Going Beyond the Busy Work
By: Maria Flores-Harris, DNP, RN, CNE
Remediation. It’s a bad word for many students. Let’s face it. It does have a negative connotation. The word “remedial” in education is associated with individuals who do not have the knowledge and/or skills they need to be successful. We can’t change the definition, but we can change what it means to our students by changing the process of remediation.
Before reading the rest of this post, ask yourself these questions:
- Does my program require remediation as part of the testing process? If yes,
- What is required of the student to complete remediation?
- What feedback do I get about the required remediation?
- Do we see positive outcomes from our current remediation?
As you ponder your answers, let me provide a picture of what the literature states and what my personal experiences have been regarding remediation.
Remediation, required or recommended, is used in most nursing programs in some way, shape, or form. The problem with remediation is two-fold. We can’t seem to agree on what appropriate remediation is, and whatever it is, students don’t want to do it! We need to turn to evidence-based practices to solve our problems.
Remediation needs to be MISC:
Meaningful
Incentivized
Simulation/case studies
Consistent
Have you heard your students state, “This remediation isn’t helpful, or remediation is a waste of time”? You are hearing this because remediation is not meaningful to the student. Providing meaningful remediation can be done in two ways – explain the why (how remediation is directly linked to becoming a better nurse) and individualize the remediation.
As educators, we should never assume that students know why they are doing something. Always take the time to explain “the why”. Your rationale for remediation may read something like this:
Our testing process includes remediation. To receive a final grade for an exam, remediation of the exam must be completed. Remediation consists of reviewing all questions on the exam. For questions answered correctly, ensure that you understand the answer and rationale and that you answered the question because your knowledge is correct and not because you guessed correctly. For questions answered incorrectly, complete the “Test Reflection Document” provided by the instructor and submit it within 48 hours of taking the exam to receive your final grade.
Remediation is required as part of the testing process because this is where the final steps of the learning process take place. Testing itself helps you with retrieval and linking information which is part of the learning process. However, remediation/reflection is a necessary part of the learning process also to ensure that the information you retrieve and link is correct and can be properly stored in long-term memory for future use. Remediation is where the most important learning takes place because you discover what you know, what you don’t know, and what you misunderstand. It’s important that you correct any misinformation during the remedial process so that you do not store incorrect information in long-term memory. The more effort you put into it, the better the likelihood that you store information for future recall. Most information you see on exams, you will need to recall in the future as a nurse!
A Test Reflection Tool, like the one provided, ensures that a student is guided in proper remediation and ensures the remediation is individualized. This document provides the opportunity for the student to identify issues in preparation for the exam and during the exam. The document guides the student to reflect on what can be done to remedy the issues identified and improve future exam scores.
To underline the importance of remediation, some type of incentive should be provided. Incentives such as points on an exam, ability to exempt an exam, etc. can be provided to ensure students complete proper remediation. Here is an example of a remediation incentive policy:
As part of the testing process, remediation must be completed to receive a final grade. The Test Reflection Document must be submitted within 48 hours of completion of a test to receive your final grade. If the document is fully completed, you will receive four additional points on your final grade for the exam. If the document is not fully completed, you receive an Incomplete for the exam. You cannot complete the course until the reflection documents are completed. If the completed documents are submitted late, you will receive one extra point added to the exam grade.
Simulation and/or case studies should be included in remediation. Our goal with nursing students is ultimately to teach students “to think like a nurse.” Thinking like a nurse is directly linked to clinical judgment, making appropriate clinical decisions when caring for our patients. One of the best means to teach clinical judgment is to provide patient scenarios and/or simulations for the topics being tested and allow students to “care” for those patients. Instruct the students to provide rationales for their actions. This does not take the place of remediating questions but is in addition to remediating questions.
Once the student has reviewed the questions and rationales, the simulation or case study provides the student the opportunity to re-test themselves and evaluate if learning occurred through remediation. Other than actual clinical practice on a patient, this is the best way to determine appropriate learning and ultimately evaluate clinical judgment progression. This is also one of the best ways to show the student that remediation is “for the real world.” Simulation for remediation demonstrates to the student that this remediation is directly linked to how to properly care for a patient.
Remediation practices should be consistent throughout the nursing program. All faculty should require remediation. All faculty should require the same type of remediation or the same types of choices for remediation. All faculty should incentivize remediation. There should be a remediation policy in place that includes all these items. Leadership should ensure that the policy is being applied across the nursing program consistently. Consistent use of remediation signals to the student that this is an important learning strategy and helps solidify the reflection process which should become a life-long activity for the future nurse.
Let’s address the questions you have been pondering:
- Does my program require remediation as part of the testing process? If yes,
- What is required of the student to complete remediation?
- What feedback do I get about the required remediation?
- Do we see positive outcomes from our current remediation?
All nursing programs should require remediation and reflection of exams and assignments. Remediation should include effort on the part of the student to identify what is known, what is not known, and what is incorrectly understood about the topic. This can be done individually with a reflection journal and/or Test Reflection Document. It can be done with a group/cohort by identifying their strengths and weaknesses (as identified by the most incorrect answers on questions) and verbally remediating questions as a cohort or in small groups.
Collaborative testing is an effective way to remediate. Though collaborative testing is part of the testing process, you will find that the group will discuss answers and rationales for correct and incorrect responses as they test. Collaborative testing then becomes a form of peer teaching and remediation.
You should hear from your students that the required remediation is beneficial and improves their preparation for the next exam/assignment and ultimately, their grade. You may not hear that it is enjoyable and that is okay. Learning takes effort and often is reported to be difficult. The true measure of effectiveness is improvement in outcomes. Outcomes can be measured by scores and/or by clinical judgment. Appropriate remediation should elicit positive outcomes. Appropriate remediation should be MISC – meaningful, incentivized, simulation, and consistent.
UWorld’s Learning Platform for Nursing was developed by nursing educators and practicing nurses in a way designed to build critical reasoning and critical thinking skills. Assignable traditional and Next Gen items, detailed answer explanations, vivid illustrations and images, and performance tracking do more than just improve a program’s NCLEX-RN or NCLEX-PN pass rates — they build student confidence, increase learning opportunities, and help prepare the next generation of nurses for a safe, accurate, and fulfilling career in nursing.
References
Harlan, A. (2017). How does Standardized Testing and a Structured Remediation Plan Affect ATI Second Attempt Assessment Scores and Student Self-Efficacy? Kentucky Nurse, 65(2), 13
Koestler DL. Improving NCLEX-RN First-Time Pass Rates with a Balanced Curriculum. Nurs Educ Perspect. 2015 Jan/Feb;36(1):55-57. doi: 10.5480/11-591.1. PMID: 29194160
Mee, Cheryl L. and Schreiner, Barb (2016). Remediation in Nursing Education Today: Review of the Literature and Considerations for Future Research. Journal of Nursing Regulation, 7 (1): 37-45. Doi: https://doi.org/10.1016/S2155-8256(16)31040-7
Nugent, P. M., & Vitale, B. A. (2012). Test success: test-taking techniques for beginning nursing students. 6th ed. Philadelphia, PA: F.A. Davis Co
Pike AD, Lukewich J, Wells J, Kirkland MC, Manuel M, Watkins K.Int J Nurs Educ Scholarsh (2019) Aug 6;16(1). Identifying Indicators of National Council Licensure Examination for Registered Nurses (NCLEX-RN) Success in Nursing Graduates in Newfoundland & Labrador.. doi: 10.1515/ijnes-2018-0060
