From Conditional to Exceptional: Achieving Nursing Education Accreditation Through Exam Item Mapping




The Texas State Technical College West Texas (TSTC-WT) LVN to ADN Nursing Program, an online program, was established in 2008 and grew to include three campuses serving 26 rural counties. It is part of the Texas State Technical College (TSTC) system, which is the only state-operated system of two-year vocational and technical schools in Texas. Designed to provide vocational and technical education to people entering the workforce or in the midst of a career change, TSTC is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACS) to award Associate of Applied Science degrees and Certificates of Completion. Additionally, the TSTC-WT LVN to ADN Nursing Program is governed by the Texas Board of Nursing (TBN), the body responsible for accrediting nursing schools in Texas.

The Problem

Though the TSTC-WT LVN to ADN Nursing Program was already a few years old and had graduated several classes of students, in October 2011, TBN placed it on conditional status due to a low National Council Licensure Examination (NCLEX) pass rate. In fear of losing their ability to train students who could become registered nurses, nursing administrators decided they needed a better way to provide students with feedback and to evaluate their programs. This would involve assessing their curriculum and identifying opportunities for improvement in teaching and testing.

Their system of curriculum mapping included tic-marks in spreadsheets and did not reveal any granular data based on actual student performance throughout the semester. In addition, their remediation efforts were not focused, which was very problematic because remediation is crucial to student learning, and faculty members were administering exams through differing methods, thus limiting the nursing administrators’ ability to adequately evaluate test validity, student performance, and the overall program testing structure. They decided to begin solving these issues by first searching for an assessment software that could replicate the testing environment of the NCLEX. When they found ExamSoft, however, they found an all-in-one solution that addressed all of their issues.

The Solution

ExamSoft enabled the nursing program at TSTC-WT to begin testing its students in a computer-based system that emulated the NCLEX testing environment. It also enabled the program to “tag” each test question back to NCLEX categories, Differentiated Essential Competencies as delineated by the TBN, and Student Learning Objectives (SLOs) as indicated by SACS. Now, after each exam, faculty generate learning analytics based on these tags to target at-risk students and immediately take action with remediation strategies focused on students’ individual needs.

The ExamSoft assessment software also generated detailed longitudinal data that the nursing program now uses to track the performance of students throughout their academic careers. TSTC-WT also uses this longitudinal data to map its curriculum: if results show that students are falling behind in a particular subject area, TSTC-WT can immediately restructure weekly objectives to correspond with the online remediation. This allows for changes to meet the individual needs of the students and the overall needs of the student cohort, and it provides the documentation necessary to trend learning challenges year to year.

Additionally, with ExamSoft’s “snapshot” feature, the program monitors student behavior during exams, which deters cheating and helps to identify students who demonstrate signs of possible learning challenges that affect testing performance. During one review, administrators noticed three students performed at an exceptional level up until a certain point. On a sixty-minute exam, these students performed greatly, but on a ninety-minute exam, snapshot revealed the students engaging in excessive answer changing and skipping questions. The time it took for students to answer questions also increased. In turn, administrators sent these students to receive testing for learning difficulties. Here, remediation required an external institutional office, in addition to faculty-driven efforts. Without ExamSoft, these problems would have been much more difficult to catch and rectify.

Since implementing ExamSoft, the program has greatly improved with respect to identifying student testing issues, determining content area deficits in the curriculum, implementing online tutoring focused on students’ individual needs, and creating topic- and behavior-focused remediation plans. During the first year of implementation, the TSTC-WT LVN to ADN Nursing Program achieved a 100% NCLEX pass rate, which includes students with identified learning challenges, and it has been taken off of conditional status by TBN.

“What’s really great is we can not only help higher-performing students who might have had a few issues that slipped through the cracks, but we can also help students who before we might not have known how to help. Being able to watch with the snapshot feature how students take tests and targeting not only the subject areas they struggle with, but also problems in their testing behavior, gives us a lot of room to make sure students are performing well.” – Shawntay Sparks, Instructor / Program Coordinator, Texas State Technical College West Texas LVN to ADN Nursing Program

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Published: December 14, 2018

Updated: July 17, 2023

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