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BrentRN PhD

Pediatric Nursing and Educational Technology
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  1. I am not sure of what you are asking here. Please elaborate. Thanks.
  2. BrentRN

    Student Not Eligible for NCLEX

    A few commenters feel that requiring graduates to take an exit exam is "manipulating statistics". I think I understand what they are getting at because they feel a passing rate should not be affected by an exit exam requirement. Based on the many statistics courses I have taken I don't think that qualifies as statistical manipulation. Statistical manipulation means altering your data or presentation of the data to show it in more favorable or misleading light. Manipulation of a passing rate is actually not possible because the data is provided by the State BON not the school. The state just reports the passing rate of candidates as they take the exam. I have taught thousands of nursing students at three different nursing programs over a 30 year period. Nursing schools face a great challenge of setting a floor for what is acceptable minimal level of mastery. A school can set a bar very high and only allow the very top scorers to graduate but then the school will criticized for high attrition. They could also set the bar very low and then have angry graduates who are incapable of passing the NCLEX or getting a nursing job. Finding that sweet spot is very challenging. Just one problem is that you have different faculty creating different exams of different difficulty levels but all are using the same cut score. When you have to stick to the cut score you get issues where someone gets to pass by a rounding error along with a better grade on one paper. The student would be better served by repeating the course but rarely choose that option. They then get to the next semester and continue to struggle but either fail or just make it. Remember that in all groups somebody has to be below average by definition. Nursing curricula are not designed just to pass NCLEX. The exam is just a minimal demonstration of safety using a testing methodology that cannot be fully duplicated by any nursing school (Computer Adaptive Testing). Exit exams are just an attempt to prepare a student for a type of testing they may never have experienced. For example, teacher prepared exams are still done on paper where the whole exam is given to the student at once. A computerized test only lets the student see one question at a time. The ATI, HESI, Kaplan and the like are simulating that testing method. That seems like a reasonable and responsible thing for students to experience before going to the NCLEX. In an ideal world all graduates should walk out of school and pass without an exit exam. The national average for first time test takers without test preparation is around 85%. Some preparation for the exam can put the passing rate above 90%. While some folks in this discussion see that requirement as a disservice, my experience is that students have thanked us for being sure they are ready. Another issue is that I have had students in the past take the exam without studying "just so I could see what it was like". My fellow faculty and I were aghast at that view because so much rides on first-time passing rates. To summarize, I don't think an exit exam is a "manipulation". It is just a preparatory requirement right along with passing all your other requirement from Art to Physiology.
  3. I think it is a good thing to try and improve the exam. The tested NGN questions are not problem. The problem comes from creating the questions before validating the CJM. The council claims the model was validated via an expert review but that is an inadequate method for a model that has far reaching effects on nursing education and practice.
  4. The problem is that the tested questions are simultaneously assuming the CJM is valid and that the questions validated the CJM. That is circular logic. Imagine this analogy: Suppose I have a theory that homeopathic medicines are using "quantum level force" that cures headaches. I then give my headache patients the medicine and find that about half the time the headache goes away within a few hours. Did I just prove "quantum level force" cures headaches? Of course not. Without a mechanism for how the force relates to headaches just showing good results does not confirm the force exists. This is just why the NCSBN cannot say their research is validating the CJM. The other problem is that the secrecy of the NCSBN keeps anyone from seeing their data, or even discussing their methods. We are just supposed to believe them but that is not how science works.
  5. The issue here is that the NCSBN has conflated two issues. The first is their ongoing efforts to improve the NCLEX-RN exam's ability to identify a safe, beginning nurse. Licensure was first done with paper and pencil tests on five areas of practice that was offered twice a year. In the 1990s, Computer Adaptive Testing was implemented to allow year round testing and to achieve reliable testing results with a minimum of questions. Since that time the NCBSN has been trying to go to a richer testing experience. They have been talking about using case studies and more intelligent computer analysis of answers but have not gotten far. A few years ago they launched their NGN initiative. It is attempt to have the candidate progress through a case by demonstrating mastery of the parts of the nursing process. The new question types being tested are mostly extensions of the current alternative question types that have already been in use. The trouble has come from the second effort of the NCSBN to declare a clinical judgment model as "driving nursing practice". There are several problems with this approach. 1. First and foremost: The NCLEX-RN should be REFLECTING nursing practice not DRIVING it. The NCSBN needs to examine what and how nurses think, and only then create exam questions to test that ability. 2. The CJM was created through a quick literature review and synthesis of existing models without first testing the validity of the model. The model may be perfectly fine, but that is not how a model with such far-reaching effects should be put into effect. Any proposed model needs to be looking beyond the few sources they cite, collecting qualitative data from practicing nurses and faculty, and then proposing a model. The model would then need testing of its validity. 3. The CJM seemingly has ignored literature on the simultaneous use of analytic and intuitive thinking. The NCSBN has just created another linear thinking model with different labels and no validity testing. 4. The NCSBN continuously conflates NGN testing with the CJM. They seem to be using a circular logic that the CJM guides the NGN which validates the CJM and NGN (my head is spinning writing that). The NCSBN is well funded and secretive. They have taken a paternalistic "we know best" attitude so far to any criticism of this process. There are good reasons for test security but they need to be more forthcoming with the process of test creation. Major changes to the NCLEX-RN will mean changes in nursing schools to nursing curricula, pedagogy, and evaluation. These will all cost money and time. It is clear that many people and organizations are ready to cash in on this change as it rushes toward implementation. It is time to slow down this push to change the basic view of how nursing judgment works and proceed in a more scientific manner.
  6. This topic may seem arcane to the average nursing student but it is important to learn about. I recommend nursing students talk with their nursing faculty about this issue when they return to school. The National Council is changing the exam and changing the foundation the questions are built on without research to support those changes.
  7. BrentRN

    Shut off at 75? You mostly likely passed!

    An interesting hypothesis. I think the NCSBN should do post-test research on candidates' state before and after the exam, and how they may correlate with success.
  8. BrentRN

    Trump's 'religious conscience'

    This has become a long thread but we need to remember that the rules were instituted to appease those who wanted others to tolerate their intolerance.
  9. BrentRN

    Is Shortage in Nursing really a hoax?

    You can receive a reduced SS benefit at 62. 67 is the age for "full benefit" but it continues to rise each month you delay until you are 70. You have larger monthly checks but you have to live long enough to get back the money you deferred.
  10. BrentRN

    Maybe Clinicals instructor doesn't like men

    As a nursing student in the 1970s I had an instructor flat out tell me she did not think men belonged in nursing. We were "taking jobs away from women". That was at a time when it was harder for women to break into professions outside nursing or teaching. Sadly, I have continued to meet nurses who hint they believe women are more suited to be nurses as they are more likely to have the correct "worldview", have greater empathy, or still think men are taking all the top jobs.
  11. BrentRN

    Shut off at 75? You mostly likely passed!

    That's why I said "you most likely passed" and not "you passed". The vast majority of 75 question exam takers passed.
  12. BrentRN

    Trump's 'religious conscience'

    Use Pinocchio to help you: Conscience = Jiminy Cricket Conscious = Pinocchio after he became animate
  13. BrentRN

    Trump's 'religious conscience'

    Some points of clarification: References to a god or higher power are only found in the Declaration of Independence but there are none in the US Constitution. The Declaration has no legal bearing. In God We Trust started appearing during the Civil War. It officially became the US motto in 1956.
  14. BrentRN

    Trump's 'religious conscience'

    The issue is not the choices of our patients. If an adult chooses not to have a hearing test due to a religious reason that is their right. The issue is what nurses should be doing with ethical dilemmas regarding patient care. If a Scientologist goes to work in a psychiatric unit, or a Jehovah Witness goes to work in a blood bank, or a Christian Scientist goes to any healthcare facility I think they would harming their own faith and the health of the patients.
  15. BrentRN

    Trump's 'religious conscience'

    My concern with the HHS ruling was that it also included "Conscience protections from compulsory health care or services generally (42 U.S.C. 1396f and 5106i(a)), and under specific programs for hearing screening (42 U.S.C. 280g-1(d)), occupational illness testing (29 U.S.C. 669(a)(5)); vaccination (42 U.S.C. 1396s(c)(2)(B)(ii)), and mental health treatment (42 U.S.C. 290bb-36(f))" How on earth are they subject to someone's religious objection? I can understand the ethical dilemmas of abortion and euthanasia, but hearing screenings? WOW!?