DOES NURSING ASSISTANT CERTIFICATION INCREASE NURSING STUDENT'S CONFIDENCE LEVEL OF BASIC NURSING CARE WHEN ENTERING A NURSING PROGRAM? ANGIE STOMBAUGH, PHD, RN, FNP-BC⁎
AND
ANDREA JUDD, RN†
The purpose of this study was to explore nursing student's confidence level with basic nursing care when entering the nursing program after implementation of required nursing assistant certification for program admission. In addition, the relationship between being employed as a nursing assistant and confidence level with basic nursing care when entering the nursing program was explored. A Likert-scale survey assessing confidence levels of basic nursing care was sent to 156 nursing students admitted to a nursing program prior to their first nursing course. Confidence level with nursing skills, nursing assistant employment, and length of nursing assistant employment were assessed. Students were most confident in hand washing (M = 5.87, SD = 0.36), gloving and gowning (M = 5.46, SD = 0.75), making an unoccupied bed (M = 5.38, SD = 0.88), and oral temperature (M = 5.30, SD = 0.87). Students were least confident in the fitting for cane (M = 1.74, SD = 1.16) and ambulation with crutches on steps (M = 1.81, SD = 1.27). Nursing assistant employment increased student confidence with basic nursing care. Nursing programs cannot assume that students are prepared in basic nursing care based on a nursing assistant certification. (Index words: Nursing assistant; Certification; Admission; Skills) J Prof Nurs 30:162–167, 2014. © 2014 Elsevier Inc. All rights reserved.
I
N RECENT YEARS, several nursing schools have been changing prelicensure nursing admission requirements to require potential nursing students to complete nursing assistant certification prior to beginning professional nursing courses. Additional nursing schools are contemplating making this change. There is rationale for this change. First, this change ensures that prelicensure nursing students have evaluated their own comfort level with providing intimate basic care for patients. Second, this change is a way to save curricular time by decreasing the amount of time required for the development of basic nursing skills in preliminary nursing courses. Finally, it
*Associate Professor, University of Wisconsin-Eau Claire, Eau Claire, WI. †Registered Nurse, University of Wisconsin-Eau Claire, Eau Claire, WI. Address correspondence to Dr. Stombaugh: University of WisconsinEau Claire, 105 Garfield Avenue, Eau Claire, WI 54702. E-mail: [email protected] 8755-7223/13/$ - see front matter 162 http://dx.doi.org/10.1016/j.profnurs.2013.09.002
would guarantee that all prelicensure nursing students would enter nursing courses with the same repertoire of basic nursing skills. Implementation of the nursing assistant certification requirement has been happening at nursing programs with no research supporting this change. Do potential prelicensure nursing students feel more confident to begin the nursing program because of this new requirement? The purpose of this study is to explore the prelicensure nursing student's confidence level with basic nursing care when entering the nursing program after implementation of required nursing assistant certification for program admission. Basic nursing care is defined as skills that can be completed by a nursing assistant and include understanding Health Insurance Portability and Accountability Act, basic infection control, bathing, bedmaking, safe patient handling, elimination assistance, nutrition and fluids, personal hygiene and grooming, and vital signs.
Journal of Professional Nursing, Vol 30, No. 2 (March/April), 2014: pp 162–167 © 2014 Elsevier Inc. All rights reserved.
CERTIFICATION AND CONFIDENCE
Background According to Bandura's social learning theory, the likelihood of learning and behavioral change is affected by three factors: self-efficacy, outcome expectations, and goals (Bandura, 1998). Self-efficacy is the primary source of action in this theory. Self-efficacy is defined as “judgments of how well one can execute courses of action required to deal with prospective situations” (Bandura, 1982, p. 122). Self-efficacy affects one's confidence to learn, one's motivation, and one's power and determination to face obstacles. In theory, by having potential prelicensure nursing students participate in nursing assistant certification, they should have increased self-efficacy related to basic nursing care and patient interactions. They should feel more confident in their choice to pursue nursing as a career. By increasing selfefficacy, an individual increases learning. The individual has more confidence in overcoming obstacles, goal setting, and obtaining goals in nursing school. One study (McLaughlin, Moutray, & Muldoon, 2007) explored the role of personality and self-efficacy in the retention of nursing students. A longitudinal design was used to follow 384 students in a nursing program. The researchers collected measures on occupational selfefficacy, academic self-efficacy, and personality and examined the relationship among retention and success in the program. Findings supported the idea that greater occupational self-efficacy (confidence in ability to perform job specifics) in nursing students is related to more successful completion of nursing courses. Specifically, basic nursing care and confidence was not addressed in this study, but the idea of occupational self-efficacy may support the idea of self-efficacy increasing overall confidence. Unfortunately, the confidence level of prelicensure nursing students with basic nursing care when entering a nursing program has not been explored in the literature. In fact, literature related to basic nursing care is difficult to find. One research study (Salmonson & Andrew, 2006) examined the influence of part-time employment on nursing students' academic performance and focused specifically on work related to nursing. In a study of 267 nursing students, more than 78% of students were in paid employment, with 64% of those working in nursingrelated jobs. The study examined the number of hours worked and academic scores in a nursing pathophysiology and nursing practice course. Results indicated that nursing-related employment was not beneficial to student academic performance in nursing courses, and the number of hours of part-time employment was negatively associated with academic performance. Another study (Higgins, 2005) linked a nursing skills course with success in passing the National Council Licensure Examination for Registered Nurses (NCLEXRN). This study examined the relationship of variables in the application process to successful completion of a nursing program and passage of the NCLEX-RN. Data from 213 students related to preadmission test scores,
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age, gender, race, English course, biology course, chemistry course, psychology course, and the nursing skills course was examined. A statistically significant relationship was found between one biology course (r = .171), the science component of the preadmission test (r = .127), and the nursing skills course (r = .281) to passing the NCLEX-RN. The higher the grade the student received in the nursing skills course, the more likely they were to pass the NCLEX-RN. This research did not address the confidence of the students with the skills, simply the course grade. Although some researchers (Higgins, 2005; Salmonson & Andrew, 2006) touch on nursing skills, no research was found that addressed the prelicensure program admission requirements of nursing assistant certification. Data have not been collected about the number of nursing schools that currently require nursing assistant certification. No literature was found related to health care experience as a component of admission that would predict success in undergraduate nursing. Several nursing programs as reported by McNelis et al. (2010) require prior experience and job shadowing as criteria for admission based on the assumption that potential nursing students should explore their profession to see if it will be a good “fit” for them. Only anecdotal accounts are available to support the idea that students need to be exposed to nursing prior to nursing school admission. The nursing assistant certification requirement for prelicensure program admission has been suggested for students to build confidence with basic nursing care when entering a program. The difficulty is that states vary in requirements for hours of initial training for certified nursing assistants. Federal mandates for nursing assistant certification is a minimum of 75 hours of classroom training and 16 hours of clinical training. State programs vary between 75 and 175 hours of classroom training and 16 to 100 hours of clinical training (Institute of Medicine, 2008). Many nursing programs require the certification and do not require students to work as a nursing assistant. By requiring nursing assistant certification, nursing programs are assuming that students have used their basic nursing skills to a minimal degree and students could have more experience based on the certification program that the student enrolled in. The purpose of this study was to explore nursing student's confidence level with basic nursing care when entering a nursing program after implementation of a nursing assistant certification for program admission. The variable confidence was selected to reflect the student's perceived self-efficacy related to their nursing assistant certification. This does not suggest competency, which is a very different concept. The variable confidence was also congruent with national data related to training received by certified nursing assistant and their confidence with their training (Sengupta, Harris-Kojetin, & Ejaz, 2010) and seemed to apply to this setting as well. An additional objective examined if being employed as a nursing assistant was related to increased confidence level with basic nursing care when
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entering a prelicensure nursing program. Many students complete nursing assistant certification but may never work as a nursing assistant.
Methods Design This descriptive correlational study explored prelicensure nursing students comfort level with 53 basic nursing skills that are included in most of the nursing assistant certification courses. After institutional review board approval was obtained, participants were asked to complete a Likert scale survey that included questions about 53 basic nursing skills, length of nursing assistant certification, employment as a certified nursing assistant, length of employment as a nursing assistant, and the number of clinical hours students completed to become a certified nursing assistant. The survey was completed prior to students beginning their first required nursing course.
Sample The sample for this study consisted of 168 prelicensure nursing students entering their first semester of required nursing courses in a baccalaureate nursing program at a university in the upper midwest. The prelicensure nursing program has a requirement that students must have nursing assistant certification to enter the program but do not have to be actively working as a nursing assistant or keep their certification active once being accepted into the program. Inclusion sample criteria include that respondents had to be accepted into the prelicensure nursing program and enrolled in their first required nursing course. Participants were recruited by e-mail 2 weeks prior to the beginning of their first required nursing course. Recruitment occurred at the beginning of three different semesters; each semester had the potential for 56 newly admitted participants. Respondents were able to answer a confidential on-line survey. One hundred fifty-six participants answered the survey. Table 1 provides demographic information on the sample.
Instrument The self-developed 58-item survey included 53 items about basic nursing care. Using a Likert scale, students ranked their confidence related to basic nursing care on a range from did not learn (0), very low confidence (1) to very high confidence (5), with 5 being the highest amount of confidence. Basic nursing skills for this survey were identified through a three-step process. First, instructors from the baccalaureate nursing program identified skills taught prior to the nursing assistant certification requirement in the nursing program that were labeled as basic nursing care. Next, these skills were compared with the skills identified as basic nursing care by Mosby's Nursing Skills (2009) and skills identified by nursing assistant programs as required skills from regional programs. Finally, a list of basic nursing care was determined and approved by six faculty members
Table 1. Demographics % (n) Gender Male Female
5 (8) 95 (148)
Age ≤ 19 years 20–21 years 22–25 years ≥ 26 years
11 64 9 16
Ethnicity White Hispanic American Indian Asian African American Unknown
95 (148) 1.9 (3) 0.6 (1) 0.6 (1) 0.6 (1) 1.2 (2)
Cumulative grade point average 4.0 3.75–3.99 3.5–3.74 3.25–3.49 3.0–3.24
(17) (100) (14) (25)
1.9 (3) 34.6 (54) 41 (64) 19.2 (30) 3.2 (5)
teaching in the foundational nursing skills course. The remaining five questions of the survey asked about length of nursing assistant certification, type and length of nursing assistant work experience, facility where nursing assistant certification occurred, and number of clinical hours completed to obtain nursing assistant certification. Content and face validity was determined by six faculty members in the foundational nursing skills course. All members agreed that the basic nursing care identified were the expected skills that a certified nursing assistant should be able to complete upon entering a prelicensure nursing program.
Data Analysis Data were analyzed using SPSS Version 18.0. Simple descriptive statistics were used to analyze the confidence level of basic nursing care and nursing assistant experience. Confidence level was grouped into three categories: did not learn, low confidence, and sufficient to high confidence. Low confidence is the combination of very low confidence (1) and some confidence (2) on the Likert scale. Sufficient to high confidence is the combination of reasonable confidence (3), sufficient confidence (4), and very high confidence (5) on the Likert scale. Correlations were conducted to assess the relationship between length of work experience as a nursing assistant and confidence in basic nursing care skill. Chisquare analysis was used to examine the categorical responses of relationship between working as a nursing assistant and basic nursing care confidence. A P level of .05 was used to determine statistical significance. An analysis of clinical hours required for nursing assistant certification and basic nursing care was desired,
CERTIFICATION AND CONFIDENCE
but there was a difficulty with data collection. For the survey question about clinical hours required for nursing assistant certification, participants answer a large range of hours. Some participants answer with the total number of hours for the certification, classroom, and clinical, and others answered zero. Some participants left this blank. Because of the large discrepancy, the data were unusable for data analysis.
Results Table 2 summarizes the responses to prelicensure nursing students' confidence in basic nursing skills. Skills that students were inadequately prepared for were defined as those reported as low confidence or did not learn by 50% or more of the participants. Students were most confident in hand washing (M = 5.87, SD = 0.36), gloving and gowning (M = 5.46, SD = 0.75), making an unoccupied bed (M = 5.38, SD = 0.88), and oral temperature (M = 5.30, SD = 0.87). Students were least confident in the fitting for cane (M = 1.74, SD = 1.16) and ambulation with crutches on steps (M = 1.81, SD = 1.27). Students also lacked confidence in manual blood pressures (M = 3.08, SD = 1.70) and automatic blood pressures (M = 3.50, SD = 2.14). Many students had never learned to obtain blood pressures with 26% not learning manual blood pressures and 34% never learning automatic blood pressures. Entry into this prelicensure nursing program requires all students to have completed a nursing assistant certification, but only 50.3% (n = 78) have worked as a certified nursing assistant. Table 3 summarizes the nursing assistant work experience of the sample. Chi-square analysis revealed a relationship between working as a certified nursing assistant and increased confidence using a razor (χ 2 = 8.936, P = .003), fitting a patient for crutches (χ 2 = 4.328, P = .037), and taking automated blood pressures (χ 2 = 5.429, P = .020). Table 4 summarizes the statistically significant relationships between length of working experience as a certified nursing assistant and basic nursing care. Findings indicate that the longer someone worked as a certified nursing assistant, the more confident the nursing student was in completing the basic nursing care independently. Those basic nursing skills not listed were not significantly related to work experience.
Discussion Prelicensure nursing programs that require nursing assistant certification for entry into the nursing program are assuming that the nursing students will be confident in basic nursing care. Results of this study revealed that nursing students are not confident in some basic nursing care, and some students (26, 0.5%) have not learned such essential skills like a manual blood pressure. Nursing programs cannot assume that students are prepared in basic nursing care based on a nursing assistant certification. Programs need to develop a way of ensuring that the basic nursing competen-
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cies have been met and that students are confident completing the skills independently. This study only explored the student's perceived confidence of basic nursing care but did not address if the students were competent in the skill. One recommendation is to have students' check-off of basic nursing care to ensure competency. In our program, nursing students are required to be prepared for the entire list of basic nursing care. Each student will complete a scenario that incorporates three of the basic skills and complete an accurate set of vital signs. The students must pass these check-offs to continue in the skills laboratory and clinical setting. In addition, our first required nursing course requires all nursing students to complete 40 sets of vital signs with a manual blood pressure to ensure that students are competent in manual blood pressures. There are difficulties with depending on established nursing assistant programs to provide training and education for basic nursing care. The mandatory federal training requirements have not changed in more than 20 years and have been recognized as being fragmented and inadequate (Institute of Medicine, 2008). Currently, nursing assistant training requirements “focus too much on clinical tasks and too little on teaching communication and relational skills that help workers deliver person-centered care” (Paraprofessional Healthcare Institute, 2012, p. 1). Nursing programs need to consider the purpose of making nursing assistant certification a requirement for program admission. Is it to guarantee a clinical skill set, or is the purpose to develop critical thinking and communication skills? The current nursing assistant programs are in need of restructuring to place greater emphasis on communication and problem-solving skills. Prelicensure nursing programs also need to consider that nursing assistant certification do not have the same number of clinical hours for nursing assistant certification. For example, in Wisconsin, nursing assistant programs are required to have a minimum of 120 hours in training, whereas in Minnesota, the requirement is 75 hours. Nursing programs admitting students from both of these states could potentially see a large difference in skill set, confidence, and experience. Yet, some nursing programs are assuming that all students would enter the nursing program on an equal playing field if the nursing assistant certification requirement is made for program admission. There is a need for updating curriculum and core competencies and alignment of core competencies at the federal and state level to ensure that nursing assistants are trained appropriately and consistently (Paraprofessional Healthcare Institute, 2012). The lack of consistency from state-to-state nurse assistant programs can be problematic for nursing programs. It is difficult to assess student confidence in nursing basic care and on how this prepares students for nursing school when the nursing assistant programs vary greatly. Further research is needed to explore what a nursing assistant certification means for prelicensure nursing program readiness. Unfortunately, this data are not available for
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Table 2. Nursing Students' Confidence With Basic Nursing Skills Nursing skill
M (SD)
Hand washing Gloving and gowning Making an unoccupied bed Oral temperature Respirations Transfer with gait belt Denture care Pulses Tooth brushing Oral hygiene Body mechanics Pericare female Intake and output Transfer bed to commode Identification with name and band Transfer wheelchair to commode Bathing with a basin Making an occupied bed Nail care Positioning and repositioning Bedpan Pericare male Passive range of motion Infection control Urinal Axillary temperature Shower Tympanic temperature Electric shaver HIPPA Temporal temperature Foley care female Toothettes Foley care male Ambulation with walker on flat surface Shaving Automatic blood pressure ⁎ Razor ⁎ Manual blood pressure ⁎ Rectal temperature ⁎ Using slide board ⁎ Ambulation with cane on flat surface ⁎ Massage effleurage ⁎ Massage petrissage ⁎ Bathing with bath in a bag ⁎ Ambulation with crutches on flat surface ⁎ Ambulation with cane on steps ⁎ Ambulation with walker on steps ⁎ Fitting for walker ⁎ Fitting for crutches ⁎ Ambulation with crutches on steps ⁎ Fitting for cane ⁎
5.87 (0.36) 5.46 (0.75) 5.38 (0.88) 5.30 (0.87) 5.35 (0.81) 5.27 (0.90) 5.22 (0.90) 5.19 (0.87) 5.14 (0.90) 5.12 (0.90) 5.06 (0.91) 5.01 (1.01) 4.96 (1.05) 4.92 (1.12) 4.89 (1.38) 4.88 (1.22) 4.85 (1.03) 4.85 (1.17) 4.76 (1.07) 4.75 (1.10) 4.74 (1.15) 4.73 (1.25) 4.71 (1.13) 4.65 (1.03) 4.59 (1.48) 4.56 (1.55) 4.46 (1.46) 4.29 (1.84) 4.13 (1.64) 4.13 (1.37) 4.08 (1.97) 4.01 (1.61) 3.99 (1.83) 3.95 (1.66) 3.85 (1.85) 3.74 (1.53) 3.50 (2.14) 3.26 (1.64) 3.08 (1.70) 2.94 (1.76) 2.81 (1.76) 2.75 (1.72) 2.64 (1.64) 2.51 (1.61) 2.49 (1.75) 2.16 (1.51) 2.04 (1.41) 2.04 (1.39) 1.94 (1.38) 1.82 (1.27) 1.81 (1.27) 1.74 (1.16)
Sufficient to high confidence, % (n)
Low confidence, % (n)
Did not learn, % (n)
99.4 (155) 96.8 (151) 94.2 (147) 96.2 (150) 85.3 (133) 78.8 (123) 94.9 (148) 78.8 (123) 94.2 (147) 95.6 (149) 93.0 (145) 91.0 (142) 87.2 (136) 88.4 (138) 85.2 (133) 86.5 (135) 87.8 (137) 84.6 (132) 85.3 (133) 87.2 (136) 82.7 (129) 84.0 (131) 84.0 (131) 84.6 (132) 83.4 (130) 81.4 (127) 76.3 (119) 72.5 (113) 70.5 (110) 70.4 (83) 65.3 (102) 64.2 (100) 65.4 (102) 62.8 (98) 62.1 (97) 60.3 (94) 49.9 (78) 46.1 (72) 39.7 (62) 34.6 (54) 35.2 (55) 36.5 (57) 32.1 (50) 30.1 (47) 27.6 (43) 21.7 (33) 18.0 (28) 17.3 (27) 13.5 (21) 13.5 (21) 15.0 (24) 10.3 (16)
0.6 (1) 3.2 (5) 5.8 (9) 1.9 (3) 14.7 (23) 21.2 (33) 5.1 (8) 21.2 (33) 5.8 (9) 3.8 (6) 7.0 (11) 8.4 (13) 12.8 (20) 10.3 (16) 9.0 (14) 10.9 (17) 12.2 (19) 15.4 (24) 14.1 (22) 11.5 (18) 17.3 (27) 12.8 (20) 15.4 (24) 14.8 (23) 8.3 (13) 10.3 (16) 19.2 (30) 11.5 (18) 19.2 (30) 25.7 (40) 13.5 (21) 24.3 (38) 15.4 (24) 24.4 (38) 18.0 (28) 27.5 (43) 16.1 (25) 32.7 (51) 34.0 (53) 35.9 (56) 25.7 (40) 25.0 (39) 27.5 (43) 25.7 (40) 24.3 (38) 26.4 (42) 26.9 (42) 29.5 (46) 28.2 (44) 25.0 (39) 22.4 (35) 26.9 (42)
0 (0) 0 (0) 0 (0) 1.9 (3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0.6 (1) 0 (0) 0.6 (1) 0 (0) 1.3 (2) 5.8 (9) 2.6 (4) 0 (0) 0 (0) 0.6 (1) 1.3 (2) 0 (0) 3.2 (5) 0.6 (1) 0.6 (1) 8.3 (13) 8.3 (13) 4.5 (7) 16.0 (25) 10.3 (16) 3.8 (6) 21.2 (33) 11.5 (18) 19.2 (30) 12.8 (20) 19.9 (13) 12.2 (19) 34.0 (53) 21.2 (33) 26.3 (41) 29.5 (46) 39.1 (61) 38.5 (60) 40.4 (63) 44.2 (69) 48.1 (75) 51.9 (81) 55.1 (86) 53.2 (83) 58.3 (91) 61.5 (96) 62.6 (97) 62.8 (98)
⁎ Inadequate skill—over 50% of participants indicated Did Not Learn of Low Confidence.
nursing programs currently considering adding nursing assistant certification requirements for admission. Additional research is needed to explore work experience beyond a nursing assistant certification for prelicensure nursing program admission. This study
suggests that the longer one works as a nursing assistant, the greater confidence they have with basic nursing care. A requirement of working as a nursing assistant would have several implications for nursing programs such as how many hours would be required beyond certification,
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Table 3. Length of Nursing Assistant Work Experience Length of time
% (n)
None b 6 months 6 months–1 year 2 years 3 years 4 years N 5 years
50 (78) 17.3 (27) 15.3 (24) 7 (11) 5 (8) 4.4 (7) 1.2 (2)
how would programs track this information, and how recent would the work experience need to be for admission? In addition, nursing program curriculum would still have to check off students on care to ensure that basic competencies are being met. Currently, some prelicensure nursing programs recommend health care volunteer or work experience and give points on nursing admission applications for this experience. The work experience is not required, and the programs do not require the experience to be nursing assistant, but it does add value to the applicant in the admission process. The difficulty with this type of admission process is that the curriculums in these programs still need to teach and evaluate basic nursing care. Therefore, curriculum time is not saved and requires some students to have duplication in their education. Further, research is needed to explore the value of health care experience and readiness for prelicensure nursing programs.
Limitations There are several limitations to this study. First, this study was conducted in one prelicensure nursing program without a control group. In order to increase generalizability, this study will need to be conducted with several prelicensure nursing programs with and without the nursing assistant certification requirement. The use of a convenience sample also limits this study. The instrument in this study was self-developed and did not have any psychometric testing done. Finally, this sample had differing nursing assistant certification experiences with students being certified in three different states. It is difficult to control for the wide variety of requirements for nursing assistant certification in each state and how this may affect skills sets and confidence in basic nursing care.
Conclusion This study provides insights into the role of nursing assistant certification in prelicensure nursing program admission and nursing confidence in basic nursing care. Nursing assistant certification does not guarantee confidence in basic nursing care or that the student has even been taught some of the required skills. Nursing programs need to consider the purpose behind the nursing assistant requirement for admission. In order to ensure basic nursing care competencies, curriculums
Table 4. Significant Correlations Between Length of Work as a Nursing Assistant and Nursing Skills Nursing skill Razor Ambulation with cane on flat surface Ambulation with cane on steps Fitting for cane Ambulation with crutches on flat surface Ambulation with crutches on steps Fitting for walker Ambulation with walker on steps Massage effleurage Massage petrissage Bath in a bag Manual blood pressure
r value .288 .229 .313 .330 .268 .311 .322 .370 .305 .322 .244 .447
need to incorporate a way to validate the skill set that a nursing student has with a nursing assistant certification. Nursing programs may want to consider a work requirement as a nursing assistant for program admission. More research is needed into how it should be incorporated into nursing school admission and curriculum development.
References Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147. Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, 623–649. Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates. Journal of Nursing Education, 44, 541–547. Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press. McLaughlin, K., Moutray, M., & Muldoon, O. T. (2007). The role of personality and self-efficacy in the selection and retention of successful nursing students: A longitudinal study. Journal of Advanced Nursing, 61, 211–221, http://dx.doi.org/ 10.1111/j.1365-2648.2007.04492.x. McNelis, A. M., Wellman, D. S., Krothe, J. S., Hrisomalos, D. D, McElveen, J. L., & South, R. J. (2010). Revision and evaluation of the Indiana University school of nursing baccalaureate admission process. Journal of Professional Nursing, 26, 188–195, http://dx.doi.org/10.1016/j.profnurs.2010.01.003. Mosby's Nursing Video Skills. (2009). Basic, intermediate, and advanced skills (Student Version 3.0). St. Louis: Mosby Elsevier. Paraprofessional Healthcare Institute. (2012). PHI national policy agenda: Training. Retrieved from , http://phinational.org/ sites/phinational.org/files/wp-content/uploads/2008/11/ policyagendatraining.pdf. Salmonson, Y., & Andrew, S. (2006). Academic performance in nursing students: Influence of part-time employment, age, and ethnicity. Journal of Advanced Nursing, 55, 342–351, http:// dx.doi.org/10.1111/j.1365-2648.2006.03863_1. Sengupta, M., Harris-Kojetin, L. D., & Ejaz, F. K. (2010). A national overview of the training received by certified nursing assistants working in U.S. nursing homes. Gerontology & Geriatrics Education, 31, 201–219.
AND
ANDREA JUDD, RN†
The purpose of this study was to explore nursing student's confidence level with basic nursing care when entering the nursing program after implementation of required nursing assistant certification for program admission. In addition, the relationship between being employed as a nursing assistant and confidence level with basic nursing care when entering the nursing program was explored. A Likert-scale survey assessing confidence levels of basic nursing care was sent to 156 nursing students admitted to a nursing program prior to their first nursing course. Confidence level with nursing skills, nursing assistant employment, and length of nursing assistant employment were assessed. Students were most confident in hand washing (M = 5.87, SD = 0.36), gloving and gowning (M = 5.46, SD = 0.75), making an unoccupied bed (M = 5.38, SD = 0.88), and oral temperature (M = 5.30, SD = 0.87). Students were least confident in the fitting for cane (M = 1.74, SD = 1.16) and ambulation with crutches on steps (M = 1.81, SD = 1.27). Nursing assistant employment increased student confidence with basic nursing care. Nursing programs cannot assume that students are prepared in basic nursing care based on a nursing assistant certification. (Index words: Nursing assistant; Certification; Admission; Skills) J Prof Nurs 30:162–167, 2014. © 2014 Elsevier Inc. All rights reserved.
I
N RECENT YEARS, several nursing schools have been changing prelicensure nursing admission requirements to require potential nursing students to complete nursing assistant certification prior to beginning professional nursing courses. Additional nursing schools are contemplating making this change. There is rationale for this change. First, this change ensures that prelicensure nursing students have evaluated their own comfort level with providing intimate basic care for patients. Second, this change is a way to save curricular time by decreasing the amount of time required for the development of basic nursing skills in preliminary nursing courses. Finally, it
*Associate Professor, University of Wisconsin-Eau Claire, Eau Claire, WI. †Registered Nurse, University of Wisconsin-Eau Claire, Eau Claire, WI. Address correspondence to Dr. Stombaugh: University of WisconsinEau Claire, 105 Garfield Avenue, Eau Claire, WI 54702. E-mail: [email protected] 8755-7223/13/$ - see front matter 162 http://dx.doi.org/10.1016/j.profnurs.2013.09.002
would guarantee that all prelicensure nursing students would enter nursing courses with the same repertoire of basic nursing skills. Implementation of the nursing assistant certification requirement has been happening at nursing programs with no research supporting this change. Do potential prelicensure nursing students feel more confident to begin the nursing program because of this new requirement? The purpose of this study is to explore the prelicensure nursing student's confidence level with basic nursing care when entering the nursing program after implementation of required nursing assistant certification for program admission. Basic nursing care is defined as skills that can be completed by a nursing assistant and include understanding Health Insurance Portability and Accountability Act, basic infection control, bathing, bedmaking, safe patient handling, elimination assistance, nutrition and fluids, personal hygiene and grooming, and vital signs.
Journal of Professional Nursing, Vol 30, No. 2 (March/April), 2014: pp 162–167 © 2014 Elsevier Inc. All rights reserved.
CERTIFICATION AND CONFIDENCE
Background According to Bandura's social learning theory, the likelihood of learning and behavioral change is affected by three factors: self-efficacy, outcome expectations, and goals (Bandura, 1998). Self-efficacy is the primary source of action in this theory. Self-efficacy is defined as “judgments of how well one can execute courses of action required to deal with prospective situations” (Bandura, 1982, p. 122). Self-efficacy affects one's confidence to learn, one's motivation, and one's power and determination to face obstacles. In theory, by having potential prelicensure nursing students participate in nursing assistant certification, they should have increased self-efficacy related to basic nursing care and patient interactions. They should feel more confident in their choice to pursue nursing as a career. By increasing selfefficacy, an individual increases learning. The individual has more confidence in overcoming obstacles, goal setting, and obtaining goals in nursing school. One study (McLaughlin, Moutray, & Muldoon, 2007) explored the role of personality and self-efficacy in the retention of nursing students. A longitudinal design was used to follow 384 students in a nursing program. The researchers collected measures on occupational selfefficacy, academic self-efficacy, and personality and examined the relationship among retention and success in the program. Findings supported the idea that greater occupational self-efficacy (confidence in ability to perform job specifics) in nursing students is related to more successful completion of nursing courses. Specifically, basic nursing care and confidence was not addressed in this study, but the idea of occupational self-efficacy may support the idea of self-efficacy increasing overall confidence. Unfortunately, the confidence level of prelicensure nursing students with basic nursing care when entering a nursing program has not been explored in the literature. In fact, literature related to basic nursing care is difficult to find. One research study (Salmonson & Andrew, 2006) examined the influence of part-time employment on nursing students' academic performance and focused specifically on work related to nursing. In a study of 267 nursing students, more than 78% of students were in paid employment, with 64% of those working in nursingrelated jobs. The study examined the number of hours worked and academic scores in a nursing pathophysiology and nursing practice course. Results indicated that nursing-related employment was not beneficial to student academic performance in nursing courses, and the number of hours of part-time employment was negatively associated with academic performance. Another study (Higgins, 2005) linked a nursing skills course with success in passing the National Council Licensure Examination for Registered Nurses (NCLEXRN). This study examined the relationship of variables in the application process to successful completion of a nursing program and passage of the NCLEX-RN. Data from 213 students related to preadmission test scores,
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age, gender, race, English course, biology course, chemistry course, psychology course, and the nursing skills course was examined. A statistically significant relationship was found between one biology course (r = .171), the science component of the preadmission test (r = .127), and the nursing skills course (r = .281) to passing the NCLEX-RN. The higher the grade the student received in the nursing skills course, the more likely they were to pass the NCLEX-RN. This research did not address the confidence of the students with the skills, simply the course grade. Although some researchers (Higgins, 2005; Salmonson & Andrew, 2006) touch on nursing skills, no research was found that addressed the prelicensure program admission requirements of nursing assistant certification. Data have not been collected about the number of nursing schools that currently require nursing assistant certification. No literature was found related to health care experience as a component of admission that would predict success in undergraduate nursing. Several nursing programs as reported by McNelis et al. (2010) require prior experience and job shadowing as criteria for admission based on the assumption that potential nursing students should explore their profession to see if it will be a good “fit” for them. Only anecdotal accounts are available to support the idea that students need to be exposed to nursing prior to nursing school admission. The nursing assistant certification requirement for prelicensure program admission has been suggested for students to build confidence with basic nursing care when entering a program. The difficulty is that states vary in requirements for hours of initial training for certified nursing assistants. Federal mandates for nursing assistant certification is a minimum of 75 hours of classroom training and 16 hours of clinical training. State programs vary between 75 and 175 hours of classroom training and 16 to 100 hours of clinical training (Institute of Medicine, 2008). Many nursing programs require the certification and do not require students to work as a nursing assistant. By requiring nursing assistant certification, nursing programs are assuming that students have used their basic nursing skills to a minimal degree and students could have more experience based on the certification program that the student enrolled in. The purpose of this study was to explore nursing student's confidence level with basic nursing care when entering a nursing program after implementation of a nursing assistant certification for program admission. The variable confidence was selected to reflect the student's perceived self-efficacy related to their nursing assistant certification. This does not suggest competency, which is a very different concept. The variable confidence was also congruent with national data related to training received by certified nursing assistant and their confidence with their training (Sengupta, Harris-Kojetin, & Ejaz, 2010) and seemed to apply to this setting as well. An additional objective examined if being employed as a nursing assistant was related to increased confidence level with basic nursing care when
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entering a prelicensure nursing program. Many students complete nursing assistant certification but may never work as a nursing assistant.
Methods Design This descriptive correlational study explored prelicensure nursing students comfort level with 53 basic nursing skills that are included in most of the nursing assistant certification courses. After institutional review board approval was obtained, participants were asked to complete a Likert scale survey that included questions about 53 basic nursing skills, length of nursing assistant certification, employment as a certified nursing assistant, length of employment as a nursing assistant, and the number of clinical hours students completed to become a certified nursing assistant. The survey was completed prior to students beginning their first required nursing course.
Sample The sample for this study consisted of 168 prelicensure nursing students entering their first semester of required nursing courses in a baccalaureate nursing program at a university in the upper midwest. The prelicensure nursing program has a requirement that students must have nursing assistant certification to enter the program but do not have to be actively working as a nursing assistant or keep their certification active once being accepted into the program. Inclusion sample criteria include that respondents had to be accepted into the prelicensure nursing program and enrolled in their first required nursing course. Participants were recruited by e-mail 2 weeks prior to the beginning of their first required nursing course. Recruitment occurred at the beginning of three different semesters; each semester had the potential for 56 newly admitted participants. Respondents were able to answer a confidential on-line survey. One hundred fifty-six participants answered the survey. Table 1 provides demographic information on the sample.
Instrument The self-developed 58-item survey included 53 items about basic nursing care. Using a Likert scale, students ranked their confidence related to basic nursing care on a range from did not learn (0), very low confidence (1) to very high confidence (5), with 5 being the highest amount of confidence. Basic nursing skills for this survey were identified through a three-step process. First, instructors from the baccalaureate nursing program identified skills taught prior to the nursing assistant certification requirement in the nursing program that were labeled as basic nursing care. Next, these skills were compared with the skills identified as basic nursing care by Mosby's Nursing Skills (2009) and skills identified by nursing assistant programs as required skills from regional programs. Finally, a list of basic nursing care was determined and approved by six faculty members
Table 1. Demographics % (n) Gender Male Female
5 (8) 95 (148)
Age ≤ 19 years 20–21 years 22–25 years ≥ 26 years
11 64 9 16
Ethnicity White Hispanic American Indian Asian African American Unknown
95 (148) 1.9 (3) 0.6 (1) 0.6 (1) 0.6 (1) 1.2 (2)
Cumulative grade point average 4.0 3.75–3.99 3.5–3.74 3.25–3.49 3.0–3.24
(17) (100) (14) (25)
1.9 (3) 34.6 (54) 41 (64) 19.2 (30) 3.2 (5)
teaching in the foundational nursing skills course. The remaining five questions of the survey asked about length of nursing assistant certification, type and length of nursing assistant work experience, facility where nursing assistant certification occurred, and number of clinical hours completed to obtain nursing assistant certification. Content and face validity was determined by six faculty members in the foundational nursing skills course. All members agreed that the basic nursing care identified were the expected skills that a certified nursing assistant should be able to complete upon entering a prelicensure nursing program.
Data Analysis Data were analyzed using SPSS Version 18.0. Simple descriptive statistics were used to analyze the confidence level of basic nursing care and nursing assistant experience. Confidence level was grouped into three categories: did not learn, low confidence, and sufficient to high confidence. Low confidence is the combination of very low confidence (1) and some confidence (2) on the Likert scale. Sufficient to high confidence is the combination of reasonable confidence (3), sufficient confidence (4), and very high confidence (5) on the Likert scale. Correlations were conducted to assess the relationship between length of work experience as a nursing assistant and confidence in basic nursing care skill. Chisquare analysis was used to examine the categorical responses of relationship between working as a nursing assistant and basic nursing care confidence. A P level of .05 was used to determine statistical significance. An analysis of clinical hours required for nursing assistant certification and basic nursing care was desired,
CERTIFICATION AND CONFIDENCE
but there was a difficulty with data collection. For the survey question about clinical hours required for nursing assistant certification, participants answer a large range of hours. Some participants answer with the total number of hours for the certification, classroom, and clinical, and others answered zero. Some participants left this blank. Because of the large discrepancy, the data were unusable for data analysis.
Results Table 2 summarizes the responses to prelicensure nursing students' confidence in basic nursing skills. Skills that students were inadequately prepared for were defined as those reported as low confidence or did not learn by 50% or more of the participants. Students were most confident in hand washing (M = 5.87, SD = 0.36), gloving and gowning (M = 5.46, SD = 0.75), making an unoccupied bed (M = 5.38, SD = 0.88), and oral temperature (M = 5.30, SD = 0.87). Students were least confident in the fitting for cane (M = 1.74, SD = 1.16) and ambulation with crutches on steps (M = 1.81, SD = 1.27). Students also lacked confidence in manual blood pressures (M = 3.08, SD = 1.70) and automatic blood pressures (M = 3.50, SD = 2.14). Many students had never learned to obtain blood pressures with 26% not learning manual blood pressures and 34% never learning automatic blood pressures. Entry into this prelicensure nursing program requires all students to have completed a nursing assistant certification, but only 50.3% (n = 78) have worked as a certified nursing assistant. Table 3 summarizes the nursing assistant work experience of the sample. Chi-square analysis revealed a relationship between working as a certified nursing assistant and increased confidence using a razor (χ 2 = 8.936, P = .003), fitting a patient for crutches (χ 2 = 4.328, P = .037), and taking automated blood pressures (χ 2 = 5.429, P = .020). Table 4 summarizes the statistically significant relationships between length of working experience as a certified nursing assistant and basic nursing care. Findings indicate that the longer someone worked as a certified nursing assistant, the more confident the nursing student was in completing the basic nursing care independently. Those basic nursing skills not listed were not significantly related to work experience.
Discussion Prelicensure nursing programs that require nursing assistant certification for entry into the nursing program are assuming that the nursing students will be confident in basic nursing care. Results of this study revealed that nursing students are not confident in some basic nursing care, and some students (26, 0.5%) have not learned such essential skills like a manual blood pressure. Nursing programs cannot assume that students are prepared in basic nursing care based on a nursing assistant certification. Programs need to develop a way of ensuring that the basic nursing competen-
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cies have been met and that students are confident completing the skills independently. This study only explored the student's perceived confidence of basic nursing care but did not address if the students were competent in the skill. One recommendation is to have students' check-off of basic nursing care to ensure competency. In our program, nursing students are required to be prepared for the entire list of basic nursing care. Each student will complete a scenario that incorporates three of the basic skills and complete an accurate set of vital signs. The students must pass these check-offs to continue in the skills laboratory and clinical setting. In addition, our first required nursing course requires all nursing students to complete 40 sets of vital signs with a manual blood pressure to ensure that students are competent in manual blood pressures. There are difficulties with depending on established nursing assistant programs to provide training and education for basic nursing care. The mandatory federal training requirements have not changed in more than 20 years and have been recognized as being fragmented and inadequate (Institute of Medicine, 2008). Currently, nursing assistant training requirements “focus too much on clinical tasks and too little on teaching communication and relational skills that help workers deliver person-centered care” (Paraprofessional Healthcare Institute, 2012, p. 1). Nursing programs need to consider the purpose of making nursing assistant certification a requirement for program admission. Is it to guarantee a clinical skill set, or is the purpose to develop critical thinking and communication skills? The current nursing assistant programs are in need of restructuring to place greater emphasis on communication and problem-solving skills. Prelicensure nursing programs also need to consider that nursing assistant certification do not have the same number of clinical hours for nursing assistant certification. For example, in Wisconsin, nursing assistant programs are required to have a minimum of 120 hours in training, whereas in Minnesota, the requirement is 75 hours. Nursing programs admitting students from both of these states could potentially see a large difference in skill set, confidence, and experience. Yet, some nursing programs are assuming that all students would enter the nursing program on an equal playing field if the nursing assistant certification requirement is made for program admission. There is a need for updating curriculum and core competencies and alignment of core competencies at the federal and state level to ensure that nursing assistants are trained appropriately and consistently (Paraprofessional Healthcare Institute, 2012). The lack of consistency from state-to-state nurse assistant programs can be problematic for nursing programs. It is difficult to assess student confidence in nursing basic care and on how this prepares students for nursing school when the nursing assistant programs vary greatly. Further research is needed to explore what a nursing assistant certification means for prelicensure nursing program readiness. Unfortunately, this data are not available for
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Table 2. Nursing Students' Confidence With Basic Nursing Skills Nursing skill
M (SD)
Hand washing Gloving and gowning Making an unoccupied bed Oral temperature Respirations Transfer with gait belt Denture care Pulses Tooth brushing Oral hygiene Body mechanics Pericare female Intake and output Transfer bed to commode Identification with name and band Transfer wheelchair to commode Bathing with a basin Making an occupied bed Nail care Positioning and repositioning Bedpan Pericare male Passive range of motion Infection control Urinal Axillary temperature Shower Tympanic temperature Electric shaver HIPPA Temporal temperature Foley care female Toothettes Foley care male Ambulation with walker on flat surface Shaving Automatic blood pressure ⁎ Razor ⁎ Manual blood pressure ⁎ Rectal temperature ⁎ Using slide board ⁎ Ambulation with cane on flat surface ⁎ Massage effleurage ⁎ Massage petrissage ⁎ Bathing with bath in a bag ⁎ Ambulation with crutches on flat surface ⁎ Ambulation with cane on steps ⁎ Ambulation with walker on steps ⁎ Fitting for walker ⁎ Fitting for crutches ⁎ Ambulation with crutches on steps ⁎ Fitting for cane ⁎
5.87 (0.36) 5.46 (0.75) 5.38 (0.88) 5.30 (0.87) 5.35 (0.81) 5.27 (0.90) 5.22 (0.90) 5.19 (0.87) 5.14 (0.90) 5.12 (0.90) 5.06 (0.91) 5.01 (1.01) 4.96 (1.05) 4.92 (1.12) 4.89 (1.38) 4.88 (1.22) 4.85 (1.03) 4.85 (1.17) 4.76 (1.07) 4.75 (1.10) 4.74 (1.15) 4.73 (1.25) 4.71 (1.13) 4.65 (1.03) 4.59 (1.48) 4.56 (1.55) 4.46 (1.46) 4.29 (1.84) 4.13 (1.64) 4.13 (1.37) 4.08 (1.97) 4.01 (1.61) 3.99 (1.83) 3.95 (1.66) 3.85 (1.85) 3.74 (1.53) 3.50 (2.14) 3.26 (1.64) 3.08 (1.70) 2.94 (1.76) 2.81 (1.76) 2.75 (1.72) 2.64 (1.64) 2.51 (1.61) 2.49 (1.75) 2.16 (1.51) 2.04 (1.41) 2.04 (1.39) 1.94 (1.38) 1.82 (1.27) 1.81 (1.27) 1.74 (1.16)
Sufficient to high confidence, % (n)
Low confidence, % (n)
Did not learn, % (n)
99.4 (155) 96.8 (151) 94.2 (147) 96.2 (150) 85.3 (133) 78.8 (123) 94.9 (148) 78.8 (123) 94.2 (147) 95.6 (149) 93.0 (145) 91.0 (142) 87.2 (136) 88.4 (138) 85.2 (133) 86.5 (135) 87.8 (137) 84.6 (132) 85.3 (133) 87.2 (136) 82.7 (129) 84.0 (131) 84.0 (131) 84.6 (132) 83.4 (130) 81.4 (127) 76.3 (119) 72.5 (113) 70.5 (110) 70.4 (83) 65.3 (102) 64.2 (100) 65.4 (102) 62.8 (98) 62.1 (97) 60.3 (94) 49.9 (78) 46.1 (72) 39.7 (62) 34.6 (54) 35.2 (55) 36.5 (57) 32.1 (50) 30.1 (47) 27.6 (43) 21.7 (33) 18.0 (28) 17.3 (27) 13.5 (21) 13.5 (21) 15.0 (24) 10.3 (16)
0.6 (1) 3.2 (5) 5.8 (9) 1.9 (3) 14.7 (23) 21.2 (33) 5.1 (8) 21.2 (33) 5.8 (9) 3.8 (6) 7.0 (11) 8.4 (13) 12.8 (20) 10.3 (16) 9.0 (14) 10.9 (17) 12.2 (19) 15.4 (24) 14.1 (22) 11.5 (18) 17.3 (27) 12.8 (20) 15.4 (24) 14.8 (23) 8.3 (13) 10.3 (16) 19.2 (30) 11.5 (18) 19.2 (30) 25.7 (40) 13.5 (21) 24.3 (38) 15.4 (24) 24.4 (38) 18.0 (28) 27.5 (43) 16.1 (25) 32.7 (51) 34.0 (53) 35.9 (56) 25.7 (40) 25.0 (39) 27.5 (43) 25.7 (40) 24.3 (38) 26.4 (42) 26.9 (42) 29.5 (46) 28.2 (44) 25.0 (39) 22.4 (35) 26.9 (42)
0 (0) 0 (0) 0 (0) 1.9 (3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0.6 (1) 0 (0) 0.6 (1) 0 (0) 1.3 (2) 5.8 (9) 2.6 (4) 0 (0) 0 (0) 0.6 (1) 1.3 (2) 0 (0) 3.2 (5) 0.6 (1) 0.6 (1) 8.3 (13) 8.3 (13) 4.5 (7) 16.0 (25) 10.3 (16) 3.8 (6) 21.2 (33) 11.5 (18) 19.2 (30) 12.8 (20) 19.9 (13) 12.2 (19) 34.0 (53) 21.2 (33) 26.3 (41) 29.5 (46) 39.1 (61) 38.5 (60) 40.4 (63) 44.2 (69) 48.1 (75) 51.9 (81) 55.1 (86) 53.2 (83) 58.3 (91) 61.5 (96) 62.6 (97) 62.8 (98)
⁎ Inadequate skill—over 50% of participants indicated Did Not Learn of Low Confidence.
nursing programs currently considering adding nursing assistant certification requirements for admission. Additional research is needed to explore work experience beyond a nursing assistant certification for prelicensure nursing program admission. This study
suggests that the longer one works as a nursing assistant, the greater confidence they have with basic nursing care. A requirement of working as a nursing assistant would have several implications for nursing programs such as how many hours would be required beyond certification,
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Table 3. Length of Nursing Assistant Work Experience Length of time
% (n)
None b 6 months 6 months–1 year 2 years 3 years 4 years N 5 years
50 (78) 17.3 (27) 15.3 (24) 7 (11) 5 (8) 4.4 (7) 1.2 (2)
how would programs track this information, and how recent would the work experience need to be for admission? In addition, nursing program curriculum would still have to check off students on care to ensure that basic competencies are being met. Currently, some prelicensure nursing programs recommend health care volunteer or work experience and give points on nursing admission applications for this experience. The work experience is not required, and the programs do not require the experience to be nursing assistant, but it does add value to the applicant in the admission process. The difficulty with this type of admission process is that the curriculums in these programs still need to teach and evaluate basic nursing care. Therefore, curriculum time is not saved and requires some students to have duplication in their education. Further, research is needed to explore the value of health care experience and readiness for prelicensure nursing programs.
Limitations There are several limitations to this study. First, this study was conducted in one prelicensure nursing program without a control group. In order to increase generalizability, this study will need to be conducted with several prelicensure nursing programs with and without the nursing assistant certification requirement. The use of a convenience sample also limits this study. The instrument in this study was self-developed and did not have any psychometric testing done. Finally, this sample had differing nursing assistant certification experiences with students being certified in three different states. It is difficult to control for the wide variety of requirements for nursing assistant certification in each state and how this may affect skills sets and confidence in basic nursing care.
Conclusion This study provides insights into the role of nursing assistant certification in prelicensure nursing program admission and nursing confidence in basic nursing care. Nursing assistant certification does not guarantee confidence in basic nursing care or that the student has even been taught some of the required skills. Nursing programs need to consider the purpose behind the nursing assistant requirement for admission. In order to ensure basic nursing care competencies, curriculums
Table 4. Significant Correlations Between Length of Work as a Nursing Assistant and Nursing Skills Nursing skill Razor Ambulation with cane on flat surface Ambulation with cane on steps Fitting for cane Ambulation with crutches on flat surface Ambulation with crutches on steps Fitting for walker Ambulation with walker on steps Massage effleurage Massage petrissage Bath in a bag Manual blood pressure
r value .288 .229 .313 .330 .268 .311 .322 .370 .305 .322 .244 .447
need to incorporate a way to validate the skill set that a nursing student has with a nursing assistant certification. Nursing programs may want to consider a work requirement as a nursing assistant for program admission. More research is needed into how it should be incorporated into nursing school admission and curriculum development.
References Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147. Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, 623–649. Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates. Journal of Nursing Education, 44, 541–547. Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press. McLaughlin, K., Moutray, M., & Muldoon, O. T. (2007). The role of personality and self-efficacy in the selection and retention of successful nursing students: A longitudinal study. Journal of Advanced Nursing, 61, 211–221, http://dx.doi.org/ 10.1111/j.1365-2648.2007.04492.x. McNelis, A. M., Wellman, D. S., Krothe, J. S., Hrisomalos, D. D, McElveen, J. L., & South, R. J. (2010). Revision and evaluation of the Indiana University school of nursing baccalaureate admission process. Journal of Professional Nursing, 26, 188–195, http://dx.doi.org/10.1016/j.profnurs.2010.01.003. Mosby's Nursing Video Skills. (2009). Basic, intermediate, and advanced skills (Student Version 3.0). St. Louis: Mosby Elsevier. Paraprofessional Healthcare Institute. (2012). PHI national policy agenda: Training. Retrieved from , http://phinational.org/ sites/phinational.org/files/wp-content/uploads/2008/11/ policyagendatraining.pdf. Salmonson, Y., & Andrew, S. (2006). Academic performance in nursing students: Influence of part-time employment, age, and ethnicity. Journal of Advanced Nursing, 55, 342–351, http:// dx.doi.org/10.1111/j.1365-2648.2006.03863_1. Sengupta, M., Harris-Kojetin, L. D., & Ejaz, F. K. (2010). A national overview of the training received by certified nursing assistants working in U.S. nursing homes. Gerontology & Geriatrics Education, 31, 201–219.
