Implications for Licensure to Practice

CHAPTER I: INTRODUCTION
English is widely spoken that most people consider it as a global language. Although it is not a primary language in many countries and regions in the world, it currently holds the record of a language that is most frequently taught as a foreign language. (Graddol, 2007)

In the Philippine setting, English is one of the two (2) official languages used in schools, the other being Filipino. It is being taught since elementary up until college and most subjects are using English as a medium of instruction. Due to this structure, the examinations that are being administered in the country’s education system are mostly expressed through English; and one very good example is the Philippine Nurse Licensure Examination (PNLE). (Espinosa, 1997)

The Philippine Nurse Licensure Examination is the primary tool of the Professional Regulation Commission (PRC) to measure the readiness of one student who holds the degree of Bachelor of Science in Nursing (BSN). It aims to test the cognitive domain of one student if he or she has the sufficient knowledge to deliver safe and quality nursing care. (Arellano Law Foundation, 2002)

With this being said, the PNLE is one of the most important examinations that a BSN graduate takes in order for him or her to practice his or her profession in the country. Passing the examination will pave way to opportunities such as working in a hospital, teaching in an educational institution, and serving the community. (Arellano Law Foundation, 2002)

There are two seasons for the administration of the PNLE. It is usually given in June-July season and November-December season. In these two seasons, the PNLE has a range of about thirty (30) to forty (40) per cent passing rate per season, which makes a high failure rate for the said examination. Just like last December 2012 examination’s result that was released January of the following year, there were only 16 908 out of 49 066 successful examinees. (PRC Board News, 2013)

The figures aforementioned make the Filipino nurses, especially those who are in the field of education, think about the reasons why there is a high number of failing examinees for the said licensure examination. Some would say that it is because of the poor education given by the institutions to these students while others would claim that it solely depends on one student’s aptitude. And the list goes on and on.

A research study similar to this proposed study was done in San Pablo City. It attempted to identify the determinants of board examination performance of nursing graduates and its relationship to English proficiency. Records review was the primary data collection tool of the study where the researcher reviewed and collated data about the students’ general average in all the English courses they took during college and their status after taking the PNLE. (Salvosa, 2008)

The researcher, however, sees a need for another study that will address this matter since there is a study that reports the occurrence of deterioration in the proficiency of a foreign language due to the passage of time and prolonged absence of contact from the utilization of the language. Thus, the use of the grade point average of the students in the school may not be totally reflective of one’s English proficiency. Even the famous International English Language Testing System (IELTS) has its two-year expiration as they believe that it is inevitable to have a diminishing English proficiency for people who do not use English as a primary language. (Rampton, Harris, & Leung, 2001) This research study aims to contribute to the mission of knowing the real factors for a BSN student’s ability to pass the PNLE.

Since the PNLE is being administered through the English language, a question comes into the researchers mind: “Can English proficiency be one of the reasons why a student fails the licensure examination? If it is, then what is the degree of their relationship to one another?” As an educator in the nursing profession, the researcher is challenged to undertake a study with the goal of determining the existence of a relationship between the proficiency in English and the status in the PNLE which can be a major contribution for larger studies that will aid in developing a framework for colleges and institutes of nursing for higher standards of nursing education that will enable the BSN graduates to pass the licensure examination and later on be part of the Filipino workforce for the health care delivery system in the country and even globally. STATEMENT OF THE PROBLEM

The study aims to determine the relationship of English reading proficiency of Bachelor of Science in Nursing (BSN) degree holders to the results of their Nurse Licensure Examination. Specifically, the study seeks to answer the following questions: 1. What is the profile of the participants in terms of their category in English reading proficiency? 2. What are the participant’s statuses in Nurse Licensure Examination under each English reading proficiency category? 3. Is there a significant relationship between status in Nurse Licensure Examination and English reading proficiency test results? HYPOTHESIS

Tested at a level of significance of 0.05, the null hypothesis is: 1. There is no significant relationship between status in Nurse Licensure Examination and English reading proficiency test results. SIGNIFICANCE OF THE STUDY

The following are deemed significant to the study:
Nursing Education. The study may help the nursing education to be able to determine one of the probable factors of a nursing student’s achievement in Nurse Licensure Examination. Since the ability of a student to pass the licensure examination is multi-factorial, this study may contribute to the larger perspective of uncovering the details and causes of one’s passing or failing an examination. Furthermore, the study may be of help to concerned individuals or groups in the nursing profession if ever they would want to conduct a seminar, talk or any inspirational and educational activity to facilitate the awareness of the students to the readiness and the necessary preparations for the nurse licensure examination. (Nurse Land, 2011) Nursing Profession. The health care delivery system, focusing specifically to the nursing division, will be the ultimate benefactor of the study.

Since there is a huge number of nurses who are unemployed, the profession targets further the global exchange of health care professionals that will help employ nurses abroad and contribute to the country’s economy by means of remittance and others alike. With this, English proficiency may be one of the important tools a nurse may use to penetrate the global market for nurses. This study will contribute in giving more serious note in the language proficiency of nurses especially the English language. Future Research. The result of the study will give future researchers more resources and motivation to come up with replication of studies that revolve around factors contributing to passing licensure examinations that will include wider range of subjects and variables. This can serve as an input on multiple regression studies to address the causalities of one’s passing or failing a health care professional examination, be it licensure or any summative type of evaluation for the learners.

CHAPTER II: LITERATURE REVIEW
This section will present information from articles, websites, books, research reports and studies, and journal entries from both local and foreign authors and researchers where the researcher based his proposal. With these sources, the researcher is able to get a wider grasp and deeper understanding of the study that will be conducted. The Philippine Nursing Profession and Its Trend

The Philippine nursing profession had its humble beginnings from the era when everyone believes in superstitions and notions in health and illness. The paradigm was often associated with witchcraft and wizardry, mysticism, spirit-guiding and herbal medicines. This era was later on succeeded by the founding of healthcare facilities and educational institutions during the Spanish era. Notable persons, who were recognized as country’s heroes, contributed to the establishment of the nursing profession of the country through becoming nurses for the wounded and sick Filipino warriors in the early days. Among these Filipino nurses were Trinidad Tecson who is famously known as Ina ng Biak na Bato, Agueda Kahabagan of Laguna, Melchor Aquino otherwise known as Tandang Sora, and Josephine Bracken, wife of Dr. Jose Rizal. Dr. Rizal later on installed a field healthcare facility in their area in Tejeros. (Dakis, 2011)

From its rich historical background, the nursing profession in the country played a major role in the global health care delivery system as it became one of the world’s largest pools of supply for nurses since the time that a shortage for health care workers was reported. The country adapted easily with this demand that it manifested a quick sprouting of nursing schools in the country. The forty (40) schools that were established in the 1970’s grew to a huge figure of four hundred and ninety one (491) nursing schools in 2010 with an approximation of forty thousand (40 000) graduates each year. (Asis, 2010)

Every year since then, a high number of registered nurses in the Philippines are being produced making it one of the countries that are a rich source of health care workers globally. This trend led to the ability of the country to meet the demands of international health care delivery system such as United States of America, Canada, Middle-east and Australia among many others. (Philippine Overseas Employment Administration, 2011)

The fact that the demand is in its high state, many of the Filipino citizens decided to take up BSN as an undergraduate course to pursue a vision of working abroad to help stabilize the economical status of their families. As the number of students who are enrolled for the baccalaureate degree increases, the supply for the number of vacancies for local health care industry drops drastically. Most Filipinos are left with no choice but to continue what they started and to bear in mind that what they have to do is to just successfully pass all the requirements that they may utilize what they have learned for four (4) years in the BSN program. (Curran and Berger, 2010)

The belief that there are still opportunities to work abroad that will address the economical needs of their families continue to linger among the minds of the nurses here in the country, thus, every BSN graduate still perceives the attainment of a local license as a primary requirement to successfully realize their plans of becoming a registered nurse overseas. (Kline, 2003)

Although many of the BSN graduates persist to pass the sole requirement for the practice of nursing in the Philippines, it is still a reality that a huge number of BSN graduates continually fail the licensure examination. Most of the nurse educators, just like the researcher, notices the decline of passing rate for the PNLE every season making the much-given effort of obtaining a BSN degree put into waste if the student failed to acquire the license. (PRC Board News, 2013) The Philippine Nurse Licensure Examination

The Philippine Nurse Licensure Examination is a five-part multiple choice test with one hundred (100) items each part that aims to measure the readiness of a BSN graduate to deliver safe and quality nursing care. It is comprised of questions that reflect the scope of responsibilities of the nursing profession which are health promotion, illness prevention, rehabilitation and alleviation of pain and suffering when death is imminent.

The examination is patterned in the key areas of responsibilities with equivalent competencies for each key as an indicator for its achievement. The curricular design of competency-based is the lay-out that the PNLE follows where each season’s examination has questions revolving around safe and quality nursing care, health education, management of the resources and the environment, ethico-moral responsibilities, legal responsibilities, personal and professional development, research, communication, quality improvement, records management and, collaboration and teamwork. (Arellano Law Foundation, 2002)

In order to pass the examination, an examinee is expected to garner a general weighted average of seventy-five (75) per cent from all the parts of the test with the lowest grade of sixty (60) per cent for each part. The results are released not more than sixty (60) days since the administration of the exam which will be posted on PRC’s bulletin boards or on the more convenient PRC website under the provision of RA 8981 otherwise known as the PRC Modernization Act. (Arellano Law Foundation, 2002)

With these mechanics, the BSN graduate is faced with a challenge of passing the examination since without a license one cannot practice the profession as stipulated under the law, specifically RA 9173 or the Philippine Nursing Act of 2002. This challenge leads to a crusade of seeking the factors that may contribute to the addressing of a BSN graduate’s need for useful methods in passing the PNLE. As mentioned earlier, passing the licensure examination has established relationships with several factors that may predict one’s ability to obtain a license to practice nursing. These factors include college entrance examination performance, result of nursing aptitude test, college grade point average, pre-board examination performance and composite scores of science, math and English tests. (Ong, Palompon, & Bañico, 2012) English Proficiency

The Philippines is recognized as the most proficient in the world in business English which was measured by Global English Corp last 2012. This reflected the country’s high proficiency that can be assumed as an indicator to the Filipino workers’ ability to take an active role in business discussions that relatively make them efficient in completion of complex tasks in the workplace. This report concluded that it poses a great advantage for our country to continually meet the global needs for manpower. (Philippine Daily Inquirer, 2012)

The claim that the language proficiency is considered to be one of the substantial factors for one’s ability to pass a licensure examination has been given a much deeper attention nowadays since it is majorly attributed to one’s performance in an international workplace. This premise can be connected somehow to the question why the education and examinations in the Philippine nursing profession use English as a primary medium for instruction and expression of questions. Globalization, indeed, affects the way Filipinos structure their form of education, learning assessment and competency evaluation. (O’Neill, Marks, & Liu, 2006)

The preceding reports are a good indicator of the Filipinos’ ability to adapt to an international language particularly the English language. However, one statistical report about an increase in sub-standard English skills showed that 44.2% of the public and private school students who participated in the study through a standardized achievement test had deficiency in English skills. This can be attributed to the brain-drain occurring in the country since most of the teachers with good English proficiency decided to go overseas to earn a better living. With this phenomenon, the Filipino citizens were left with decreasing foreign language proficiency leading to hybrid dialects such as the Taglish – a combination of Tagalog and English. (Jomor, 2013) Synthesis

With the current scenario that the PNLE uses English as a medium of stating questions, the query arises: Can one student’s English proficiency affect his PNLE performance? Is it safe to say that if one is English proficient, his ability to pass the PNLE increases? Or is it all right not to focus much on this factor since the ability to pass the PNLE is multi-factorial? All of these questions boil down to the depth of the relationship of the variables “English proficiency” and “PNLE performance”. As the PNLE performance of BSN graduates decrease gradually and that the English proficiency of Filipino students may be considered standing on a dangerous ground, the motivation to undertake a study that will contribute to the knowledge regarding the factors that may be related to a BSN graduate’s ability to pass a licensure examination is greatly enhanced and empowered.

These sources and readings are sufficient enough to prove the substantial, educational and significant value of this proposal to be pursued. Now that the variables are discussed comprehensively, the researcher formulates a plan to address the problem about the degree of relationship between the previously stated variables. CONCEPTUAL FRAMEWORK

In order to provide a clear lay-out for the proposed study, the researcher utilized a theory known as The Chun Model created in 1997, which reports ideas about text comprehension and language learning which can contribute greatly to the undertaking of the study.

The theory encompasses primarily the full comprehension of text that assumes that when a person reads, an understanding is synthesized in the reader’s mind making a construct referred to by the theory as the “comprehension process”. Furthermore, there is also an assumption that a reader build three distinct representations mentally which are: 1.) a verbatim representation, 2.) a semantic representation that gives a description of the read text, and 3.) a situational representation.

According to the theory, text comprehension of a reader can be improved by means of instruction that will aid the reader in utilizing a specific comprehension strategy. This strategy will have to address the transformation of list of propositions to network of propositions that can only be attained through coherence.

With this theoretical basis, the researcher was able to formulate further a conceptual framework that will reflect the flow of the proposed study. The PNLE will solely be testing a BSN graduates reading proficiency, hence, The Chun’s Model provides a reliable structure and basis for the study to only focus on the reading comprehension of the participants. Figure 1 below shows the planned process of the study by the researcher. As it is illustrated, the Nurse Licensure Examination performance of the participants will be reviewed prior to determining other aspects of the study. This will then lead the researcher to classify the participants according to their profiles that is reflective of their statuses in the PNLE. Two groups will then be created where the Case Group will be those who were not able to pass the PNLE and the Control Group which will represent the group that successfully passed the said examination. This division of groups will then be utilized by the researcher to connect their statuses to the categories of their English proficiency. An arrow connecting both the PNLE performance mirrored by the statuses and the English reading proficiency symbolizes the relationship that the researcher is about to determine in the course of the study.

As the illustration shows, red arrows from the Nurse Licensure Examination are directed to the left as it represents the chronological order of events for the study. Since the study will be using a retrospective point-of-view, the researcher will have to determine the PNLE statuses of the participants first before testing their English proficiency levels. This will ensure a greater validity in terms of correlation between the given variables since the PNLE performance is perceived to be actual and not theoretical.

Figure
Conceptual Model of the Proposed Study

CHAPTER III: METHODS
RESEARCH DESIGN
The study will utilize a Quantitative Non-experimental Retrospective Case-Control type of research study. It will be quantitative in nature since the researcher plans to use tools that will measure a variable and later on test a hypothesis through statistical treatment. No manipulation of the participants will be done, making the study non-experimental in nature. Since the researcher does not plan to introduce intervention to the participants, the occurrence of the phenomena, specifically the variables, will only be observed through an ex-post facto method called as retrospective research design. In a retrospective design, the researcher will have to include and observe one of the variables that already happened in the past instead of making it happen in a present time.

In this case, it is the PNLE performance of the participants. It is perceived that the instruction and learning process for the English proficiency comes before taking the licensure examination. In this study however, the researcher would want to make the result of the PNLE as valid as possible, thus, the retrospective design is suggested to be utilized. Moreover, the case-control design provides the researcher the ability to compare groups for better distinction of who between the groups has better English proficiency: the case, which is the group that failed the licensure examination; or the control, which is the group that successfully passed. (Polit & Beck, 2008)

PARTICIPANTS OF THE STUDY
The participants of the study will be selected through a non-probability sampling technique particularly convenience sampling. The researcher takes into consideration the availability of the participants since the most of the review center’s previous students may already have been engaged into activities since they already took the licensure examination. Available applicants will be utilized in the study and the selecting of samples will end once the proposed number of participants has been met. There will be one hundred (100) in total where fifty (50) will be under the case and the other half will be under the control. Inclusion Criteria

For both the case and the control group, the researcher will have to include participants who are: 1.) holders of the Bachelor of Science in Nursing degree, and 2.) previous students of the selected review center prior to taking the PNLE.

For the case, participants should have not yet passed the PNLE with their Notice of Admission provided by the PRC as a proof of their current status; and as for the control group, participants should have already passed the PNLE with their licenses as a proof of such status. Exclusion Criteria

The researcher will have to exclude all participants that have previous courses prior to BSN to promote homogeneity of the samples. These students are more commonly known as second-coursers.

Recruitment Procedure
The participants’ availability can be one of the challenges that the researcher may face in the course of conducting the study. As mentioned earlier, the projected samples of the study may have activities on the data collection period of the study hindering them to participate that may eventually lead to shortage in the number of samples.

This foreseen problem, however, can be addressed accordingly along the process since the proposed locale for the study that is a review center holds an average of one thousand (1 000) enrolled students per season. This is a large pool for recruiting the participants of the study. Meanwhile, when it comes to the availability and the willingness of the participants to undergo the study may be dealt through offering them the benefit of taking the English reading proficiency test that may later on serve as their baseline data, which can be useful come the time that they decided to process working overseas where English proficiency is one of the requirements.

The researcher will ask the permission of the administrators of the review center to retrieve the contact details of their previous students from their archive. Since the researcher is affiliated with the review center, the profile of the possible participants may be seen to make the sorting of the case and the control group more efficiently.

After sorting the contacts, the researcher will then invite the participants through different communication media such as through text message, phone call, email invitation and use of social networking sites. The participants will be invited a week before the actual data collection and confirmation is expected within a 48-hour time frame. If the projected sample did not affirm his or her attendance to the said data collection, he or she will be automatically deleted from the roster of possible participants. A day prior to the actual English reading proficiency test, the participant will be reminded once again to confirm his or her attendance for the following day’s data collection to ensure that the projected one hundred (100) participants who will undergo the study is met. RESEARCH LOCALE

The study will be conducted at a selected review center in Metro Manila that has a mean population of five hundred (500) nursing students who previously enrolled to the center and took the licensure examination for nurses in years 2010, 2011, 2012 and 2013. The review center offers review program for nurses who applied to Professional Regulations Commission to take the examination. The review center will play an important role for the undertaking of the study because of its contribution to provide the venue for the data collection through administration of the TOEIC examination and to provide the necessary contact details to communicate with the possible participants of the study.

The researcher will send a letter of permission to conduct the TOEIC examination and retriebal of contact information of the previous students who already took the nurse licensure examination. Helping hand assistance from the representative of the review center will be asked to assist the researcher in the retrieval of contact information and administration of the TOEIC examination. Moreover, the review center has a documentation of the current statuses of the possible participants whether they passed or failed the licensure examination. Further description of the chosen review center will be given upon the approval of the proposed study.

DATA GATHERING PROCEDURE
The researcher will have to obtain permission from the administrators of the selected review center prior to the actual undertaking of the study. The status in the PNLE of the participants will be reviewed and recorded from the review center’s data bank. On the aspect of retrieving the possible participants’ contact details to invite them, the researcher will have to ask permission from the review center also. The recruitment procedure is discussed in details earlier in the selection of the participants section. Full disclosure of the nature of the study will be done to the participants before asking them to affix their signatures on the informed consent. The participants will be assured of their anonymity once the results are processed.

After obtaining the consent, the participants will be divided into two groups: the case and the control, which will be based on the inclusion and exclusion criteria. Each group will be invited to separate rooms labelled as case and control. The English reading proficiency test will be a 50-item examination that will be based on the Test of English for International Communication (TOEIC) which will be tested for validity through the experts’ testing. Two (2) hours will be the maximum time allowed for a participant to finish the entire examination. Both groups will be taking the examination simultaneously. The participant may leave the locale once finished. Results will later on be disseminated through electronic means.

Instrumentation
An English reading proficiency test will be lifted from TOEIC Reading Examination. Please see attached Appendix A for the sample of the TOEIC Reading Examination. This test will be subject to test of validity through an expert’s testing. If the proposal has been approved, the researcher will compile a 100-item reading proficiency examination that will be from TOEIC.

The status will then collated and the results of the English reading proficiency examination from TOEIC will be checked, transmuted, and categorized according to the level of proficiency: Table

Level of English Reading Proficiency Based on Transmuted Scores NUMERICAL VALUE
TRANSMUTED SCORE RANGE
LEVEL OF PROFICIENCY
1
900 – 990
Highly Proficient
2
800 – 899
Advanced
3
650 – 799
Upper Intermediate
4
450 – 649
Intermediate
5
300 – 449
Pre-intermediate
6
10 – 299
Beginner

OPERATIONAL DEFINITION OF VARIABLES
The following are the terms that are operationally defined by the researcher to provide consistent understanding on the variables measured by the study:
Philippine Nurse Licensure Examination (PNLE) is a 500-itemmultiple choice exam to test basic nursing level competency which considers the objectives of the nursing curriculum, the broad areas of nursing and other related disciplines and competencies. It is held every June and December annually in various public schools throughout the Philippines. According to R.A. 9173, Article IV, Section 14, the scope of this examination for the practice of nursing in the Philippines is determined by the Board. Specifically, the statuses in the PNLE are divided into the “passed” and “failed”. Where passed means obtaining a license and failed means not achieving the minimum grade requirement for the PNLE.

English Reading Proficiency is the ability of an individual to comprehend or to understand texts written in the English language which has to be tested through an English Reading Proficiency test. Such proficiency has hierarchical levels with interpretations that are based on the TOEIC Score and Conversion Table:

Highly Proficient is someone who is able to communicate effectively in any situation.
Advanced is someone who is able to satisfy most work requirements with language that is often, but not always, acceptable and effective.
Upper Intermediate is someone who is able to satisfy most social demands and limited work requirements.
Intermediate is someone who can initiate and maintain predictable face-to-face conversations and satisfy limited social demands.
Pre-intermediate is someone who functional but with limited proficiency and is able to maintain very simple face-to-face conversations on familiar topics.
Beginner is someone who is able to satisfy immediate survival needs. ETHICAL CONSIDERATION
The researcher will provide a letter of notification to the authorities of the review center prior to the retrieval of contact information for the sampling procedure and also for the administration of the English reading proficiency test.

Furthermore, the researcher has prepared a written consent form for the participants of the study that they will affix their signatures after a full disclosure of the study was done by the researcher himself. LIMITATIONS OF THE STUDY

The study is designed to measure the relationship between the English reading proficiency and the Nurse Licensure Examination status of a nursing student. It is designed as Quantitative Non-Experimental Retrospective Case-Control research study. The respondents of the study will be selected through Convenience-type of sampling which may pose a limitation when it comes to representativeness of the samples. Although, to ensure the generalizability of the results, the researcher will make sure that the inclusion and exclusion criterion are met by the participants before administering them the English reading proficiency test.

Furthermore, the researcher perceives the limitations in several areas of the study including the accessibility of the samples for the study which is discussed in the Participants of the Study section of this proposal. Moreover, the researcher sees that time is limited for the data collection of this study since it is a must for the researcher to gather all the participants in one session to administer the examination simultaneously to avoid bias in the results. DATA PROCESSING

Once the scores are collated, tabulated and coded, the scores of the student will be grouped according to the range of each category. Each category then will be given a particular rank to show the distribution of the students to each English reading proficiency category. The ranks will then be treated with the Passed and Failed status of the students by using Spearman’s rank. STATISTICAL TREATMENT OF THE DATA

Frequency and percentage distribution will be used to describe the characteristic profile of the respondents in terms of their categories in the English reading proficiency test from TOEIC. Also, a similar descriptive statistical procedure will be applied to determine the participant’s statuses in Nurse Licensure Examination under each English reading proficiency category.

On the other hand, to determine the relationship between the statuses in Nurse Licensure Examination and the English reading proficiency test, A Spearman’s correlation, otherwise known as Spearman’s rank, will be used since the level of measurement for the variables in this study are nominal and ordinal in nature. The values of the variable “status in NLE” will be converted to nominal where 1 represents “Passed” and 2 is for “Failed”. Meanwhile, the “English reading proficiency” test scores will be categorized accordingly and each category will be converted in ranks. Finally, both of the variables will be correlated accordingly.

Proposed Gantt Chart for the research study entitled, “English Reading Proficiency of Nurse Licensure Examinees: Implications for Licensure to Practice” Researcher: Timothy Escusa, RN
Steps
2013

Mar
Jun
Jul
Aug
Sep
Oct
1. Writing of Proposal

2. Proposal Defense

3. Finalizing the Research Protocol

4. Provisions of Letter Requests to the selected Research Locale

6. Validating the research instrument