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National Standardize Specialty Exams
Improve Predictive Exit Exam Scores
and NCLEX-RN Success
October 29, 2011
Elizabeth Zweighaft, EdD, MEd., RN
®
Making a Difference
Nurse Educators constantly search for
strategies to identify at-risk students
early in the educational process with the
intention of identifying knowledge gaps
and providing remediation to improve
student success on the NCLEX-RN
examination.
®
The purpose of any nursing program is to educate
competent, committed, and caring registered
nurses (RNs).
Nursing Education
Purpose of Study
The purpose of this study was to evaluate
the effectiveness of Elsevier/HESI
Specialty Exams used throughout the
curriculum has on the HESI Exit Exam
and NCLEX-RN student performance. ®
™
™
Definition of Terms
Specialty exams - exams “designed to
measure the students’ ability to apply
concepts related to specific clinical
nursing content areas” (Morrison et al., 2004, p. 223).
Exit exams - exams that cover the entire
nursing curriculum
Sources of Data
A total of 761 departments were included in the random selection.
Description of Program Types and Number of Students in the Study Sample
_____________________________________________________________
Measure Total Baccalaureate Associate Diploma
_____________________________________________________________
Programs 63 26 (41.27%) 31 (49.92%) 6 (9.52%)
Students 3,790 1,489 (39.29%) 2,103 (55.49%) 198 (5.22%)
______________________________________________________________
Program type Exit exam Specialty and Total
Only Exit Exam
Baccalaureate 144 156 300
Associate degree 235 205 440
Diploma 12 9 21
Total 391 370 761
Sources of Data
68.25% utilized both the HESI exit and the HESI specialty exams.
Research Question 1
Did the use of standardized specialty exams
as a standard part of the curriculum
significantly increase baccalaureate,
Associate degree, and diploma nursing
students’ scores on the Exit exam when
compared with scores of nursing students
who did not participate in standardized
specialty exam testing throughout their
curriculum?
Research Question 2
What are the standardized specialty exam
score ranges that predict success in the
passage of the NCLEX-RN Exam by
baccalaureate, Associate degree, and
diploma nursing students?
Research Question 3
For which specialty exams does a test score
above 850 increase the odds of passing the
NCLEX-RN?
Supporting Research
“94.08% of the students who achieved a
HESI exit score between 850–899 were
successful in passing the NCLEX on
their first attempt” (Nibert et al., 2003, p. 145).
Supporting Research
For this study, the range of
850-899
was used.
Predictive Validity Exit Exam V1
Scoring Category N Passed Failed
A/B (900 & >) 1326 96.6% 3.4%
C (850-899) 735 95.7% 4.3%
D (800-849) 485 95.9% 4.1%
E/F (700-799) 698 91.1% 8.9%
G/H (< 699) 301 72.4% 27.6%
Predictive Accuracy of Register Nurse (RN)
HESI™ Exit Exam Validity Studies
RN Study Sampling
Methodology
Participants Predictive
Accuracy One convenience 2,555 97.3
Two convenience 3,296 96.5
Three convenience 5,588 97.6
Four convenience 5,903 98.3
Five convenience 9,695 97.8
Six convenience 10,147 96.4
Seven stratified random* 4,383 99.2
Eight stratified random* 4,134 98.3
Nine stratified random* 3,545 96.6
*Stratified by Program Type-BSN, ADN, Diploma
Results
Analysis
An independent samples t test was used
to compare scores on the Exit exam of
students who attended schools that used
both the specialty exams and the exit
exam with scores of students who
attended schools that did not use any
specialty exams.
Results
There was a statistically significant difference
in the average scores of students who took
specialty exams (M = 865.7, SD = 108.7) and
students who did not take specialty exams (M
= 837.3, SD = 123.7; t (3790) = 7.19, p = ≤
.0001, two-tailed), which indicates that the
HESI specialty exams were associated with
higher scores of students on the HESI exit
exam.
Took specialty exams Did not take specialty
exams
Passed NCLEX-RN n % n %
____________________________________________________________
Yes 2,001 52.80 1,303 34.38
No 331 8.73 155 4.09
_________________________________________________________
Note. Chi-square = 10.187.
Prevalence of Students Passing the National Council
Licensing Exam for Registered Nurses (NCLEX-RN) Who
Took Specialty Exams (n = 2,332) and Students Who Did
Not Take Specialty Exams (n = 1,458)
Research Question 2
What are the standardized specialty exam
score ranges that predict success in the
passage of the NCLEX-RN overall and by
baccalaureate, Associate degree, and
diploma nursing students?
Analysis
Specialty Examination Score Ranges and Passing the National Council Licensing Exam for Registered Nurses (NCLEX –RN) Overall
____________________________________________________________________________________________________________________________
Scores on specialty examinations
NCLEX-RN
passage ≥950 900-949 850-899 800-849 750-799 700-749 650-690 ≤649 Total
_____________________________________________________________________________
Yes 274 237 326 349 284 187 100 111 1,868
No 14 22 29 43 51 36 37 65 297
% Passing 95 92 92 89 85 84 73 63 86
Total 288 259 355 392 335 223 137 176 2,165 _____________________________________________________________________________________________________________________________________________
Analysis
Specialty Examination Score Range 850 - 899 and
Percentage of Passing the NCLEX-RN by Program
Baccalaureate Program: 94.23%
Associate Degree: 90.6%
Diploma: not significant
CMH statistic was significant (7, N = 2165) = 139.051, p
< .0001, indicating a difference between exam score
ranges and achieving a passing score on the NCLEX-
RN.
Overall, 91.5% of the students with a score of 850–899 on the
specialty exams would pass the NCLEX-RN.
Results
As HESI Specialty Exam scores decreased, the percentages of NCLEX-RN failures increased.
Supported by the work of Nibert et al. (2002).
Secondary Research Question 3
For which specialty exams does a test
score above 850 increase the odds of
passing the NCLEX-RN?
Was it ???
Critical Care
Medical/surgical
Fundamentals
Maternity
Pediatrics
Critical thinking
Pharmacology
Psychology
Management
Since a score of 850 is generally used as
an indicator of student performance,
scores less than or equal to 850 were
compared to scores greater than 850 on
each specialty exam with respect to
subsequently passing the NCLEX-RN.
A chi-square test for independence was
performed for each specialty exam.
Analysis
Greatest Odds of Passing
Exam Odds Ratio
Critical Care 11.165
Pediatrics 5.510
Medical/Surgical 5.502
Fundamentals 3.710
Best Predictors
Predicting Success in Passing the National Council Licensing Exam for Registered
Nurses (NCLEX-RN) Using the Elsevier/HESI Specialty Exams as Predictors:
Summary
________________________________________________________
95% confidence interval
Specialty n Odds ratio Lower Upper p
Examination
Critical care 328 11.164 2.598 47.97 < .0001
Pediatric 655 5.510 2.643 11.48 < .0001*
Medical/surgical 1099 5.502 3.388 8.932 < .0001*
Fundamentals 600 3.71 1.783 7.726 .0002*
Psychology 1350 3.390 2.250 5.107 < .0001*
Maternity 802 3.373 1.999 5.691 < .0001*
Management 693 2.984 1.785 4.989 < .0001*
Pharmacology 590 2.122 1.271 3.543 < .0034
Critical thinking 121 2.03 0.747 5.540 .1596
________________________________________________________
Odds ratio of passing the NCLEX-RN.
*p < .001.
The more educators know about
what will make students successful
on the licensure exam, the better
the chance that interventions will
be successful.
Nurse educators should identify which specialty exams have the highest predictability for passing the licensure exam. Then, faculty can develop specific remediation plans during the course of the students’ education as a way of providing ongoing assessment and remediation.
Questions
The End