National Standardize Specialty Exams Improve Predictive ...

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