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HESI TESTING—A HISTORY OF

EVIDENCE-BASED RESEARCH
AINSLIE NIBERT, PHD, RN, FAAN⁎ AND SUSAN MORRISON, PHD, RN, FAAN†

The Health Education Systems, Inc. (HESI) Exit Exam (E 2) was originally developed using sound
educational principles. In an effort to ensure product quality and to scientifically address the
development of new HESI testing products, these principals continue to be practiced today, thereby
adding to the evidence-based testing science and significantly contributing to the scholarship of
educational practice. This review sequentially presents the evidence related to the E 2 by study details
and outcomes and sets the stage for the continued work presented in this supplement to the Journal
of Professional Nursing. (Index words: HESI; Health Education Systems, Inc.; Standardized testing; Exit
Exam; E2; Validity) J Prof Nurs 29:S2–S4, 2013. © 2013 Elsevier Inc. All rights reserved.

S INCE THE INCEPTION of Health Education Sys-


tems, Inc. (HESI) in the early 1990s, evidence-based
research has driven the development of HESI testing
over the past 13 years (Adamson & Britt, 2009; Langford
& Young, 2013; Lauchner, Newman, & Britt, 1999;
Lewis, 2005; Newman, Britt, & Lauchner, 2000; Nibert &
products. Following Elsevier's acquisition of HESI in Young, 2001; Nibert, Young, & Adamson, 2002; Young
2006, 1 this research-focused practice has continued to & Willson, 2012; Zweighaft, 2013). These studies
be the guiding force behind ongoing product evalu- investigated the accuracy of the E 2 in predicting success
ation and new product development. HESI's mission on the National Council Licensure Examination for
has always been to provide students with psychomet- Registered Nurses (NCLEX-RN). Based on a total student
rically sound standardized testing and review mate- sample of 49,115, the E 2 was determined to be between
rials that address individual students' remediation 96.36% and 99.16% accurate in predicting NCLEX-RN
needs, which are identified by their exam scores. As success. Each of the nine validity studies also investigated
faculty expand their understanding of how to best one or more additional variables related to HESI testing,
implement standardized testing within their particular for example, the effects of monitoring, the predictive
environment and how to use the exam findings to accuracy of repeated testing with parallel versions of the
enhance students' remediation efforts, they are better E 2, and the impact of administering HESI Specialty
able to help students who are seeking careers in Exams throughout the nursing curriculum. Figure 1
nursing or other health professions achieve licensure describes the findings of the E 2 validity studies. Data
or certification success. analysis for the tenth validity study and data collection
This introduction provides a historical perspective of for the eleventh validity study are currently underway.
the previously published research related to HESI testing. The historical accuracy of the E 2 in predicting NCLEX-
The first exam developed by HESI—the HESI Exit Exam RN success is an outcome of the conceptual framework
(E 2)—is the subject of nine validity studies conducted used to design the research studies. The model for writing
critical thinking test items, the ongoing item analysis of all
exams returned to Elsevier for scoring, and the application
of the HESI predictability model to the test scoring
*Vice President, Review and Testing/HESI, Elsevier Health Science, algorithm are described in this conceptual framework
Houston, TX. (Morrison, Adamson, Nibert, & Hsia, 2004; Morrison &
†Founder of HESI, Nurse Consultant, Houston, TX.
Free, 2001; Morrison, Nibert, & Flick, 2006).
Disclosure Statement: Dr. Nibert is employed as Vice President of HESI
Review & Testing. Dr. Morrison is the founder of Health Education HESI testing products were originally designed and
Systems, Inc., which was acquired by Elsevier in 2006, and currently produced for undergraduate and advanced practice
serves as a consultant to Elsevier. nursing students, as well as newly hired hospital
Address correspondence to Dr. Nibert: 11011 Richmond Avenue, employees and licensed nursing professionals in specialty
Suite 450, Houston, TX 77042. E-mail: a.nibert@elsevier.com
units within acute care settings. After the acquisition
(A. Nibert), smorrison13@gmail.com (S. Morrison)
1
HESI™ is the trademark granted to Elsevier at the time Health of HESI by Elsevier, HESI testing was expanded to
Education Systems, Inc. products were acquired by Elsevier. offer standardized testing to students preparing for
8755-7223/12/$ - see front matter certification in other health care professions, such as
S2 Journal of Professional Nursing, Vol 29, No. 2S (March/April), 2013: pp S2–S4
http://dx.doi.org/10.1016/j.profnurs.2012.06.004 © 2013 Elsevier Inc. All rights reserved.
HESI—HISTORICAL PERSPECTIVE S3

Figure 1. History of HESI Exit Exam Validity Studies.


S4 NIBERT AND MORRISON

emergency medical technicians, radiographers, and Langford, R. & Young, A. (2013). Predicting NCLEX-RN
medical assistants. More than 50 research studies have success with the HESI Exit Exam: Eighth validity study. Journal
been published describing the use of HESI testing within of Professional Nursing, 29, S5–S9.
nursing, health care settings, and other health care Lauchner, K., Newman, M., & Britt, R. (1999). Predicting
licensure success with a computerized comprehensive nursing
professions. A reference list of HESI-related research is
exam: The HESI Exit Exam. Computers in Nursing, 17, 120–125.
available online (Elsevier, n.d.).
Lewis, C. (2005). Predictive accuracy of the HESI Exit Exam
The Review and Testing division of Elsevier and the on NCLEX-RN pass rates and effects of progression policies on
editors of Journal of Professional Nursing partnered to nursing student Exit Exam scores. Dissertation Abstracts
develop this supplement because nurse researchers International, 66, 154B (UMI No. 3195986).
believe that the assimilation of HESI-related research Morrison, S., Adamson, C., Nibert, A., & Hsia, S. (2004).
within one resource can benefit those who wish to launch HESI exams: An overview of reliability and validity. CIN:
new research efforts and can therefore help expedite Computers, Informatics, Nursing, 22, 220–226.
dissemination of knowledge related to HESI testing. The Morrison, S., & Free, K. W. (2001). Writing multiple-choice
articles selected for this supplement have undergone the test items that promote and measure critical thinking. Journal of
same rigorous peer review process as required for all Nursing Education, 40, 17–24.
Morrison, S., Nibert, A., & Flick, J. (2006). Critical thinking
manuscripts submitted to the Journal of Professional
and test item writing (2nd ed.). Houston, TX: Health Education
Nursing. It is our hope that the new research findings
Systems, Inc.
presented in this supplement and in the reference list Newman, M., Britt, R., & Lauchner, K. (2000). Predictive
provided on the Elsevier Web site will inspire another accuracy of the HESI Exit Exam: A follow-up study. Computers
generation of researchers to further expand the science in Nursing, 18, 132–136.
supporting these products and the dissemination of Nibert, A., & Young, A. (2001). A third study on predicting
knowledge surrounding standardized testing as used by NCLEX success with the HESI Exit Exam. Computers in Nursing,
nursing and health professions. 19, 172–178.
Nibert, A., Young, A., & Adamson, C. (2002). Predicting
NCLEX success with the HESI Exit Exam: Fourth annual validity
References study. CIN: Computers, Informatics, Nursing, 20, 261–267.
Adamson, C., & Britt, R. (2009). Repeat testing with the HESI Young, A., & Willson, P. (2012). Predicting NCLEX-RN
Exit Exam—Sixth validity study. CIN: Computers, Informatics, success: The seventh validity study of the HESI Exit Exam. CIN:
Nursing, 27, 393–397. Computers, Informatics, Nursing, 30, 55–60.
Elsevier. (n.d.). HESI Assessment Advantage: HESI Research. Zweighaft, E. (2013). Impact of HESI specialty exams: The
Available from http://www.elsevieradvantage.com/article.jsp? ninth HESI Exit Exam validity study. Journal of Professional
pageid=11887. Nursing, 29, S10–S16.

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