Establishing Progression Policies with the HESI Exit Examination: A Review of the Evidence

Accuracy and completeness are required: A response to Dreher et al (2019)

The authors of this response outline numerous factual errors and mischaracterizations about their prior work made by Dreher et al (2019). The authors reaffirm their original findings and conclusions and further argue that substantial empirical evidence not reviewed by Dreher et al (2019) support the conclusions reached by Spurlock and Hunt (2008) and Phelan (2012).

Standardized Testing Practices: Effect on Graduation and NCLEX® Pass Rates

The use standardized testing in pre-licensure nursing programs has been accompanied by conflicting reports of effective practices. The purpose of this project was to describe standardized testing practices in one states' nursing programs and discover if the use of a cut score or oversight of remediation had any effect on (a) first time NCLEX® pass rates, (b) on-time graduation (OTG) or (c) the combination of (a) and (b). Administrators of 38 nursing programs in one Southwest state were sent surveys; surveys were returned by 34 programs (89%). Survey responses were compared to each program's NCLEX pass rate and on-time graduation rate; t-tests were conducted for significant differences associated with a required minimum score (cut score) and oversight of remediation. There were no significant differences in NCLEX pass or on-time graduation rates related to establishment of a cut score. There was a significant difference when the NCLEX pass rate and on-time graduation rate were combined (Outcome Index "OI") with significantly higher program outcomes (P=.02.) for programs without cut-scores. There were no differences associated with faculty oversight of remediation. The results of this study do not support establishment of a cut-score when implementing a standardized testing.

Comparative analysis of NLN NCLEX-RN readiness exam performance: BSN versus ADN

Abstract

Nursing schools are committed to improving the passing rate of the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and to remain above acceptable levels. Therefore, the National League for Nursing (NLN) readiness exam taken before graduation can be used as a diagnostic test. The NLN scores are used to investigate which clinical course grade has the highest correlation with the readiness exam and ultimately with the NCLEX. With that knowledge, educators could strengthen particular courses in order to ultimately enhance a higher NCLEX-RN passing rate. To investigate the relationship among nursing clinical course grades, foundational science courses, and NCLEX-RN readiness exam scores, the initial study in 2004 on BSN performance was compared to a follow-up study on ADN students in 2007 in another college within the same university. Stepwise regression and Pearson moment correlation analysed the data. The first nursing course, adult health nursing and maternal child health nursing, truly appears foundational for the NCLEX readiness exam. These results were consistent in both BSN and ADN programs. As adult learning theory suggests, the first nursing course may provide an overview into which the facts and skills of later courses are integrated.

Essential steps in implementing a comprehensive testing and review program

Nursing education literature reveals a proliferation of articles about interventions designed to prepare undergraduate nursing students for success on the professional licensure examination. An intervention featured in much of this literature is a comprehensive testing program. However, there is little information about implementing a curricular adoption of such a program. The authors discuss this issue and provide guidance to faculty and schools of nursing in adopting a comprehensive testing and review program.

Nursing program assessment and evaluation: evidence-based decision making improves outcomes

The authors explore how an evidence-based decision-making process improved National Council Licensure Examination passing rates for a bachelor of science in nursing program. The process is one that may be applicable to other nursing programs despite differences in school mission, philosophy, and student population. The essential components of a nursing program that contribute to student success are examined. Lessons learned and opportunities for more comprehensive pertinent assessment methods are discussed.

Commentary: Use of the HESI Exit Examination in Schools of Nursing

There are several valid and reliable instruments available to help predict student success on the NCLEX-RN. None, however, should be used as the only predictor of success.

Choosing a Theoretical Framework to Guide HESI Exit Examination Research

This article responds to issues raised in 2004 by Spurlock and Hanks, who interpreted data that were presented in four published studies describing the validity of the Health Education Systems, Inc. (HESI) Exit Examination. The argument for using classical testing theory as the preferred theoretical framework to a clinical disease detection model is advanced. While the Spurlock and Hanks article promotes a philosophical bias against the establishment of progression policies within schools of nursing, this article offers another assessment of the merits of detecting at-risk students so timely remediation can occur prior to administration of the National Council Licensure Examination for Registered Nurses (NCLEX-RN). From data presented in the four validity studies, the HESI Exit Examination was reported to be 96.36% to 98.30% accurate in predicting NCLEX-RN success, and those original findings are reaffirmed.

Do No Harm: Progression Policies and High-Stakes Testing in Nursing Education

Many schools of nursing are adopting progression policies to ensure that school licensure pass rates remain above acceptable levels. These policies prevent students who are predicted to fail the licensure examination from taking the examination, usually by preventing graduation from or completion of the nursing program. Progression policies frequently rely on a single test score from a predictive exit examination, such as the Health Education Systems, Inc. (HESI) Exit Examination, as a measure of whether students are likely to pass or fail the licensure examination and, therefore, whether they are permitted to graduate from the nursing program. In this article, questions about the HESI Exit Examination's test-use validity are explored. Best practices in testing and assessment require faculty to perform a more comprehensive assessment of students' abilities and to not rely on one predictor alone when making important educational decisions. Recommendations and suggestions are provided to guide faculty in decision making about progression policies.