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Nursing School Exit Exams

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By Barbara Tone, RN, NurseZone contributor

In times gone by, you finished nursing school, got your degree, and took your state board exams. These days, however, you finish your nursing program, get your degree, but may not be permitted to sit for the NCLEX examination. At the heart of this change is the so-called "exit examination."

In many nursing programs, the school will not recommend students to sit for the NCLEX examination if they do not pass the exit exam. Students must have the school's recommendation to take the state board examination for licensure.

"At my school, in the fall of our senior year, we were told that we wouldn't even get our BSN if we didn't pass the HESI," (one of several exit exams nursing schools currently administer), said Kimberly Collins, BSN, RN, a recent graduate of an Arkansas nursing program. "They subsequently gave us our degrees, but still would not recommend us to sit for boards unless we passed the exit exam."

Susan Morrison, Ph.D., president and owner of Health Education Systems Inc., (HESI) said the test was designed to assist faculty and students.

"If the students take the HESI exam and don't pass, it gives them the opportunity to sign up for remediation prior to taking the NCLEX," she explained.

Morrison is aware that the initial response to such a program is not always positive.

"Many students are upset the first year a change is announced," she said. "They have marched and called the media - but then the pass rates go up, and they don't care anymore."

Morrison added that the HESI has a high rate of predictability for passage of the NCLEX examination.

"The last one was 98.5 percent," she said.

She noted, however, that not all schools use the exam in a remedial way.

"It's not intended to be punitive," she said. "It's meant to help the student and faculty."

Case Western Reserve University in Cleveland, Ohio, began its exit program in 2000.

"For the last two years, students must pass an exit exam at a level that predicts success, or remedial work is required," said Lynn Lotas, Ph.D., RN, director of the BSN program.

According to Lotas, if a student does not successfully complete the exam, the school works closely with him or her to prepare for the NCLEX examination.

"We first require that they take an NCLEX examination prep course, which we provide at minimal cost to the student," she said.

If follow-up exams remain questionable, each student meets with Lotas to draw up a contract that outlines a plan to address the student's weaknesses.

"We want to maximize the chance that the student will succeed," Lotas said.

The information obtained from the exams can also be helpful to faculty.

"[The exam] gives us data on our weaknesses and we have made curriculum changes based on patterns we have seen," said Lotas.

While most agree that exit exams, used properly, are a help to students and faculty, some argue that the increased interest in pass rates may also have been prompted by the increased pressure on schools from state boards of nursing and accrediting organizations.

Fay L. Bower, DNSc, chair of the department of nursing at Holy Names College in Oakland, California, said that there has been a drop in the pass rates of students in baccalaureate programs over the past 5-10 years.

"Schools get jumpy when they get a 70 percent pass rates," she said, "And some of them get kind of frantic. If they don't get pass scores up, they are in serious trouble of not staying in business."

Bower believes that the NCLEX examination is an entry to practice exam, focused on hospital nursing, and that most baccalaureate programs teach beyond that scope of practice. She explained that the students learn to think conceptually and may not be as prepared for a test that asks primarily practice questions.

"As faculty, we have to go back and see what we need to do. Part of that is helping students learn to take computerized exams, and helping them to think in a more concrete way," Bower said.

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