Use of the HESI Admission Assessment to Predict Student Success

CIN: Computers, Informatics, Nursing & Vol. 26, No. 3, 167 172 & Copyright B 2008 Wolters Kluwer Health Lippincott Williams & Wilkins F E A T U R E A R T I C L E Use of the HESI Admission Assessment to Predict Student Success KAREN TARPEY MURRAY, DrPH, RN CAROLYN S. MERRIMAN, MS, APRN CAROLYN ADAMSON, PhD, RN The Bureau of Labor Statistics 1 projects that new jobs in nursing will increase by 29.4% between 2004 and 2014. Health Resources and Services Administration (HRSA) 2 projects that the nation s nursing shortage will grow to more than 1 million nurses by the year 2020 and reports that to meet projected growth in demand for RN services, United States nursing programs must graduate approximately 90% more nurses than they are currently graduating. Unprecedented recruiting efforts have been initiated that are designed to bring new applicants into college and university nursing programs, and they have offered some abatement to the persistent nursing shortage in the United States. However, the shortage of qualified nursing faculty to teach the increased number of applicants has created a new type of nursing shortage, one that has abruptly stifled the temporary relief offered by rising enrollments. The American Association of Colleges of Nursing (AACN) 3 reported that enrollment in entry-level baccalaureate nursing (BSN) programs increased by 7.60% in 2006 over the previous year. However, the AACN also reported that 42,866 qualified applicants were turned away from baccalaureate and graduate nursing programs in 2006. Of those who participated in the 2006 AACN survey, 71% identified faculty shortages as a reason for not accepting all qualified applicants into entry-level nursing programs. Furthermore, the AACN 4 projected an 8.8% nursing faculty shortage for the 2007 2008 academic year. Based on data obtained from a national survey of nursing schools conducted in 2006, Malone, 5 chief executive officer of the National League for Nursing, testified before the United States House of Representatives and estimated that the number of budgeted, unfilled, full-time nursing faculty This study examined the value of the HESI Admission Assessment in predicting student success. Associate degree (N = 68) and baccalaureate (N = 69) nursing students took the HESI Admission Assessment after acceptance into the nursing programs for the purpose of identifying their academic weaknesses and focusing their remediation efforts. Findings indicated that the HESI Admission Assessment was a valid predictor of students academic ability to succeed in the nursing programs. In the associate degree nursing program, HESI Admission Assessment scores were significantly positively correlated with 88.89% of all nursing course grades in the program and 100% of the beginning-level course grades. In the baccalaureate nursing program, HESI Admission Assessment scores were significantly positively correlated with 50.00% of all nursing course grades in the program and 80.00% of beginning-level course grades. Furthermore, associate degree nursing students who completed the program had significantly higher HESI Admission Assessment scores than those who did not complete the program. KEY WORDS Admission examinations & Health Education Systems, Inc, (HESI) & Student success positions in the United States was 1390, which represented a 5.6% nursing faculty vacancy rate in associate degree nursing (ADN) programs. Yordy 6 referred to the shortage of nursing faculty as a crisis in healthcare and reported that as recruitment efforts succeed, the demand for faculty will increase, thereby making the projected faculty shortage even worse. Author Affiliations: College of Nursing and Health Sciences, Texas A&M University, Corpus Christi (Dr Murray); College of Nursing, East Tennessee State University, Johnson City (Ms Merriman); and College of Nursing, Texas Woman s University, Houston (Dr Adamson). Corresponding author: Karen Tarpey Murray, DrPH, RN, College of Nursing and Health Sciences, Texas A&M University, CI-367, 6300 Ocean Dr, Corpus Christi, TX 78412 (karen.murray@tamucc.edu). Reprinted with permission from Murray KT, Merriman CS, Adamson C. Use of the HESI admission assessment to predict student success. Comput Inform Nurs 2008; 26(3): 167 172. 61S

The fact that large numbers of students are being turned away from nursing programs forces nursing faculty to make increasingly difficult decisions concerning their applicant pools. Specifically, nursing faculties are called upon to make evidence-based decisions when selecting applicants to help ensure that the most qualified candidates are admitted to the program. Applicants high school and prerequisite nursing course grade point averages (GPAs) are of questionable value because of concerns about grade inflation and variable grading systems. In contrast, standardized tests exhibit greater precision and methodological rigor and thus are believed to provide a more reliable and consistent measure of students achievement and ability. Nursing faculty whose workload is already stretched beyond capacity because of the large number of faculty vacancies need to fairly and efficiently identify applicants who are most likely to succeed in their particular undergraduate nursing program. To determine the value of HESI Admission Assessment (A 2 ) in predicting student success, the faculty at an ADN program in Texas and the faculty at a BSN program in Tennessee designed this study, using a sample of students who were already admitted into their nursing programs. LITERATURE REVIEW The need for a reliable predictor of applicants ability to succeed in a nursing program is well documented. Byrd et al 7 examined academic records of students in a BSN program (N = 285) and found that the prenursing GPA was predictive of successful completion of the program. Gallagher et al 8 investigated the value of reading comprehension test scores in predicting students probability of success in an ADN curriculum (N = 121) and found that 50% of student success could be attributed to reading comprehension. Yoho et al 9 used Pearson correlations to determine the relationship between ADN students A 2 math and reading comprehension scores and their HESI Mid-curricular (MC) examination scores. The MC was an examination designed by HESI in collaboration with the ADN faculty to evaluate students knowledge of the content and concepts presented in the first half of their nursing curriculum. In essence, the MC was a custom exit examination for the first half of this particular school s curriculum. The findings of Yoho et al indicated that the students A 2 reading comprehension scores were positively correlated with their MC scores (P =.001). However, their A 2 math scores were not significantly correlated with their MC scores. Yoho et al conjectured that the lack of correlation between the students A 2 math scores and their MC scores could have occurred because math questions contained on the MC were basic calculations and examinees had access to a calculator within the computer program to complete these calculations. Yoho et al also reported that the A 2 math examination test blueprint was changed in 2005 to include more word problems that require critical thinking in addition to the ability to calculate and recommended conducting further research to examine the predictive accuracy of the A 2 math examination following this test blueprint change. Hardin 10 reported that the A 2, the HESI customized MC, and HESI specialty examinations were useful for predicting success in ADN nursing programs and that the HESI Exit Exam (E 2 ) was useful for predicting NCLEX-RN examination success. Symes et al 11 described a nursing success program designed to assist BSN students with academic difficulties (N = 94) and found a strong association between students reading comprehension ability and their completion of the nursing program. A nursing program s annual NCLEX-RN examination pass rate is often used as a criterion for evaluation of the program s effectiveness. Findings from several studies indicate that students who have low grades in basic science courses and clinical nursing courses are less likely to pass the NCLEX-RN examination than are those with high grades. 12 14 Daley et al 15 examined GPAs and standardized comprehensive examination results of senior BSN students (N = 224), using scores on the Mosby Assess Test and the HESI E 2, and found that the cumulative GPAs and E 2 scores were significant predictors of NCLEX-RN examination success. Higgins 16 reported that assessment testing throughout the nursing curriculum helped lower attrition rates and increase NCLEX-RN examination success. Is it possible that data provided by an entrance examination such as the A 2 could assist faculty in making evidence-based decisions regarding the selection of applicants who are academically prepared to meet the challenges of a nursing program? If remediation is indicated, would it not be better to initiate individualized remediation before admission, rather than wait until the student is attempting to complete the nursing curriculum? Can preadmission assessment and preadmission remediation ultimately help improve schools annual NCLEX-RN examination pass rates and reduce attrition? These questions provided impetus for this investigation of the relationship between A 2 scores and students success in an ADN and a BSN program. PURPOSE Based on a review of the nursing literature, the authors concluded that there was a need to assess nursing program applicants academic skills beyond basic math and reading comprehension. The A 2 assesses math; 62S

English, including vocabulary and grammar skills; and knowledge of the basic sciences chemistry, biology, and anatomy and physiology. The A 2 also provides personal information such as learning and motivation styles that might be useful to students in understanding themselves. Because the A 2 provides data that faculty believed might be useful in predicting students ability to succeed in a nursing program, this study was designed to assess the value of the A 2 in predicting student success. The specific research questions addressed in this study were: (1) Do A 2 scores predict student academic success in an ADN program and a BSN program as measured by the relationship between A 2 scores and nursing course grades? (2) Do A 2 scores of students who complete a nursing program differ from those who do not complete the program? METHODOLOGY A longitudinal, descriptive design was used to assess the value of the A 2 in predicting student success in an ADN program and a BSN program. The sample consisted of 286 total students, 217 ADN students and 69 BSN students who took the A 2 after admission to their respective nursing programs. Course grades throughout the nursing curriculum were available for 68 ADN students and 69 BSN students. At the time this study was conducted, both schools of nursing used A 2 scores for placement, rather than as an admission criterion. The A 2 was administered to students immediately after admission into the nursing program, and the findings were used to identify the students academic weaknesses. Referrals were made to remediate these weaknesses so that students who were at risk for academic failure might obtain additional assistance and improve their chances for success within the nursing program. To protect the subjects anonymity, students were assigned a number, and all personal information was removed before the data collection process was begun. HESI A 2 The A 2 is a computerized examination that was administered electronically over a secure Internet link or downloaded to the school s server, and students results were available upon completion of each examination. At the time the A 2 was administered to both the ADN and the BSN students, it consisted of nine examinations. Six examinations were academically oriented: math, reading comprehension, grammar, vocabulary, anatomy and physiology, and science (chemistry and biology). The remaining three examinations were personally oriented: a learning styles assessment, a personal inventory, and a behavioral inventory. * The A 2 produces a percentage score on each of the academically oriented examinations as well as a composite score (A 2 cumulative), which is the average percentage score for all academically oriented examinations the examinee completes. y The current psychometric properties of the academically oriented A 2 examinations are described in Table 1. These data include the average point biserial correlation coefficient and the average difficulty level for all test items included in each examination and the estimated reliability coefficient for each examination, as measured by the Kuder-Richardson formula 20. 17 FINDINGS Students A 2 cumulative scores were used to assess the accuracy of the A 2 in predicting success in nursing school. A bivariate regression analysis was conducted to determine if A 2 composite scores could predict course grades in all nursing courses. In the ADN program, students A 2 scores were significantly positively correlated (r = 0.253 0.442; P =.05.01) with eight of the nine (88.89%) nursing course grades in the total curriculum. In the first level of the ADN curriculum, three of three (100%) course grades were positively correlated with A 2 scores; in the second level, one of two (50.00%) course grades was positively correlated with A 2 scores; and in third and fourth levels, four of four (100%) course grades were positively correlated with A 2 scores (Table 2). In the BSN program, students A 2 scores were significantly positively correlated (r = 0.241 0.374; P =.05.01) with 10 of the 20 (50.00%) nursing course grades in the total curriculum. In the sophomore year of the BSN curriculum, four of five (80.00%) course grades were positively correlated with A 2 scores; in the junior year, five of nine (55.56%) course grades were positively correlated with A 2 scores; and in the senior year, one of six (16.67%) course grades was positively correlated with A 2 scores (Table 2). Data reported for the BSN program indicated that all 69 students who took the A 2 after admission into the upper division of the nursing program completed the program within 2 years of admission. A 2 scores * The A 2 currently consists of seven academically oriented exams: reading comprehension, math, vocabulary, grammar, anatomy and physiology, chemistry, and biology. There are currently two personally oriented exams: learning styles assessment and personal inventory. y The A 2 currently produces an English-language subset score, which is the average of reading comprehension, grammar, and vocabulary scores; and a science subset score, which is the average of anatomy and physiology, chemistry, and biology scores. 63S

Table 1 HESI Admission Assessment, Version 1: Average Test Items Discrimination Levels (PBCC), Average Test Items Difficulty Levels, and Exams Estimated Reliability Coefficients (KR20) a Examinations Average PBCC Average Difficulty Level KR20 Math 0.3224 0.8161 0.9900 Reading comprehension 0.2591 0.8220 0.9900 Vocabulary 0.2764 0.7673 0.9900 Grammar 0.2506 0.8780 0.9900 Anatomy and Physiology 0.2716 0.6886 0.9793 Biology 0.2892 0.7156 0.9821 Chemistry 0.2968 0.7006 0.9847 Abbreviations: PBCC, point biserial correlation coefficient; KR20, Kuder-Richardson formula 20. a Data provided by Elsevier Inc and current as of July 29, 2007. were reported by four different cohorts of the ADN program, but data regarding course grades were inconsistently reported for all but one of these four cohorts. Therefore, the one cohort that consisted of 68 ADN students with reported course grades throughout the curriculum was used to analyze the relationship between A 2 scores and course grades. The four cohorts who took the A 2 after admission to the ADN program provided a total sample of 217, and 80 (36.87%) of these 217 students did not complete the nursing program within two years of admission. A two-tailed t test was used to determine if the A 2 scores of those who completed the ADN program were different from those who did not complete the program. The mean A 2 score for the four cohorts of ADN students who completed the program was 75.98, and the mean A 2 score for those who did not complete the program was 70.44. Findings indicated that those who completed the Table 2 Pearson Correlations of HESI Admission Assessment Scores With Course Grades and Completion of the ADN and BSN Programs ADN Program BSN Program Course N Pearson Correlation of A 2 Scores With Course Grades Course N Pearson Correlation of A 2 Scores With Course Grades Level I Year I (sophomore) Fundamentals 68 0.415 b Communication 67 0.303 a Pharmacology 69 0.442 b Community-I 69 0.374 b Communications 67 0.333 b Introduction to 69 0.196 nursing Level II Health assess 69 0.299 a Surgical 65 0.176 Pathophysiology 69 0.241 a Chronic 64 0.397 b Year II (junior) Level III Pharmacology 67 0.266 a Psychiatric/ 62 0.253 a Assess 69 0.321 b Mental Health populations Maternal/Child 60 0.340 b Fundamentals 64 0.318 a Level IV Adult & family-i 64 0.064 Advanced 58 0.318 a Behavioral 69 0.337 b Medical/Surgical health Management/ 58 0.327 a Pediatrics 69 0.107 Leadership Adolescents 69 j0.015 Research-family 68 0.360 b Adult & family-ii 69 0.071 Year II (senior) Middle age adult 69 0.229 Research-adult 69 0.262 a Adult & family-iii 69 j0.025 Transition 69 0.033 Community-II 69 j0.100 Practicum 69 0.159 a P G.05. b P G.01. 64S

Table 3 A 2 Scores for ADN Students Who Completed the Nursing Program and Those Who Did Not Complete the Program Two-tailed Status N Mean A 2 Score t test Completed program 168 75.98 4.48 a Did not complete 49 70.44 program a P G.001. ADN program scored significantly higher (P G.001) on the A 2 than those who did not complete the program (Table 3). DISCUSSION Although research findings continue to describe GPA in prerequisite nursing courses as a predictor of student success, 7,15 scores on a standardized admission examination provide additional objective data that can be used for making evidence-based decisions about applicant selection. Such measures should be reliable and valid. The data obtained from this study indicate that the A 2 is a reliable instrument and that it was a valid predictor of student success in the participating ADN and BSN programs. In the ADN program, A 2 scores were positively correlated with 100% of the course grades in the first, third, and fourth levels of the curriculum and with 88.89% of the course grades in the total curriculum. In the BSN program, A 2 scores were positively correlated with 80.00% of the course grades in the sophomore year of the curriculum and with 50.00% of the course grades in the total curriculum. As students progressed within the BSN curriculum, the number of nursing course grades that were significantly correlated with A 2 scores decreased. This finding is not surprising because attrition that results from academic inadequacies is likely to occur in the beginning-level courses. The findings obtained in this study are not only relevant to nursing faculties who use or might use A 2 scores as a resource when making admission selection decisions, they are also valuable to individual examinees who take the A 2. Scoring reports provide information about an individual applicant s basic academic skills, and this information can serve as a guide to remediation so that applicants can improve their chances of success in the nursing program. Individualized scoring reports also describe the applicant s learning style and personally oriented inventories, which can assist applicants in tailoring self-guided activities that are likely to improve their chances of success in clinical nursing courses. The cost of attrition is expensive not only monetarily but also in terms of the loss of potential graduates who might help ameliorate the current nursing shortage as well as the shortage of qualified nursing faculty. It is therefore imperative that faculty have access to reliable predictors of applicants ability to succeed in a nursing program so that attrition might be reduced and applicants weaknesses remediated prior to admission. The mean A 2 score for the ADN students who completed the nursing program was significantly higher than the mean A 2 score for those who did not complete the program. Based on data obtained from this study, the faculty at the participating ADN program chose to use applicants A 2 scores as a criterion for selection with future applicants to the program. All students in the participating BSN program completed the nursing program; therefore, no data existed for BSN student participants who did not complete the program. Further study is needed to determine if there is a difference in the mean A 2 scores for BSN students who complete the nursing program and those who do not complete the program. The findings of such a study should be compared with the findings of this study regarding mean A 2 scores of ADN students who completed the nursing program and those who did not complete the program. In addition, further study is needed to examine the value of using the A 2 as an admission criterion and to determine if there is a relationship between use of the A 2 as an admission criterion and attrition from the nursing program. CONCLUSION The increased interest in nursing as a career choice might indicate amelioration of the nursing shortage problem if it was not for the shortage of nursing faculty to teach the increased number of applicants. This faculty shortage limits the ability of nursing programs to increase enrollments. It is therefore imperative that nursing faculty seek resources to assist in the arduous task of selecting the most qualified applicants, those who have the ability to succeed in an academically challenging nursing program and become licensed upon graduation from these programs. Findings of this study indicate that A 2 scores are valid predictors of student success and can therefore assist faculty in the selection process as well as assist students in identifying their academic weaknesses so that these weaknesses can be remediated before they enter a nursing program. Although use of the A 2 will not ameliorate the nursing shortage or the nursing faculty shortage, it can enhance 65S

faculty effectiveness and efficiency and provide evidencebased data for the decisions that faculty are required to make regarding applicant selection. Nursing faculty are a valuable but limited resource, and technological advances that enable them to be more productive are extremely valuable. With the severe current nursing faculty shortage and the HRSA mandate to increase the number of graduates from United States nursing programs by 90%, 2 faculty can little afford to admit students into nursing programs who are academically ill-prepared to succeed in the program. The findings of this study indicate that the A 2 provides valuable information about students academic ability to succeed in a nursing program, thereby making it a valuable tool for faculty to use in selecting applicants for the limited number of nursing student admissions. However, because the A 2 provides only additional objective data, it is the authors collective opinion that it should not be used as the sole criterion for admission into a nursing program. GPAs should continue to be evaluated both quantitatively and qualitatively by assessing the numerical value, evaluating particular course grades such as science, and reviewing which institutions awarded the course grades. Considering that GPA data can be affected by grade inflation and differences in grading systems, the A 2 provides a worthwhile, objective measure that can enhance the selection process for nursing school admissions. REFERENCES 1. Bureau of Labor Statistics. Occupations with the largest job growth, 2006 16. http://www.bls.gov/emp/emptab3.htm. Accessed July 29, 2007. 2. Health Resources and Services Administration. What is behind HRSA s projected supply, demand, and shortage of registered nurses? http://bhpr.hrsa.gov/healthworkforce/reports/ behindrnprojections/index.htm. Accessed July 29, 2007. 3. American Association of Colleges of Nursing (AACN). 2006 2007 Enrollment and graduations in baccalaureate and graduate programs in nursing. http://www.aacn.nche.edu/media/factsheets/ FacultyShortage.htm. Accessed July 29, 2007. 4. American Association of Colleges of Nursing (AACN). Special survey of AACN membership on vacant faculty positions for academic year 2007 2008, June 2007. http://www.aacn.nche.edu/ IDS/pdf/vacancy07.pdf. Accessed July 29, 2007. 5. Malone B. Title VIII-Nursing workforce development programs health resources and services administration. 2007. http://www.nln.org/ governmentaffairs/pdf/ceo_testimony.pdf. Accessed July 29, 2007. 6. Yordy KD. The nursing faculty shortage: a crisis for health care. In: Holmes DE, Pryce-Jones KE, eds. Factors Affecting the Health Workforce. Association of Academic Health Centers Web site. http://www.rwjf.org/pr/product.jsp?id=15889. Accessed July 29, 2007. 7. Byrd G, Garza C, Nieswiadomy R. Predictors of successful completion of a baccalaureate nursing program. Nurse Educ. 1999;24(6):33 37. 8. Gallagher P, Bomba C, Crane L. Using an admissions exam to predict student success in an ADN program. Nurse Educ. 2001; 26(3):132 135. 9. Yoho M, Young A, Adamson C, Britt R. The predictive accuracy of Health Education System Inc., examinations for associate degree nursing students. Teach Learn Nurs. 2007;2:80 84. 10. Hardin J. Predictors of Success on the National Council Licensing Examination Computerized Exam (CAT NCLEX RN) in Associate Degree Nursing Programs: A Logistic Regression Analysis. [doctoral dissertation]. Commerce, TX: Texas A&M University; 2005. 11. Symes L, Tart K, Travis L, Toombs M. Developing and retaining expert learners: the student success program. Nurse Educ. 2002; 27(5):227 231. 12. Campbell A, Dickson C. Predicting student success: a ten-year review using integrative review and meta-analysis. J Prof Nurs. 1996;12(1):47 59. 13. Endres D. A comparison of predictors of success on NCLEX-RN for African American, foreign-born, and white baccalaureate graduates. J Nurs Educ. 1997;36(8):365 371. 14. Roncoli M, Lisanti P, Falcone A. Characteristics of baccalaureate graduates and NCLEX-RN performance. J N Y State Nurses Assoc. 2000;31(1):17 19. 15. Daley L, Kirkpatrick B, Frazier S, Chung M, Moser D. Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation. J Nurs Educ. 2003;42(9):390 398. 16. Higgins B. Strategies for lowering attrition rates and raising NCLEX-RN pass rates. J Nurs Educ. 2005;44(12):541 547. 17. HESIops [database online]. Houston, TX: Elsevier Review and Testing. Updated July 29, 2007. 66S