Risk Assessment In Nursing Education
Whats Is Risk Assessment
Risk assessment is defined as the threatened ability of nursing students at all levels of education to gain access, progress in a nursing program, graduate, and pass licensing examinations for pre-licensure, and certification examinations for advanced practice nurses.
Factors identified for at risk students include speaking English as a second language (ESL); first generation attending college; retaking prerequisite science courses to obtain at least a C not having completed or within 5 years taken prerequisite college or college preparatory courses (algebra, biology, chemistry), not scoring within the average range or higher of a pre-entrance standardized test; less than a 30 science and overall grade point average (GPA); work hours increase: greater than or equal to 20 hours part time or greater than or equal to 40 hours full-time to finance undergraduate and graduate education, and those with family responsibilities, especially those with a lack of a family/support system.
Students at Risk to Pass NCLEX-RN
The importance of at risk students' characteristics for passing the National Council Licensure Examination Registered Nurse (NCLEX-RN”) as an outcome measure of pre-licensure nursing programs is evidenced by the plethora of research studies conducted by nurse educators for more than 20 years. Breckenridge's Risk Assessment Profile, Strategies for Success (RAPSS) instrument development has evolved for more than two decades with risk indicator additions based on evidence. RAPSS consists of 13 items used to assess at risk students for admission and progression through nursing programs to determine strategies to enhance student success, as well as to predict students' graduation rates. licensure, and certification examination pass rates (Breckenridge, 2006, 2010; Breckenridge, Wolf, & Roszkowski, 2012).
The RAPSS score assists directors, faculty, and advisors to identify students during the admissions process, prospectively, who benefit from a remediation program aimed at improving the potential for academic success. The application of the RAPSS is a central component in the Students at Risk, Strategies for Success (SRSS) and Nursing Workforce Diversity (NWD) program (Breckenridge, 2013), whereby the purpose is to assist underserved, underrepresented, and diverse nursing students to Achieve success by completing a bachelor of science in nursing (BSN) degree and passing the NCLEX-RN as first-time candidates.
This program is intended to close the gap of poverty, educational disparities, and preparation for at-risk students and increase the number of diverse under served registered nurses (RNs) joining the workforce. A structured learning. risk-reduction approach increases the retention of currently enrolled students and provides financial support through stipends or scholarships. Programs for the recruitment and remediation of disadvantaged and ethnically diverse baccalaureate nursing students continue to be developed, especially through the NWD Program of Health Resources and Services Administration (HRSA).
Condon et al. (2013) developed the Success in Learning Individualized Pathways Program (SLIPP) at a private west coast baccalaureate school of nursing implemented to promote academic success for nursing students who were at a higher risk for attrition than traditional nursing students.
Risk Factors for Students' Success
Several studies have identified risk factors targeted to develop interventions for student success for more than 20 years. Billings and Halstead (2012), found that ESL students experienced several barriers that put the students at risk for academic achievement. This included lack of self-confidence reading, writing, and learning difficulties: isolation prejudice, and lack of family and financial support. Scheele, Pruitt, Johnson, and Xu (2010) identified that Asian students struggle with English language difficulties around gender and tense; in spoken Asian languages, gender and tense are not differentiated.
Several studies have outlined barriers for Hispanic students. Bond et al. (2008) reported that problems Hispanic students face are lack of financial support, emotional and moral support, mentoring, professional socialization, academic advising, and technical support. Moceri (2010) identified non flexible or non culturally appropriate curricula and language barriers as detrimental obstacles for Hispanic students, Mount Carmel's Learning Trail student success program, developed in 2003, assists Hispanic students to be successful by providing mentoring, tutoring, counseling and follow up ( Billings & Halstead, 2012).
The risk of failing the NCLEX-RN increases with the number of C or lower grades students receive in nursing courses. In addition to academic performance, variables of test anxiety and student predicted NCLEX-RN scores need to be considered regarding students at risk. Hopkins (2008) developed a model of student support using specified academic predictors including the SAT or ACT; cumulative GPA; math and reading scores; and nonacademic variables: age, race, and gender. After at risk students are identified, a mechanism for referring the student to support systems should be implemented. For example, McGahee, Gramling, and Reid (2010) proposed limiting admission to nursing programs to students with no more than one science course failure.
Organizations and Programs for Financial Support of Nursing Students
Benner, Sutphen, Leonard, and Day (2010) noted that there are schools and health care organizations that offer outreach and pipeline programs for high school students, and encouraged that these types of programs be strengthened through financial support. recruitment, and retention infrastructures. Jeffreys (2012) recommended to avoid predicting retention of students based only on demographic characteristics. The environmental mental factors regarding living arrangements, financial status, family financial support for school, family responsibilities, family emotional support, transportation arrangements, and financial aid and/or scholarships were more influential for retention than other factors.
Jeffreys (2012) noted that retrospective studies have been the norm to determine nursing student performance outcomes, but recommends prospective assessment of risk and early intervention to maximize retention of at risk students. Consistent with this assertion, RAPSS is criterion based, incorporating both demographic and academic risk indicators for student applicants at the time of the admission process. This measure determines if students are in need of additional remediation to prospectively meet the admission requirements and progress in a nursing program. If students are at risk and in need of support services, Breckenridge (2013) recommends that remediation begins in the pre entry phase of an SSR.
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