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Strategies for Success for Practice Ready Nurses by Diane Breckenridge | E4 - Amplified RN News Show

ANA\California Member and media-trained nurse, Dr. Diane Breckenridge, PhD, MSN, RN, ANEF, FAAN, discusses how registered nurses can advocate for better NCLEX testing outcomes through evidence-based testing strategies and make an impact on today's nursing shortage.


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Jared Fesler 0:14

Welcome to the Amplified RN News Show where we're turning the volume on nursing news in California. Today, we're going to be diving in the topic of strategies for success for practice ready nurses to increase the nursing workforce. We're pleased to be joined by Dr. Diane Breckenridge and an ANA\California member and media trained nurse. Diane, thank you so much for joining us. Would you please introduce yourself and tell us a little bit why you're an expert on this topic.


Diane Breckenridge 0:42

Thank you Jared, right. I am the founding Dean and Professor of Nursing at Westcliff University in Irvine, California. But I have been a nurse since 1974, and teach in nursing, and in advanced practice nursing since 1977. And at that time, I developed a program to help my fellow students, as well as even myself do better in nursing programs. By the time of 1988, I developed the program specifically as strategies for success. Whereby we could help then 42 schools of nursing with over 20,000 students to increase their retention, graduate on time and join the nursing workforce by passing the NCLEX on their first time. And then working with those that did not pass with bootcamps to increase their chances of passing.


Jared Fesler 2:01

And so we've seen stories out and about, around nursing retention, especially new nurses entering the workforce quitting the nursing profession within a rather short amount of time. You're saying that there's some issues here with the process that leads to them becoming nurses correct?


Diane Breckenridge 2:22

There are issues and if we do things proactively, and we work with our students before they even come into nursing programs, and we do exams, and interviews with them, so we can determine their challenges not to keep them out of nursing school, but determine their challenges and work with them, we definitely have a better chance to help them with their success.


Jared Fesler 2:54

So how many nurses are currently passing the NCLEX entrance exam?


Diane Breckenridge 3:01

Right now in 2022 63,836, took the NCLEX of those 16,597 did not pass the NCLEX.


Jared Fesler 3:20

So we're about a little over a quarter percent of students are not passing the NCLEX right now is what you're saying?


Diane Breckenridge 3:26

Right! The NCLEX exam has dropped to an average of 74% pass rate.


Jared Fesler 3:34

So what's causing these issues? Why are these students not passing the NCLEX on their first attempt?


Diane Breckenridge 3:41

When I developed the strategies for success, and even though it was 1988, I have kept pace with evidence based work, even to present day. I've been very fortunate to have been taught very well to develop grants, as well as approaches from donor support money, because there are three major categories.


Diane Breckenridge 4:08

One is family issues. They love their families, our nurses love their families, but they have childcare, they have eldercare. So, the risk assessment profile strategies for success that the students back in the Philadelphia area helped me named as the RAPs instrument back in the end of the 80s into the 90s. At that time, it was really important to ask the students where are your challenges, not to keep you out of nursing school, but how can we help you so family issues was number one.


Diane Breckenridge 4:49

Number two socio economic, socio economic our students needed scholarships. I worked very hard to mimic Some of the approaches that were given to me, I was in a high school. And my honors teacher helped me find a scholarship. And that was the Health Education and Welfare scholarship, way back in 1971. And that helped me go to nursing school. As long as I said, I would work for the underserved for five years, that was my repayment. And I'd love doing that. And I stayed working for the underserved because I myself came from a very loving family. But we didn't have the financial means due to my father being a disabled veteran and not receiving the 100%. So we didn't have any of those benefits for education. So everyone worked with me, so I could get scholarships. And I did. And I worked also, and that's another situation, social economically, what I found what my strategies for success approach is that if someone's working full time, they have a double risk factor. If they're working part time, they have a risk factor. I worked, but I had to give the elder things up, so that I could work to help my family and be in school. And we know that that's necessary. So then I started working toward donor money. And I was able to bring in over these years $32 million. That was from donor money, and grant money. Now that money obviously goes to the universities, it goes to the nursing programs, it goes to the hospitals so that the nurses then can receive reimbursement monies, or scholarship money or another, we even were able to put in a childcare facility back in the Philadelphia area for those that had children, and didn't have the means to take care of their childcare.


Jared Fesler 7:00

So we have family issues and socio economic issues, play a part in passing the NCLEX. You said there were three what was the third?


Diane Breckenridge 7:09

Academic, so you have your students that need more, but let's use the word remediation and tutoring. But I didn't want that to be the fourth runner. In my work. I wanted to be strategies for success. So we kept a positive attitude about it. Yes, we have to remediate. And we have remediation courses. And yes, we need tutoring. And that's a part of it. But I don't want the students to just hear that. I want them to hear how can we be successful. So by given entrance exams, and instead of SATs like they used to give like I talk and many talk, we have more specific exam specifically for nursing today, from the testing approaches, by you do in those approaches, we can see who has an area in math that they still need to have some extra help, who need has some comprehension approaches that they need. Again, we want our nurses to speak other languages. That is what we want for our diversity, equity and inclusion. I wanted that from the very beginning and that they spoke other languages. But then again, since the NCLEX, is in the English language, we really need to work on making sure our students are able to translate the information. And it takes 30% extra time to do so. And then my postdocs at University of Pennsylvania, I was able to study that more and through some studies, that I received some grant money through Sigma Theta Tau, to look at that to really help the students be able to take the exams and do better in their passing.


Jared Fesler 9:09

So it seems like there's a lot of compounding effects here that could be leading to as low or pass rate. I'm happy that you mentioned earlier on in the show a few of the potential solutions that are helping you increase that pass rate at the some 40 plus schools you've been working with over the years. Could you speak a little bit more about these solutions for the academic perspective, and how we can increase pass rates among nursing students in California?


Diane Breckenridge 9:42

Yes, I can. There are testing systems that have comprehensive testing systems from when a student enters a nursing program, as well as every clinical specialty, such as OB, Peds, med surg, gerontology and psychiatric nursing, as well as community and leadership. By having those exams all the way through instead of a student feel that it's a negative reason, it's again, a positive, we keep it positive, if they are able to pass those areas, again, let them always stay in school. As long as they meet their usual 80 grade point average of that class, they stay in the program. If they're fallen down on one of those areas, we then have, they call it remediation. Again, there's the remediation, but we call it strategies for success. You go on to the programs, and then your predictor increases. If you have the predictor in the 90s, probably 97%. At the end, and they call it the green light. If you go from red, that's at risk, yellow in need improvement, green, you're there, you get into that green light area. And I have had students who actually want these kinds of programs, at first, they might get a little negative, but they really want to be successful. And if we keep it positive, I have found within one year, if everyone engages the faculty administration, the students, we can bring that NCLEX score up. So we've had schools that 41%, not even 74%, Jared 41%, we've been able to raise them in one year to approximately 70 74%, that another year, into the 70. At the higher level into the 80s. And just keep going one school in two and a half years. 91% from 46%. It just the balloons go up. Everyone is excited. And what happens then is it was everyone's idea, which is great. By then I probably am helping another school by then. And they are on their way to success.


Jared Fesler 12:32

Well, let's let's continue to talk about that piece of the conversation here. As we look to give actionable next steps for our audiences turning into us today. How can education systems and health systems work together? And what are you suggesting that they do as next steps?


Diane Breckenridge 12:55

There's quite a few grants. And I've been very fortunate again, I've been going to a research intensive graduate program, then my Ph. D program. And then I was double postdoc back on the east coast at University of Pennsylvania. They taught me how to look for the grants so that I can help the schools and others I can mentor to write the grants so that these grants come forward then. And some of these grants, I started with a couple $100 And I got the $5,000 than the $1,000. I've always said 5000 $1 million. But now I got that one in 2010. That was a big deal. But I received that one, I moved up to 1.5 million. And then 3.5 has been the highest from the government from the HERSA grants. But I get those grants, the schools of nursing then have their budgets already they can put in the grant for these testing systems for the other challenges we just spoke about. And then we have that money in there. And that way the students don't have to pay more, as well as the schools do not have to use all their budgets. And we're able to do this I've said but 32 million at this time. There's also donor money. There's been quite a few individuals. I was very fortunate. A couple of individuals gave $5 million to help students, not just for testing systems, that was part of it, but also to put in simulation centers, and also to give scholarships to our students and put in like I said before a child care sector. This is what's really important today. We need to really work on this so that we have the funds for this.


Jared Fesler 14:58

Well Dr. Diane Breckenridge, thank you so much for joining us and providing some actionable insights and best practices. Strategies for success for practice reading nurse workforce. That's a such a topical topic for today, and nursing world. Thank you for tuning in. And for those joining us today, have a wonderful nurses week and nurses month. We look forward to seeing you on the next episode of the Amplified RN News Show. Thank you so much.


Diane Breckenridge 15:28

Thank you.

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