Predictors of Success on Wound Ostomy Continence Nursing
Certification Board Examinations: A Regression Study of Academic Factors
Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP
SUPPLEMENTAL DIGITAL CONTENT
Literature Review
The extant research on predicting success or analyzing factors associated with NCLEXRN (National Council Licensing Exam for Registered Nurses) performance is substantial and has
been conducted over two decades intently. The research targets various levels of nursing
education (baccalaureate, associate, diploma). Studies have examined personality factors,
academic variables, life circumstances (required work and personal demands, etc.), and specific
pre-programmatic and programmatic outcomes and interventions.1-13 Similar approaches have
been used for medical and other health professionals’ licensure success.14-20 Sometimes results
are consistent with other research outcomes and sometimes inconsistent. For example, Turner12
analyzed faculty and program predictors of NCLEX-RN examination success in nursing
programs of West Virginia from 1991-2000 (N = 19 programs). Factors associated with
NCLEX-RN success were mandatory classroom and clinical attendance policies and number of
repeated courses. No significant relationships were noted between licensure success and
standardized pre-graduation comprehensive tests, course grades, GPA, etc. in contradiction to the
repeated findings of many of the previously cited references in which standardized tests, GPA,
etc. were predictive of success.
Vandenhouten13 also studied factors associated with success and failure on NCLEX-RN
for baccalaureate graduates of a Midwestern single purpose BSN program. A sample of 296
graduates from 2002 to 2007 was analyzed for predictive factors. Success on NCLEX-RN was
predicted by older age on admission, higher ACT (American College Testing) comprehensive
scores, course grades in pharmacology, adult medical-surgical and community health predicted
success. End of program testing (ATI) (Assessment Technologies Incorporated) RN
comprehensive predictor exam results and cumulative GPA also predicted NCLEX-RN success.
Predicting failure was less effective. Notably, lower scores on the RN comprehensive predictor
exam and lower cumulative GPA were associated with NCLEX-RN failure.
Research has also examined the issue of success within medical, nursing and health
professional programs. This research targets attrition of students who do not “survive” long
enough academically to even sit for licensure examinations.9,21-25 Even status of program
accreditation has been examined for predictive validity.26
The research literature examining success in specialty or advanced practice certifications
is surprisingly much more modest. The trajectory of most studies is similar to the previously
mentioned research: Factors or variables associated with and possibly predictive for certification
success or the association of self-assessment examinations with later certification success.
Althouse and McGuiness14 analyzed the predictive value of the “In-Training
Examination” (ITE) for pediatric residents performance on the general pediatrics (GP)
certification examination. The ITE is a 200-item examination that mimics the “real” test. They
analyzed all first time test takers (N = 13,614) in a five-year period who took it at least once in
the three year residency. They found that the scores on the ITE taken in the third year were most
predictive of the general pediatrics examination (R² = .506). They suggested that the ITE is an
important predictor of a resident’s success on the GP test.
Bauchmoyer and colleagues 15 analyzed academic predictors of national dental hygiene
examination success for 173 dental hygienist graduates of Ohio State University from 1998
through 2002. Predictors of success included science GPA (anatomy, physiology, microbiology)
and entering GPA. Notably, consistency in site of science preparation was positively correlated
with success.
Ward et al 25 studied predictive factors associated with dental hygiene examination
success in dental hygiene students (N = 156) in 2002 to 2007 at Medical College of Georgia.
Incoming GPA, GPA at end of first year of the program, and SAT test scores predicted success
on dental licensing examination.
Palmer 23 analyzed preadmission factors effects on certification success in clinical
perfusion graduates. He studied 95 graduates of the perfusion technology program at Carlow
University – University of Pittsburgh Medical Center. Among the many variables he examined
were academic variables such as undergraduate GPA, science GPA, and anatomy and physiology
GPA. All three academic variables correlated well with achieving a high clinical perfusion GPA.
However, they were not statistically predictive of certification success.
Sandroni et al27 analyzed factors predictive of candidate success in advanced life support
(ALS) specialty courses. All participants (N = 283) were medical doctors in Italy. The
researchers studied candidate demographics, professional background and pre-course knowledge
measured by a multiple choice quiz (MCQ) score: Candidates who successfully passed were
younger (31 vs. 37 years); had a higher mean MCQ score; and had BLS certification. Gender
and professional background did not correlate with ALS positive outcomes.
Stewart and colleagues 20 scrutinized the relationship between a school administered
“mockboards” and dental licensure examination performance for the former’s predictive ability.
In an analysis of all dental graduates from University of Florida College of Dentistry (UFCD) in
the years from 1996 to 2003, the researchers studied performance on senior mock board exam,
licensure exam performance and clinical productivity (number of procedures performed).
Significant components of the mock boards predicted licensure success including prosthodontic
preparation, clinical amalgams, and number of completed composite procedures. These mock
exams tested both knowledge base and psychomotor abilities.
In one of the few recent studies on certification success in nursing, Bolender 28 analyzed
potential predictors of certification success for family nurse practitioner graduates (N = 83) from
nine universities in Wisconsin and Illinois. The researcher studied five personality factors, two
demographic variables (age and years of clinical experience prior to FNP program) and three
academic variables (undergraduate GPA, pathophysiology grade and pharmacotherapeutics
grade). Multiple regression analyses found that four variables explained 29.8% of the variance
in certification success: Undergraduate GPA, pharmacotherapeutics grade, years of clinical
nursing experience, and “agreeableness.” The pathophysiology grade was correlated with
certification exam score (r = .341; p = .002)
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