Open Educational Resources Help Promote Student Success

Abstract

Background:

A significant economic barrier for prelicen-sure nursing students is the skyrocketing cost of textbooks and learning activities. Adopting high-quality open educational resources (OER) is an innovative teaching strategy that promotes student success by making education more accessible and more affordable.

Method:

The Open Resources for Nursing (Open RN) project has published 15 OER textbooks reviewed by more than 350 peer reviewers from across the United States and Canada. Open RN textbooks have received widespread international usage with adoption by more than 1,300 institutions.

Results:

The NCLEX-RN pass rate can be used to objectively measure student success in programs adopting OER. The annual 2023–2024 NCLEX-RN pass rate of graduates from the associate degree nursing program that led the creation of Open RN resources was 98%.

Conclusion:

High-quality OER created by nursing faculty that is aligned with competency-based curriculum and the NCLEX Test Plan can help promote success for all nursing students.

The Future of Nursing 2020–2030 (^{Wakefield et al., 2021}) encourages continued work to reduce barriers to student success. This work includes developing pedagogical strategies to support students' educational needs. Sanderson et al. (²⁰²¹) proposed, “Ensuring educational justice means all students, regardless of ethnicity, race, culture, financial status, or other factors, have access to quality college education that leads to equitable careers” (p. 205). Without intentional intervention, existing barriers will continue to exacerbate disparities in educational attainment and workforce representation.

Many prelicensure nursing students struggle with financial barriers and report the need to work while attending college to cover educational expenses as well as living expenses for themselves and their families (^{Jeffreys, 2015}; ^{Loftin et al., 2012}; ^{Osakwe et al., 2022}). The skyrocketing cost of tuition and commercial textbooks exacerbates these financial barriers. According to a report from the Education Data Initiative, textbook costs increased 1,041% between 1977 and 2015, with the average college student spending $1,212 annually for books and supplies as of the 2022–2023 academic year. Sixty-five percent of college students skipped buying textbooks because they were too expensive, 25% reported they work extra hours to pay for books and materials, and 11% reported they skipped meals to afford books and course materials (^{Hanson, 2024}). Twenty-five percent of students report they work extra hours to pay for their books and materials, and 11% report they skipped meals to afford books and course materials. This financial burden for students is a significant concern. To compound the issue, most of postsecondary faculty are not aware of the cost of course materials when selecting them, which can unknowingly exacerbate the financial challenge for students (^{Hanson, 2024}). As a result, students may be forced to forgo purchasing required materials, which can hinder their performance and jeopardize their success in rigorous nursing programs.

In response to ongoing financial challenges, educators and institutions are exploring innovative solutions to support student learning. There is a growing national movement regarding the creation and adoption of Open Educational Resources (OER) to promote affordable education and student success. A national survey in 2024 with 3,447 responses from higher educational faculty indicated that 41% used OER in their courses (^{Seaman & Seaman, 2024}). Globally, the adoption of OER is gaining momentum, supported by international frameworks such as the United Nations Educational, Scientific, and Cultural Organization's (UNESCO) 2019 Recommendation on Open Educational Resources. OER are “learning, teaching and research materials in any format and medium that reside in the public domain or are under copyright that have been released under an open license that permit no-cost access, re-use, re-purpose, adaptation and redistribution by others” (^{UNESCO, 2019}). Creative Commons licensing grants the public permission to use one's creative work under copyright law (^{Creative Commons, n.d.}). Together, OER and Creative Commons licensing support equitable access to high-quality educational materials, making them a valuable solution to reducing financial barriers in nursing education.

Institutional support for OER commonly includes financial incentives for adopting, adapting, or creating OER, along with professional development opportunities to help faculty find, evaluate, and integrate OER into their teaching (^{Colvard et al., 2018}). Quality assurance guidelines for authors and adopters of high-quality OER include the following criteria (^{Kawachi, 2013}):

The content included in OER is reliable and co-development practices are used in the creation of OER.

Diverse learning and teaching methods are included.

OER are easy to navigate and accessibility standards are incorporated.

OER are easy to find, and users know under which copyright terms and conditions they can share or modify them.

OER are maintained and updated on a regular basis.

A synthesis of research published between 2015 and 2018 involving 121,168 students and faculty suggested students achieve the same or better learning outcomes when using OER while saving significant amounts of money (^{Hilton, 2020}). Additionally, the majority of faculty and students who used OER reported a positive experience and indicated they would do so again. A large-scale study of 21,822 students found that in addition to improving affordability, OER improved end-of-course grades and decreased frequency of failing grades and withdrawals for all students, especially for low-income students receiving federal financial aid, part-time students, and other vulnerable student populations (^{Colvard et al., 2018}).

A recent study by Panday-Shukla (²⁰²⁴) found that OERs resulted in similar academic performance outcomes and enhanced learner engagement while saving students money. Furthermore, a large-scale systematic review by Adil et al. (²⁰²⁴) found that students who use OER have increased access to knowledge that supports lifelong learning and enhanced student learning outcomes, while also having pedagogical benefits for instructors. These recent findings are promising and suggest that although the direct effect on grades may be comparable, OERs lead to a more inclusive, engaging, and enriched learning environment that benefits both students and educators.

Method

The Open Resources for Nursing (Open RN) project has published 15 nursing OER textbooks that contain hundreds of interactive, online learning activities and over 48 virtual simulations, all with Creative Commons licensing (^{Creative Commons, n.d.}). Open RN textbooks are developed by nursing educators and based on the statewide, competency-based, pre-licensure nursing curriculum of the Wisconsin Technical College System (WTCS). Content also is aligned with the 2023 NCLEX-RN^® Test Plan, the American Nurses Association's Nursing: Scope and Standards of Practice (2021) and Code of Ethics for Nurses With Interpretive Statements (2025), the National League for Nursing's Competencies for Graduates of Nursing Programs, the American Association of Colleges of Nursing Essentials (2021), and other external standards (^{Ernstmeyer & Christman, 2023}).

More than 100 nursing faculty and RNs in clinical practice have contributed to the development of Open RN textbooks, and more than 350 nursing faculty have served as peer reviewers. Open RN OER textbooks can be viewed or downloaded from www.cvtc.edu/OpenRN. Affordable soft-cover versions also may be purchased from a print publisher for approximately $40 to $60 retail cost.

Open RN textbooks are created using universal design for improved accessibility. They are written using “plain language” principles published by the National Archives (²⁰²³) to promote improved reading comprehension and understanding. Interactive learning activities are included that range from knowledge-based flash cards and quizzes to application of content to client scenarios using NCLEX Next Generation-style case studies with immediate formative feedback. Additionally, interactive virtual simulations contextualize case studies with simulated patient and nurse handoff videos and include decision points that promote the development of clinical judgment (^{Ernstmeyer & Christman, 2023}).

Adoption of OER textbooks expands learning opportunities for all students by providing free course materials on the first day of class. Students can immediately view and interact with the online resources or download PDFs of the books to use at home if they do not have adequate internet access. They also may elect to purchase affordable print versions if they prefer a hard copy of the textbook. By using OER, students are not required to order books from a bookstore or wait for financial aid to be able to purchase their books. OER eliminates the difficult decision that many vulnerable students face when determining whether to buy a textbook or pay for other living expenses, such as meals, transportation, rent, or day care (^{Ernstmeyer & Christman, 2023}).

Results

Institutional review board approval was not required for the data described in this section because individual student data were not obtained. More than 1,300 institutions have adopted one or more Open RN textbooks in their learning management systems across all 50 states and in 61 countries. According to Google Analytics, usage of online Open RN textbooks from January 1, 2024 to December 2024 included more than 2.1 million international users with over 6.2 million page views. Countries with the top users in 2024 included the United States (957,000), Philippines (255,000), India (174,000), Canada (128,000), Australia (72,000), United Kingdom (62,000), and Nigeria (43,000).

Usage and course completion rates for course sections across the 16 WTCS stand-alone colleges was collected and analyzed using a system-wide reporting system by the institutional research department of the college leading the development of Open RN textbooks. During the first academic year (2020 to 2021), the nursing pharmacology textbook was adopted in 66 WTCS course sections, affecting 1,259 students. These OER course sections had a 5% higher successful course completion rate (A to C grades) compared with the WTCS benchmark for this course (75.7%). Overall WTCS course data from the 2020–2021 and 2022–2023 academic years indicate similar course completion rates in course sections adopting Open RN OER textbooks compared with the WTCS average completion rates for these courses. These data indicate colleges and courses that adopted OER did not experience a drop in course performance while promoting the benefits associated with OER (^{Ernstmeyer & Christman, 2023}).

Perceptions of Open RN OER textbooks initially were gathered from faculty and students using an anonymous survey. A total of 201 survey respondents (84% students, 14% faculty, and 2% “other”) rated the Open RN textbooks compared to commercial textbooks using a 5-point Likert scale ranging from 1 = much worse to 5 = much better. Survey criteria included quality, cost, ease of use, helpfulness of learning activities, inclusion of evidence-based practices, navigation to other credible sources, and application of content to patient care. The mean ratings for each criterion ranged from 3.83 to 4.49 with an average rating of 4.07, indicating the Open RN textbooks were considered better or much better than commercial textbooks (^{Ernstmeyer & Christman, 2023}).

A second anonymous survey provided within the virtual simulations was completed by more than 2,000 respondents, of which 94% were students. Ninety-two percent of the respondents agreed or strongly agreed the virtual simulations encouraged the development of clinical judgment.

The annual NCLEX pass rate for the associate degree nursing program that led the creation of Open RN textbooks further supports the effectiveness of Open RN OER materials in promoting the development of clinical judgment. According to the National Council of State Boards of Nursing Performance Reports and Mountain Measurement (²⁰²⁴) for the academic year 2023–2024, the annual NCLEX-RN pass rate for this nursing program was 98.2%, significantly higher than the national average NCLEX-RN pass rate of 93.1%. The data reflect the success of the first student cohort who primarily used Open RN OER textbooks throughout their program of study and was significantly higher than previous student cohorts using commercial textbooks, with a 2022–2023 annual NCLEX-RN pass rate of 82.5% and a 2021–2022 annual pass rate of 82.6%.

Discussion

Course completion rates in WTCS course sections that adopted OER compared with course sections using commercial textbooks were similar, with some courses such as Nursing Pharmacology having significantly higher course completion rates after adopting OER.

The improved annual NCLEX-RN pass rate of 98.2% for the college leading the development of Open RN textbooks illustrates how OER that are created by faculty using quality assurance guidelines, aligned with competency-based curriculum, and based on the NCLEX-RN Test Plan can help promote student success. Survey data also indicate that student perceptions of Open RN resources were better or much better than commercial textbooks, and more than 93% of student respondents believed the associated virtual simulations in the Open RN textbooks helped develop their clinical judgment.

A shortcoming of the preliminary data related to improved NCLEX-RN pass rates associated with adoption of Open RN OER textbooks is its limited timeframe and inclusion of only one college. Further research is needed to trend and analyze annual NCLEX-RN pass rates for multiple colleges across longer periods of time. Confounding variables also occurred during this time period, such as concurrent faculty training in the development of NCLEX Next-Generation style questions for use in formative and summative course assessments.

Sustainability is a critical issue for OER, with initial funding for OER development often coming from grants and ongoing investment required for maintaining and updating these resources. The Open RN project has a sustainability plan based on royalties generated from optional print and audiobook purchases, as well as partnerships established with commercial vendors. This model allows the core digital resources to remain free and openly licensed, while generating modest revenue to reinvest in content updates and expansion. Updated editions of Open RN textbooks will continue to be released on a 3-year cycle in coordination with the release of updated NCLEX-RN Test Plans. Furthermore, as part of the WisTech Open project, development of OER textbooks has been scaled to other disciplines, such as respiratory therapy, emergency services, and early childhood education. Interested parties can register for quarterly updates regarding Open RN and other OER textbooks on the WisTech Open website at wistechopen.org.

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