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Academic Predictors of Success in a

Nursing Program
Amanda A. Wolkowitz, PhD; and Jeffrey A. Kelley, PhD

Abstract subscores from standardized assessments, or should


The academic content areas that best predict success programs consider only overall scores? The purpose of
early in a nursing program affect admission and placement this article is to answer this question by determining
decisions in nursing programs nationwide. The purpose of which academic areas best predict a student’s success
this research was to apply a multiple regression model to in a nursing program.
student test scores to determine the relative strength of
science, mathematics, reading, and English content ar- Literature Review
eas in predicting early nursing school success. Using a
standardized nursing entrance examination, the subtest Two common criteria that nursing program admission
scores of these four academic areas for 4,105 registered committees review are standardized test scores and grade
nurse students were used as the predictors in the regres- point averages. There are multiple standardized tests that
sion model. Performance on a standardized Fundamentals nursing schools use, such as the Scholastic Aptitude Test
of Nursing assessment was the criterion variable. Results (SAT), the American College Test® (ACT), the Nursing
confirmed those found in the majority of the literature Entrance Test (NET), and the Test of Essential Academic
indicating that science is both a statistically significant Skills® (TEAS). The former two tests are designed to be
predictor and the strongest of the four content areas in the used during the admission process into post-secondary
prediction of early nursing program success. schools. The latter two tests are also post-secondary as-
sessments, but the intended audience is more specific and
the tests are designed for students applying to nursing

A
d a u n ti n g task facing nursing programs around programs. This review discusses different standardized
the country is determining which students to assessments and which content areas of the tests best pre-
admit into their programs. Should programs dict nursing program success. Because many standardized
consider grade point averages from specific courses or assessments do not include a science component, science
grade point average is also reviewed to determine how
Received: March 11, 2009 well it predicts success in a nursing program.
Accepted: February 10, 2010 Standardized tests often report subscale scores and
Posted: May 28, 2010 composite scores. With the exception of the TEAS, many
Dr. Wolkowitz is a psychometrician and Dr. Kelley is Director of of these tests weigh each subscale score equally. For ex-
Psychometrics, Assessment Technologies Institute, Stilwell, Kansas. ample, the ACT assesses reading, mathematics, English,
The authors thank Tony Juve and Dawn Clayton for their editorial and science skills. Despite the fact that these four sections
contributions. do not all have the same number of items, the compos-
The authors have no financial or proprietary interest in the material ite is an unweighted average of the four components. The
presented herein. NET also uses the mean of the reading and mathemat-
Address correspondence to Amanda A. Wolkowitz, PhD, Psy- ics subscale scores to compute the overall composite score.
chometrician, Assessment Technologies Institute, 7520 West 160th However, the TEAS versions 1.0 to 4.0 assesses the same
Street, Stilwell, KS 66085; e-mail:awolkowitz@atitesting.com. four content areas as the ACT, but the composite score is a
doi:10.3928/01484834-20100524-09 weighted average. In these versions of the TEAS, English

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Wolkowitz & Kelley

is weighted the most heavily in the overall score, followed program success. However, Hopkins (2008) and Sayles et
by mathematics, reading, and science, respectively. al. (2003) measured success with more stringent criteria
The research is unclear regarding which of the different of earning at least 80% in a first-semester nursing course
content areas assessed on standardized assessments are and success on the NCLEX, respectively. In these studies,
the best predictors of success in a nursing program. Little the researchers did find reading to be a statistically sig-
research addresses how well the science component of a nificant predictor of success.
standardized assessment predicts nursing program suc- Few published research studies compare how well each
cess. However, several research studies investigated the of the four content areas of science, reading, mathematics,
relationship between students’ science grade point aver- and English predict success in a nursing program, and no
age and their success in a registered nurse (RN) program. research uses the TEAS in such a comparison. Although
These research studies repeatedly reported a statistically the literature presented in this review does not constitute
significant relationship between these two variables (Lew- a true meta-analysis of the research because no empirical
is & Lewis, 2000; Potolsky, Cohen, & Saylor, 2003; Wong & comparison of effect sizes or other statistics was made be-
Wong, 1999). Furthermore, students’ science grade point tween studies, published literature consistently cites sci-
averages while in an RN program significantly predicted ence knowledge as a significant predictor of success more
overall success in the nursing program, as measured by often than mathematics or verbal knowledge. Reading abil-
program completion or final nursing school grade point ity also appears to be a stronger predictor of nursing pro-
average (Baker, 1994; Byrd, Garza, & Nieswiadomy, 1999; gram success than English or mathematics. The research
Phillips, Spurling, & Armstrong, 2002). presented in this article compares the four subscale compo-
The research remains unclear about whether reading nents of the TEAS to early success in an RN program to test
scores are a good predictor of success in an RN program. the hypothesis that science and reading abilities are better
Hopkins (2008) and Sayles, Shelton, and Powell (2003) re- predictors of success than mathematics or English abilities
ported that the reading section of the NET was predictive and to address the gap in the literature.
of success, whereas the research by Gallagher, Bomba, and
Crane (2001) did not support that conclusion. Sayles et al. Method
(2003) also found that the ACT reading section was not
a good predictor of success. The use of grade point aver- The TEAS is an admissions assessment designed to
age to measure reading ability was not commonly studied; measure the overall academic preparedness of students
however, several studies reported that requiring a reme- entering a nursing program. The TEAS does not purport
dial reading course significantly predicted success in RN to measure nonacademic qualities, such as motivation
programs (Baker, 1994; Phillips et al., 2002). or temperament. Because nonacademic variables have
Whether performance on the mathematics section of a more time to affect criterion measures given at the end
standardized assessment is a good predictor of success in of a nursing program, the accuracy of an academic pre-
an RN program is also unclear. Some research indicates paredness test in predicting program success is likely to
that mathematics performance on standardized assess- be best measured when the criterion is early program suc-
ments is predictive of success (Hopkins, 2008), whereas cess (Zwick, 2006). Comparing TEAS scores with those of
other research does not (Gallagher et al., 2001). Other re- a standardized nursing content test administered early in
search found mathematics performance to be a significant nursing programs allows for a cleaner measure of predic-
predictor of success depending on which standardized as- tive accuracy.
sessment is used (Sayles et al., 2003). Assessment Technologies Institute’s (ATI) RN Funda-
Little research addresses the predictability of success in mentals assessment is a standardized test that measures
an RN program based on a student’s English subscore on a student’s knowledge of the fundamentals of nursing. The
a general knowledge standardized assessment. Literature content assessed on this examination is usually covered in
may be available that discusses the usefulness of assess- a Fundamentals of Nursing course. Because such courses
ments designed to assess English as a foreign language, may vary greatly from one program to another, using the
but that is not the purpose of the English component of the results from ATI’s Fundamentals assessment standardizes
TEAS, nor the purpose of this study. the results, allowing for direct comparisons among students
The results presented thus far do not conclude that from different programs. This test is also an appropriate
standardized tests should be removed from the admissions test for the study because it is given during a student’s first
process of nursing schools. Instead, they indicate that no year in a nursing program and can be taken as a surrogate
universal conclusion can yet be drawn from an analysis of for early program success. Student performance on both
such research. Not only is the research currently limited the TEAS and RN Fundamentals tests can readily be com-
in this field, but the studies should be cautiously compared pared, and student performance on the two assessments
because they do not all use the same criterion variables. can be matched together by the student ID number.
For example, Gallagher et al. (2001) measured success by
the achievement of at least 73.5% in the first-semester Participants
nursing course. On the basis of this criterion, they did not The participants in this study were students who com-
find the NET reading subscore to be predictive of nursing pleted both ATI’s TEAS and RN Fundamentals 2.1 assess-

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Predictors of Success in a Nursing Program

dent’s score from a retake


Table 1 of the same test because
Survey Results from 314 Directors of Nursing Programsa the latter student would
Survey Question No. (%) have been exposed to the
test multiple times.
What is your program type? (select all that apply)
To ensure that examin-
Associates degree in nursing 77 (51.7) ees’ first attempt at TEAS
Bachelors of science in nursing 71 (47.7) were the scores used in this
study, examinee data were
Diploma in nursing 9 (6)
first gathered for each ver-
Practical nursing 21 (14.1) sion of the TEAS. The data
Missing 2 (1.3) files were then merged into
For what purpose(s) do you use the TEAS? one file. Because it was
possible that examinees
Preadmission decisions only 72 (48.3)
completed two different
Postadmission decisions only 45 (30.2) versions of the assessment
Both preadmission and postadmission decisions 20 (13.4) at different times, the data
were filtered by the stu-
We do not use TEAS 12 (8.1)
dent ID variable and the
Do students at your institution complete ATI’s Fundamentals assessment? earliest TEAS score was
Yes 135 (90.6) retained. The total num-
No 14 (9.4) ber of TEAS examinees re-
maining was 14,827.
Data were also gath-
TEAS = Test of Essential Academic Skills; ATI = Assessment Technologies Institute.
a
ered for ATI’s RN Funda-
Eleven programs indicated that they had both bachelors of science in nursing (BSN) and associates degree
mentals 2.1 assessment
in nursing (ADN) programs, 18 indicated that they had both ADN and practical nursing (PN) programs, and 1
indicated that it had BSN, ADN, and PN programs. from the time of its release
on February 27, 2006, un-
til December 17, 2008.
Similar to the filters used
ments. The participants were identified by first sending a for the TEAS, only the first attempt and the schools indi-
survey to the directors of all nursing programs that had cating that they use both TEAS and Fundamentals were
purchased both the TEAS and Fundamentals assessments retained in the dataset. The total number of examinees
since May 1, 2005, resulting in 314 directors. The survey taking the Fundamentals assessment after applying these
asked for the name of the respondent’s institution, as well filters was 6,940. It was expected that this number would
as responses to the three questions listed in Table 1. be considerably less than the number taking the TEAS
Of the 149 (47%) directors who responded, 126 in- because the TEAS is an entrance examination and not all
dicated the use of both ATI’s TEAS and Fundamentals students who complete the TEAS ultimately enroll in a
assessments. Of these schools, 64 use TEAS for pread- nursing program.
mission decisions only. Data for the TEAS versions 1.0 Such a restriction of range is typical of post hoc valida-
through 4.0 were gathered between May 1, 2005, and tion studies involving admissions tests, and this restric-
May 1, 2008. All versions of the TEAS were statistically tion of range is likely to weaken the correlations between
equated such that differences in version difficulty were the TEAS and RN Fundamentals scores. Students who
accounted for, making scores fully exchangeable. The are not admitted are more likely to have lower TEAS
data were then filtered to include only those schools scores; therefore, the range of academic preparedness lev-
that reported on the survey using both the TEAS and els among those included in the study is likely to be less
Fundamentals assessment. To ensure that participants than that for all applicants. Furthermore, some admitted
took the TEAS with roughly the same level of stakes, students drop out of nursing programs before ever tak-
only the 64 schools that reported using TEAS for pre- ing the Fundamentals assessment. Restricting the range
admission decisions were included in the sample. Also, of either variable in a regression study will tend to lower
because examinees have the option to retake the TEAS statistical estimates of the relationship.
multiple times, the data were filtered to include only an The final step in establishing the dataset was to merge
examinee’s first attempt at this standardized test. This and match the TEAS data with the Fundamentals data
latter filter was applied to provide some commonality by student identification number. Only those examin-
between the test takers. Regardless of the admission re- ees who completed all four subsections of the TEAS and
quirements for a particular program, it would be inap- completed the RN Fundamentals 2.1 examination were
propriate for this study to compare an examinee’s scores included. The final number of examinees who completed
from their first attempt on the TEAS with another stu- both assessments and were included in the study was

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Wolkowitz & Kelley

4,105. These examinees


came from 49 different RN Table 2
programs in the country. Test Statistics on ATI’s TEAS and RN Fundamentals Assessments
®

Assessment No. of Items Mean (SD) Alpha (SEM)


Instruments
ATI’s TEAS and RN RN Fundamentals version 2.1 (N = 25,933) 60 68.75% (8.91%) 0.62 (5.49%)
Fundamentals 2.1 as- TEAS version 3.0 (N = 46,865) 170 72.62% (10.23%) 0.92 (2.89%)
sessments were the as-
Reading 40 86.09% (10.82%) 0.79 (4.96%)
sessments analyzed. The
number of items and the Mathematics 45 66.79% (16.39%) 0.86 (6.13%)
mean percentage correct, Science 30 63.08% (13.72%) 0.71 (7.39%)
standard deviation, and English and Language Usage 55 74.23% (9.71%) 0.77 (4.66%)
reliability of these assess-
ments are displayed in Ta-
ble 2. The sample in Table ATI = Assessment Technologies Institute; TEAS = Test of Essential Academic Skills; RN = registered nurse.
2 includes first-attempt
scores of 46,865 examin-
ees who completed TEAS
3.0 between January 8, 2008, and January 8, 2009, and Fundamentals scores after taking into account all other
25,933 examinees who completed Fundamentals between subscores. From Table 3, it is apparent that the science
January 8, 2008, and December 17, 2008. subtest was the strongest predictor in terms of overall and
unique variance explained. This was also the case for the
Procedures ADN and BSN programs. The unique contribution to ex-
Multiple regression was performed on the data to de- plained variance in RN Fundamentals score was statisti-
termine the best predictors of success on ATI’s RN Fun- cally significant for all predictor variables except for the
damentals 2.1 assessment. The predictors were the four ADN group. For this group, mathematics did not have a
subscores of the TEAS. The analyses were completed for statistically significant unique contribution.
RN examinees in ADN and BSN program types. Separate
analyses were not completed for examinees enrolled in di- Discussion
ploma programs due to low sample sizes.
The results of this study help answer the question of
Results which academic areas are the best predictors of early suc-
cess in a nursing program. The results indicate that the
The statistical analyses included 4,105 RN students strongest predictor of early nursing program success is
who completed both ATI’s Fundamentals assessment and science, followed by reading, written/verbal, and math-
TEAS versions 1.0 through 4.0. SPSS version 15.0 soft- ematics, respectively.
ware (SPSS Inc., Chicago, IL) was used to perform the Although the results of this study are based on stan-
multiple regression to determine the strength of the rela- dardized assessments, the literature review discussed re-
tionship between each of the four TEAS subscores and the sults from studies of both standardized tests and science
RN Fundamentals score. The linear combination of the grade point averages. Because few standardized entrance
four TEAS subscores to the RN Fundamentals score was tests include science as a subtest, there is limited research
statistically significant, R2 = 0.20, F(4, 4100) = 256.467, on the best predictors of success in a nursing program that
p < 0.01, indicating that the linear combination of the four include this field. The research studies that did find science
TEAS subtest scores explains 20% of the variance in the to be significantly predictive of success were those that an-
Fundamentals scores. alyzed students’ science grade point average in reference
Correlations between ATI’s RN Fundamentals scores to their nursing school performance (Baker, 1994; Byrd et
and each of the four subscores, along with the corre- al., 1999; Lewis et al., 2000; Phillips et al., 2002; Potolsky
sponding proportion of variance explained, are displayed et al., 2003; Wong & Wong, 1999). The research conducted
in Table 3, as well as the standardized regression coef- in this study used the science subscore of a standardized
ficients and statistical tests assigned to each subscore. entrance test as the independent variable and confirmed
The zero-order correlations indicate the strength of the the results found by the grade point average studies.
relationship between individual subscores and RN Fun- The results of this study showed a low to moderate
damentals without considering the other three subscores. correlation between the TEAS science subscores and per-
All zero-order correlations were statistically significant (p formance on ATI’s Fundamentals assessment. Although
< 0.001). The semi-partial correlations indicate the unique these values may initially seem low, the correlations are
strength of this relationship for each subtest after the oth- attention worthy. An R2 value of 0.15 for the science sub-
er three are factored in. In other words, this value is the score achieved by all RN groups combined, for example,
unique contribution of each subtest to variance in the RN means that 14.9% of the variance in predicting early nurs-

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Predictors of Success in a Nursing Program

area in terms of predicting


Table 3 early nursing program suc-
Zero-order (r) and Semi-Partial Correlations (ra.b) Between Fundamentals Score and cess for students enrolled in
TEAS® Subscores as well as Regression Results by Program Type BSN programs and for all
RN programs combined.
TEAS Significance
Program Type Subscore r (R )
2
ra.b(R a.b)
2
b Test p
In accordance with
past research, the results
All (n = 4,105) of this study found that
Reading 0.32 (0.10) 0.11 (0.01) 0.13 t(4104) = 7.53 < 0.00001 mathematics and English
Mathematics 0.33 (0.11) 0.08 (0.01) 0.10 t(4104) = 5.58 < 0.00001 tended to predict nursing
program success less well
Science 0.39 (0.15) 0.19 (0.03) 0.23 t(4104) = 13.28 < 0.00001
than reading and science.
English 0.33 (0.11) 0.10 (0.01) 0.12 t(4104) = 6.98 < 0.00001 Because the demands
ADN (n = 1,743) on a student in a nurs-
Reading 0.26 (0.07) 0.10 (0.01) 0.11 t(1742) = 4.35 0.00001
ing program are heavily
placed in understanding
Mathematics 0.22 (0.05) 0.01 (< 0.01) 0.01 t(1742) = 0.51 0.61333 the science involved with
Science 0.32 (0.10) 0.18 (0.03) 0.21 t(1742) = 7.91 < 0.00001 nursing and comprehend-
English 0.28 (0.08) 0.11 (0.01) 0.13 t(1742) = 4.86 < 0.00001 ing medical textbooks, the
results of the current and
BSN (n = 2,000)
past studies are not sur-
Reading 0.30 (0.09) 0.12 (0.01) 0.14 t(1999) = 5.79 < 0.00001 prising. From a practical
Mathematics 0.30 (0.09) 0.08 (0.01) 0.10 t(1999) = 4.14 < 0.00001 standpoint, more empha-
sis should be placed on
Science 0.35 (0.13) 0.18 (0.03) 0.22 t(1999) = 8.91 0.00004
students’ ability in science
English 0.27 (0.07) 0.07 (0.01) 0.08 t(1999) = 3.33 0.00087 and reading versus math-
ematics and English dur-
TEAS = Test of Essential Academic Skills; ATI = Assessment Technologies Institute; RN = registered nurse; ADN = ing the admission process.
associates degree in nursing; BSN = bachelors of science in nursing. Although the results of
Note. The value r is the correlation between the stated subscore and the score on ATI’s Fundamentals assessment, this study come from an
while ra.b is the semipartial correlation between the stated subscore and the Fundamentals score after factoring in
analysis of a standardized
the other three subscores. The value R2 is the amount of variance in Fundamentals scores that can be explained
by the stated subscore alone, while R2a.b is the unique proportion of variance that can be explained by the stated assessment, there are oth-
subscore above and beyond that explained by the other three subscores. er variables that could po-
tentially predict academic
success in nursing. Sug-
gested by past research
ing program success can be explained by the science sub- (Baker, 1994; Byrd et al., 1999; Phillips et al., 2002), sci-
score alone. The additional 85.1% of the variance may be ence and reading grade point averages could be analyzed
explained by other factors, such as reading, mathematics, during the admission process to help determine the po-
and English scores, as well as grade point average in vari- tential success of a student. Other potential variables in-
ous subjects, test anxiety, and other possible academic or clude the number of science and reading courses a student
nonacademic factors. Because there are multiple factors to has completed prior to enrolling in a nursing program or
consider when trying to determine whether a student will whether students have or plan to complete a remedial sci-
be successful in a particular nursing program, it is note- ence or reading course.
worthy that approximately 15% of the success formula is The suggestions listed in the previous paragraph are
measured by a single science subtest score. Furthermore, areas for future research. At this point, the research
the science subscore accounts for 3% of the variance after merely suggests that science and reading are better pre-
the other subtests have been factored in, as evidenced by dictors of nursing program success than either mathe-
the R2a.b value. matics or English. In considering further research, it is
Studies in the literature review that included standard- important to establish an appropriate criterion variable.
ized test scores for reading did not agree on whether read- In this study, ATI’s Fundamentals assessment was used
ing was predictive of nursing program success (Gallagher et to measure academic success given that this assessment
al., 2001; Hopkins, 2008; Sayles et al., 2003). Reading was is given early in a student’s nursing school career and
consistently reported as a significant predictor of success in the TEAS is an entrance examination measuring general
studies that required remedial reading or at least one read- academic preparedness. The further amount of time sep-
ing course in a nursing program (Baker, 1994; Phillips et al., arating the independent and dependent variables in this
2002). The multiple regression analysis reported in this study type of research, the less reliable the results are likely
found that reading was the second most predictive academic to be because other nonacademic factors may influence

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Wolkowitz & Kelley

a student’s performance in a nursing program (Zwick, affect success in a practical nursing program or other
2006). allied health programs; therefore, it cannot be conclu-
sively stated that these results would generalize beyond
Conclusion RN programs or to other admissions tests. In addition,
this study limited the data analysis to include only
The purpose of this research was to answer the follow- those students who had completed both TEAS and ATI’s
ing question: Which academic areas are the best predic- Fundamentals assessment. Different predictor or crite-
tors of early success in a nursing program? The literature rion variables could be used to include more examinees.
review and the research presented in this article suggest Further research is warranted into academic predictors
that science knowledge should be a prominent academic of success in other program types and with other instru-
area considered when admitting students. Whether by ments.
analyzing a student’s standardized test score in science
or by analyzing their knowledge in other ways, success- References
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