1. Reiter, Peg PhD, RN
  2. Young, Anne EdD, RN
  3. Adamson, Carol PhD, RN

Article Content

In our article, data about decreasing the costs associated with the orientation of new graduates are described in the review of the literature and in the discussion. Although specific cost reductions were not delineated, the benefit of using the HESI Exit Examination (E2) to measure entry-level competency and thereby reduce education costs could easily be deduced by most readers.


Whereas data are available regarding the reliability and validity of the E2,1-5 no such data are available for the Performance Management Systems, Inc. (PMSI), the Medication Administration Safety Test (MAST), and the 90-day performance appraisal that were routinely used by the hospital where the research was conducted. The purpose of this study was to provide research data so that evidence-based decisions could be made about the use of these instruments.


The E2 was indeed 100% accurate in predicting NCLEX-RN success because, according to the company that developed the E2, those who score 90 and above are predicted to pass the NCLEX-RN, whereas those who score below 90 have varying degrees of risk of failing the NCLEX-RN, as described by Nibert et al.4 Categorizing E2 test takers into 2 categories based on the application of an inappropriate conceptual framework was refuted by Nibert et al6 who stated that "Applying such a model ignores the concept of risk reduction and negates the ability of students to use E2 findings to guide their remediation efforts so that they can become successful NCLEX-RN candidates."


Because the E2 is highly predictive of licensure success and the NCLEX-RN evaluates the ability of newly graduate nurses to function as entry-level nurses, then it seems logical that the E2 might also predict workplace competency. That was precisely the intent of this research project-to investigate the possibility of extending the use of the E2 to another domain by assessing its merit in evaluating newly graduate nurses for employment in acute care settings.


The findings of our study support numerous previously published studies that have found the E2 to be a highly accurate and useful instrument for making evidence-based decisions in nursing education. Based on the findings of our study, the E2 might also be useful in nursing service by assisting those who are making employment decisions regarding the new graduates' entry-level workplace competency.




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2. Newman M, Britt R, Lauchner K. Predictive accuracy of the HESI Exit Exam: a follow-up study. Comput Nurs. 2000;18(3):132-136. [Context Link]


3. Nibert A, Young A. A third study on predicting NCLEX success with the HESI Exit Exam. Comput Nurs. 2001;19(4):172-178. [Context Link]


4. Nibert A, Young A, Adamson C. Predicting NCLEX success with the HESI Exit Exam: fourth annual validity study. Comput Inform Nurs. 2002;20(6):261-267. [Context Link]


5. Morrison S, Adamson C, Nibert A, Hsia S. HESI exams: an overview of reliability and validity. Comput Inform Nurs. 2004;22(4):220-226. [Context Link]


6. Nibert A, Adamson C, Young A, Lauchner K, Britt R, Hinds M. Choosing a theoretical framework to guide HESI Exit Examination research. J Nurs Educ. 2006;45(8):303-307. [Context Link]