Ulrich and Glendon (11)

allows several groups to function individually to

meet the large group role. Each group contributes

a piece to the completion of a puzzle.

Conclusions are posted or reported to the class

for collective learning. Small groups are asked to

accomplish a task, such as diagnosing a cluster of

client conditions, analyzing different legal case

studies, and teaching across the lifespan at different

developmental levels. The instructor circulates

among the groups and helps communicate

results to the entire class.

All things being equal Students are given three

assessments or conditions about a client and must

prioritize client needs based on the given data with

the caveat "all things being equal." Delineating priorities

in the face of several pieces of information is

useful for developing skills in taking multiple choice

tests and NCLEX.

When you think of this, think of that This is

essentially a matching exercise to be used immediately

after a brief lecture to reinforce and clarify

key concepts. Two columns of data are presented

on overheads or PowerPoint slides. Students must

match the left and right columns.

Current events Current news stories, both

local and broad in scope, provide a "real-world"

application of learned content. Students are accustomed

to discussing current events from grade

school on. A significant number of nursing issues

can be discussed within the context of world

affairs. This strategy reinforces the need for nursing

professionals to be cognizant of current issues.

Research moments / corners Integrating

nursing research into every nursing topic establishes

currency of knowledge and provides a mechanism

for students to see the integral nature of research.

Providing a research moment in every lecture

enhances interest and discussion. Posting appropriate

research on a bulletin board, kiosk, or website

may stimulate the spirit of inquiry by allowing for

immediate application to current topics.

TABLE 2.

CASE STUDIES

Quickie cases These one-slide or overhead cases

provide real-world application of content without

taking up much time. Students are asked to consider

a case study with limited data. Quickie cases provide

a segue into new topics, reinforce complex

prototypes of conditions, and relate clinical cases to

didactic content.

Before-class case studies Many students do not

spend time preparing for class. Providing case studies

in student workbooks that students must read

and research in order to answer questions adds to

the value of time spent in class for clarifying concepts

and identifying potential test areas. These cases

appeal to those students who need to read,

write, and hear concepts to actively learn. Cases

published in texts for educators may be helpful for

generating ideas and formats (12).

Continuing case studies / unfolding case

studies Developed by Glendon and Ulrich (13,14),

unfolding cases can be used to stimulate large group

discussion. Cases are presented and questions discussed

in small groups. Additional information is

provided and discussions are generated concerning

new developments. Continuing cases can be distributed

throughout the lecture to reinforce each step

of the discussion, providing a creative way to

strengthen critical thinking.

TABLE 3.

IN-CLASS QUIZZES AND TEST QUESTIONS

Quizzes Administering unannounced quizzes

meets several goals. Students are given one point for

simply attending class, one point for a question on

preparatory readings, and one point for content discussed

in class.

In-class questions Showing test questions every

few minutes during a lecture enables students to

test their skills. Published test banks, nursing review

books, and questions in the text provide a ready

supply of test items that can be integrated into lecture

content. Computerized slide presentations

allow for the presentation of a question and highlighting

the correct answer, allowing for a realistic

simulation of computer testing.

Leap questions To increase critical thinking,

instructors can develop test questions that ask students

to go to the next level. Rather than simply

testing knowledge, in-class test questions should ask

students to leap to the next point, apply knowledge,

determine key interventions, and establish priorities.

Play it again, Sam Repeating in-class test questions

throughout the semester or from year to

year allows students to see what they have

learned. Using similar test questions demonstrates

previous learning, increases confidence, and provides

practice.

TABLE 4.

SMALL-CLASS STRATEGIES

Using prompts or manipulatives People of

all ages learn visually. Using toys, common household

objects, clime store prizes, or health care

equipment can aid in retention.

What's the point? After presenting content or

a client case, students are asked, "What's the

point?" This simple question helps ground content

and emphasize priorities.

The right thing to do Students are given a case

for analyzing legal and ethical issues and asked,

"What is the right thing to do?" This strategy can

promote discussion of some of the common

sense aspects of nursing. Presented with a client

scenario, students may be asked to reflect on

common interventions and the common sense

orientation inherent in nursing care.

Twosies Students pair off to demonstrate facial

expressions, assess each other's shoes, or discuss

a topic. This allows for personal discussion, even

when the size of the entire group precludes personal

sharing. In one example, the student turns

to a neighbor and says "nice shirt," using several

vocal tones and gestures. This exercise reinforces

the importance of the nonverbal elements of

communication.

Admit tickets Students are asked to answer a

question, ask a question, or make a comment about

class and write it on a ticket. The instructor allows

only those students who have a ticket into the

classroom, reinforcing the need for personal

responsibility, class preparation, and active involvement.

This strategy requires the instructor to maintain

a strict policy in dealing with nonparticipants.

Some instructors reverse this strategy and require

a ticket to leave the class.

The same information Students are given a

case in class, unaware that two groups have two different

sets of information. Students discuss the case

and realize that they are dealing with information

from different perspectives. This exercise may be

used to reinforce principles of communication, culture,

and caring.

Student-led seminars Students are asked to

lead small discussions. This common classroom

strategy provides reinforcement and another voice

while cultivating public speaking talents.

Let's be real By saying "Let's be real" after a theoretically

based discussion, information is framed

within the context of true nursing practice. Clinical

examples provide a mechanism for discussion. This

is an excellent opportunity to help students differentiate

between real-life health care issues and

those on TV and elsewhere.

The six hats This activity, developed by Gross

(15), cultivates decision-making, teamwork, and

empathy in participants. Each color hat represents

a different perspective of an issue and provides

a forum for discussion (red = feelings/emotions,

yellow = optimism, green = creativity, blue

= the global, rational perspective, black = pessimism,

and white = pure logic).

Think-pair-share / Teaching trios / Group

think Described by several authors, including

Ulrich and Glendon (11), this versatile method

works well with clinical groups and all class

sizes, allowing for full participation. A question

or issue is posed. Students are asked to contemplate

the issue, pair up, and share insights. If done

in Teaching Trios, one member moderates or

evaluates the process. Larger groups can work in

a mode called Group Think, in which problems

are solved using group process.

In-basket exercises The methods above can

be incorporated into "In-basket" exercises. Students

are given a task, a time frame, and a limited

amount of information. They solve the problem

using only the data presented. These exercises are

effective in developing group cohesiveness and as

early group activities.

Write to learn Writing frequent statements during

a lecture or small group activity will stimulate

thinking, engage learners, and enhance writing skills.

Students may be instructed to describe a clinical

experience in one sentence, summarize the key

point of a discussion, or react to a statement (16).

Imagine Teaching empathy to new nurses can be

a challenge. Asking students to imagine what it

would be like to live through an ordeal and use personal

imagery to describe the emotions evoked is a

valuable way to enhance sensitivity.

Games Any content can be put into the format of

a marketed game, an adapted game show, or a

home-made rendition. Keep in mind group size,

class objectives, and the volume of content. Games

may last 10 minutes or the entire class period, provide

for out-of-class study, or test for the acquisition

of knowledge.

Icebreakers Small groups frequently require

some method of introducing participants. Instructors

may have students introduce each other or

seek out answers to the "Why are you here?" question.

An effective icebreaker is to have pairs of students

try to find four characteristics they have in

common and four differences. Discussions may follow

around which proved easier, and commonalities

among students.

TABLE 5.

RESEARCH EXERCISES

How do you pick your shampoo? In a

larger group, students can be asked about the

decision-making process used to select a

brand of shampoo. Using the steps of the

research process, students correlate

research, decision-making, and the nursing

process.

Mike's scale / Shoot the arrow / Measuring

head exercises using straight rulers,

thread, and elastic Froman and Edwards

(17) describe several methods to teach about

reliability and validity. These exercises illustrate

the differences between these concepts

and their relevance to the research process.

Readers are encouraged to look to this

source for further details.

Designing mock studies Students plan

and implement mock research studies in

which they reinforce concepts of the

research process, including protection of

human subjects, data collection and analysis,

and nursing implications.

Campus research Students survey peers

and other students to learn elements of tool

development, field research, observational

research, and data analysis.

Concept maps Visual maps of research

concepts and methods may be used to reinforce

the research process or for the critique

of individual studies (18).

Clinical application of findings To apply

findings, students are asked to find a nursing

research article that applies to personal clinical

practice. Emphasis is on the critique of the

study and on the ability to utilize study

results in nursing practice.

TABLE 6.

CLINICAL TEACHING STRATEGIES

One-minute care plan Prior to patient care, students

develop a short problem/nursing diagnosis list.

Goals and strategies are established. The students

use the plan to guide patient activities, organize their

care, and evaluate goal attainment. Students create

useful and realistic patient profiles based on the

nursing process.

Grand rounds Use one-minute care plans to conduct

bedside or room-side nursing rounds. In a private

setting, students present their clients, have discussions

with colleagues, and work through difficult

patient issues.

Field trips Trips to the grocery store, pharmacy, or

toy store may be used to teach concepts of wellness,

nutrition, development, or pharmacology. Wikstrom

documented using trips to an art gallery to teach

nursing concepts (19).

Clinical questioning The ability to question students

about their preparation and readiness for care,

learning in the clinical setting, and ability to think critically

is truly an art. Students frequently find this type

of questioning offensive. Instructors must develop

nurturing, yet valid, methods to assess and teach in

the clinical area (20,21).

Ah-hah journals Journaling is a common method

of supporting student reflection and learning. Ah-hah

journals require students to identify a critical event,

something they did not know before, had not thought

of, or found surprising. In the journal they identify this

"ah-hah" describe the details and setting, pinpoint the

thoughts and feelings that accompanied the event, and

generalize learned concepts to future situations.

Using ah-hah journals helps steer students away from

chronological, nonreflective journal writing.

V-8 postconferences Much like ah-hah journals, V-8

conferences serve as a forum for discussing newly

learned concepts, ideas, or surprises in the clinical

setting. Students learn vicariously from one another.

Student-led discussions Students asked to lead

pre- or postconferences often come up with creative

ways to present information. Whether as a case

study, procedure, or debate, students sensitive to

each others' needs after a long day of clinical can

make these conferences fun and informative.

Pass the problem This is a great postconference

activity for students new to care planning. Students

place the age, gender, background information, medical

diagnosis, and nursing diagnosis for a client at the

top of a paper. The paper is passed to the next students.

Each student is asked to add client goals and a

nursing strategy to the information. Passed around a

group of eight to 10, the activity facilitates the planning

of client care and associated written work.

Quick-write Much like write-to-learn in small

groups, students in postconference are asked to

quickly write their reactions to the day, to a proposed

dilemma, or a note to their client. These may

be kept private or shared with the group.

Active reading Students can be taught the value of

policies or procedures by reading a policy from the

text or agency prior to performing the skill in the

clinical area. The skill is carried our, and the experience

stimulates a postconference discussion. Students

who were not able to practice the skill can

learn from the experience of others.

Group concept mapping Concept mapping is a

common strategy to enhance thinking in individual

nursing students (18). Working in teams can lead to

mapping activities of complex topics, such as care of

the burn client, dehydration, and heart failure.

Debate Formal debate is not often used in postconference,

but providing the opportunity to prepare

for a debate encourages involvement in public

issues and exploration of the nursing role. Many real-world

topics would be relevant to any clinical setting.

Learn from each other More a philosophy than a

strategy, students are encouraged to capitalize on

the experiences of others to gain the most out of

clinicals. Active discussion, meeting each other's

clients, and assisting one another in providing care

not only increases the value of the clinical setting, but

also encourages teamwork and collegiality.

References

(1.) Skiba, D. J. (1997). Transforming nursing education to celebrate learning. Nursing and Health Care Perspectives, 18, 124-131.

(2.) Simplicio, J. S. C. (2000). Teaching classroom educators how to be more effective and creative teachers. Education, 120, 675-682.

(3.) Billings, D. M., & Halstead, J. A. (1998). Teaching in nursing: A guide for faculty. Philadelphia: Saunders.

(4.) Irwin, S. M. (1996). Creative teaching strategies. Journal of Continuing Education in Nursing, 27, 108-114.

(5.) Herrman, J., Saunders, A., & Selekman, J. (1998). Beyond hospital walls: Educating pediatric nurses for the next millennium. Pediatric Nursing, 24, 96-99.

(6.) Paulson, T. L. (1989). Making humor work: Take your job seriously and yourself lightly. Los Altos, CA: Crisp.

(7.) Lundin, S. C., Paul, H., & Christensen, J. (2000). Fish: A remarkable way to boost morale and improve results. New York: Hyperion.

(8.) Beitz, J. M. (1999). Keeping them in stitches: Humor in perioperative education. Seminars in Perioperative Nursing, 8(2), 71-79.

(9.) Sullivan, B. (1996). Teachers: A tribute. Kansas City, MO: Andrews and McMeel.

(10.) Johnson, S., & Johnson, C. (1986). The one minute teacher; How to teach others to teach themselves. New York: Quill.

(11.) Ulrich, D. L., & Glendon, K. J. (1999). Interactive group learning: Strategies for nurse educators. New York: Springer.

(12.) Castillo, S. (1999). Strategies, techniques, and approaches to thinking: Case studies in clinical nursing. Philadelphia: Sounders.

(13.) Glendon, K., & Ulrich, D. L. (1997). Unfolding cases: An experiential learning model. Nurse Educator, 22(4), 15-18.

(14.) Glendon, K., & Ulrich, D. L (2001). Unfolding cases: Experiencing the realities of clinical nursing practice. Upper Saddle River, NJ: Prentice Hall.

(15.) Gross, R. (1991). Peak learning. New York: Tharcher/Putnam.

(16.) Lashley, M., & Wittstadt, R. (1993). Writing across the curriculum: An integrated curricular approach to developing critical thinking through writing. Journal of Nursing Education, 32, 422-424.

(17.) Froman, R. D., & Owens, S. V. (1991). Teaching reliability and validity: Fun with classroom application. Journal of Continuing Education in Nursing, 22, 88-94.

(18.) Rooda, L. A. (1994). Effects of mind mapping on student achievement in a nursing research course. Nurse Educator, 19, 25-27.

(19.) Wikstrom, B. M. (2000). Nursing education at an art gallery. Journal of Nursing Scholarship, 32(2), 197-204.

(20.) Ironside, P. M. (1999). Thinking in nursing education Part I: A student's experience. Nursing and Health Care Perspectives, 20, 238-243.

(21.) Ironside, P. M. (1999). Thinking in nursing education Part II: A teacher's experience. Nursing and Health Care Perspectives, 20, 243-250.

Judith W. Herrman, MS, AN, a doctoral candidate at the School of Urban Affairs and Public Policy, University of Delaware, is undergraduate clinical coordinator, Department of Nursing, University of Delaware, Newark. Special thanks are extended to Kathleen A. Schell, DNSc, AN, for her review of the morificecript.

COPYRIGHT 2002 National League for Nursing, Inc.

Link: http://www.highbeam.com/library/doc0.asp?docid=1G1:92448173&refid=hbr_flinks1

[VickyRN, MSN, DNP, RN]

An EXCELLENT article on getting the most miles out of your classroom instruction (and preparing the students for the NCLEX examination):

Herman, J.W. (2002). The 60-second nurse educator: creative strategies to inspire learning. Nursing Education Perspectives, 9/1/2002

TODAY'S NURSE EDUCATORS serve multiple roles in the classroom. We are mentors, sages, entertainers, information jugglers, motivators, and more. One of our primary goals is to inspire. Through our connections with our students, we hope they will develop greater motivation and a greater capacity to learn, remember the information we impart and think about its relevance, and essentially "turn on" to learning.

The strategies presented in this article can be integrated into large classrooms, small classes, and clinical learning experiences. An inherent message is that content that is presented and reinforced in a fun manner will have a greater likelihood of being learned, and creating environments that celebrate learning will enhance nursing education (1).

We all face obstacles to using creative methods in the classroom, including lack of preparation time and insufficient class time, our own teaching style habits, the divergent learning styles of students, and the perceived need to cover all the content in class. The strategies presented here are quick, easy to implement, and transferable to a wide range of teaching topics and settings. It is important to remember that "shared perspectives, shared knowledge, and shared experiences are key foundational building blocks of creativity" (2, p. 675). Creating an atmosphere that promotes sharing and establishes rapport with students enhances learning and makes it memorable.

The Large Classroom Teaching in a large room with more than 50 learners offers significant challenges. The physical distance between teacher and learner can lead to an impersonal atmosphere in which the teacher does not know the learners, and the learners do not know one another. In larger classrooms where it is difficult to see all participants, it may be difficult to engage all the learners (3).

Strategies that increase student comfort, personal interpretation of content, and learning in large classrooms include in-lecture short methods, case studies, and in-class quizzes and tests. In-lecture innovations are quick, easy exercises or experiences that stimulate interest, build rapport, and reinforce concepts. While delivering information in a lecture format, the instructor can intersperse activities and ideas that grab the student's attention. (See Table 1.)

Case studies and scenarios are commonly used in nursing education. Rich clinical anecdotes, the drama of the human experience, and the practical nature of nursing knowledge all contribute to the value of this method. Case studies can be as brief or as extensive as time and abilities permit. Several types of cases are introduced in Table 2.

The in-class quizzes and test questions in Table 3 are important for reinforcing content. Students themselves, especially seniors facing the NCLEX exam, often request test items to be discussed in class. They are useful for testing knowledge, gaining a glimpse into test formats and content, and identifying learning needs.

The instructor should caution the class to wait for a signal before giving the answer. Students who are slower readers or need to think about test options find it frustrating to have peers answer a question before they find the answer.

These strategies may be implemented in large classrooms to enhance traditional lectures. Well-planned in-lecture innovations, case studies, and quizzes and test questions provide diversion, opportunities to assess student learning, tools to serve as memory builders, and reinforcement of key concepts.

Small Classes The definition of a small class varies with the environment. In some academic settings, a small class consists of no more than 10 students. In others, classes with fewer than 50 students are considered small. Generally, small groups of 20 to 30 students offer a great number of teaching advantages.

Working with a small group can be an enjoyable and effective teaching experience. By engaging learners and employing cooperative learning and problem-based techniques, teachers may perceive that they are in the most fertile ground for educational enhancements (4). However, challenges remain. Some students are reluctant to participate even in smaller groups, and the dynamics of the group may present some negative aspects.

While a cohesive group may encourage active learning, the dynamics of some groups discourage participation and the spirit of inquiry. A teacher who is able to assess group attitudes and needs can enhance group function through the use of learning interventions such as the ice-breakers, group exercises, and cooperative activities found in Table 4.

Teaching nursing research and scholarly appreciation is frequently a challenge for nurse educators. The need to make research understandable, relevant, useful, and enjoyable is necessary to develop future nurse scientists and enhance nursing care and client outcomes. Whether taught as a separate course or incorporated throughout the curriculum, research concepts are often taught in smaller groups. Several methods that may enhance learning are listed in Table 5.

Clinical Teaching Clinical teaching is undoubtedly one of the most rewarding venues in nursing education. It also offers significant challenges due to the intensity of the environment, the potential for large clinical groups, and the varying needs of students. Instructors grapple with the balance between teaching students and providing valid evaluation. Fostering independence in students is always tempered by the need to maintain control and organization within the group.

Several strategies can enhance clinicals and postconferences to create valuable learning experiences. The innovative strategies and enjoyable learning experiences in Table 6 can help both students and faculty balance the stress and frustration associated with clinical instruction (5). Teaching critical thinking, priority setting, and the application of theory are integral to nursing education. Ultimately, the clinical setting is where the practice of nursing is learned, and novice nurses grow and develop.

The Pros and Cons Creativity interfaces with content and the teacher's knowledge when ingenuity and imagination are used to design teaching strategies. Innovation and humor can drive home points and enhance retention (6), and the use of cartoons, film clips, and carefully expressed anecdotes can help change the pace of the traditional lecture, place content on a human plane, and demonstrate to students an enjoyment of teaching and sharing (7,8).

There are, however, disadvantages as well as advantages to the use of these strategies. On the positive side, these strategies appeal to different learning styles, stimulate students to attend to information, and, by making concept connections, facilitate the transition from one topic to another. The disadvantages arise from the risk inherent in each strategy. Some student's may not understand the significance or application of content, some may misconstrue meanings, and others may consider methods childish. Methods may "crash and burn" if students feel ill prepared for the activity or prefer passive learning methods.

To enhance effectiveness, creative 60-second strategies should be dealt in appropriate doses, casually added to content, and not forced or overused. Using them involves preparation time and class time. It is best to start with a few methods and adapt them to one's personal teaching style. The activities offered in this article can serve as a springboard for the development of new exercises.

Like any other skill, integrating new teaching strategies into one's instructional style demands a willingness to take risks, stretch one's imagination, and practice. To enter a realm where learning is active, fun, and memorable, and encourage students to respond positively to the experience, educators may want to remember this quotation from William Butler Yeats, "Education is not the filling of a pail, but the lighting of a fire" (9, p. 35).

Key Words Clinical Teaching--Creative Teaching Strategies--Nursing Education--Student Learning

TABLE 1.

IN-LECTURE INNOVATIONS

Why are you here? Open the class with the

question, "Why are you here?" Responses to this

question allow instructors to compare their own

goals with those of their learners and gear content

to student needs. Sharing of class plans sets boundaries

about what will and will not be covered and

clarifies expectations.

Short clips Show movie segments, commercials,

or clips from television shows to reinforce concepts.

Health care shows offer positive and negative

portrayals of nursing, medicine, client perspectives,

and key issues. Popular videos bear poignant

messages for today's TV generation. Rapport is

enhanced and information retained when content

relates to the learner's frame of reference. Even

greeting cards and comic strips provide humorous

ways to emphasize key information.

Stories Lay, business, parenting, or news literature

can enhance the relevance of key concepts.

Children's books may be used to develop an

appreciation of the universal nature of health

care issues and priorities. Nurses and students

instinctively cling to "war stories" and clinical

anecdotes to capture attention and reinforce

information. Telling brief, current, and well-spaced

stories may entice learners to attend to

content and establish priorities. Several publications

provide rich anecdotes to augment nursing

content (6,7,10).

What's the big deal? A common source of

frustration for many nursing students is setting

priorities and selecting initial, key nursing

actions. Many students are shocked to find that

all four options on a multiple choice exam represent

correct answers, with their role being to

delineate the most correct answer. Implement

this strategy by asking, "What's the big deal?"

after teaching a concept. Focus on clinical scenarios,

cultural and spiritual priorities, and personal

experiences by asking this question and

having students discuss priorities and the impact

of health problems on clients.

Jigsaw This strategy by Ulrich and Glendon (11)

allows several groups to function individually to

meet the large group role. Each group contributes

a piece to the completion of a puzzle.

Conclusions are posted or reported to the class

for collective learning. Small groups are asked to

accomplish a task, such as diagnosing a cluster of

client conditions, analyzing different legal case

studies, and teaching across the lifespan at different

developmental levels. The instructor circulates

among the groups and helps communicate

results to the entire class.

All things being equal Students are given three

assessments or conditions about a client and must

prioritize client needs based on the given data with

the caveat "all things being equal." Delineating priorities

in the face of several pieces of information is

useful for developing skills in taking multiple choice

tests and NCLEX.

When you think of this, think of that This is

essentially a matching exercise to be used immediately

after a brief lecture to reinforce and clarify

key concepts. Two columns of data are presented

on overheads or PowerPoint slides. Students must

match the left and right columns.

Current events Current news stories, both

local and broad in scope, provide a "real-world"

application of learned content. Students are accustomed

to discussing current events from grade

school on. A significant number of nursing issues

can be discussed within the context of world

affairs. This strategy reinforces the need for nursing

professionals to be cognizant of current issues.

Research moments / corners Integrating

nursing research into every nursing topic establishes

currency of knowledge and provides a mechanism

for students to see the integral nature of research.

Providing a research moment in every lecture

enhances interest and discussion. Posting appropriate

research on a bulletin board, kiosk, or website

may stimulate the spirit of inquiry by allowing for

immediate application to current topics.

TABLE 2.

CASE STUDIES

Quickie cases These one-slide or overhead cases

provide real-world application of content without

taking up much time. Students are asked to consider

a case study with limited data. Quickie cases provide

a segue into new topics, reinforce complex

prototypes of conditions, and relate clinical cases to

didactic content.

Before-class case studies Many students do not

spend time preparing for class. Providing case studies

in student workbooks that students must read

and research in order to answer questions adds to

the value of time spent in class for clarifying concepts

and identifying potential test areas. These cases

appeal to those students who need to read,

write, and hear concepts to actively learn. Cases

published in texts for educators may be helpful for

generating ideas and formats (12).

Continuing case studies / unfolding case

studies Developed by Glendon and Ulrich (13,14),

unfolding cases can be used to stimulate large group

discussion. Cases are presented and questions discussed

in small groups. Additional information is

provided and discussions are generated concerning

new developments. Continuing cases can be distributed

throughout the lecture to reinforce each step

of the discussion, providing a creative way to

strengthen critical thinking.

TABLE 3.

IN-CLASS QUIZZES AND TEST QUESTIONS

Quizzes Administering unannounced quizzes

meets several goals. Students are given one point for

simply attending class, one point for a question on

preparatory readings, and one point for content discussed

in class.

In-class questions Showing test questions every

few minutes during a lecture enables students to

test their skills. Published test banks, nursing review

books, and questions in the text provide a ready

supply of test items that can be integrated into lecture

content. Computerized slide presentations

allow for the presentation of a question and highlighting

the correct answer, allowing for a realistic

simulation of computer testing.

Leap questions To increase critical thinking,

instructors can develop test questions that ask students

to go to the next level. Rather than simply

testing knowledge, in-class test questions should ask

students to leap to the next point, apply knowledge,

determine key interventions, and establish priorities.

Play it again, Sam Repeating in-class test questions

throughout the semester or from year to

year allows students to see what they have

learned. Using similar test questions demonstrates

previous learning, increases confidence, and provides

practice.

TABLE 4.

SMALL-CLASS STRATEGIES

Using prompts or manipulatives People of

all ages learn visually. Using toys, common household

objects, clime store prizes, or health care

equipment can aid in retention.

What's the point? After presenting content or

a client case, students are asked, "What's the

point?" This simple question helps ground content

and emphasize priorities.

The right thing to do Students are given a case

for analyzing legal and ethical issues and asked,

"What is the right thing to do?" This strategy can

promote discussion of some of the common

sense aspects of nursing. Presented with a client

scenario, students may be asked to reflect on

common interventions and the common sense

orientation inherent in nursing care.

Twosies Students pair off to demonstrate facial

expressions, assess each other's shoes, or discuss

a topic. This allows for personal discussion, even

when the size of the entire group precludes personal

sharing. In one example, the student turns

to a neighbor and says "nice shirt," using several

vocal tones and gestures. This exercise reinforces

the importance of the nonverbal elements of

communication.

Admit tickets Students are asked to answer a

question, ask a question, or make a comment about

class and write it on a ticket. The instructor allows

only those students who have a ticket into the

classroom, reinforcing the need for personal

responsibility, class preparation, and active involvement.

This strategy requires the instructor to maintain

a strict policy in dealing with nonparticipants.

Some instructors reverse this strategy and require

a ticket to leave the class.

The same information Students are given a

case in class, unaware that two groups have two different

sets of information. Students discuss the case

and realize that they are dealing with information

from different perspectives. This exercise may be

used to reinforce principles of communication, culture,

and caring.

Student-led seminars Students are asked to

lead small discussions. This common classroom

strategy provides reinforcement and another voice

while cultivating public speaking talents.

Let's be real By saying "Let's be real" after a theoretically

based discussion, information is framed

within the context of true nursing practice. Clinical

examples provide a mechanism for discussion. This

is an excellent opportunity to help students differentiate

between real-life health care issues and

those on TV and elsewhere.

The six hats This activity, developed by Gross

(15), cultivates decision-making, teamwork, and

empathy in participants. Each color hat represents

a different perspective of an issue and provides

a forum for discussion (red = feelings/emotions,

yellow = optimism, green = creativity, blue

= the global, rational perspective, black = pessimism,

and white = pure logic).

Think-pair-share / Teaching trios / Group

think Described by several authors, including

Ulrich and Glendon (11), this versatile method

works well with clinical groups and all class

sizes, allowing for full participation. A question

or issue is posed. Students are asked to contemplate

the issue, pair up, and share insights. If done

in Teaching Trios, one member moderates or

evaluates the process. Larger groups can work in

a mode called Group Think, in which problems

are solved using group process.

In-basket exercises The methods above can

be incorporated into "In-basket" exercises. Students

are given a task, a time frame, and a limited

amount of information. They solve the problem

using only the data presented. These exercises are

effective in developing group cohesiveness and as

early group activities.

Write to learn Writing frequent statements during

a lecture or small group activity will stimulate

thinking, engage learners, and enhance writing skills.

Students may be instructed to describe a clinical

experience in one sentence, summarize the key

point of a discussion, or react to a statement (16).

Imagine Teaching empathy to new nurses can be

a challenge. Asking students to imagine what it

would be like to live through an ordeal and use personal

imagery to describe the emotions evoked is a

valuable way to enhance sensitivity.

Games Any content can be put into the format of

a marketed game, an adapted game show, or a

home-made rendition. Keep in mind group size,

class objectives, and the volume of content. Games

may last 10 minutes or the entire class period, provide

for out-of-class study, or test for the acquisition

of knowledge.

Icebreakers Small groups frequently require

some method of introducing participants. Instructors

may have students introduce each other or

seek out answers to the "Why are you here?" question.

An effective icebreaker is to have pairs of students

try to find four characteristics they have in

common and four differences. Discussions may follow

around which proved easier, and commonalities

among students.

TABLE 5.

RESEARCH EXERCISES

How do you pick your shampoo? In a

larger group, students can be asked about the

decision-making process used to select a

brand of shampoo. Using the steps of the

research process, students correlate

research, decision-making, and the nursing

process.

Mike's scale / Shoot the arrow / Measuring

head exercises using straight rulers,

thread, and elastic Froman and Edwards

(17) describe several methods to teach about

reliability and validity. These exercises illustrate

the differences between these concepts

and their relevance to the research process.

Readers are encouraged to look to this

source for further details.

Designing mock studies Students plan

and implement mock research studies in

which they reinforce concepts of the

research process, including protection of

human subjects, data collection and analysis,

and nursing implications.

Campus research Students survey peers

and other students to learn elements of tool

development, field research, observational

research, and data analysis.

Concept maps Visual maps of research

concepts and methods may be used to reinforce

the research process or for the critique

of individual studies (18).

Clinical application of findings To apply

findings, students are asked to find a nursing

research article that applies to personal clinical

practice. Emphasis is on the critique of the

study and on the ability to utilize study

results in nursing practice.

TABLE 6.

CLINICAL TEACHING STRATEGIES

One-minute care plan Prior to patient care, students

develop a short problem/nursing diagnosis list.

Goals and strategies are established. The students

use the plan to guide patient activities, organize their

care, and evaluate goal attainment. Students create

useful and realistic patient profiles based on the

nursing process.

Grand rounds Use one-minute care plans to conduct

bedside or room-side nursing rounds. In a private

setting, students present their clients, have discussions

with colleagues, and work through difficult

patient issues.

Field trips Trips to the grocery store, pharmacy, or

toy store may be used to teach concepts of wellness,

nutrition, development, or pharmacology. Wikstrom

documented using trips to an art gallery to teach

nursing concepts (19).

Clinical questioning The ability to question students

about their preparation and readiness for care,

learning in the clinical setting, and ability to think critically

is truly an art. Students frequently find this type

of questioning offensive. Instructors must develop

nurturing, yet valid, methods to assess and teach in

the clinical area (20,21).

Ah-hah journals Journaling is a common method

of supporting student reflection and learning. Ah-hah

journals require students to identify a critical event,

something they did not know before, had not thought

of, or found surprising. In the journal they identify this

"ah-hah" describe the details and setting, pinpoint the

thoughts and feelings that accompanied the event, and

generalize learned concepts to future situations.

Using ah-hah journals helps steer students away from

chronological, nonreflective journal writing.

V-8 postconferences Much like ah-hah journals, V-8

conferences serve as a forum for discussing newly

learned concepts, ideas, or surprises in the clinical

setting. Students learn vicariously from one another.

Student-led discussions Students asked to lead

pre- or postconferences often come up with creative

ways to present information. Whether as a case

study, procedure, or debate, students sensitive to

each others' needs after a long day of clinical can

make these conferences fun and informative.

Pass the problem This is a great postconference

activity for students new to care planning. Students

place the age, gender, background information, medical

diagnosis, and nursing diagnosis for a client at the

top of a paper. The paper is passed to the next students.

Each student is asked to add client goals and a

nursing strategy to the information. Passed around a

group of eight to 10, the activity facilitates the planning

of client care and associated written work.

Quick-write Much like write-to-learn in small

groups, students in postconference are asked to

quickly write their reactions to the day, to a proposed

dilemma, or a note to their client. These may

be kept private or shared with the group.

Active reading Students can be taught the value of

policies or procedures by reading a policy from the

text or agency prior to performing the skill in the

clinical area. The skill is carried our, and the experience

stimulates a postconference discussion. Students

who were not able to practice the skill can

learn from the experience of others.

Group concept mapping Concept mapping is a

common strategy to enhance thinking in individual

nursing students (18). Working in teams can lead to

mapping activities of complex topics, such as care of

the burn client, dehydration, and heart failure.

Debate Formal debate is not often used in postconference,

but providing the opportunity to prepare

for a debate encourages involvement in public

issues and exploration of the nursing role. Many real-world

topics would be relevant to any clinical setting.

Learn from each other More a philosophy than a

strategy, students are encouraged to capitalize on

the experiences of others to gain the most out of

clinicals. Active discussion, meeting each other's

clients, and assisting one another in providing care

not only increases the value of the clinical setting, but

also encourages teamwork and collegiality.

References

(1.) Skiba, D. J. (1997). Transforming nursing education to celebrate learning. Nursing and Health Care Perspectives, 18, 124-131.

(2.) Simplicio, J. S. C. (2000). Teaching classroom educators how to be more effective and creative teachers. Education, 120, 675-682.

(3.) Billings, D. M., & Halstead, J. A. (1998). Teaching in nursing: A guide for faculty. Philadelphia: Saunders.

(4.) Irwin, S. M. (1996). Creative teaching strategies. Journal of Continuing Education in Nursing, 27, 108-114.

(5.) Herrman, J., Saunders, A., & Selekman, J. (1998). Beyond hospital walls: Educating pediatric nurses for the next millennium. Pediatric Nursing, 24, 96-99.

(6.) Paulson, T. L. (1989). Making humor work: Take your job seriously and yourself lightly. Los Altos, CA: Crisp.

(7.) Lundin, S. C., Paul, H., & Christensen, J. (2000). Fish: A remarkable way to boost morale and improve results. New York: Hyperion.

(8.) Beitz, J. M. (1999). Keeping them in stitches: Humor in perioperative education. Seminars in Perioperative Nursing, 8(2), 71-79.

(9.) Sullivan, B. (1996). Teachers: A tribute. Kansas City, MO: Andrews and McMeel.

(10.) Johnson, S., & Johnson, C. (1986). The one minute teacher; How to teach others to teach themselves. New York: Quill.

(11.) Ulrich, D. L., & Glendon, K. J. (1999). Interactive group learning: Strategies for nurse educators. New York: Springer.

(12.) Castillo, S. (1999). Strategies, techniques, and approaches to thinking: Case studies in clinical nursing. Philadelphia: Sounders.

(13.) Glendon, K., & Ulrich, D. L. (1997). Unfolding cases: An experiential learning model. Nurse Educator, 22(4), 15-18.

(14.) Glendon, K., & Ulrich, D. L (2001). Unfolding cases: Experiencing the realities of clinical nursing practice. Upper Saddle River, NJ: Prentice Hall.

(15.) Gross, R. (1991). Peak learning. New York: Tharcher/Putnam.

(16.) Lashley, M., & Wittstadt, R. (1993). Writing across the curriculum: An integrated curricular approach to developing critical thinking through writing. Journal of Nursing Education, 32, 422-424.

(17.) Froman, R. D., & Owens, S. V. (1991). Teaching reliability and validity: Fun with classroom application. Journal of Continuing Education in Nursing, 22, 88-94.

(18.) Rooda, L. A. (1994). Effects of mind mapping on student achievement in a nursing research course. Nurse Educator, 19, 25-27.

(19.) Wikstrom, B. M. (2000). Nursing education at an art gallery. Journal of Nursing Scholarship, 32(2), 197-204.

(20.) Ironside, P. M. (1999). Thinking in nursing education Part I: A student's experience. Nursing and Health Care Perspectives, 20, 238-243.

(21.) Ironside, P. M. (1999). Thinking in nursing education Part II: A teacher's experience. Nursing and Health Care Perspectives, 20, 243-250.

Judith W. Herrman, MS, AN, a doctoral candidate at the School of Urban Affairs and Public Policy, University of Delaware, is undergraduate clinical coordinator, Department of Nursing, University of Delaware, Newark. Special thanks are extended to Kathleen A. Schell, DNSc, AN, for her review of the morificecript.

COPYRIGHT 2002 National League for Nursing, Inc.

Link: http://www.highbeam.com/library/doc0.asp?docid=1G1:92448173&refid=hbr_flinks1

[VickyRN, MSN, DNP, RN]

While searching the literature, I came upon a good research article:

Powell, H. (2003). Predictors of success in nursing education.

ABNF Journal, 11/1/2003

Abstract: This correlational study was designed to determine if successful completion of the associate degree nursing program and success on the NCLEX-RN were correlated to scores on the Educational Resources, Inc. NET and Pre-RN Examinations. Data were collected from the educational records of the sixty-eight successful graduates from the fall 2001 class. This study found composite scores on the NET and Pre-RN were statistically significant, and were useful in predicting success on the NCLEX-RN. Consistent with the literature, this study found standardized measures and educational records may be useful screening tools for admission to nursing school, to predict success in the nursing program, and the NCLEX-RN. Faculty may utilize these findings in advising students, for developing support services and to assist students in developing an action plan to prepare for the NCLEX-RN. As suggested by sample size and correlations, a replication study was designed.

Key Words: Predictors of Success, Nursing Education Outcomes, NCLEX-RN

Available from: http://www.highbeam.com/library/doc0.asp?docid=1G1:112905385&refid=hbr_flinks1

[VickyRN, MSN, DNP, RN]

While searching the literature, I came upon a good research article:

Powell, H. (2003). Predictors of success in nursing education.

ABNF Journal, 11/1/2003

Abstract: This correlational study was designed to determine if successful completion of the associate degree nursing program and success on the NCLEX-RN were correlated to scores on the Educational Resources, Inc. NET and Pre-RN Examinations. Data were collected from the educational records of the sixty-eight successful graduates from the fall 2001 class. This study found composite scores on the NET and Pre-RN were statistically significant, and were useful in predicting success on the NCLEX-RN. Consistent with the literature, this study found standardized measures and educational records may be useful screening tools for admission to nursing school, to predict success in the nursing program, and the NCLEX-RN. Faculty may utilize these findings in advising students, for developing support services and to assist students in developing an action plan to prepare for the NCLEX-RN. As suggested by sample size and correlations, a replication study was designed.

Key Words: Predictors of Success, Nursing Education Outcomes, NCLEX-RN

Available from: http://www.highbeam.com/library/doc0.asp?docid=1G1:112905385&refid=hbr_flinks1

[sandysue]

Hi Indie,

I was reading your comments to some of the other nurses and would be interested in learning more on how to write NCLEX style questions. Do you have any references or suggested articles that would help me develop this skill?

Any help would be appreciated.

Thanks

Sandysue

In my school we revamped all our examinations to be in the form of NCLEX style questions. It took a few years to get to that point, but it did help our students by their own reports.

Writing NCLEX style questions is a skill in itself - I had been an 'item writer' in another state and was also used to teaching part time for Kaplan, so I gave a workshop on how to write appropriate questions - this needed DON support and some staff were against it at first. I was also surprised at the low level of educational knowledge of the instructors - things like Bloom's taxonomy were new to so many. Eventually, with DON support, we gave workshops/CEUs for staff in these areas too.

Schools with 'low' pass rates do not continue to receive BoN approval for the program; this is one thing the BoN monitors well because they are a consumer advocate agency and the students, to some extent, are consumers of what the school purports to offer. So I question the issues over 'low' pass rates. How does your school compare to the average in your state, or nationwide?

When pushed by students to recommend an NCLEX style question book I would suggest the National Student Nurses' Association book - it seemed closest to what I knew about NCLEX questions.

I do think it is very important to dispel the myths about NCLEX-RN (CAT) for students. Hold a fact session about the test with exact details on how a student is determined to pass or fail (this is complex - best illustrated by a graph with a hurdle on it, I believe), about the time issues involved and the mandatory break and optional break.

Remind them to take water and possibly a snack and to take a test run to be sure they know how to get there and where to park etc. Do reinforce, 'while the computer is running, you still have a chance to show you can pass the test. Keep on.' I've had students take five hours and get thru nearly all the questions and still pass. Or had students failed with a shut off at 75.

Remind students that the first questions are for practice, but they run into the real test with no clear break. Tell them that if a question just reads in a weird manner, to make a choice and move on (it is just possible that question is not part of the test, but is itself being 'tested'.

Warn students that the test center may not have ideal conditions e.g. some students of mine took NCLEX with road works and drills outside the window or noise in the test center.

Otherwise I just taught good nursing care, did not get into expert care scenarios with students as NCLEX tests a new graduate, not a critical care RN, critical thinking skills (e.g. we all know that to prevent osteoporosis, regular weight bearing exercise on the long bones is a good idea - make sure they can translate these sort of stylized responses into real life and realize this includes dancing, safe weight lifting.) I was surprised at the number of students who could trot out the text book statements, but did not know what these statements really meant in practice.

Hope this helps.

[VickyRN, MSN, DNP, RN]

Attended a seminary this weekend hosted by one of the top experts on NCLEX-RN passage in the country, Dr. Frances Eason. The following was Dr. Eason's advice:

One of the most salient points for teaching undergraduate nursing students (and future NCLEX passage): We teach our students beyond what they need to know.

"Get to the bottom line."

Are we teaching at a level that will not be tested?

ICU nursing is not on the NCLEX-RN.

No hemodynamic monitoring on NCLEX.

Medical-surgical nursing is.

NSR, V-fib, asystole are (basics).

Another tip for successful NCLEX passage: Teach adult health last semester (general medical-surgical nursing).

Most common disease state: CHF. Most common treatments: doctor-dependent treatments.

OB/PEDS is worth only 6% on the NCLEX.

Very little fetal monitoring will be on the NCLEX (not enough to really affect a student's passage rate).

Most questions on the NCLEX are from the category of "Safe, Effective Care Environment" (~16%) and "Physiological Integrity" (~55%).

If something is taught or tested (including extra credit items), needs to be covered in course objectives and in the syllabus. Never question at a difficulty level that is beyond the difficulty level (Bloom's) of the objectives, or is beyond the difficulty of the lecture/ instructional content.

Prioritization is big on the NCLEX.

Leadership course should focus on:

1. Getting organized

2. Leading yourself

3. Getting the whole patient-care team organized

4. Teaching the leader to be a member of the team (RN, LPN, CNA, etc. - Who can do what? To whom do you delegate? Which patient is top priority for the RN?)

Should not teach budget issues in the undergraduate nursing Leadership Course - this is more suitable for MBA's and will not be on the NCLEX. The NCLEX is not about leading a hospital. The NCLEX is, however, about nursing care issues.

At graduation, questions should be at 85% application/analysis, 15% knowledge/recall.

In terms of nursing process, there should be more items dealing with interventions (senior level), plus rationales.

New NCLEX has 265 items, 6 hours to complete. Need to give students in the last semester a 265-item test, so they can adjust to the rigor of the NCLEX.

15 items on the NCLEX - are tryout or experimental (not necessarily at beginning of test).

Only the last 60 items on the NCLEX really count. No matter how many questions it takes for the student to either pass or fail, the last 60 questions determine the person's score.

[Happyrn4U]

In my school we revamped all our examinations to be in the form of NCLEX style questions. It took a few years to get to that point, but it did help our students by their own reports.

Writing NCLEX style questions is a skill in itself - I had been an 'item writer' in another state and was also used to teaching part time for Kaplan, so I gave a workshop on how to write appropriate questions - this needed DON support and some staff were against it at first. I was also surprised at the low level of educational knowledge of the instructors - things like Bloom's taxonomy were new to so many. Eventually, with DON support, we gave workshops/CEUs for staff in these areas too.

Schools with 'low' pass rates do not continue to receive BoN approval for the program; this is one thing the BoN monitors well because they are a consumer advocate agency and the students, to some extent, are consumers of what the school purports to offer. So I question the issues over 'low' pass rates. How does your school compare to the average in your state, or nationwide?

When pushed by students to recommend an NCLEX style question book I would suggest the National Student Nurses' Association book - it seemed closest to what I knew about NCLEX questions.

I do think it is very important to dispel the myths about NCLEX-RN (CAT) for students. Hold a fact session about the test with exact details on how a student is determined to pass or fail (this is complex - best illustrated by a graph with a hurdle on it, I believe), about the time issues involved and the mandatory break and optional break.

Remind them to take water and possibly a snack and to take a test run to be sure they know how to get there and where to park etc. Do reinforce, 'while the computer is running, you still have a chance to show you can pass the test. Keep on.' I've had students take five hours and get thru nearly all the questions and still pass. Or had students failed with a shut off at 75.

Remind students that the first questions are for practice, but they run into the real test with no clear break. Tell them that if a question just reads in a weird manner, to make a choice and move on (it is just possible that question is not part of the test, but is itself being 'tested'.

Warn students that the test center may not have ideal conditions e.g. some students of mine took NCLEX with road works and drills outside the window or noise in the test center.

Otherwise I just taught good nursing care, did not get into expert care scenarios with students as NCLEX tests a new graduate, not a critical care RN, critical thinking skills (e.g. we all know that to prevent osteoporosis, regular weight bearing exercise on the long bones is a good idea - make sure they can translate these sort of stylized responses into real life and realize this includes dancing, safe weight lifting.) I was surprised at the number of students who could trot out the text book statements, but did not know what these statements really meant in practice.

Hope this helps.

Hi Indie,

I recently graduated with my MSN and will be taking a job writing test questions. I have not done very much of this so would appreciate any advice that you can give me. FYI, I wanted to give you my email address but your mailbox is full.

Thanks.

[jjjoy, LPN]

One of the most salient points for teaching undergraduate nursing students (and future NCLEX passage): We teach our students beyond what they need to know.

"Get to the bottom line."

Are we teaching at a level that will not be tested?

ICU nursing is not on the NCLEX-RN.

No hemodynamic monitoring on NCLEX.

Yet new grads, when they start working, ARE expected to know and be able to function at a level beyond what the NCLEX tests...

And if much of what is covered in school IS beyond what a new grad needs to know, why the *BLEEP* is it being covered? There's already a ton of material to cover and very little time and opportunity to digest it and apply it and really make it real - and not just a piece of information to be recognized as 'best answer' on the NCLEX.

Okay, my bias is probably obvious by now... something seems wrong to me when nursing school (at some schools) seems to be more about prepping students to pass the NCLEX (& covering all NLN required materials & writing long care plans from scratch) than to train up competent new grad nurses who will be expected to work with a full load of patients anywhere from a few days (LTC) to a few months after graduation.