Academic journal article Nursing Education Perspectives

An Integrative Review of the Use and Outcomes of HESI Testing in Baccalaureate Nursing Programs

Academic journal article Nursing Education Perspectives

An Integrative Review of the Use and Outcomes of HESI Testing in Baccalaureate Nursing Programs

Article excerpt

In nursing education, a current trend is to use standardized examinations for student remediation and to predict passage of the National Council of State Boards of Nursing licensure examination (NCLEX-RN®). Health Education Systems, Inc. (HESI) offers a series of computerized examination products. The original product was a program exit exam (E2), created in 1994, to provide a standardized method of integrating evidence-based research into nursing practice, evaluating knowledge, testing critical thinking, and helping students succeed (Nibert & Morrison, 2013); HESI is currently owned by Elsevier Publishing.

Though the general goal in using standardized testing is to increase the pass rate for the NCLEX-RN, perspectives on the theoretical basis for testing platforms (Nibert et al., 2006), the method by which they are integrated into nursing curricula (English & Gordon, 2004; Morton, 2008; Nibert, Young, & Adamson, 2002), the validity and reliability of the exams (Morrison, Adamson, Nibert, & Hsia, 2008; Morrison, Free, & Newman, 2002), and the drawbacks and benefits of testing vary widely in the literature (Spurlock, 2006). Therefore, the purpose of this inquiry is to utilize the integrative review method of Whittemore and Knafl (2005) to evaluate the current utilization of HESI in baccalaureate nursing education, the theoretical and research evidence supporting or contraindicating the use of HESI standardized testing in nursing education, and what is known regarding outcomes related to the use of these examinations.


The National Council of State Boards of Nursing (NCSBN) is charged with maintenance of minimum practice standards for nurses entering the workforce. The many sociopolitical, economic, and demographic changes affecting the nursing workforce that have taken place in recent years have increased expectations for the nursing workforce (NCSBN, 2014a) and have led the NCSBN to significantly change the NCLEX-RN exam to accommodate the increased competency demands for nursing practice (Morrison et al., 2002). With the changes came a decrease in the NCLEX-RN national pass rate (NCSBN, 2014b).

It is important to critically view interventions that have been undertaken to amend nursing education to meet higher demands. Standardized examinations as they relate to NCLEX outcomes are increasingly used as high-stakes testing in nursing education programs. The National League for Nursing (NLN) finds that an increasing number of nursing schools are utilizing standardized testing in some manner to determine progression through or graduation from programs (2012). Though studies show improved NCLEX-RN pass rates with the use of standardized testing (Harding, 2010; Lauchner, Newman, & Britt, 1999; Morrison et al., 2002; Nibert & Young, 2001), the process by which remediation based on testing is utilized within programs is inconsistent (Morrison et al., 2002). In addition, it is not clear which intervention strategies contribute to improved test performance (DiBartolo & Seldomridge, 2005; Harding; Spurlock, 2006), and reliability and validity of tests are not abundantly clear (Spurlock).

There is also debate regarding the appropriateness of the underlying theoretical framework to guide the use of standardized testing in nursing programs (Nibert et al., 2006). Consequently, with the identified need for transformation in nursing education (Institute of Medicine, 2011), clear delineation of the use and benefits of interventions such as standardized testing is vital, and an integrative review of the literature regarding topics surrounding standardized examinations in nursing education is warranted.


Problem Identification

The integrative review method of Whittemore and Knafl (2005) was used to search and evaluate the evidence related to the identified problem to answer the following research questions: a) What is the current utilization of the HESI examinations in baccalaureate (BSN) nursing education? …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.