Conceptual Model for Predicting Academic Success in Prelicensure Nursing Programs Through Expanded Cognitive Aptitude Assessment Julie Twidwell, PhD, RN, CNE; Ericka Sanner-Stiehr, PhD, RN; Kimberly Allen, PhD; Kathie Records, PhD, RN, FAAN; and Kuei-Hsiang Hsueh, PhD, RN ABSTRACT Background: Attrition from prelicensure nursing programs is a serious issue with implications for students, nursing programs, and the nursing workforce. Academic failure due to insufficient cognitive aptitude often contributes to this problematic attrition rate. Thus, cognitive aptitude could be included in admission criteria, as a predictor of academic success and a strategy to minimize attrition. Problem: Currently, admissions practices are often incomplete and lack standardization for measuring cognitive aptitude. Approach: The Nursing Cognitive Aptitude Model (NCAM) presented in this article is an innovative conceptual model to guide educators in expanding current admissions processes. Conclusion: The NCAM model depicts the cognitive domains involved in student academic success including current scholastic knowledge, previous academic performance, and critical-thinking ability. Together, these three domains predict student academic success and are a useful reference for the admissions process. Keywords: academic success, admission, attrition, cognitive aptitude, prelicensure nursing program Cite this article as: Twidwell J, Sanner-Stiehr E, Allen K, Records K, Hsueh K-H. Conceptual model for predicting academic success in prelicensure nursing programs through expanded cognitive aptitude assessment. Nurse Educ. 2019; 44(6):330-334. doi: 10.1097/NNE.0000000000000635 T he world is reaching a critical shortage of nurses who are able to care for aging populations with in- creasingly complex medical problems. 1,2 Prelicensure nursing programs are essential in preparing a sustainable supply of nurses to meet the growing demand. Attrition occurs when students leave an academic program for any reason, threatening the supply of nurses and ultimately nursing care delivery. In some programs, up to half of the students who matriculate do not complete their pro- grams, with the attrition typically occurring early within the program. 3,4 With the high cost of education, student loans are at an all-time high. 5 The average student loan debt for college graduates in 2016 was $37 172. 6 Attrition can leave students with tremendous debt and no reliable income by which to pay it back. Furthermore, attrition creates an emotional toll by causing stress and disappointment. 7 Multiple personal challenges contribute to first-semester attrition rate including lack of career fit, difficulty balancing family responsibilities with academic workload, financial constraints, and lack of social support to manage the in- herent challenges of nursing school. 8,9 The personal chal- lenges associated with nursing school are not the only culprits for the alarmingly high attrition rates. Attrition due to academic failure is often linked to a lack of cogni- tive aptitude for learning. 8,10,11 Students lacking the cog- nitive ability necessary for the rigor of nursing programs often struggle throughout the program and are later un- successful on the NCLEX-RN. 12 Most programs currently use various metrics to evalu- ate and rank applicants for admission that may include grade point average (GPA), standardized tests, essays of in- tent, and interviews. 13 Holistic admissions processes are also gaining popularity in an effort to capture multiple char- acteristics and criteria that are broad based, linked to the program's mission and goals, and designed to promote di- versity. 14 Regardless of the approach, most admissions met- rics include academic background, cumulative GPA, science course grades, number of repeated courses, overall grade trends, and standardized admission examination scores. 15 Standardized testing is a common method of measuring ap- plicants' current level of scholastic ability. Unfortunately, Author Affiliations: Undergraduate Program Director (Dr Twidwell), Southeast Missouri State University, Cape Girardeau; Assistant Professor (Dr Sanner-Stiehr), PhD Program Director (Dr Records), and Associate Professor (Dr Hsueh), University of Missouri–St Louis; and Assistant Academic Vice President (Dr Allen), Maryville University, St Louis, Missouri. The authors declare no conflicts of interest. Correspondence: Dr Twidwell, Southeast Missouri State University, MS8300, Crisp 318, One University Plaza, Cape Girardeau, MO 63701 (jetwidwell@semo.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.nurseeducatoronline.com). Accepted for publication: November 1, 2018 Published ahead of print: December 20, 2018 DOI: 10.1097/NNE.0000000000000635 Nurse Educator 330 Nurse Educator • Vol. 44 • No. 6, pp. 330–334 • Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. www.nurseeducatoronline.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.