Impact of HESI Specialty Exams: The Ninth HESI Exit Exam Validity Study

doi:10.1016/j.profnurs.2012.06.011

Journal of Professional Nursing

Volume 29, Issue 2, Supplement 1, March–April 2013, Pages S10-S16

https://doi.org/10.1016/j.profnurs.2012.06.011 Get rights and content

Using an ex post facto, nonexperimental design, this, the ninth validity study of Elsevier's HESI Exit Exam (E²), reexamined the predictive accuracy of the E². The value of administering HESI Specialty Exams within the nursing curriculum in terms of E² scores was also investigated. The sample was composed of nursing students (N = 3,790) from 63 randomly selected schools—26 baccalaureate, 31 associate degree, and 6 diploma programs—throughout the United States who took the E² between September 2008 and August 2009. As in the previous 8 studies, the E² was found to be highly accurate (96.61%) in predicting success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Findings also indicated that students who took one or more HESI Specialty Exams during their nursing curriculum had a significantly higher mean E² score (P ≤ .0001) than students who did not take HESI Specialty Exams during their nursing curriculum. Of the 8 HESI Specialty Exams investigated, scores on the Critical Care, Pediatrics, and Medical–Surgical specialty exams were most predictive of NCLEX-RN success. Schools of nursing that used HESI Specialty Exams as course final exams had a significantly higher mean E² score (P < .01) than schools that used the exams for remediation and practice.

Section snippets

Background

Poorman (2011) stated that faculty should spend a majority of their time teaching students, not evaluating them, and further acknowledged that the process of becoming a better evaluator makes for a better teacher. Considering the current faculty shortage and the complexity of providing sound testing throughout the curriculum, many schools are outsourcing a portion of their testing to companies that provide standardized exams so that faculty have more time to devote to what they do best—teaching

Conceptual Framework

Classical test theory described by Crocker and Algina (1986) and critical thinking theory described by Paul (1990) were used as the theoretical basis for developing a model for writing critical thinking test items described by Morrison et al. (2006). This model was used to formulate the conceptual framework for the eight previously conducted studies that examined the accuracy of the E² in predicting NCLEX-RN success. The model, described in detail by Morrison et al. (2004), was also used for

Methods

After institutional review board approval was obtained, participating schools of nursing reported school policies, strategies, and deidentified student cohort information. An ex post facto, nonexperimental design was used to compare E² scores and NCLEX-RN outcomes of students who took one or more HESI Specialty Exams during their nursing curriculum (users) with E² scores of students who did not take HESI Specialty Exams during their nursing curriculum (nonusers). The population consisted of

Findings

Eight previously conducted studies determined the predictive accuracy of the E² based on students who scored 900 and higher, which is the score at which Elsevier describes students as predicted to pass the NCLEX-RN. Of the 3,790 students who participated in this study, 1,394 (36.78%) scored 900 and higher on the E². NCLEX-RN results were reported for 1,326 of these 1,394 students, and 1,281 (96.61%) of the 1,326 students for whom licensure exam outcomes were available passed the NCLEX-RN on

Discussion and Recommendations

The predictive accuracy of the E² for this ninth validity study (96.61%) remains within the range of the eight previous validity studies (96.36% to 99.16%) that were conducted over the past 13 years. Once again, the E² was determined to be a highly accurate predictor of NCLEX-RN success. Because of its predictability, scoring data provided by the E² can confidently be used by nursing faculty and students to guide remediation, thereby reducing students' risk of failing the licensing exam and

Conclusions

The E² and HESI Specialty Exams are standardized exams that contain critical thinking test items and, as such, evaluate students' ability to apply content and concepts to clinical problems. Limitations such as curricular differences, varying faculty expertise, and students' individual experiences may have influenced the findings of this study. However, based on analyses of the data obtained, the E² can be confidently used to evaluate students' readiness for the NCLEX-RN, and HESI Specialty

References (21)

LangfordR. et al.
Predicting NCLEX-RN success with the HESI Exit Exam: Eighth validity study
Journal of Professional Nursing
(2013)
C. Adamson et al.
Repeat testing with the HESI Exit Exam—Sixth validity study
CIN: Computers, Informatics, Nursing
(2009)
R. Bentley
Comparison of traditional and accelerated baccalaureate nursing graduates
Nurse Educator
(2006)
L. Crocker et al.
Introduction to classical and modern test theory
(1986)
L. Daley et al.
Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation
Journal of Nursing Education
(2003)
M.C. DiBartolo et al.
A review of intervention studies to promote NCLEX-RN success of baccalaureate students
Nurse Educator
(2005)
K.H. Frith et al.
Best practices in NCLEX-RN readiness preparation for baccalaureate student success
CIN: Computers, Informatics, Nursing
(2005)
M. Harding
Predictability associated with exit examinations: A literature review
Journal of Nursing Education
(2010)
K. Lauchner et al.
Predicting licensure success with a computerized comprehensive nursing exam: The HESI Exit Exam
Computers in Nursing
(1999)
Lewis C. (2005). Predictive accuracy of the HESI Exit Exam on NCLEX-RN pass rates and effects of progression policies...

There are more references available in the full text version of this article.

Cited by (19)

A retrospective study of the association between BSN courses grades and scores on the specialty health education systems incorporated (HESI) exams
2023, Teaching and Learning in Nursing
The purpose of this study was to determine how students' individual grades in BSN courses associated with their medical surgical, fundamentals, and pharmacology raw HESI scores. The average of three HESI scores were calculated and recursive partitioning and regression trees were used to identify associations between course grades and the composite HESI score. The model results provide insight into assessing student progression and can help in implementing tailored remediation strategies.
Evidence-based strategies for standardized exam remediation in nursing: An integrative review
2022, Teaching and Learning in Nursing
Citation Excerpt :
Among the articles in which a specific standardized exam company was identified, HESI was most common, and the most frequently reported benchmark score was 850. The value of selecting 850 as a benchmark score is supported by prior research in which scores of 850 or higher on eight HESI specialty exams were associated with increased odds of NCLEX-RN success (p = .0001– .0034) (Zweighaft, 2013). Additional studies are needed to discern how remediation requirements should be customized based on where students score in relation to benchmarks.
Many nursing programs use standardized exams to prepare students for the National Council Licensure Examination (NCLEX). Often, students are encouraged or required to remediate based on results. The value and common use of remediation in nursing education is well documented. However, evidence is less clear regarding remediation best practices. The purpose of this integrative review of literature was to identify evidence-based standardized exam remediation strategies and policies that help students achieve higher standardized exam scores and pass the NCLEX. Five computerized databases were systematically searched for primary research and quality improvement studies that examined remediation strategies following the administration of standardized nursing exams. Results were screened using a three-phase process, leading to a final sample of 24 articles. Three remediation strategy themes were identified: self-guided activities and assignments; faculty-guided group activities; and faculty-guided individual activities. Four remediation policy categories were revealed: required remediation if benchmark score is not met; required retesting if benchmark score is not met; delay in progression if benchmark score is not met; and credit awarded for completing remediation. These findings provide guidance for nursing programs seeking to develop or refine remediation policies and practices to better support students’ learning and increase NCLEX pass rates.
NCLEX-RN readiness: HESI Exit Exam validity and nursing program policies
2022, Journal of Professional Nursing
Citation Excerpt :
The average KR-20 for the E2 is 0.90 or higher, indicating satisfactory reliability (Vesey & Brunnert, 2018). Considerable research conducted over the past 20 years has provided extensive knowledge regarding the predictive accuracy of the E2 (Adamson & Britt, 2009; Barton et al., 2014; Langford & Young, 2013; Lauchner et al., 1999; Lewis, 2005; Newman et al., 2000; Nibert et al., 2002; Nibert & Young, 2001; Riley & Gouveia, 2022; Young & Willson, 2012; Zweighaft, 2013, 2017). Twelve large-scale studies indicated that recommended E2 scores were highly predictive of success on the NCLEX-RN, with students who achieved a score of 900 or higher passing the NCLEX-RN from 96.4% to 99.2% of the time (Riley & Gouveia, 2022).
The HESI® Exit Exam (E2) has been used to assess student readiness for the NCLEX-RN® examination for over two decades.
In this study, we examined the relationship between students' average E2 scores and their first time NCLEX-RN pass or fail outcomes to understand the validity of the E2 as a predictor of NCLEX-RN readiness. In addition, we examined the relationship between policies governing E2 use in programs and success on the NCLEX-RN.
Over 40 programs across the United States participated in the study, providing NCLEX-RN outcome information for 3686 students that took the E2 in 2018–2019 and information about policies.
Students who achieved an average E2 score of 850 and above had a NCLEX-RN first-time pass rate (FTPR) of 96.33%. The NCLEX-RN FTPR was 97.29% for students whose average E2 score was 900 and above. Policies such as test preparation requirements and remediation for the E2 were associated with statistically significantly higher student NCLEX-RN FTPR.
This study builds upon past evidence about the validity of the E2 and extends research in new directions by demonstrating the role of specific E2 policies in supporting students' success on the NCLEX-RN.
Academic and Demographic Predictors of NCLEX-RN Pass Rates in First- and Second-Degree Accelerated BSN Programs
2017, Journal of Professional Nursing
Citation Excerpt :
Thomas and Baker (2011) have emphasized the importance of both content mastery and skill in taking computerized tests in preparing BSN students to pass the NCLEX-RN. The HESI Exit Exam, which assesses both content mastery and test-taking skill, is a well-established, reliable, effective predictor of first-time NCLEX-RN success (Langford & Young, 2013; Zweighaft, 2013). However, this exam is considerably less reliable in predicting first-time NCLEX-RN failure (Harding, 2010; Spurlock & Hunt, 2008).
Relatively few studies have addressed predictors of first-attempt outcomes (pass-fail) on the National Council Licensure Examination-Registered Nurses (NCLEX-RN) for accelerated BSN programs. The purpose of this study was to compare potential predictors of NCLEX outcomes in graduates of first-degree accelerated (FDA; n = 62) and second-degree accelerated (SDA; n = 173) BSN programs sharing a common nursing curriculum. In this retrospective study, bivariate analyses and multiple logistic regression assessed significance of selected demographic and academic characteristics as predictors of NCLEX-RN outcomes. FDA graduates were more likely than SDA graduates to fail the NCLEX-RN (P = .0013). FDA graduates were more likely to speak English as a second or additional language (P < .0001), have lower end-of-program GPA and HESI Exit Exam scores (both P < .0001), and have a higher proportions of grades ≤ C (P = .0023). All four variables were significant predictors of NCLEX-RN outcomes within both FDA and SDA programs. The only significant predictors in adjusted logistic regression of NCLEX-RN outcome for the pooled FDA + SDA graduate sample were proportion of grades ≤ C (a predictor of NCLEX-RN failure) and HESI Exit Exam score (a predictor of passing NCLEX-RN). Grades of C or lower on any course may indicate inadequate mastery of critical NCLEX-RN content and increased risk of NCLEX-RN failure.
HESI Exams: Consequences and Remediation
2013, Journal of Professional Nursing
A growing body of knowledge supports the use of Elsevier's standardized HESI exams as an admission criterion to evaluate ongoing student performance and curricular outcomes and to measure students' preparedness for the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Because a plethora of research indicates that the HESI Exit Exam (E²) is a valid predictor of NCLEX-RN success, faculty often designate a benchmark E² score that students are required to achieve. Students who do not achieve the faculty-designated benchmark score are required to remediate and retest with a parallel version of the E² to determine the effectiveness of the remediation and to reevaluate the student's preparedness for the licensure exam. This study compared mean E² scores of students who attended schools that attached consequences to E² scores with students who attended schools that did not attach consequences to E² scores. Based on data obtained from the Eighth Validity Study Questionnaire, findings indicated that E² scores were significantly higher (P < .01) in schools that associated consequences with failure to achieve the faculty-designated E² score and were also significantly higher (P < .01) in schools that required, rather than merely suggested remediation.
HESI Testing-A History of Evidence-Based Research
2013, Journal of Professional Nursing
The Health Education Systems, Inc. (HESI) Exit Exam (E²) was originally developed using sound educational principles. In an effort to ensure product quality and to scientifically address the development of new HESI testing products, these principals continue to be practiced today, thereby adding to the evidence-based testing science and significantly contributing to the scholarship of educational practice. This review sequentially presents the evidence related to the E² by study details and outcomes and sets the stage for the continued work presented in this supplement to the Journal of Professional Nursing.

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: Disclosure Statement: Dr. Zweighaft has participated in research activities and received presentation honoraria from HESI Review & Testing within the past 3 years.

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Impact of HESI Specialty Exams: The Ninth HESI Exit Exam Validity Study

Section snippets

Background

Conceptual Framework

Methods

Findings

Discussion and Recommendations

Conclusions

Journal of Professional Nursing

Repeat testing with the HESI Exit Exam—Sixth validity study

CIN: Computers, Informatics, Nursing

Comparison of traditional and accelerated baccalaureate nursing graduates

Nurse Educator

Introduction to classical and modern test theory

Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation

Journal of Nursing Education

A review of intervention studies to promote NCLEX-RN success of baccalaureate students

Nurse Educator

Best practices in NCLEX-RN readiness preparation for baccalaureate student success

CIN: Computers, Informatics, Nursing

Predictability associated with exit examinations: A literature review

Journal of Nursing Education

Predicting licensure success with a computerized comprehensive nursing exam: The HESI Exit Exam

Computers in Nursing