By: Maria Flores-Harris, DNP, RN, CNE
As a nursing educator, you have likely noticed the heightened anxiety among your students and faculty as the NGN® launch date approaches. There is fear of the unknown on both sides, but particularly for nurse educators who are unsure about how the NGN will impact nursing education and how they can adapt their remediation plans for students struggling to pass the NCLEX.
The NGN launches April 1, 2023 and anyone testing or retesting on or after that date will receive the revised NCLEX – the NGN exam. The NGN will still primarily consist of traditional question items. However, the new exam comes with a twist. All candidates will receive three case studies within the first 85 questions. Each case study consists of 6 questions that follow the new Clinical Judgment Measurement Model (CJMM). The question types within each case study may or may not look familiar.
It is essential that faculty quickly become familiar with the NGN and its new question types. This is the only way to prepare and remediate students who are unfamiliar with the question types or struggling with nursing content. Remediation is a critical part of nursing education that allows each student an opportunity for success. Educators are expected to identify areas of weakness and implement solutions for success. It is therefore essential to focus on three main strategies to optimally remediate your students.
- Ensure remediation is part of the learning process for every student.
- Use strategies for remediation that are supported by evidence.
- Propagate the development of clinical judgment and “stop the drop” of NCLEX pass rates through remediation.
Who Benefits from Remediation?
This requires a one-word answer. Everyone! In my experience, every student, no matter how good their performance, has something they can do better. If we use the “no need to remediate” mantra as a carrot to dangle for good performance, we are sending the message that remediation is only necessary for some students. This is not the message we want to send regarding remediation. Let’s not put a period where a comma should be. Let’s continue learning through remediation so that identified gaps are filled and future performance improves for all students. Remediation is as much part of the learning process as required readings and participating in the skills lab.
Remediation is typically indicated for nursing students who are consistently underperforming (Custer, 2018). Remediation corrects deficiencies and faulty thinking and helps to identify potential problems. The first step is to ensure that remediation is available to all students. A needs analysis should be performed for each student following each test or task to identify actual and potential problems. (Olsen, et al, 2022). This can be accomplished with a test reflection tool.
What Are the Benefits of Remediation?
The most significant benefit of remediation is that it continues the learning process. Nursing education is cumulative. The concepts learned from day one are necessary to understand future concepts and enable students to make connections that will eventually augment their clinical reasoning and clinical judgment skills. When applied consistently, remediation ensures that effective learning is occurring as every concept is introduced throughout nursing school.
Remediation identifies learning gaps and faulty thinking so that they can be corrected before a student moves on to another concept or course. In the process of identifying learning gaps, students should be guided to identify deficiencies in study skills and test-taking skills. This ensures that deficiencies can be corrected early and the benefits can be seen in nursing school and before taking NCLEX.
Finally, remediation forces reflection. Reflection is a part of the learning process and is a necessary part of developing critical thinking and clinical reasoning skills (Darby, 2019). Nursing students should reflect on their content knowledge, application of that content, and their ability to make safe clinical judgments. As a student reflects, they should be able to identify gaps in their decision-making, evaluate alternative decisions, and predict the outcomes of their actions. These types of reflections reinforce the development of clinical judgment.
When Should Nurse Educators Begin Remediation?
In many instances, remediation is initiated at or near the end of a course or program (Custer, 2018). Because remediation is part of the learning process, it should be incorporated throughout our nursing programs, from the initial nursing course to the final course. Nursing students should remediate after every quiz, test, or evaluation. Students should be given the opportunity to remediate any activity, be it in a classroom, lab, or clinical environment.
How Do Nurse Educators Remediate?
There is literature that supports the value of remediation but there is little research that evaluates best practices for remediation in nursing education. In 2022, an integrative review of evidence-based strategies for standardized exam remediation was published in the journal, Teaching and Learning in Nursing (Olsen, et al). The article identified three main categories of remediation—self-guided, faculty-guided with a group, and faculty-guided with an individual.
Students can be left to remediate on their own with no guidance (individual remediation), however, the literature does not support the efficacy of this. Most students, left on their own, do not complete optional work. They have too much on their plate that is mandatory. Also, if it is not required, it is not perceived as important, so why should they bother?
You can certainly ask students to complete remediation exercises and evaluate the outcome, but I suggest providing guidance as well. Reflection tools can be provided after exams, skills labs, simulations, and clinical tasks. The reflection tool should ask specific questions to guide students to identify content gaps, faulty thinking and the presence of anxiety. Reflection tools can include an optional free-writing area so that students can share their thoughts and self-reflections.
It’s important to give your students choices beyond the reflection tool questionnaire. For example, if you are remediating an exam, ask your students to provide you with evidence that they have made corrections. They can choose what evidence they want to submit, with the understanding that you have the option to ask for more if the evidence is not sufficient. Other alternatives include flashcards, answering new questions related to the identified topic, or retesting. Students who have input and a choice in their learning perform better and learn better (Darby, 2019).
Faculty input with individuals is also needed. Students must have individualized plans for remediation that target their own deficiencies (Olsen, et al, 2022). It is a waste of time for students to remediate something they already know. Meetings with faculty help students, (1) identify their weaknesses, (2) ensure appropriate activities for remediation, (3) develop rapport, and (4) increase personal accountability.
Remediation can also occur as a group with the faculty as a guide. Group deficits can be identified and discussed with the entire group instead of with each individual. For example, if you notice that 80% of the class missed the same three questions on an exam, you may want to review those questions as a group and discuss the rationales for correct and incorrect answer choices. Another example from clinical may be that you notice your clinical group did not perform well on a specific simulation. You may want to debrief, review the taped scenario, and reevaluate as a group.
Speaking from experience and supported by evidence (Olsen, et al), NCLEX practice questions, like those from UWorld, are effective remediation for tests. Remediating with new or unused questions is a win-win. You win because the remediation becomes the reevaluation of the student. If students can answer new questions correctly, they have most likely learned the concept. Students win because they like to practice NCLEX-style questions. As students answer more and more questions, they are continuously evaluating their performance and improving their application and analysis of knowledge, preparation, test-taking, and reflection skills.
In summary, remediation, whatever the type, should be consistently applied to all students and for all evaluative activities. Remediation is more than just analyzing incorrect test questions. It involves reflection on content but also reflection on the preparation for the test and the test-taking experience. Remediation should identify knowledge gaps, faulty thinking, the presence of study skills, and test-taking deficiencies. It should also help identify the presence of test anxiety. Remediation should be incorporated early in a nursing program and continue throughout the program so that before a student sits for NCLEX, all deficiencies have been addressed. When remediation is incorporated appropriately, it will increase student test scores, retention, graduation rates, and NCLEX pass rates. Remediation can be a “remedy” for most of our nursing program ailments, including the fear of NGN.
Custer, N. (2018) Remediation in Nursing Education: A Concept Analysis. Teaching and Learning in Nursing 13 (2018) 147-152. https://doi.org/10.1016/j.teln.2018.02.002
Darby, F. & Lang, J. (2019) Small Teaching Online: Applying Learning Science in Online Classes. Jossey-Bass, San Francisco, CA
Olsen, J. M., Mota, D., Wildenberg, C., Donahue, R. J., Thomas, R. (2022) Evidence-based strategies for standardized exam remediation in nursing: An integrative review. Teaching and Learning in Nursing 17 (2022) 371-377 https://doi.org/10.01016/j.teln.2022.05.007
Remediation (2017b). In the Free Dictionary. Retrieved from http://www.thefreedictionary.com/remediation
Remediation (2017c). In MacMillan Dictionary. Retrieved from http://www.macmillandictionary.com/dictionary/british/remediation
Wiles, L. (2015) “Why can’t I pass these exams”: Provided individualized feedback for nursing students. Journal of Nursing Education 54, 3 (2015) S55-58