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Due to the current nursing shortage in the United States (American Nurses Association, 2015), it is imperative that new graduates of entry-level RN programs pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) as soon as possible after graduation so they can enter the workforce. Currently, many schools of nursing offer standardized testing to prepare nursing students to pass the NCLEXRN on first attempt. The Health Education Systems, Inc. (HESI) Exit Exam, an end-of-program summative product, is a standardized test that is frequently used to assess student competencies across a nursing program (Schooley & Kuhn, 2013). Eight HESI-developed Specialty Examinations (Critical Care, Pediatrics, Medical–Surgical, Fundamentals, Psychiatric, Maternity, Management, and Pharmacology), which are also standardized tests, are also available. These examinations measure student competencies in specific areas of practice (Schooley & Kuhn, 2013).
Nine validity studies reported that the HESI Exit Exam is highly predictive of NCLEX-RN success (96.36% to 99.16%) (Nibert & Morrison, 2013). The HESI scores most frequently reported to be predictive of success were 900 and higher (Langford & Young, 2013; Spurlock & Hunt, 2008). Although evidence exists that the HESI predicts NCLEX-RN success, there is also evidence that it is less effective in predicting NCLEX-RN failure (Brodersen & Mills, 2014; Spurlock & Hunt, 2008). Lavandera et al. (2011) found that a predictive model of the HESI Exit Exam score, nursing grade point average, and a grade of D or F were more effective in predicting NCLEX-RN failure than the HESI Exit Exam score alone.
Several studies have examined the effect of consequences for students regarding HESI testing. Lauer and Yoho (2013) reported that schools that have imposed consequences on students for not meeting a HESI benchmark score had higher mean HESI Exit Exam scores than those that did not impose consequences. Consequences included remediation, failure of a nursing course, delayed or denied graduation, or delayed or denied RN candidacy. As part of a testing policy for an associate degree in nursing program, students who did not achieve a HESI score of at least 850 on HESI Specialty Exams and the HESI Exit Exam were required to remediate (Schroeder, 2013). Students who took the NCLEX-RN after implementation of the testing policy had significantly higher pass rates on first attempt than those who...