Improved Nursing Licensure Exam Pass Rates Result From Refresher Design

1
Improved Nursing Licensure Exam Pass Rates Result
From Refresher Design

• Matthew Grayson South Bay RHORC, Mission College
• Patricia Perkins, Interior Bay Area RHORC, CCSF
• Healthcare Initiative of the Economic Workforce
  Development Programs
• California Community Colleges Chancellors Office
• Data presented here were supported in part by
  grant agreements 04-307-011 and 05-307-015
  through annual funding from the California
  Community Colleges Chancellors Office.

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About the EWD Program

• Mission of the EWD Program is to advance
  Californias economic growth and global
  competitiveness through quality education and
  services

3
Health Care Delivery Initiative
California Community College Economic Workforce
Development
4
The Mission
To promote the advancement of Californias health
and Economic growth through quality education and
services focusing on workforce development and
continuous workforce improvement in health care
delivery.
5
Health Care Initiatives Purpose

• Identify health care workforce development needs
• Develop solutions through a comprehensive
  problem-solving process
• assessment and analysis,
• planning and development,
• implementation and
• evaluation.

6
Regional Health OccupationsResource Centers

• RHORCs
• Strategically located Statewide
• Facilitate collaboration between the education
  segments and the health care delivery system to
  respond to identified needs

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North/Far North RHORC - Butte College, Chico
Health Initiative Office -Sacramento City College
- Sacramento
EWD Health Care Delivery Initiative
Interior Bay RHORC - City College of San Francisco
Bay Area RHORC-Mission College, Santa Clara
Central RHORC-Hartnell College, Salinas
LA County RHORC - Mt. San Antonio College, Walnut
Orange County RHORC Golden West College,
Huntington Beach
South Coast RHORC - Santa Barbara City College
San Diego/Imperial RHORC - Grossmont College, El
Cajon
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Acknowledgements

• For LVN Refresher Development at CCSF Jewish
  Vocational Services, San Francisco The
  California Endowment, Woodland Hills, CA
• For Implementation of the LVN Refresher at
  Mission College The Health TrustTM, San Jose, CA
• For Travel and Presentation Costs at CCCAOE
  CCCCO Grants 04-307-011 05-307-015

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Acknowledgements

• Sylvia Moreno, LCSW formerly CCSF Welcome Back
  Program, now Mission Neighborhood Health Center
  for
• Jim Torrens, MSW Jewish Vocational Services, San
  Francisco for helping to institutionalize the
  LVN Refresher program at CCSF
• Naomi Marcus, MSW formerly Jewish Vocational
  Services, now CCSF Welcome Back, for provision of
  background history

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Need for LVN Refresher

• Goal of Healthy People 2010 Goal 23-8
• skilled workforce must be culturally and
  linguistically competent to understand the needs
  of and deliver services to select populations and
  to have sensitivity to diverse populations
• (see http//www.healthypeople.gov)

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Other Needs Address Nursing Shortage in Bay Area

• LVN Refresher Program helps identify, train, and
  prepare for nurse licensure exams foreign trained
  nurses for practice in acute care, nursing home,
  and community clinic settings.
• Satisfy goals of Healthy People 2010 and
  consistent with RHORCs and community colleges
  overall mission.

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Background to LVN Refresher Program

• History Academic-community partnership CCSF,
  SFSU and community-based organization (CBO)
  SF-based Jewish Vocational Services (JVS)
• Partnership of long-term collaborators in health
  training and social services delivery to
  immigrants and displaced workers, even prior to
  RHORC or Welcome Back

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Background to LVN Refresher, Cont.

• From 1990-95, JVS provided intensive case
  management for foreign trained immigrant nurses
  (Russian/former Soviet Union) RNs and US
  nationals returning to nursing workforce.
• For foreign-trained nurses, NCLEX pass rates
  above 90 but unable to retain in full-time
  hospital jobs
• Language, cultural negotiation, and lack of
  understanding of scope of practice and US
  healthcare systems roadblocks to sustained
  employment

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Background to LVN Refresher, Cont.

• JVS Executive Director approached Dean of SFSU
  Nursing Program to develop a curriculum specific
  to the RN Russian immigrant community
• RN Refresher Course offered 3 times/year,
  17-week, one semester course, from 1992-95
  grant-funded
• LVN Refresher developed out of the RN Refresher
  with modifications for scope of practice
  differences

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Background to LVN Refresher, Cont.

• Both the RN the LVN curricula include
• hospital clinical rotations
• medico-legal ethical issues
• RN and/or LVN scope of practice
• US healthcare system 101
• Working/studying in a dynamic and diverse
  multi-ethnic and linguistic community difficult
  for people coming from largely mono-ethnic/racial
  cultures

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Background to CCSF JVS Collaboration

• By 1995, program shifts at JVS, with influx of
  Bosnian other Eastern Europe refugees, and
  mixture of persons from Central Latin America
• Fewer openings for RNs as result of hospital
  consolidation. In 1995, no recognition of nursing
  shortage.
• Results less placement opportunities for foreign
  trained RNs

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Background to CCSF JVS, cont.

• Industry need JVS CCSF approached by area
  health departments on expansion of LVN education
  for skilled nursing, community clinics, SFGH
• Board Response JVS and CCSF board members
  shepherded concept of LVN Refresher to private
  funders and CCSF nursing department

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Welcome Back Program Support

• Mission To build a bridge between the pool of
  internationally trained health workers living in
  California and the need for linguistically and
  culturally competent health services in
  underserved communities.
• Funded through The California Endowment and now a
  host of local, corporate, and national
  foundations
• Welcome Back RHORC funded the continued upgrade
  of the LVN Refresher Program at CCSF, including
  the programs case management delivery system
  with JVS from 2001 to 2003.

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Welcome Back Program Support, cont.

• Program institutionalized at CCSF Spring 2004
  JVS continues to provide case management, student
  transportation stipends, childcare
• Success at CCSF included 95 retention and 92
  pass rate on the VN exam and/or the NCLEX RN exam

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LVN Refresher ExpansionMission College, Santa
Clara, CA

• Program and Grant Development
• Faculty and Curriculum
• Student Assessment and Placement
• Case Management and Social Worker Support
• Challenges
• Critical Pathway
• Successes
• Primary Recommendations

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Program and Grant Development

• In spring 2003, CCSF RHORC assisted with grant
  development with Mission College for program
  replication in Santa Clara
• Program funded by Health Trust winter 2004
• Spring 2004, WB case manager Sylvia Moreno
  assisted with goal to select 30 board eligible
  foreign trained RNs residing in South Bay, all of
  whom were WB participants

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Program and Grant Development
23
Program and Grant Development

• Goals and Objectives
• Educate 30 foreign-trained nurses (100 hours)
• Pass Rate 14 out of 30
• Create Ongoing Program
• Share Best Practices and Program Development

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2005 Number of Candidates Taking NCLEX
Examination and Percent Passing, by Type of
Candidate

• PN2
• Jan-Mar 2005 Apr-Jun 20053 Jul-Sep 2005 Year
  to Date Total
• First Time, US Educated
• 12,090 90.6 9,211 88.3 19,931 90.2 41,232 89.
  9
• Repeat, US Educated
• 2,169 46.9 2,079 38.7 2,020 42.4 6,268 42.7
  
• First Time, Internationally Educated
• 410 55.1 480 49.4 430 47.4 1,320 50.5
• Repeat, Internationally Educated
• 372 25.3 451 18.4 458 22.1 1,281 21.7
• All Candidates
• 15,041 81.7 12,221 75.8 22,839 83.8 50,101 81
  .2

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2005 Number of Candidates Taking NCLEX
Examination and Percent Passing, by Type of
Candidate

• RN1
• Jan-Mar 2005 Apr-Jun 2005 Jul-Sep 2005 Year
  to Date Total
• First Time, US Educated
• Diploma 887 887 89.2 679 92.2 1,499 91.0 3,06
  5 90.7
• Baccalaureate Degree 7,335 87.6 9,391 90.7 15,
  691 85.1 32,417 87.3
• Associate Degree 12,189 86.7 17,480 90.7 25,86
  0 87.0 55,529 88.1
• Invalid or Special 27 77.8 15 73.3 29 75.9 71
  76.1 Program Codes
• Total First Time, US Educated
• 20,438 87.1 27,565 90.7 43,079 86.4 91,082 8
  7.9
• Repeat, US Educated
• 4,534 48.3 4,903 53.8 6,019 57.7 15,456 53.7
  
• First Time, Internationally Educated
• 3,838 58.1 4,489 57.2 4,379 56.2 12,706 57.1
  
• Repeat, Internationally Educated
• 3,434 27.0 4,106 26.9 3,928 26.9 11,468 26.9
  
• All Candidates
• 32,244 71.8 41,063 76.3 57,405 77.0 130,712
  75.5

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Faculty and Curriculum

• Selection of Committed Faculty
• Identify Instructors
• Use Specialist OB/Gyn, Pedi, Psych
• Review Curriculum
• Foundations of Ideology
• Student Population Matchup
• Continued in Challenges

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Student Assessment and Placement

• Welcome Back Partnership
• Well Known Organization throughout Bay Area
• Purpose Filter foreign-trained health
  professionals into appropriate health education
  programs to enable re-entry into the workforce
• Rely on referrals from WB to acquire 30 students
• Provide Case Management and Social Work Support
• ESL and Math Placement Testing at Mission College

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Case Management and Social Worker Support

• Student Placement Mission College
• ESL, Math, ATI Tests
• Educational Plan Welcome Back
• Review Class
• Future Planning to Become RN
• Time Management Welcome Back
• Confidence Support Welcome Back
• Students need to reconnect with their
  skills/abilities

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Challenges

• Student Preparation Evaluation
• ESL Placement
• BVNPT Board Qualification Transcripts
• One Plan for Student Recruitment vs. Time
• Social Support Network
• Family Commitment
• Time Management
• Reality Check

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Challenges

• Curriculum Content and Faculty
• No Lead Instructor Coordinating
• Ideological Differentiation Between Faculty
• Skills and Abilities of Students Must be Verified
  Prior to Clinical Rotations
• Do Not Use Clinical Rotations for Observation
  Time
• Changing Leadership
• 3 RHORC Directors Over Life of Program

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Successes

• 5 students passed the NCLEX-RN
• 5 students passed the NCLEX-PN
• Gained further understanding on how to educate
  foreign-trained professionals.
• Significantly changed the lives of 10 people.
• Appropriately met Healthy People 2010 goals and
  hospitals workforce needs.
• Commitment and Flexibility of Faculty

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Primary Recommendations

• Review South Bay RHORC LVN Refresher Program
  Workplan
• Participants View Workplan From Your Packets

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Critical Pathway
34
Primary Recommendations

• Identify Lead Instructor
• Establish Minimum ESL Level (ESL 960 for Mission
  College, Santa Clara, CA)
• Require BVNPT or BRN Approval Letters To Take
  NCLEX-PN or RN by 3rd Week of Class
• Counseling Student Placement, Educational Plan,
  Time Management, Confidence Support
• Identify Ongoing Funding

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Questions And Answers

• LVN Refresher Program Budget Information
  Available from Matthew Grayson.
• Thank You For Attending This Workshop
• For More Information You May Contact
• matthew_grayson_at_wvmccd.cc.ca.us
• rhorc_at_sfsu.edu