29 minute read
n Nursing Students’ Experiences on NCLEX-RN Preparation
Susan Joseph, PhD, RN, CNE
n Abstract
Nursing educators have a crucial responsibility for maintaining first-time National Council of Licensing Examination for Registered Nurses (NCLEX-RN) pass rates and reducing the impact of a national nursing shortage. A qualitative multiple case study was conducted to explore nursing students’ experiences on NCLEX-RN preparation, including learning styles and approaches. Data were collected from nine associate degree nursing (ADN) graduates as three cases defined by years of graduation from 2011 to 2013. Kolb’s Learning Style Inventory (LSI) was used to explore the learning styles. Eight major themes emerged from the study, including learning approaches and learning styles that were used by students for NCLEX-RN preparation. Nursing students that passed NCLEX-RN on their first attempt had a deeper learning approach. Also, the specific Kolb’s learning styles of diverging, converging, and assimilating were helpful to students in passing the NCLEX-RN on their first attempt. This study provides information for nurse educators and leaders that can be used to improve NCLEX-RN pass rates.
Keywords: First time NCLEX pass rate, student nurse learning style, Kolb's learning style, nurse education
Introduction
Maintaining first-time National Council of Licensing Examination for Registered Nurses (NCLEX-RN) pass rates at or above the national average is a major challenge for nursing schools nationally. Both a school’s first-time pass rate and accreditation status of their nursing program are affected when a nursing student becomes unsuccessful on the NCLEX-RN (Hinderer et al., 2014; Homard, 2013). Studies have shown that most strategies to improve the NCLEX-RN outcome are the result of data gathered from the perspectives of faculty members rather than data that explore how students prepare for the licensure examination (Koestler, 2015; Schroeder, 2013). Student perspectives are fundamental aspects for program effectiveness and can be different from faculty perspectives in many areas, especially in preparation for the licensure examination. Given the problem of low NCLEX-RN pass rates and its contribution to ineffective program outcomes and the subsequent jeopardization of accreditation status, nursing shortage increases, and a weakened workforce, attention needed to be given to exploring nursing students’ experiences on preparation for licensure, including their learning styles and approaches.
The chosen research location was a hospital-based nursing school in the Northeastern region of the United States with five consecutive years
Susan Joseph PhD, RN, CNE
Montefiore School of Nursing, Mount Vernon, New York of low NCLEX-RN pass rates, beginning from 2008, that jeopardized its accreditation status. Though the reason for the low pass rates was unclear, educators had implemented changes in different areas such as increasing the passing grades, reducing student enrollment, and offering remediation for students. A multiple case study was undertaken to explore NCLEX-RN preparation experiences from the students’ perspectives. Two research questions (RQs) guided the study: RQ1. What are the perceptions and experiences of associate degree nursing (ADN) graduates with learning approaches used to prepare for the NCLEX-RN? RQ2. What are the perceptions and experiences of ADN graduates with learning styles used to prepare for the NCLEX-RN?
method
literature review
To identify the preferred learning styles and explore the students’ experiences on NCLEX-RN preparation, a comprehensive literature review was conducted for peer-reviewed articles categorized by main themes into NCLEX-RN examination, nursing workforce, strategies to promote
Student perspectives are fundamental aspects for program effectiveness and can be different from faculty perspectives.
NCLEX-RN success, predictors of NCLEX-RN success, and student learning styles. A study conducted by Chen and Lo (2015) on student satisfaction, affirmed the importance of studying students’ experiences for better program accountability. According to past studies, various external factors, including academic and non-academic issues, affect the NCLEX-RN outcome (Homard, 2013; Taylor et al., 2014); however, very limited inquiries have been done to explore nursing students’ experiences that include learning approaches and styles regarding NCLEX-RN preparation. None of the studies predominantly explored nursing students’ learning styles and learning approaches used in preparation for the NCLEX-RN (Andreou et al., 2014; Frantz & Mthembu, 2014). Moreover, Kolb (1981) endorsed the need for further discipline-specific studies to confirm students’ learning style preferences for improvement of academic disciplines. Furthermore, there are no studies existing to confirm specific learning styles used by ADN students for NCLEX-RN preparation.
Nursing accreditation agencies such as the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) set standards for the nursing programs to measure program efficiency and evaluate program mission and goals (Serembus, 2016; Yeom, 2013). First-time NCLEX-RN success is crucial to students, faculty, and accrediting agencies as a benchmark for nursing program quality (Salvucci, 2015; Serembus, 2016). It’s a challenge to prepare nurses to be successful on the NCLEX-RN at the first attempt with the increasing passing standards necessary to meet the minimum competencies for an entry-level registered nurse (RN) (Salvucci, 2015). According to statistics from the National Council of State Boards of Nursing (NCSBN) (2014), of 89,032 candidates who took the NCLEX-RN in the United States, only 85.54% passed the examination on their first attempt. In 2014, among 157,372 first-time, U.S.-educated graduates, 86,377 were from an ADN program and took the NCLEX-RN (NCSBN, 2014). The AACN reported that the current nursing shortage in the United States is expected to increase by 2025 and predicted the nation will require more nurses (AACN, 2014). When nursing students are unsuccessful on the NCLEX-RN, there are fewer RNs added to the workforce, exacerbating the nursing shortage as demand exceeds supply (Yeom, 2013).
Teaching can be more efficient if faculty know the learning style of students (Lockie et al., 2013). The learning style is how a student grasps new information and the process to understand it, whereas a learning approach is how a student approaches a learning situation to study a new concept (Tsingos et al., 2015). To support nursing students’ success in the program and on their boards, awareness of student learning styles and learning approaches is essential. Nursing students are also unique, each with unique learning styles. Tsingos et al. (2016) claimed that a preferred learning style might affect academic performance positively if the style fits with the learning environment.
Nevertheless, learning approaches are methods that reveal how a student moves toward studying, whether by using superficial or in-depth learning (Tsingos et al., 2016). Howie and Bagnall (2013) analyzed Biggs and Tang’s (2007) model of learning approach and affirmed that there are two types of learning approaches comprised of surface and deep. In a surface approach to learning, students learn only the bare minimum, learning concepts required to complete the course and used a lower cognitive level while learning (Howie & Bagnall, 2013). There are many rationales why a student might use a surface learning approach, including (a) planning to achieve only a minimum grade, (b) having other priorities in life, (c) not having enough time to study, (d) having confusion over course materials and requirements, (e) taking grades too lightly, (f) having anxiety, (g) having too much to handle, or (h) lacking an ability to learn (Howie & Bagnall, 2013). A deep approach to learning is when students study meaningfully and significantly to comprehend using a superior cognitive level of learning (Howie & Bagnall, 2013). Students use a deep approach to learning by (a) focusing on the course materials in-depth, (b) relating learned concepts to one another to get the entire perspective, (c) showing an interest in the subject matter to comprehend the details, (d) feeling optimistic about the subject, and (e) being challenged to be successful (Howie & Bagnall, 2013). Some students learn in a systematic way by planning, organizing, and following a study schedule.
Approaches to learning aren’t wholly responsible for students’ comprehension of new information, however a preferred learning style assists students with comprehending, grasping, and processing new information for knowledge. Li et al. (2014) acknowledged that a student’s preferred learning style is a way of obtaining new knowledge and arranging and holding on to it consistently. There are different learning style inventories (LSIs) in existence, and educators need to identify and understand different learning styles of students in order to guide their learning process (Frantz & Mthembu, 2014). Li et al. (2014) recommended Kolb’s LSI as an authentic and reliable tool to assess the ways in which a student receives and processes information. Kolb’s LSI is a self-scored assessment of 9–12 items, which identify four different learning styles, including abstract conceptualization (AC), concrete experience (CE), active experimentation (AE), and reflective observation (RO) (Lockie et al., 2013; Fogg et al., 2013; Ponto et al., 2014).
Theoretical Framework
David Kolb’s (1984) experiential learning theory (ELT) was used in the study to explore nursing students’ experiences of NCLEX-RN preparation, including learning styles and learning approaches. Kolb proposed in ELT that “Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38). Kolb’s ELT has been used in some education studies; however, it has rarely been used to identify nursing students’ experiences and learning styles for NCLEX-RN preparation (Poore & Cullen, 2014; Witt et al., 2013).
research method
A qualitative research method was appropriate for this study since there is no form of quantification needed to answer the research questions. Rather, an exploration of students’ experiences and perceptions was needed to interpret the meanings of their beliefs and practices (Baškarada, 2014). A case study design is recommended by Robert Yin (2014) when an inquiry is done to comprehend profound experience,
such as a school performance, small group behavior, and an institutional practice by focusing on a case to find out real-world viewpoints. “A multiple case design is a study that involves more than a single case” (Polit & Beck, 2014, p. 476). In this study, the cases were three groups of nursing students, each from a different graduating class (2011, 2012, and 2013), and the context was the nursing school.
The target population was 239 ADN graduates who successfully completed the nursing program at the research location from 2011 to 2013. Since the nursing students graduated between 2011 to 2013, a period of time in which the NCLEX-RN first-time pass rate dropped at this location, they were appropriate for the study. The selection criteria for the study sample included students who successfully completed the ADN program between the spring and the fall semesters of 2011 to 2013 and who had attempted to take the NCLEX-RN at least once. A strategic and purposive sampling was used to focus on the cases’ unique context as an effective method of recruitment in this study (Miles et al., 2014). In a case study, it is typical to choose a minimum number of cases for a deep exploration of a significant phenomenon in order to get in-depth meaning of real-life events (Yin, 2014). There are qualitative studies that used sample sizes mostly ranging from five to 18 (McFarquhar, 2014; Ozturk & Guven, 2016). Therefore, this study selected nine participants who met the criteria for the study. Additionally, when the participants were interviewed, data saturation also occurred that determined the nine participants were adequate for the study.
materials, Instruments, Data Collection, and Analysis
The study instrumentation was open-ended, semi-structured interview questions to guide the interview process with research participants. The school performance report from 2011 to 2013, in particular the NCLEX-RN first-time pass rates, were collected from school’s archival data. Kolb’s LSI was purchased for each participant and the questionnaire was used before the interview to explore their preferred learning styles. By interviewing the participants, the researcher had an opportunity to gather detailed information and explanations from students, including “personal views, attitudes, perceptions, and meanings” (Yin, 2014, p. 106). Triangulation of data collected from interview, verbal, and nonverbal cues, LSI, and school documents determined the consistency of findings (Yin, 2014). The collected data were arranged and organized with the help of NVivo 11 software and other computer tools, such as word processing and Microsoft Excel, to help identify themes and patterns in the statements of the participants (Mills et al., 2014; Yin, 2014). There were three cases defined by the students’ years of graduation (2011, 2012, and 2013) and three participants in each case. Frequencies and percentages for demographic characteristics are presented in Table 1.
Findings
learning Approaches and Themes
The study construct of learning approaches was explored in RQ1 and five major themes were found (Table 2).
Eight participants reported they had an organized study plan, including setting aside time to practice questions, taking breaks in Table 1 Demographic Characteristics
Characteristic Frequency (n)
Gender Male 4
Female Ethnicity
Black
Latino
Asian Age 32 33 35 37 41 5
4 2 3
1 1 1 2 2
42 1
45 Marital status
Married
Unmarried Work
Worked while in school
Did not work while in school NCLEX-RN
Passed NCLEX on first attempt 1
5 4
4 5
8
Passed NCLEX after multiple attempts 1
Year of graduation 2011 2012 2013 3 3 3
Percentage (%)
44.4 55.6
44.4 22.3 33.3
11.1 11.1 11.1 22.2 22.2 11.1 11.1
55.6 44.4
44.4 55.6
88.9
11.1
33.3 33.3 33.3
between, and planning for a specific number of hours to study, exercise, eat, shop, and sleep. This was illustrated by Participant 1, who said, “I had a plan for studying daily, set aside a lot of time, and I did not work during the preparation, and had a plan for studying 5 hours a day for 5 days a week.” In addition, Participant 2 stated, “I had a schedule for studying, practiced question and answers, planned for days to rest before the exam to take a mental break, and I wanted to be alone and not add anything to my life 48 hours before that exam.” Participant 6 also stated, “I had a plan to separate 4 to 5 hours for studying daily, planned to take a practice test after studying each system and then go back to the rationale for each answer before studying again. I looked at the NCLEX-RN blueprint and template from NCSBN to make my study schedule. I would
Table 2 Major Themes for Research Question 1
Theme Frequency (n)
1. A study plan is an important learning approach for NCLEX-RN. 8
2. Constant practice of NCLEX-RN-style questions and answers is a helpful learning approach. 3. Note-taking and summarizing is an effective learning approach for
NCLEX-RN. 7
6
4. Staying focused is a learning approach for NCLEX-RN preparation. 5. Commitment to study is crucial while preparing for NCLEX-RN.
Note. N = 9 6
6
Percentage (%)
88.89
77.78
66.67
66.67
66.67
say today I should get through this section and these many questions. I also planned and took a break to go to the mall in between studying.” Moreover, Participant 7 reported, “Before I started studying, I set a date to take the exam, if you don’t have a date for the exam; it’s hard for me to study with a plan.”
Seven participants reported that they practiced taking NCLEX-style questions either from a review book or online resources. For example, Participant 2 said, “I was a full-time employee; I did 250 to 300 questions per day during the week. On weekends, Saturdays and Sundays, I will sit at Barnes and Noble and I put all the questions that I got wrong together and review each topic, focus on area of wrong questions, and Monday again start over with practicing questions. I also practiced questions during work since I had understanding people and a good work place.” Similarly, Participant 4 stated, “I used a review book, and after reviewing contents of each systems initially for first two weeks, then I take practice exams; studying and practicing questions and answers helped me.” And Participant 5 said, “I did too much questions, finished the book, and did same questions again and again.”
In addition, Participant 6 said, “I started doing questions from the beginning, sometimes it made me panic and thinking, ‘Oh my God, many hours have passed reviewing topics and I didn’t understand much.’ Then I will decide to go to practice questions and then come back to review the contents again. It can be overwhelming, especially when you are tackling a subject you are not good [at]. You don’t know even if you read it 10 times, you may still think you are not getting it. So, I hit pause on it and do the practice questions and then come back to contents. Especially with the NCLEX, you can be a good student but a bad test taker. NCLEX is a type of standardized test, so the more test questions you practice, the more you [get] used to how they are going to ask you the questions.” Similarly, Participant 7 said, “I did 120 to 150 questions and answers per day. The more I did the questions, the more comfortable I was…. I also had an app on my cell phone and I used it everywhere to practice questions, at supermarket while shopping and during laundry, as I was continuously practicing and preparing for NCLEX.” Likewise, Participant 8 stated, “Practicing tests by doing questions [was] very helpful, I did 100 to 200 questions per day, and when I do the questions, I went back to text book to review the contents on the questions that I got wrong.” Participant 9 said, “I did a lot of online practice questions, rationales, and felt that the anxiety level can decrease with doing more practice questions.”
Participant 1 stated, “Just reading was not helpful for me to study. I had to take notes, a lot and lots of notes. I wrote in the books and the side of the PowerPoint notes, then I studied referring [to] my notes and I had to write repeatedly that it just stuck.” Also, Participant 2 and 8 said, “Taking notes were helpful while preparing,” and Participant 5 said, “I took notes while I was reading and that was helpful to summarize at the end.” Likewise, Participant 6 said, “While reading and reviewing, I take notes in the book so I will come back to review that topics. Also, just reading the topics is very passive to me, so I use the strategy of writing and highlighting to make it [a] more active learning experience.” In addition, Participant 7 stated, “I used a lot of writing on index cards and summarizing a lot of important lines.”
Staying Focused While Preparing for NCLEX-RN Is a Very Important Learning Approach
Participant 1 stated, “I just focused on reviewing questions, not getting distracted with other life issues.” Participant 2 and 3 said, “Focusing is important. You need to focus when you study; focusing is the key that I passed NCLEX.” In addition, Participant 5 said, “I focused on reading review books, on practicing to prepare for NCLEX.” Participant 6 said, “I needed to focus on studying while preparing for NCLEX, I even got out of my house to avoid distraction, rented a hotel the night before the exam to stay focused on preparation. I ate well, relaxed, and went straight from [the] hotel to take the exam.” In a like manner, Participant 8 stated, “I tried staying focused and don’t get distracted while preparing.”
Participant 1 stated, “I had some form of commitment in studying. It is not easy, and you need the same commitment that used for the program in nursing school to be used for NCLEX too. You can do everything, but having a commitment to be prepared well is a must; otherwise you will not be successful. My theme was the school is not over until I pass NCLEX.” Likewise, Participant 3 said, “I had a commitment in preparing for NCLEX by balancing work and studies.” Participant 4 stated, “I had a commitment to study a full month by my own, not taking any review class, [I] only used review books.” And Participant 5 recommended, “Don’t take the NCLEX light; have a form of commitment to study.” Participant 7 and 9 stated, “I had a commitment and determination to pass at first time. I wanted to take NCLEX only once and pass.”
Table 3 Major Themes for Research Question 2
Theme Frequency (n)
Percentage (%)
Students need to watch and think (assimilating) while learning for NCLEX-RN. 7 77.77
Students learn by doing and thinking (converging) for NCLEX-RN. 7 77.77
Students learn by feeling and watching (diverging) while preparing for NCLEX-RN. 6 66.66
Note. N = 9
learning Styles and Themes
Three major themes emerged for RQ2 (Table 3).
Participant 1 said, “For me, I did two things: watched a lot of videos, especially after clinical I go home, and watch YouTube videos and think again to make sure that what I learned is right.” Similarly, Participant 2 stated, “I recorded all my lectures, reviewed and listened [to] all my recorded lectures, and I listened [to] the lectures again and again.” Also, Participant 4 said, “I mostly watch an interactive video, animations, and cartoons to think and understand the material.” In contrast, Participant 4 stated, “I didn’t like YouTubes, but only used it to learn procedures.” Similarly, Participant 5 said, “I used interactive case studies like patient is coming with something and what I should do to take care of those patients and such scenarios.” In addition, Participant 6 said, “I learned through simulation specifically on how to put protective equipment and there was question about it on NCLEX.” Participant 8 said, “I am a visual learner. I have to watch to learn.” Likewise, Participant 9 said, “I watched a lot of YouTube video clips and online medical clips that were available.” was a great resource for me. And I used critical thinking to connect the dots and think why I am putting different parts of a care map.” Similarly, Participant 7 said, “I had to think why my answer is wrong when I do practice question.” Participant 9 stated, “Though I used practice questions, I gathered information from different books and went to the explanations and rationales for answers to think why my answers were wrong.”
Participant 2 said, “When I don’t understand, I will look at the information with imaginations and watch more information from YouTubes or interactive simulation videos. [I] also gathered information from coworkers who were more experienced.” Similarly, Participant 3 said, “When I don’t understand things, I think an alternate way of gathering more information on the topic such as visualizing the topics and solve the confusion.” Participant 5 said, “I gathered information from books mainly, and when I have problems to understand, I used interactive videos.” Similarly, Participant 6 said, “When I need additional information, I googled, went to text books, videos, and websites to see detailed information.” Participant 7 stated, “I tried to gather information from different sources. Also, I watched people during my externship on the medical-surgical floor. I spoke to different people to know different points of view.” Similarly, Participant 9 said, “When I don’t understand something, I asked my doubts to peers, teachers, and friends. And my experience in medical-surgical clinical rotation helped me to imagine the practical aspects. I also watched YouTubes, video clips on various medical contents when I needed more information.”
limitations
This study was a multiple case study at a single ADN program; therefore, the findings may not be generalized to other programs including bachelor’s degree in nursing because of the use of various teaching and learning strategies and diverse student population in other nursing programs. This study focused on the participants’ experience on NCLEX-RN preparation, including specific learning styles and approaches of the graduates that will not take in to account any other variables that may have affected their NCLEX-RN outcomes.
Participant 1 said, “In order to understand the information while learning, I used critical thinking strategies and I had a good anatomy and physiology foundation that helped me to know the basic information, and think critically. You need a solid, basic knowledge to understand the nursing concepts.” Participant 3 stated, “To gather and understand information, I did a lot of thinking and recalling what I learned in medical-surgical and basics nursing courses, to understand why my answer is right or wrong and the rationale. I also tied what I am reading to procedures.” Likewise, Participant 4 said, “To gather information for learning, I focused on what I need to concentrate especially on each system, reviewing the class materials and notes, thought different ways to get information on topics.” Participant 5 said, “I concentrated on books for gathering information and do lots of critical thinking exercises from the book.” Additionally, Participant 6 stated, “In terms of actually understanding what to learn…doing [a] care map Implications and recommendations
The implications of the study results may be important to nursing educators in providing future students the necessary guidance, advice, remediation, and recommendations on NCLEX-RN preparation. This study filled a gap in the literature through participant perceptions on learning approaches and learning styles used by ADN students for NCLEX-RN preparation. The theoretical lens used to analyze RQ2 was Kolb’s theory of experiential learning that proposed that learning is the process whereby knowledge is created through the transformation of experience (Kolb, 1984, p. 38).
learning Approach Implications
The implications of having a study plan and schedule allowed nursing students to become more organized to study by using a deep approach to learning and reinforced student success in the program and on the
NCLEX-RN by improving study and time management skills (Maile & Akir, 2012). The nursing students who practiced NCLEX-style questions regularly became familiarized with the type of questions, increased their language skills, alleviated fear and test anxiety, improved test-taking abilities, comprehension, confidence, and knowledge inorder to pass the NCLEX-RN (Blozen, 2015; Davis, 2016; Homard, 2013; McFarquhar, 2014). Note-taking and summarizing the concepts while studying helped nursing graduates to be successful on the NCLEX-RN (Nelson, 2016; Nugent & Vitale, 2016). The nursing students who used note-taking and summarizing techniques as a key learning approach improved critical thinking skills, learning performance, and helped them to understand the concepts clearly for success on the NCLEX-RN (Chan, 2012; Nelson, 2017; Nakayama et al., 2017). Staying focused on academic goals decreased students’ barriers to NCLEX-RN success. Though the students needed to make modifications in their life routines inorder to focus on course material in depth, learning was meaningful and active (Davis, 2016; Sandvik et al., 2014). The commitment of nursing students to studying was critical to balancing the demands of their professional education, made a better academic outcome, and helped to pass the NCLEX-RN on a first attempt (Clements et al., 2016; Sandvik et al. 2014).
learning Style Implications
The three major themes that emerged from RQ2 supports the ELT model that the main process of learning is by grasping and transforming experience into knowledge (Kolb, 1984). The nursing students prepared for the NCLEX-RN using an assimilating learning (watching and thinking) style that included grasping the information by watching and transforming it into knowledge by thinking (Kolb, 1984). The students who used a converging learning style passed the NCLEX-RN when they used problem-solving and decision-making skills through a thinking and doing learning style (Chan, 2012; Kolb, 1984). The students with diverging style rationalized the information using their judgment, practical explorations, and different viewpoints during preparation to pass the NCLEX-RN (Andreou et al., 2014); and when students rationalized the information using their judgment and explorations, they were combining practice and reflection (Kolb, 2000; Kolb & Kolb, 2005). Nursing students in this sample showed a deeper approach to learning and specific learning styles helped them pass the NCLEX-RN on their first attempt. Research shows that nursing educational leaders and educators need to
The Kolb’s learning styles of diverging, converging, and assimilating were helpful to students in passing the NCleX-rN on their first attempt.
encourage and support nursing students to take a deeper approach to learning during the program and in preparation for the NCLEX-RN. When students used a deep learning approach they studied meaningfully and significantly to comprehend the concepts using a higher cognitive level of learning (Howie & Bagnall, 2013). The research also shows that nursing education leaders should plan mandatory study strategy seminars that include training students in effective learning approaches.
recommendations and Summary
Recommendations for nursing education are: (a) provide study strategy seminars, (b) begin an NCLEX-RN Review Center that would provide opportunities for students to practice unlimited NCLEX-RN-style questions, (c) include higher cognitive level questions that use application, analysis, and evaluation levels on the course examinations, and (d) imitate NCLEXstyle questions on course exams to increase student confidence levels for passing NCLEX-RN (Blozen, 2014; Davis, 2016; Homard, 2013; McFarquhar, 2014). Additional recommendations to improve the first-time pass rate are: (a) extend NCLEX-RN support for graduating students until they pass the NCLEX-RN, and (b) identify the students’ preferred learning styles (D’ Amore et al., 2012; Ponto et al. 2015). Further, identifying the preferred learning styles of students using Kolb’s (1984) ELT will surely assist nursing students in grasping the concepts well and transforming them into new knowledge for passing the NCLEX-RN (Lockie et al., 2013; Ponto et al., 2015). The findings of this study indicate that the Kolb’s learning styles of diverging, converging, and assimilating were helpful to students in passing the NCLEX-RN on their first attempt. Additionally, nursing students need to use a deeper approach to learning when preparing for NCLEX-RN because students who passed the NCLEX-RN on their first attempt employed a deep-learning approach.
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