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Seeking the cure – nursing program at South Carolina State University – special report: health sciences

ORANGEBURG, S.C.–Facing the threat of closure, the nursing program at South Carolina State University is searching for a cure to its problem of low passing rates among graduates who take the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

S.C. State has asked an administrative law judge to overturn the state Board of Nursing’s July decision to end its four-year nursing program. The decision was made because, despite having the highest passing percentage since its inaugural class of 1992, the program was still 10 percent below the national average.

Schools in South Carolina with students taking the NCLEX-RN for the first time must have a failure rate no greater than 5 percent below the national average to avoid a deficiency citation. The 1996 passing percentage for S.C. State–which had just five graduates take the test, with one failure–was 80 percent. Nationally, 90 percent of those taking the NCLEX-RN passed the exam. Virginia programs need an 85 percent passing rate to avoid a deficiency notice from the nursing board.

The number of students in S.C. State’s program has always been low–as have the passing percentages. The first graduating class of nine students had a 77.7 percent pass rate. In 1993, five students graduated and 40 percent passed. The next year, the number of graduates grew to fourteen, but only 41.7 percent passed. And in 1995, eleven students graduated, but the pass rate was a mere 45.4 percent.

“When we went to the appeal, we were optimistic that we would be allowed to reopen the program–especially with the statistics,” says Cherie Smith, president of the student nursing association. “Because we are so small, we suffer more. In my class, we only have ten students and if one person fails we’re already at 90 percent.”

“I am surprised that S.C. State has not come up to snuff,” says Dr. Sallie Tucker-Allen, a fellow of the American Academy of Nursing. “I’m disappointed. We really need Black schools of nursing.”

The National League for Nursing has consultants who work with schools having problems and, according to Tucker-Allen, the league makes a special effort to assist historically Black colleges and universities (HBCUs) before they reach the point where they face closure.

Says Smith: “We were, and still are, in a state of shock, but the only thing we can do as students is to do well.” More than sixty students are currently enrolled in the four-year program. However, no new students will be allowed to register for prerequisite classes to enter the nursing program. Juniors and seniors will be able to continue their studies during the next two years. Sophomores are faced with the options of changing their majors or transferring to another nursing program.

Registered nurses with associate degrees or diplomas can still participate in the two-year program to earn their baccalaureate degrees.

Attempting to Improve the Prognosis “Even with the first class, we began to analyze the predictors,” says Dr. Sylvia Whiting, professor and interim chair of the nursing department. “That kind of analysis continued as we added all kinds of tools to track these students.”In 1993, the school added a system to determine the potential success on the national exam and compared it with their grade point averages (GPAs) and Scholastic Aptitude Test (SAT) scores.

“We tried to look at what the students could do. Our philosophy was that all students ought to have a chance to be admitted,” says Whiting. “We tried to mold students with [required] 750 SAT scores and 2.3 GPA and so on. We gave them every c chance. We tried to pull them through and [the students from whom we expected problems] were fairly well identified by 1995.”

Students are allowed to take the NCLEX-RN three times, and, according to Whiting, most of those who fail the first time, pass the second time.

The department had wanted to raise the grade point average to 2.5, SAT scores to 850, and the passing grade to 75. However, university policy dictates that 70 is the minimum passing grade. “We knew people who scored lower than 75 were going to score low on tests,” concedes Whiting. After the nursing board ruling to end the program, the school gave permission to raise the passing grade to 78, “which we think will make a major difference,” says Whiting.

“There have been major changes that put students under greater pressure, but they seem to be doing well,” she adds. “Students were required to take tests on the clinical and if they went lower than the 43 percentile, [they] were required to retake the test. Seniors take more comprehensive tests, but many students just don’t do well on standardized tests. “We have to drill over and over again to prepare students,” Whiting admits.

Instead of closing the program, the school should be given a chance to make it work, suggests Smith. “We didn’t start out with all the computer programs that we have now. Change comes over time and I feel they didn’t give us enough time.

“My class was the first affected by [the] new entrance and retention requirements,” explains Smith. “It’s better to judge our class, not the last class. We’re hoping that our class and the class of 1998 do well. [Then] the school should have no reason to close the program.”

Although Whiting says, “We don’t think what the board did was wrong in terms of interpretation,” she feels that the board’s interpretation was very narrow, considering it’s a relatively new program. “If you make a change in a program, it takes four years to prove it works.”

If the appeal is denied, S.C. State administrators can submit a proposal to start a new nursing program at a later date. The proposal would then have to be approved by the nursing board and the state’s Commission on Higher Education.

Helped Offered From Those Who Have Been There S.C. State isn’t the first HBCU to face closure of its four-year nursing program. Three schools in North Carolina faced the same dilemma in the late 1980s, but those schools have rebounded and now consistently score about the 90 percentile.

“I believe there should be a link up between successful schools and those floundering,” says Tucker-Allen. “I don’t know why they don’t form coalitions.” In an effort to help S.C. State avoid closure, Dr. Sylvia Flack, Winston-Salem State University’s (WSSU) Director of Nursing, spoke on behalf of the ailing school. She told the board how her school fought extinction in 1989 and volunteered to serve as a consultant to S.C. State.

The threat to WSSU came from the North Carolina Board of Governors, not the state nursing board, and the first thing that the institution did was organize its nursing alumni into a political force.

“We could not produce students in 1989 who could pass and that’s how I ended up here,” admits Flack, a WSSU nursing program alumna. The program quickly began increasing enrollment. The student population climbed from thirty to more than 174 in the four-year program. The school also has 135 students in the R.N.-to-Bachelor’s in Science nursing program and five outreach programs. Also, in collaboration with the University of North Carolina-Charlotte, WSSU has started a master’s in nursing program.

“We had to get our board scores up to 85 percent and in 1990 we had to go above 90 percent. At this time, we can’t make under 90 percent two consecutive years,” Flack says. North Carolina’s nursing board requires the school to stay above 75 percent.

“It’s not difficult if you have things working together–if you have faculty who realize what they need to do, if you have a strong curriculum, and you have students who are willing to learn,” advises Flack. “We have a strong retention plan. We expect students to master a certain level. We teach based on a philosophy that everybody can learn the same thing, given the right amount of time.”

But Flack acknowledges that Black students traditionally do not score well on standardized tests. And she insists that the problem is not content, suggesting that if students are properly assessed and diligently guided through the clinical requirements, 95 percent of them would pass. “We literally work with them a week and give them a test comparable to the state board. If they don’t pass, they do it again,” Flack says.

Also, the program at WSSU has evolved into a diversified one–something that happened without planning. Although “the Black student population increased five times, about 50 percent of [current] students are African Americans and 50 percent are [of] European [extraction]–white, European American, European, and International,” according to Flack, who adds that some student transfers are licensed practitioners and paramedics seeking a Bachelor of Science in Nursing.

“We’re probably averaging about a 93 to 94 percent pass rate on the NCLEX-RN,” she says. North Carolina Central and North Carolina A&T also faced threats of closure but have increased their pass rates above 90 percent, as required by the governing board. In the 1990s, South Carolina has had a spate of difficulties with nursing programs. Clemson University received a deficiency in 1995 when its graduate passing percentage dropped to 81.6 percent.

Lander University’s percentage dropped to 71.4 percent in 1993. The four-year programs at the University of South Carolina and the Medical University of South Carolina have received no citations since 1992.

Outside the Carolinas

Each state has different criteria for their programs, although most rules are consistent with the National Council of State Nursing Boards. Virginia programs do not face the threat of closure by nursing boards.

In order for programs to work, the student-faculty ratio should never exceed ten-to-one, according to Tucker-Allen, who also criticizes schools which add programs without doing the proper preparatory research.

In Virginia, the schools monitor themselves–cutting programs for lack of production, poor quality, or inefficient cost–says Nancy Durrett, the executive director of Virginia’s board of nursing. Although the board has a twenty-page criteria to follow which is consistent with the National Council of State Nursing Boards, there is no rate requirement. Hampton University and Norfolk State University are the only HBCUs in Virginia that have four-year nursing programs.

The pass rate for Hampton University students averages between 85 and 95 percent, says Dr. Arlene Montgomery, interim dean of nursing. The program also has a tutorial component with computerized testing that helps give students an idea of what to expect on the NCLEX-RN.

Until recently, there also was no pass rate criteria at Howard University in Washington, D.C., according to Dorothy Powell, college of nursing dean. However, she adds, the nursing board in the District of Columbia has drafted new regulations which requires that nursing programs maintain a standard level of performance.

“The 80 percent [pass rate criteria] is just being implemented because of the difficulty of how the District is operated. Unlike other states the staff is small,” she said. Howard has about 400 students in its program and multiple ways an applicant can enter the program.

“There have always been regulations for how to operate. Howard is going to do all its power to be in compliance. We’re always going to do our business,” promises Powell. In Louisiana, Dillard University’s pass rate dropped to 63 percent in 1993, but the number increased to 100 percent in 1994 before dropping back to 92 percent in 1995.

Grambling University and Southern University have consistently scored above 80 percent. The worst year for both schools was 1993, when 83 percent passed at Grambling and 84 percent passed at Southern.

Supplying the Demand

Demand for African-American nurses and doctors is still a concern. About 4 percent of this country’s registered nurses are African American. “One of our mandates was to increase that number in South Carolina, as well as increase diversity,” Whiting said.

Montgomery notes that the demand for nursing is shifting from hospital care to primary and managed care. Hospitals are laying off nurses, who must find employment in other health care areas. This leaves limited positions for new graduates, particularly in large cities. While stating that there is not a shortage of nurses, Montgomery says, “There is an under representation of African American nurses…. We need to increase minorities, but the job market is a lean market.”

Only twenty-seven out of the 117 HBCUs have nursing programs, according to the American Association of Colleges of Nursing. Montgomery feels that there are enough undergraduate programs, but for minorities to advance in the field, they must go on to the graduate schools. Tucker-Allen doesn’t quite agree. She says that the number of HBCUs offering nursing programs is not good.

“It doesn’t produce the number of [minority] nurses we need,” says Tucker, who claims that traditionally white schools aren’t producing many Black nurses. “You have 2.2 million nurses and [African Americans constitute] only 19,000 [of them].”

COPYRIGHT 1996 Cox, Matthews & Associates

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