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Over the course of a two-quarter pilot, student retention in a first-quarter nursing class improved by 15 percentage points from 67 percent to as much as 82 percent. This article briefly outlines the institution, the Nursing Study Table concept, and the results of our pilot. Our hope is that this information will help similar institutions improve their retention of nursing and other health students.
Background—With a total enrollment of over 30,000 credit-seeking students, Columbus State Community College (CSCC) is the largest comprehensive community college in Ohio. The nursing associate degree program begins with one year of preadmission coursework, which includes nurse aide and patient care skills certification, followed by an application to the program, with up to a one-year lag before starting the nursing courses. (The program is considered "traditional track." An online nursing track is offered to students with a baccalaureate or higher.) Full-time students take seven quarters to complete the nursing coursework, including clinicals. If students fail more than two courses, they are terminated from the program. Although an academic coordinator was hired to help struggling first-year nursing students, the first nursing class, which is an assessment course, experienced an average attrition rate of 25 percent from autumn 2006 through spring 2009.
The Nursing Study Table Project was funded through the Carl D. Perkins Grant at the college as an intervention strategy designed to improve low test scores, overall failing grades, high dropout/withdrawal rates, and consistently high attrition from the course. This strategy addressed the college's goal of strengthening academic and career and technical skills through academic/technical integration, which is a requirement of the Perkins legislation (ACTE, 2006). The root cause was suspected to be problems with test taking skills and a shift in assessment from "knowledge" and "comprehension" to "application," according to Bloom's Taxonomy (Clark, 1999; Krathwohl, 2002).
The Nursing Study Table and Lessons from Supplemental Instructional Principles—The Nursing Study Table Project was inspired by the philosophy of Supplemental Instruction (SI) developed Dr. Deanna Martin at the University of Missouri, Kansas City. SI does not identify high-risk students but rather historically difficult classes (The Center for Academic Development, 2010). For this project the targets are the classes that have high rates of D's, F's, and withdrawal. The process, which is not considered remedial (UMKC, 2007; Widmar, 1994), is designed to increase student performance and retention through academic assistance in the form of regularly scheduled out-of-class peer-facilitated sessions that start the first day of the term.
The Nursing Study Table Project modified the SI model by using faculty as facilitators and developers. Two faculty members who had been trained in SI piloted the first quarter; one faculty member continued with the second quarter. These faculty members were not the instructors for the class. In fact, they intentionally "dressed down" from suits to jeans to relax the atmosphere and deemphasize the traditional classroom roles of instructor and student. Results were successful (please see below) and the supervisors of the program are now considering the transition to student-led sessions.
How the Nursing Study Table Worked—The project had two major goals: (1) to improve test taking skills and study habits, which would be reflected in test scores; and (2) to improve retention rates in Nursing 100 by 50 percent, which would be reflected in pass rates. During the "Orientation to Nursing" in winter quarter 2010, the Nursing Study Table leaders presented a handout and explained the program. Approximately 40 to 50 percent of students stated that they would like to attend the sessions. The scheduled sessions, which started in spring quarter 2010, required that the SI leaders attend all lectures and provide three 50-minute Nursing Study Table sessions per week with one hour of planning each week. The faculty members were paid at half the college's hourly adjunct faculty rate for the session and planning, and the full adjunct rate for their analysis of the data below. In addition, a study skills text that focused on application testing for beginning nursing students was purchased through the Perkins Grant to focus on improving test-taking skills (Nugent and Vitale, 2008). The total cost for piloting the project, including training, materials, and hourly compensation, was $14,000 in the first year.
Results for Spring Quarter 2010—Attendance started out well with an average of 19 students prior to Test #1 (approximately 21 percent of the first-year nursing students). Attendance decreased after the second test because some students chose to withdraw. However, the number of withdrawals was much lower than in past quarters. We were surprised and pleased that overall 79 percent of graded students in the class participated in at least one session.
The greatest improvement in test scores, compared to previous quarters, occurred on Test #1, which was administered the fourth week of the quarter (see Figure 1). In autumn 2009, with no intervention beyond the academic coordinator, 55 percent of students passed the first exam with an A, B, or C, and 45 percent failed with a D or F, which was seven percentage points lower than the previous spring 2009. In spring 2010, with the Nursing Study Table intervention, the pass rate improved by 29 percent from AU09 to 84 percent passing with an A, B, or C and only 16 percent failing with a D or F. As a result of the improvement in the performance on this exam, a higher number of students were retained and the students in the class did better in their overall GPA for the course.
Tina Berry is assistant professor of nursing and Ben Williams is Perkins coordinator at Columbus State Community College in Columbus, Ohio. They can be contacted at firstname.lastname@example.org and email@example.com.
Fig 1: NURS 100 Exam 1 Comparisons SP09, AU09, and SP 10
Effects of Nursing Study Table Intervention on Course Grade and Retention—Students who attended one to four sessions during the quarter averaged the same mean grade as those who did not come at all, and by and large those students seemed to treat the sessions as test content preparation rather than as a means of learning new test-taking and study skills strategies. Students who came five times or more, however, averaged a 2.66 GPA for the class, which was half a point higher than the average of their peers who came four or fewer times. This fifth session seemed to be a tipping point in student success. Overall, the pass rate in the class improved from 67 percent to 82 percent, an increase of 15 percentage points (see Figure 2). The results from our first attempt at this strategy demonstrated that consistent attendance in the Nursing Study Table sessions, which focused on study and test-taking skills, especially those assessing "application skills," improved performance and retention. In addition, the instructors who facilitated the sessions received student approval rates of 3.74 on a five-point scale, which was considered above average.
Fig 2: Overall Retention (Pass Rate) NURS 100 AU06-SP10
Where We Are Going from Here—The data from the first Nursing Study Table pilot was so encouraging that the project was funded again for autumn 2010 and spring 2011 for an additional $12,500 from the college's FY11 Perkins grant. This data will be available by summer 2011. In the first quarter pilot, the sessions leading from Test #1 to Test #2 focused mainly on "content" rather than on test-taking and study skills. Analysis of the performance of students on that test indicates that the focus on content did not help the students to do better. As a result, the sessions for Test #2 in the autumn 2010 pilot focused only on study skills and test-taking strategies. Preliminary results from the autumn 2010 pilot indicate that this shift was warranted. In fact, 67 percent of the autumn 2010 students passed Test #2 whereas only 59 percent had passed the same exam in spring 2010.
We are encouraged by the positive results that the Nursing Study Table pilot has yielded in improved test performance, course grades, and overall retention in the Nursing Assessment course. Our goal is for the lessons and tools learned from this pilot to help other career and technical departments at the college to improve their student success rates as well.
ACTE (2006). Perkins Act of 2006: The Official Guide. Alexandria, VA: Association for Career and Technical Education.
The Center for Academic Development (2010). The Supplemental Instruction Supervisor Manual. The University of Missouri-Kansas City.
Clark, D. (1999). Learning Domains or Bloom's Taxonomy. Retrieved October 20, 2006, from http://www.nwlink.com/~donclark/hrd/bloom.html.
Krathwohl, David R. (2002). A revision of Bloom's taxonomy: An overview. Theory into Practice, 41 (4), 212-18.
Nugent, P. M., & Vitale, B. A. (2008). Test Success Test-Taking Techniques for Beginning Nursing Students. (5th ed.). Philadelphia, PA: F.A. Davis Co.
UMKC. (2007). The International Center for Supplemental Instruction. Kansas City Missouri, 64110. Retrieved August 16, 2009 from http://web2.umkc.edu/cad/si/index.html.
Widmar, G. E. (1994). Supplemental Instruction: From small beginnings to a national program. In D.C. Martin & D.R. Arendale (Eds.), Supplemental Instruction: Increasing Achievement and Retention (pp. 3–10). San Francisco, CA: Jossey-Bass.
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