The School of Health Sciences at Milwaukee Area Technical College in Wisconsin offers an Associate Degree in Nursing and a Diploma in Practical Nursing. The nursing programs are accredited by the National League for Nursing Accrediting Commission and have about 400 full-time nursing students.
The nursing program in the School of Health Sciences had been placed on probation in the past because of declining student pass rates on the NCLEX exam. After the school implemented HESI Review & Testing as part of its improvement plan, pass rates steadily increased to 100%.
“There had been a decline in our students’ pass rates for the NCLEX® exam,” says Dessie Levy, PhD, RN, Dean of the School of Health Sciences at Milwaukee Area Technical College in Wisconsin. She adds that after implementing HESI Testing as part of an overall improvement plan for the nursing program, “We increased our scores over a four-year period of time, and as of last quarter, we’ve had a 100 percent pass rate for six of the last eight quarters.”
Facilitating Turnaround in NCLEX Pass Rates
As part of its response to probation, the nursing program was asked “to identify an action plan that would increase the success of the students taking the NCLEX,” Levy says. “Part of the plan was the implementation of HESI.”
After implementing the HESI Exit and Mid-Curricular Exams as part of the academic improvement plan, NCLEX pass rates “turned around for both RNs and PNs,” Levy says.
Faculty also saw an increase in student scores on the HESI Exit Exam. “We saw our HESI scores go up from a average of 786,” she says. “We increased our benchmark score to 900, and now our average score is well over 1,000 for students taking the HESI Exit Exam.” The nursing program uses both the HESI RN Exit Exam and the HESI PN Exit Exam.
The HESI Exit Exam makes up 10-15 points of a student’s final grade in the capstone course. The HESI Mid-Curricular Exam is administered after the second quarter of the four-quarter program. The Mid-Curricular Exam is a customized exam developed specifically for the program to assess student performance based on topics covered in the first two semesters of the program.
Preparing Students for Success
Levy says HESI identifies areas of weaknesses that students can address through remediation questions and multimedia resources. The deep pool of questions in different categories “has strengthened students’ critical thinking skills, helping them to problem solve,” she notes.
Although students initially pushed back against HESI Testing, Levy says, “I’ve had a number of students who have come back and say, ‘Dr. Levy, we really appreciate the use of testing and remediation because it strengthened me.’” Students often find that they do not have to answer as many NCLEX questions as they expected. “They felt that NCLEX was challenging, but were surprised that they were able to end it in a short time frame,” she says.
The students’ experience affirms the value of an exam that has question formats and a blueprint that matches the latest NCLEX test plan. The HESI Exit Exam also has an accuracy rate of 98.4% for predicting success on NCLEX at a 900 Exit score, the highest among these types of exams.
Analyzing and Adapting
Levy says faculty members have “changed their pedagogic instruction and are able to teach to general concepts instead of teaching to a test or a recipe for learning how to be a nurse.”
She and the faculty review HESI reports regularly. “We look at the outcomes at the end of each semester,” she says. “That’s how we gauged moving our cut score from 850 to 900.” She says the analytic reports are particularly helpful because in addition to individual data, they compare scores of Milwaukee Area Technical College students with national averages. HESI summary analysis reports also contain a breakdown of aggregate scores in key categories, including nursing process, nursing concepts, client needs, specialty and sub-specialty areas, and QSEN categories and help to gather and trend needed data for accreditation visits.
“The reports have been a valuable resource to both faculty and the administration in terms of making adjustments and tweaking the curriculum and we know students are in the range of other students in the country,” Levy says. For example, “We saw that students were not as strong in terms of public health issues, so the curriculum was adjusted accordingly.” Faculty is currently evaluating how that adjustment is being reflected in the most recent HESI score data.
Adding HESI Admission Assessment Exam
As a result of the positive outcomes of HESI in the nursing program, Levy says the School of Health Sciences began using the HESI Admission Assessment Exam in 2012 for students applying for any allied health associate degree programs. Applicants “are expected to achieve 80% and we look at that score along with their entire portfolio,” Levy says. “We have a petition process because most of the allied health programs are very competitive.” Adding the Admission Assessment Exam helps ensure slots are filled with the best candidates.
Levy adds that the Admission Assessment Exam has other benefits too. “It allows us to see where there is an opportunity for strengthening the curriculum,” she says. The faculty also knows that students who fail to meet the desired score will need additional academic support if accepted into a program.
Levy advises those planning to implement HESI not to make passing the Exit Exam a requirement for allowing a student to sit for the NCLEX. The college first used the exam in this way, but soon realized that was not the best use of the test. Instead, she recommends faculty, “incorporate it as part of the curriculum, establish expected outcomes, and provide students with the opportunity to remediate.”
Levy, who completed her dissertation in 2010, adds, “Everything I saw in the literature supported employing some type of an assessment exam, but the controversy was in requiring students to achieve a set score on the HESI in order to graduate and sit for the NCLEX, so we are not using it that way.”
Students are introduced to HESI during orientation. An educational assistant in the computer lab handles the technical aspects of administering HESI exams.
Promoting Better Practice
“We have an excellent product and are very pleased with the outcomes of our students,” Levy sums up. “Our students resisted HESI at first but now every single graduate is appreciative. They feel it strengthened them and really prepared them for their practice.”