L I P P I N C O T T F O R L I F E
White Paper
HESI/ATI
Research Summary
by Dr. Julia Phelan, National Center for Research on Evaluation,
Standards, and Student Testing, University of California-Los Angeles
S U M M A RY / C O N C L U S I O N S Assessment in Nursing Education
• Existing research does not accurately predict students who
will not pass the NCLEX—and this group is most in need Assessment in nursing education world has typically focused on
NCLEX success prediction using tests such as HESI and ATI predic-
of identification and intervention.
tors. And much of the research conducted on predictive exams tends
to focus on tests given towards the end of the nursing program (e.g.,
• Studies which report accurate predictions of students who HESI E2) (Spurlock, 2012). This is problematic because results are
will pass the NCLEX tend to focus on predicting success for sometimes used to prevent, or delay graduation, and yet there is little
time to effectively remediate based on results.
a small group of students who are the highest-achievers.
The NCLEX
• Studies looking at predictors to NCLEX success tend to
find aptitude measures such as GPA and SAT and school Several features of the NCLEX make predicting student success very
difficult:
entrance requirements exams to be the best predictors.
• In 1988 the test became pass/fail which makes teasing out different
• The NLN recommends that predictor tests not be used levels of performance impossible.
to preclude graduation or progressions as they are not • Pass rates are typically high.
• In 2004 the NCLEX became a computer adaptive test which may
adequately designed for this purpose, nor is there reliable require students to have experience with computerized test-taking
guidance on setting cut scores or thresholds. (Beeman & Kissling, 2001).
• The passing standard changes over the years also makes cohort
• Most schools using predictor tests to preclude gradua- comparisons more challenging.
tion choose cut off scores which unfairly hold back a high Futhermore, one cannot ignore the impact of student characteristics
percentage of students who would most likely pass the and other less tangible variables on NCLEX outcome.
NCLEX if permitted to sit for it.
, HESI/ATI Research Summary
High-Stakes Testing: Progression and Predictor®, they have a 99% chance of passing the NCLEX, an 80%,
they have a 98% chance and so on (see Table 1 for ATI scores and
Graduation policies their reported “correlation” to NCLEX success).
The likelihood of a nursing student graduating and passing the NCLEX
the first time is difficult to predict given the myriad interacting
variables which influence success or failure (Uyehara, Magnussen,
Itano, & Zhang, 2007). Despite this difficulty, many nursing programs
use standardized assessment programs to predict student success on
the NCLEX (Holstein et al., 2006). And many schools have policies
which preclude students from graduating until they have reached a
certain scores on these tests. Data collected in a 2011 survey
conducted by the NLN indicated that 33% of RN programs required
a minimum score on a standardized test to progress, 20% require
a minimum score to graduate, and 12% will not allow students to
register for the board exam until they reach a minimum score. But
as Spurlock (2006) has indicated, little or no guidance is available to
faculty who wish to set cut, or decision, scores for their progression
or graduation policies, nor are there accepted policies in place as
to how to best implement standardized tests (NLN, 2012).
This process of using tests to allow for progression and graduation is
also known as “high-stakes” testing (NLN, 2012), and two of the most Table 1: ATI Comprehensive Predictor categories, scoring intervals and
commonly used testing programs used in high-stakes testing are expectations
Health Educational Systems, Inc., (HESI) and the Assessment
Technologies Institute (ATI). Although both companies have a suite For the HESI Exit Exam (E2) the typical cut-score is 850, although
of exam offerings, many schools use the HESI Exit Exam (E2) as an some schools implement a cut score of 900. (see Table 2 for HESI
NCLEX predictor test, or the ATI Comprehensive Predictor. scores and their reported “correlation” to NCLEX success)
ATI describes the comprehensive predictor as “a powerful tool in as-
sessing students’ readiness to take NCLEX.” (ATI Research Brief) They
do acknowledge that end-of-program testing may come too late for
some students who are at-risk for NCLEX failure, and offer a Content
Mastery Series of assessments designed to be used throughout the
program. Presumably, if a student took the Content Mastery Series
earlier in the program the risk of attrition at the end of the program
might be decreased as issues would have been addressed earlier.
HESI also has a host of assessment products, but the one most often
used to “predict” NCLEX success is the HESI exit exam (E2). The HESI Table 2: HESI Exam categories, scoring intervals and expectations
E2 is a 150-item comprehensive examination designed to measure
student preparedness for the NCLEX-RN by using a blueprint similar
to that of the NCLEX-RN examination. (HESI Exam Guide, 2014).
What does the available research tell us about
how well predictive tests work?
High-Stakes Test Scores Because end-of-program tests are marketed as NCLEX predictors,
much of the associated research focuses on evaluating these claims.
Most commercially available standardized predictive tests provide
See for example Langford and Young (2013) who report that the E2 is
individual student scores linked to a reported probability of passing
96.36-99.16% accurate in predicting NCLEX success.
the NCLEX-RN. For example, according to ATI, if a student scores
between an 80.7% and 100% on the RN Comprehensive
2 Transforming Nursing Education and Nursing Practice Together
White Paper
HESI/ATI
Research Summary
by Dr. Julia Phelan, National Center for Research on Evaluation,
Standards, and Student Testing, University of California-Los Angeles
S U M M A RY / C O N C L U S I O N S Assessment in Nursing Education
• Existing research does not accurately predict students who
will not pass the NCLEX—and this group is most in need Assessment in nursing education world has typically focused on
NCLEX success prediction using tests such as HESI and ATI predic-
of identification and intervention.
tors. And much of the research conducted on predictive exams tends
to focus on tests given towards the end of the nursing program (e.g.,
• Studies which report accurate predictions of students who HESI E2) (Spurlock, 2012). This is problematic because results are
will pass the NCLEX tend to focus on predicting success for sometimes used to prevent, or delay graduation, and yet there is little
time to effectively remediate based on results.
a small group of students who are the highest-achievers.
The NCLEX
• Studies looking at predictors to NCLEX success tend to
find aptitude measures such as GPA and SAT and school Several features of the NCLEX make predicting student success very
difficult:
entrance requirements exams to be the best predictors.
• In 1988 the test became pass/fail which makes teasing out different
• The NLN recommends that predictor tests not be used levels of performance impossible.
to preclude graduation or progressions as they are not • Pass rates are typically high.
• In 2004 the NCLEX became a computer adaptive test which may
adequately designed for this purpose, nor is there reliable require students to have experience with computerized test-taking
guidance on setting cut scores or thresholds. (Beeman & Kissling, 2001).
• The passing standard changes over the years also makes cohort
• Most schools using predictor tests to preclude gradua- comparisons more challenging.
tion choose cut off scores which unfairly hold back a high Futhermore, one cannot ignore the impact of student characteristics
percentage of students who would most likely pass the and other less tangible variables on NCLEX outcome.
NCLEX if permitted to sit for it.
, HESI/ATI Research Summary
High-Stakes Testing: Progression and Predictor®, they have a 99% chance of passing the NCLEX, an 80%,
they have a 98% chance and so on (see Table 1 for ATI scores and
Graduation policies their reported “correlation” to NCLEX success).
The likelihood of a nursing student graduating and passing the NCLEX
the first time is difficult to predict given the myriad interacting
variables which influence success or failure (Uyehara, Magnussen,
Itano, & Zhang, 2007). Despite this difficulty, many nursing programs
use standardized assessment programs to predict student success on
the NCLEX (Holstein et al., 2006). And many schools have policies
which preclude students from graduating until they have reached a
certain scores on these tests. Data collected in a 2011 survey
conducted by the NLN indicated that 33% of RN programs required
a minimum score on a standardized test to progress, 20% require
a minimum score to graduate, and 12% will not allow students to
register for the board exam until they reach a minimum score. But
as Spurlock (2006) has indicated, little or no guidance is available to
faculty who wish to set cut, or decision, scores for their progression
or graduation policies, nor are there accepted policies in place as
to how to best implement standardized tests (NLN, 2012).
This process of using tests to allow for progression and graduation is
also known as “high-stakes” testing (NLN, 2012), and two of the most Table 1: ATI Comprehensive Predictor categories, scoring intervals and
commonly used testing programs used in high-stakes testing are expectations
Health Educational Systems, Inc., (HESI) and the Assessment
Technologies Institute (ATI). Although both companies have a suite For the HESI Exit Exam (E2) the typical cut-score is 850, although
of exam offerings, many schools use the HESI Exit Exam (E2) as an some schools implement a cut score of 900. (see Table 2 for HESI
NCLEX predictor test, or the ATI Comprehensive Predictor. scores and their reported “correlation” to NCLEX success)
ATI describes the comprehensive predictor as “a powerful tool in as-
sessing students’ readiness to take NCLEX.” (ATI Research Brief) They
do acknowledge that end-of-program testing may come too late for
some students who are at-risk for NCLEX failure, and offer a Content
Mastery Series of assessments designed to be used throughout the
program. Presumably, if a student took the Content Mastery Series
earlier in the program the risk of attrition at the end of the program
might be decreased as issues would have been addressed earlier.
HESI also has a host of assessment products, but the one most often
used to “predict” NCLEX success is the HESI exit exam (E2). The HESI Table 2: HESI Exam categories, scoring intervals and expectations
E2 is a 150-item comprehensive examination designed to measure
student preparedness for the NCLEX-RN by using a blueprint similar
to that of the NCLEX-RN examination. (HESI Exam Guide, 2014).
What does the available research tell us about
how well predictive tests work?
High-Stakes Test Scores Because end-of-program tests are marketed as NCLEX predictors,
much of the associated research focuses on evaluating these claims.
Most commercially available standardized predictive tests provide
See for example Langford and Young (2013) who report that the E2 is
individual student scores linked to a reported probability of passing
96.36-99.16% accurate in predicting NCLEX success.
the NCLEX-RN. For example, according to ATI, if a student scores
between an 80.7% and 100% on the RN Comprehensive
2 Transforming Nursing Education and Nursing Practice Together
