GCU’s passage rates on national nursing exam fell below state standard in last two years for first-time test takers; school officials have a plan to boost rates
Arizona’s largest nursing school has agreed to a decree of censure after state regulators alleged violations of nursing rules and after the school’s graduates slipped below the state’s standards for passage rates on the registered nurse licensing exam two years in a row.
Grand Canyon University’s registered nursing program agreed to a decree of censure, which is a reprimand from the Arizona State Board of Nursing, in December, ending a 1½ year investigation that started after board staff said they received complaints from three students, a spouse of a student and two instructors.
University officials said they have developed a correction plan to increase first-time test-passage rates above the state’s 80 percent standard for nursing schools and to address other issues raised in the decree. Some changes already have been made, while others will be completed by this month, officials said in the correction plan.
The board’s action does not affect the school’s ability to teach or enroll students.
Board staff members followed up with a visit to the school the first week in April, said Kathy Malloch, the nursing board’s associate director of education. They interviewed students and faculty and observed classroom activities. Staff members will report on the visit at the board’s May meeting but declined comment until then.
“I strongly recommended GCU do (a correction plan). And the board wanted a site visit,” Malloch said.
The decree of censure is the lowest level of discipline handed out by the nursing board. The board, which regulates nursing programs and nurses in the state, also can put schools on probation or suspend their teaching programs.
GCU could face additional discipline from the board if passage rates don’t improve or issues identified by the board aren’t corrected.
“We’ll be above 80 percent” in 2017, Grand Canyon President Brian Mueller told The Republic about test-passage rates. “In ’18, we’ll be above 90 percent.”
In the past two years, the board also disciplined eight nursing programs besides Grand Canyon’s.
Arizona State University’s College of Nursing and Health Innovation, another large nursing program, agreed to a decree of censure in May because two students enrolled in a nurse-practitioner program were not licensed RNs in Arizona, though they were licensed in other states. The school also acknowledged previous letters of concern from the nursing board in 2011 and 2012 for employing a faculty member without a bachelor’s degree in nursing. ASU officials said they self-reported the licensing issue to the board.
Five programs that are smaller than ASU’s and GCU’s received probation within the last two years.
The nursing board censured GCU for five violations related to faculty rules and two tied to curriculum, under the parties’ agreement. GCU also acknowledged in the decree of censure that its nursing license exam passage rates have fallen below state standards two years in a row.
GCU officials said the decline in the exam-passage rate occurred when the nursing school rapidly grew enrollment to help address a nationwide nursing shortage. GCU’s nursing school enrollment grew from 247 pre-licensure graduates in 2012 to 693 in 2015, before dropping to 510 last year. GCU officials said the program scaled back last year after an off-campus location was closed.
Officials further attribute the decline to a tougher standard for passing the national test beginning in 2013 and to significant curriculum changes made by GCU that took effect in fall 2014.
Passage rates at nursing schools statewide and nationally declined under the new licensing-test standards. But GCU’s rates have fallen more sharply than Arizona’s pass rate.
Nursing exam scores fall
State nursing board rules require programs to have pass rates of at least 80 percent for first-time test takers on the national nursing exam, known as NCLEX-RN.
In 2015, the pass rate for GCU was 79 percent compared with 87 percent statewide. Last year, GCU’s rate fell further to 73 percent, compared with 86 percent statewide.
Ultimately, 95 percent of 2015 graduates passed the exam, GCU officials said.
Nursing is one of the university’s signature programs. Grand Canyon’s performance on the exam has historically been above the state average and has been a point of pride for the school.
GCU Provost Hank Radda said GCU graduates continue to be in high demand by hospitals.
As to the lower pass rates on the test the past two years, he said, “Our performance in this period of time was not up to our usual standard. We have a plan in place … by the end of 2017 we’ll be delivering the same way we have for 35 years.”
Changes to boost passage rates include hiring an NCLEX-RN success manager to help faculty and students. The program also offers individual and group coaching sessions for students. Students take “adaptive quizzes,” which test their individual ability and take them through different levels of testing until they reach their goals.
The nursing board’s website shows six of 31 registered-nursing programs in the state were below the 80 percent passage rate for 2016. GCU had 461 students take the test for the first time that year. The graduating classes in the other programs ranged from three to 55 students, according to nursing board data.
An 80 percent NCLEX-RN pass rate for first-time test takers is the rule in 22 states, including Arizona, according to the National Council of State Boards of Nursing.
State Board of Nursing President Randy Quinn said that he voted to censure GCU because it fell below state standards for nursing programs in multiple instances. Quinn said it likely was the multiple violations of nursing rules that caused GCU’s pass rate on exams to fall below state standards.
“I did not find any one thing more concerning than another,” he said. “But instead it was the pattern of issues that concerned me most.”
Mueller said GCU disputes some of the nursing board’s eight violations. He said GCU agreed to a decree of censure in an effort to resolve disagreements and move forward in a positive manner with the board.
READ: GCU’s consent decree
READ: GCU’s plan of correction
Issues with faculty supervision and evaluation
Other violations alleged by the nursing board involved issues in the classroom and inconsistent evaluations of faculty.
In October 2015, board staff observed several students who failed to perform hand hygiene. One used a trash can to dispose of a needle, instead of a container for sharp objects.
The board said the two faculty members for 24 students were focused on answering student questions and provided “very little surveillance to detect and remediate errors.”
In its written response to the board, GCU said any deficiencies observed by board staff were a one-time occurrence after a faculty member was unexpectedly absent. The absence caused the class ratio to be one instructor for 12 students, instead of one for eight students. University officials said they have procedures in place to ensure the faculty-to-student ratio is 1 to 10 or fewer for lab and clinical components.
On another visit in September 2016, board staff saw a student who didn’t maintain sterile conditions when starting an IV but was given a passing grade on a test in class.
GCU said the student’s evaluation by a single faculty member isn’t reflective of the procedures used for lab evaluation. And, at the time, the program had started to add additional procedures to ensure all lab personnel got consistent instruction as to how student errors should be treated during a test.
The board said GCU did not consistently evaluate nursing faculty according to its evaluation policy between 2013 and 2015. All new nursing faculty were to be evaluated in the first year and then every three years. GCU was unable to produce performance evaluations for all 24 faculty files during an October 2015 visit to the school, the board said.
School officials acknowledge that some part-time faculty may not have been evaluated according to policy. GCU officials said they have developed a schedule for faculty evaluations to be completed. They also will assure student input is part of the evaluations.
Complaints from inside school spur investigation
Nursing board staff members said they launched the investigation into GCU’s bachelor’s degree in nursing program after receiving six complaints in January 2015.
The board issued a notice of deficiency, which is a written notification of alleged violations that must be corrected within six months, to GCU in March 2015.
Separately, Marshall King, whose daughter enrolled in the nursing program in 2015, told The Republic he became concerned about the quality of instruction after his daughter told him an instructor was wasting time and she had to teach herself the course material. He said he learned in fall 2015 of the notice of deficiency from earlier that year.
King said he met with a school official and later called the nursing board with concerns about instructor quality.
The board issued Grand Canyon a second notice of deficiency in May 2016, and then voted in November to end the investigation by offering GCU a consent agreement for a decree of censure, which Mueller signed Dec. 6.
GCU officials said that during this time, two accrediting bodies — the Higher Learning Commission and the Commission on Collegiate Nursing Education — also reviewed complaints about the nursing program.
Both bodies “were well aware of the allegation by Mr. King and the letter of censure” and determined there were no compliance concerns, Mueller said.
Mueller provided The Republic with a copy of a letter from the nursing commission that said the board reviewed King’s complaint on Dec. 8, 2016, and found “no compliance concerns.”
The letter asks GCU officials to forward the nursing commission information related to the decree of censure, and GCU officials said they have done so.
The Commission on Collegiate Nursing Education did not respond to requests for comment.
Steve Kauffman, a spokesman for the Higher Learning Commission, said the organization is aware of GCU’s decree of censure, and the team reviewed the issues. Those issues, he said, are most appropriately addressed by the state nursing board and the Commission on Collegiate Nursing Education.
The Higher Learning Commission, “looks more holistically at the institution as a whole. Grand Canyon University passed the rigor of institutional review for reaffirmation of accreditation,” he said.
Dignity Health: ‘We’ve had excellent students’
Grand Canyon Education Inc. is a private university that offers graduate and undergraduate programs online and at its Phoenix campus. The for-profit company posted net income of $148.5 million in 2016.
Mueller said the university loses $1,300 on each pre-licensure nursing student each year and runs the program to give thousands of Arizona students the chance to become nurses.
“This isn’t a situation where the pass rate is 50 percent, students go into huge amounts of debt and they don’t get a job. That would be a story. This isn’t a story. Nobody is being harmed here,” he said.
Dignity Health St. Joseph’s Hospital and Medical Center in Phoenix hires significant numbers of GCU students once they graduate, said Patty White, president and CEO. The hospital has an agreement with GCU where students get their lectures and clinical hours at the hospital.
She said she is aware of the decree of censure and isn’t concerned.
“We’ve had excellent students” she said. “Everybody embraces them here at the hospital. It’s been a really good relationship.”
How common is discipline?
The overarching goal of state nursing rules is to ensure students are “safe and competent” when they graduate from school, said Joey Ridenour, executive director of the state nursing board.
She said decrees of censure are not common.
Quinn, the nursing board president, said, “A lot of times nobody is perfect; no program is perfect. So when we go in and do our surveys, we expect to find things that aren’t perfect. Usually they can rectify things easily.”
Besides GCU and ASU, these nursing programs also have been disciplined in the past two years:
Coconino Community College’s registered nursing program in Flagstaff agreed to a decree of censure in December for not providing adequate supervision for students in a spring 2016 nursing preceptor program. In preceptor programs a student nurse, at the end of his or her training, works with an experienced nurse to obtain a better understanding of work circumstances and conditions.The school agreed to probation in 2015 for a variety of issues, including test pass rates falling below 80 percent in 2013 and 2014. Pass rates have since improved to 84 percent. College officials say the school is no longer on probation.
Breckinridge School of Nursing @ITT agreed to probation in May 2015 for multiple violations of nursing rules, including NCLEX-RN passage rates of 43 percent for 2014. The school’s graduation rate was below the state standard. The school and its parent company, ITT Technical Institutes, have since closed.
Brookline College School of Nursing in Phoenix agreed to a decree of censure in May 2015. Staff found during site visits to the school in September 2014 that classrooms were overcrowded and lab space and practice stations were inadequate. Officials say the issues were remedied. The school in November 2015 agreed to probation for multiple violations of nursing rules, including failing to provide sufficient instruction for students to meet clinical objectives. Officials said they have worked to address the issues and have maintained accreditation throughout probation.
The Associate of Applied Science in nursing program at Brown Mackie College in Phoenix agreed to probation in November 2015 for multiple violations, including failing to evaluate and revise the program and for anticipated NCLEX-RN test scores below 80 percent for 2015. The school has since raised its pass rates above state standards.
The Practical Nursing Diploma program at Brown Mackie College in Tucson agreed to probation for two years in May 2015 for multiple violations, including not having adequate books, clinical placement, supplies, faculty and other tools. ?In some instances, Brown Mackie College was using veterinary technician supplies, board documents said. The Tucson program stopped accepting new nursing students during probation and has since closed.
Carrington College’s registered nursing program in Phoenix agreed to a decree of censure in November 2015 for awarding extra points to several failing students so they could pass courses. One instructor failed to follow a tutoring schedule and told students after the midterm she would no longer meet with or provide tutoring. School officials said the issue was resolved.
Everest College’s nursing program in Phoenix surrendered its nursing program in April 2015 after its parent institution, Corinthian Colleges Inc., announced it was losing its accreditation from the Higher Learning Commission and closing all campuses.
For further information
You can check the nursing board’s online database of recent disciplines for the performance of a specific school.
More consumer information on choosing a school is available here on the nursing board’s website.
Reach the reporter at 602-444-8072 or [email protected]
GCU pre-licensure nursing graduates
2012: 247 graduates.
Source: Grand Canyon University
GCU percentage passing NCLEX-RN exam on first try
This is the national test students must pass to become licensed nurses.
2010: GCU: 91 percent. State average: 90 percent.
2011: GCU: 96 percent. State average: 91 percent.
2012: GCU: 97 percent. State average: 94 percent.
2013: GCU: 90 percent. State average: 88 percent.
2014: GCU: 91 percent. State average: 90 percent.
2015: GCU: 79 percent. State average: 87 percent.
2016: GCU: 73 percent. State average: 86 percent.
Source: Arizona State Board of Nursing, results for first-time test takers
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