1. Downey, Theresa A. PhD, RN, CIC

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This letter comments on issues that emerge from an article by Nibert, Young, and Adamson-"Predictive NCLEX success with the HESI Exit Examination: Fourth annual validity study"-published by CIN in November/December 2002. The authors report that 3 prior studies validated the (Health Education Systems, Inc.) HESI Exit Examination as a predictor of NCLEX success as well as of NCLEX failure.


Yet, in 1999, Lauchner, Newman, and Britt asked, "[H]ow many of the students predicted by the E2 to pass the NCLEX-RN or NCLEX-PN failed the licensing examination[?]" Then, in 2000, Newman, Britt, and Lauchner asked, "How many of the high-scoring students (predicted to pass) failed the licensing examination?" and "How many of the low-scoring students [predicted not to pass] failed the licensing examination?" Finally, in 2001, Nibert and Young asked, "How many of the high-scoring and how many of the low-scoring students failed the NCLEX-RN or NCLEX-PN?"


Although data collection methods were refined, the researchers neither asked, "How many students passed the examination?" nor did they ask, "How many students passed the examination on the first attempt?" In other words, they did not collect data relative to NCLEX-RN or NCLEX-PN success!! Thus, the research consumer is led to believe that all students who took the HESI E2 and did not fail either licensing examination actually did take one of the licensing examinations and passed. Efforts to confirm that all students who took the HESI E2 and actually did take the licensing examination were not made. Students may not take the licensing examination for a variety of reasons: marriage, childbirth, serious injury, changes in health status, or decision to not pursue nursing as a career.


In the current study, "Predictive NCLEX success with the HESI Exit Examination: Fourth annual validity study," the researchers state that they expanded the population under study to include middle-scoring students as well as high-scoring students and low-scoring students. However, they still do not collect data relative to licensing examination success.


As in the past, the HESI Predictability Model (HPM) is identified as a proprietary mathematical model and is not described. Thus, the research consumer is unable to verify the accuracy of the calculations of the HPM!!


According to the researchers, the HESI Exit Examination has content validity, construct validity, criterion-related validity, and predictive validity. It would be more helpful to the research consumer to explain the process to ensure that the domain of nursing is tested on the HESI Exit Examination (and the domain of each specialty area is tested on the HESI Specialty Examinations). A few examples of the constructs that are included in the examinations would be of further use. Omitting data collection of licensing examination successes and licensing examination nontakers compromises the truth-value of the published research.


The researchers go on to say that they could not export data from 40.26% of the RN students and from 29.22% of the LPN students. Although they do not describe efforts to establish that the population studied is representative of the total group taking the HESI Exit Examination, they stated that the population studied was indeed representative of the total group. The possibility that important differences could exist is not acknowledged.


In addition, a rationale for having uneven scoring intervals has not been provided. An explanation for not combining the C/D categories and a statement that it would not have affected the reported inverse relationship between HESI Predictability score and licensing examination success would have enabled the research consumer to interpret this aspect of the study.


Although the researchers state that "standard statistical methods were used[horizontal ellipsis]," calculations of chi squares are addressed. Other statistics are not mentioned.


It is interesting that HESI suggests that students who achieve at the recommended level on the HESI Exit Examination need no further preparation. When the researchers discuss progression and remediation policies, they do not differentiate between review and remediation. Review, according to Webster, is renewed study of material previously studied. In contrast, remediation is concerned with correction of faulty habits and raising of a pupil's general competence. All students who graduate from programs that lead to professions that require licensing examinations need to be cognizant of the need for intensive review prior to taking licensing examinations.


However, students who require remediation ought not to be at the end of their sojourn in such programs before they are identified and provided the assistance they need to learn effective study habits. Attention to the development and implementation of remediation has been partially addressed. If remediation is needed, the need for it is usually obvious early in the student's academic career. The need for review prior to taking any external examination needs to be emphasized.


Information about students who achieve a HPM predictability score greater than or equal to 90 is not provided. The researchers accurately point out that the research design lacked control of intervening variables that may have occurred between the administration of the HESI Exit Examination and the administration of the NCLEX-RN or NCLEX-PN. How students who are high scorers differ from students who are low scorers has not been addressed. Students who are high scorers may be more likely to participate in independent NCLEX-RN or NCLEX-PN Review Courses or alternative systematic review. than their peers who are low scorers.


Differences in performance on the licensing examination in students who scored in the middle range on the HESI or any other external examination may reflect whether they participated in independent NCLEX-RN or NCLEX-PN Review Courses or alternative systematic review rather than the score on the external examination.


Although the researchers suggest that the HESI Exit Examination is a good predictor of NCLEX success, nursing faculty would do well to tread cautiously when applying the findings of this series of studies to their individual academic settings.


We, as nursing educators, could learn something from the latest requirements for clinical drug trials. Pharmaceutical companies can no longer say, "Our new drug is effective." They must compare the performance of their product with that of the other drugs that have been traditionally used to determine if their drug is better and more cost-effective.


Theresa A. Downey, PhD, RN, CIC