Faculty development is an important indicator of a nursing program's quality.1 Lack of ongoing and substantive administrative support for faculty development is associated with lower pass rates on the National Council Licensure Examination (NCLEX).1 Beginning in April 2023, nursing program graduates will take an updated licensure examination that includes new methods for evaluating clinical judgment, known as Next Generation NCLEX (NGN).2 Faculty development related to NGN is needed, as research suggests that many faculty members do not feel ready to prepare students for the changes coming to NCLEX.3 For example, a national study found that 71% of respondents did not think their programs were ready to incorporate NGN items into their examinations.3
Faculty development related to NGN can focus on many aspects of a nurse educator's role such as facilitating learning, using appropriate evaluation strategies, using curriculum design, and functioning as change agents. While updating teaching and testing practices may be considered fundamental for programs preparing for NGN, focusing efforts on what leadership deems is most important may not adequately help faculty develop their skills.1 Understanding what faculty believe is helpful to facilitate the change process is important.
Q methodology is a mixed-methods research design used to objectively measure variations in opinions, beliefs, attitudes, and perceptions.4 The method uses unique data collection techniques and by-person factor analysis to find groups with similar perspectives and is a useful research method to discover viewpoints using small sample sizes. Participants actively sort and rank order their levels of agreement with a group of subjective stimuli, typically statements. This method has been used in nursing education research to discover attitudes about patient populations, perceptions about teaching methods, and beliefs about professional issues.4 Framed within the Theory of Planned Change, the purpose of this Q methodology study was to explore of what educators believed were motivating and restraining forces for faculty and programs preparing for NGN.
Institutional review board approval was obtained for this study. The set of subjective statements about the topic, known as the concourse, was populated with 125 opinion statements generated from 21 educators in response to 5 open-ended questions following an NGN workshop. Sixty-one additional statements were taken from another NGN readiness survey, and 33 statements were solicited from 2 content experts (see Supplemental Digital Content, Figure, available at: https://links.lww.com/NE/B309). The concourse was reduced to a Q sample of 42 statements for sorting about external (n = 12), program (n = 18), and faculty (n = 12) motivating and restraining factors.
A purposive sample, or P sample, was recruited from 2 baccalaureate nursing programs in the Northeastern United States. The stratified sample included educators with varied teaching experience: more than 10 years (n = 4), 3 to 10 years (n = 3), and 2 years or less (n = 3). Participants received a $25 gift card as a thank you upon completion of the study.
Data were collected using the online program, Q-sortware (www.qsortware.net), between December 2021 and January 2022. Participants initially sorted the statements into one of 3 categories: those they agreed with; those they disagreed with; and those they felt undecided or neutral about. Then participants performed a secondary sort, ranking statements from “most strongly disagree” to “most strongly agree” on the −4/+4 quasi-normal web sorting grid. The study included a demographic profile and 2 open-ended questions asking participants to explain why they placed items in the most agree and most disagree columns.
Data analysis was completed using KADE: Desktop application for Q methodology version 1.2.1 (Creative Commons Attribution 4.0 International License). Participants' sorts were correlated to each other, and factors were extracted using principal components analysis (PCA), followed by varimax rotation. Factors with eigenvalues greater than 1 were retained. Factors scores for each statement were calculated as both Z and Q scores.
The final solution resulted in 4 factors, or viewpoints, that explained 76% of the variance (see Supplemental Digital Content, Table, available at: https://links.lww.com/NE/B310). There were 8 consensus statements where Z scores did not differ significantly among the factors. Most notably, there was general disagreement with the statement, “My program uses a testing platform that will be easy to adapt for NGN questions.”
Factor I: Prioritizing Competing Demands
Three sorts loaded on Factor I, named Prioritizing Competing Demands. This perspective, which explained 21% of the variance, represented beliefs of experienced educators who also had administrative responsibilities. That viewpoint perceived accreditation and program survival as major motivating factors while believing the pandemic had affected NGN preparation efforts. Although item writing workshops had been helpful, their programs were relying on NGN products from external vendors. Compared with other perspectives, this viewpoint believed that NGN had been made way too difficult and had more neutral feelings that preparing for NGN was important to graduating safe providers.
Factor II: Needing More Resources
Factor II: Needing More Resources explained 19% of the variance. The 2 participants, who loaded on this factor, each had less than 2 years of teaching experience. These faculty members believed workshops on item writing had been helpful, preparing for NGN was important to ensure programs were graduating safe nurses, their programs consistently used a clinical judgment model, there had been a coordinated preparation effort by regional leaders, and NGN was not too difficult. Most notably, this viewpoint did not see creating new NGN item types as being a tremendous amount of work, nor were competing demands seen as barriers. Yet, compared with other viewpoints, they desired access to more NGN item types from commercial test banks.
Factor III: Making It Work
One new faculty member and another with 3 to 10 years of experience loaded on Factor III: Making It Work. This factor explained 17% of the variance. Ensuring provider safety was perceived as the major driver for NGN, but creating new test items and changing teaching practices were perceived as a tremendous amount of work. This change-focused viewpoint believed getting faculty to switch from lectures to active learning was going to be very challenging. Using tools and templates was seen as being helpful. Compared with other perspectives, this viewpoint believed there had been much faculty collaboration getting ready for NGN, but they did not believe faculty development efforts had been as helpful.
Factor IV: Getting on the Same Page
Factor IV, named Getting on the Same Page, explained 19% of the variance. The 2 faculty members who loaded on this factor had 3 to 10 years of teaching experience. They believed they were ready for NGN, but their programs and students were not. While workshops on writing NGN type questions were viewed as being very helpful, they believed that getting faculty to switch to active learning was going to be very challenging and that students lack basic reading skills. They perceived that their colleagues were not on the same page and needed to take greater responsibility for attending training sessions to educate themselves on NGN. Compared with other viewpoints, this perspective was more likely to believe it was going to take seeing NCLEX pass rates drop to get their program to act and more strongly disagreed that their colleagues were willing to embrace new teaching and testing technologies.
As high-quality nursing programs strive to provide substantive faculty development workshops and presentations, these findings illuminate the need for leaders to understand within-group variations as they plan NGN-related sessions. Some faculty members need how-to knowledge and tools. Other faculty members may need more assistance managing barriers to change.
This study was limited to represent the needs identified in a small group of educators a year before changes to NCLEX were due to take effect. Information from this study was used to inform the development of a template and training sessions to target the needs of the Factor III viewpoint. While larger studies conducted closer to or after NGN implementation might yield different results, this study serves as an exemplar of one way to holistically assess needs to inform the creation of comprehensive faculty development programs.
1. Spector N, Silvestre J, Alexander M, et al. NCSBN regulatory guidelines and evidence-based quality. J Nurs Regul. 2020;11(2):S1–S64.
2. National Council of State Boards of Nursing. Next Generation NCLEX resources. Updated 2022. Accessed January 15, 2023. https://www.ncsbn.org/exams/next-generation-nclex/ngn-resources.page
3. Moran V, Wade H, Moore L, Israel H, Bultas M. Preparedness to write items for nursing education examinations: a national survey of nurse educators. Nurse Educ. 2022;47(2):63–68. https://doi.org/10.1097/nne.0000000000001102
4. Hensel D, Toronto C, Lawless C, Burgess J. A scoping review of Q methodology nursing education studies. Nurse Educ Today. 2022;109:105220. https://doi.org/10.1016/j.nedt.2021.105220