1. Improving NCLEX – RN results at Muskingum University Improving NCLEX – RN results at Muskingum University

2.  Located in east-central Ohio in the Village of New Concord  Chartered in 1837 as Muskingum College  Presbyterian Heritage  Noted for Liberal Arts education  Located in east-central Ohio in the Village of New Concord  Chartered in 1837 as Muskingum College  Presbyterian Heritage  Noted for Liberal Arts education

3. Muskingum University Department of Nursing  Pre-licensure program track started fall 2008  RN to BSN program track started spring 2009  Pre-licensure graduates (first class) in 2012  RN-BSN graduates (first group) in 2011  Approved by the Ohio Board of Nursing  Accredited by The Commission on Collegiate Nursing Education (CCNE)  Pre-licensure program track started fall 2008  RN to BSN program track started spring 2009  Pre-licensure graduates (first class) in 2012  RN-BSN graduates (first group) in 2011  Approved by the Ohio Board of Nursing  Accredited by The Commission on Collegiate Nursing Education (CCNE)

4. NCLEX-RN results  2012 – 17 graduated – 8 passed first attempt 47%  2013 – 7 graduated – 3 passed first attempt (one graduate did not take NCLEX until 2014) 50%  2014 – 23 graduated – 18 passed first attempt 78%  2015 – 11 graduated – 10 passed first attempt 90%  2012 – 17 graduated – 8 passed first attempt 47%  2013 – 7 graduated – 3 passed first attempt (one graduate did not take NCLEX until 2014) 50%  2014 – 23 graduated – 18 passed first attempt 78%  2015 – 11 graduated – 10 passed first attempt 90%

5. Goal #1  Improve NCLEX-RN results for currently enrolled seniors – 95% of the national average and beyond

6. The How  Selected ATI summer 2013 Consultants reviewed nursing syllabi for placement of ATI remediation and proctored assessments across the sophomore, junior and senior nursing courses Faculty developed an integration strategy for all levels of currently enrolled students  Selected ATI summer 2013 Consultants reviewed nursing syllabi for placement of ATI remediation and proctored assessments across the sophomore, junior and senior nursing courses Faculty developed an integration strategy for all levels of currently enrolled students

7. Integration Plan: Sophomores (2013-2016)  TEAS Exam  NURS 225  Orientation to ATI – “Getting Started” video  Nurse Logic 2.0  Assigned ATI Readings and Skills video  Practice Assessments –with required remediation (see rubric) Form A (1 st assessment)  RN CMS Fundamentals Proctored Assessment (see rubric) Form B  TEAS Exam  NURS 225  Orientation to ATI – “Getting Started” video  Nurse Logic 2.0  Assigned ATI Readings and Skills video  Practice Assessments –with required remediation (see rubric) Form A (1 st assessment)  RN CMS Fundamentals Proctored Assessment (see rubric) Form B

8. Integration Plan: Juniors (2013-2015)  NURS 350  Nurse Logic 2.0 – Plus ATI Orientation “Getting Started” video  Assigned ATI Readings and review materials, skills, lab videos and Pharmacology Made Easy 2.0 & Dosage Calculation Tutorials 2.0  Practice Assessment – RN TMS align with course content (see rubric) – Fluid, Electrolyte & GI  Proctored Assessment – RN CMS Fundamentals (see rubric) Form B  NURS 350  Nurse Logic 2.0 – Plus ATI Orientation “Getting Started” video  Assigned ATI Readings and review materials, skills, lab videos and Pharmacology Made Easy 2.0 & Dosage Calculation Tutorials 2.0  Practice Assessment – RN TMS align with course content (see rubric) – Fluid, Electrolyte & GI  Proctored Assessment – RN CMS Fundamentals (see rubric) Form B

9. Integration Plan: Seniors (2013-2014)  NURS 460  ATI Orientation “Getting Started” video  ATI Reading and Review  Practice Assessment – Community Health (see rubric) Form B  RN CMS Community Health Proctored Assessment (see rubric) Form B  NURS 460  ATI Orientation “Getting Started” video  ATI Reading and Review  Practice Assessment – Community Health (see rubric) Form B  RN CMS Community Health Proctored Assessment (see rubric) Form B

10. Seniors cont.  NUR 490  Comprehensive Predictor Form B All Classes  Maternal/Newborn Practice Assessment (see rubric)  Maternal/Newborn Proctored Assessment (see rubric)  Pediatric Practice Assessment (see rubric)  Pediatric Proctored Assessment (see rubric)  Mental Health Practice Assessment (see rubric)  Mental Health Proctored Assessment  Med-Surg Practice Assessments (see rubric)  Cardiovascular  Gastrointestinal  NUR 490  Comprehensive Predictor Form B All Classes  Maternal/Newborn Practice Assessment (see rubric)  Maternal/Newborn Proctored Assessment (see rubric)  Pediatric Practice Assessment (see rubric)  Pediatric Proctored Assessment (see rubric)  Mental Health Practice Assessment (see rubric)  Mental Health Proctored Assessment  Med-Surg Practice Assessments (see rubric)  Cardiovascular  Gastrointestinal

11. Seniors cont  Endocrine  Respiratory  Neurosensory & Musculoskeletal  Renal & Urinary  Fluid/Electrolytes/Acid-Base  Perioperative  RN NCLEX Final  RN Comprehensive Assessment Practice (see rubric)  RN Comprehensive Predictor (see rubric) ATI Based Individual Plan for Students  NCLEX Review Course  Endocrine  Respiratory  Neurosensory & Musculoskeletal  Renal & Urinary  Fluid/Electrolytes/Acid-Base  Perioperative  RN NCLEX Final  RN Comprehensive Assessment Practice (see rubric)  RN Comprehensive Predictor (see rubric) ATI Based Individual Plan for Students  NCLEX Review Course

12. ATI Rubric ATI Assigned Practice Assessment* Remediation (Active Learning) ATI Proctored Test Remediation Points Possible (course total 10 points) Weight (or %) varies by individual course Score 90-100% **see Remediation below Proficiency level 3 - 4 pts **see Remediation below 10/10 Score 80-89% **see Remediation below Proficiency level 2 - 3 pts **see Remediation below 9/10 Score 70-79% **see Remediation below Proficiency level 1 - 2 pts **see Remediation below 8/10 Score below 70%**see Remediation below Below Proficiency level 1 - 2 pts **see Remediation below 7/10

13. ATI Remediation Rubric cont * ATI Practice Assessment will be specified (A or B) **Remediation Remediation must include at least two bullet points (handwritten) for each item missed during the assessment (each ‘topic to review’). Remediation is awarded Pass or Fail credit only, NO partial credit. No late assignments accepted for points. Remediation will be considered as entrance criteria for future course or ATI exams or assessments. * ATI Practice Assessment will be specified (A or B) **Remediation Remediation must include at least two bullet points (handwritten) for each item missed during the assessment (each ‘topic to review’). Remediation is awarded Pass or Fail credit only, NO partial credit. No late assignments accepted for points. Remediation will be considered as entrance criteria for future course or ATI exams or assessments.

14. Implemented Virtual ATI (VATI)  Enroll in VATI program  Complete the 2013 comp predictor  Watch VATI getting started video  Complete enrollment survey  Complete all customized learning activities on time as identified by VATI coach  Complete proctored assessments per VATI coaches’ recommendation  Wait for the VATI coach to give the “green light” to take NCLEX  Take NCLEX within 3 weeks of “green light”  Program Cost = $  Enroll in VATI program  Complete the 2013 comp predictor  Watch VATI getting started video  Complete enrollment survey  Complete all customized learning activities on time as identified by VATI coach  Complete proctored assessments per VATI coaches’ recommendation  Wait for the VATI coach to give the “green light” to take NCLEX  Take NCLEX within 3 weeks of “green light”  Program Cost = $

15. VATI cont o To be reimbursed students must: Pay fees up front to Muskingum Enroll in VATI program Complete all customized learning activities on time as identified by the prescribed ATI plan Wait for the “green light” from ATI before taking NCLEX Schedule the NCLEX exam within the 3 week window after receiving the “green light” o To be reimbursed students must: Pay fees up front to Muskingum Enroll in VATI program Complete all customized learning activities on time as identified by the prescribed ATI plan Wait for the “green light” from ATI before taking NCLEX Schedule the NCLEX exam within the 3 week window after receiving the “green light”

16. Implemented Virtual ATI (VATI) cont VATI Coach/Program  Coach develops individual plan based on comp predictor results  Coach facilitates student’s progress by providing individualized support  Coach provides a calendar to guide student’s daily review of material  Reviews are individualized and tailored as the student progresses, special focus is given to topic areas that need more attention  Coach gives “green light” when student is ready to take NCLEX VATI Coach/Program  Coach develops individual plan based on comp predictor results  Coach facilitates student’s progress by providing individualized support  Coach provides a calendar to guide student’s daily review of material  Reviews are individualized and tailored as the student progresses, special focus is given to topic areas that need more attention  Coach gives “green light” when student is ready to take NCLEX

17. Implemented Virtual ATI (VATI) cont Muskingum Coach  Meet with students and watch VATI video  Facilitate VATI start-up after enrollment survey complete  Monitor student progress weekly and foster student participation and engagement  Work with students regarding optimal testing  Collaborate with VATI coach and provide additional student assistance with content weaknesses  Verify “green light” with VATI coaches to optimize student success on NCLEX Muskingum Coach  Meet with students and watch VATI video  Facilitate VATI start-up after enrollment survey complete  Monitor student progress weekly and foster student participation and engagement  Work with students regarding optimal testing  Collaborate with VATI coach and provide additional student assistance with content weaknesses  Verify “green light” with VATI coaches to optimize student success on NCLEX

18. * NCLEX pass rate is 97.5% when students wait to receive the “green light” from the VATI coach

19. VATI Results  2014 graduates – 78% passed on first attempt 22 of 23 registered 17 of 22 completed VATI and received the “green light” 14 of 17 passed NCLEX on first attempt (82%) 5 did not wait on green light; 3 passed and 2 failed (60%)  2014 graduates – 78% passed on first attempt 22 of 23 registered 17 of 22 completed VATI and received the “green light” 14 of 17 passed NCLEX on first attempt (82%) 5 did not wait on green light; 3 passed and 2 failed (60%)

20. VATI Results cont  2015 graduates – 90% passed on first attempt 10 of 11 registered 8 of 10 completed VATI and received the “green light” 8 of 8 passed NCLEX on first attempt (100%) 2 did not wait on green light; 1 passed and 1 failed (50%)  2015 graduates – 90% passed on first attempt 10 of 11 registered 8 of 10 completed VATI and received the “green light” 8 of 8 passed NCLEX on first attempt (100%) 2 did not wait on green light; 1 passed and 1 failed (50%)

21. Other Strategies Implemented o Senior students attended 3 day live review on campus (ATI) o Elective nursing course spring semester on NCLEX preparation; 5,000 – 6,000 questions with remediation o Comprehensive predictor in the spring semester (ATI) o Provided faculty development using ATI consultants Item writing Teaching strategies o Senior students attended 3 day live review on campus (ATI) o Elective nursing course spring semester on NCLEX preparation; 5,000 – 6,000 questions with remediation o Comprehensive predictor in the spring semester (ATI) o Provided faculty development using ATI consultants Item writing Teaching strategies

22. Other Strategies Implemented cont o Implemented a process to evaluate item discrimination and item difficulty on nursing exams o Assessed nursing course content using the NCSBN blueprint and ATI content o Increased the use of low, moderate and high fidelity simulation strategies in the lab o Incorporated computer based testing in all nursing courses with NCLEX focus o Implemented a process to evaluate item discrimination and item difficulty on nursing exams o Assessed nursing course content using the NCSBN blueprint and ATI content o Increased the use of low, moderate and high fidelity simulation strategies in the lab o Incorporated computer based testing in all nursing courses with NCLEX focus

23. The Work Continues…  2015 - Implementing curriculum revisions for incoming freshman partially based on ongoing assessment of ATI comprehensive predictor and proctored assessment results