Hesi Exit Test

Our small private school just started using HESI for our third graduating group in their final quarter. The students took version 1 of the exit exam as a diagnostic tool when they began the "NCLEX Prep" course. Throughout the course they took content exams (Fundamentals, Obstetrics, Peds, Med/Surg...), they worked on case studies, and they answered over 3000 NCLEX style computerized test questions, providing textbook-referenced rationales for every incorrect answer they scored. At the end of the course they took HESI version 2 and had to pass with 800 or they got an incomplete (they were allowed to "walk" with their classmates at graduation and we have since raised the score to 850 for subsequent groups.) Over the next quarter, those who failed version 2 may take version 3 and version 4. If they don't pass those two exams they fail the course and they must repeat it (the NCLEX Prep course), at the end of which they must pass HESI version 5. If they don't, there is version 6 and 7 to continue remediating. Only after failing all 7 HESI exit exams and repeating the course do they finally and completely fail the program.
HESI has become our program's safety net. We had abysmal pass rates for the first 2 graduating groups. The State Board was literally moving toward closing us down - cease and desist, lock our doors, end of the program's existence, take a deep sigh and get a new job (including the students currently enrolled).
The third graduating group of 38 students was reduced by 9 who could not pass the second HESI. In retrospect, these are the students who have not been strong throughout the program - generally not quite grasping the critical thinking component so essential to quality nursing. These nine are now remediating with us in an "NCLEX Refresher" course which focuses on content support and how to read and answer NCLEX style questions. They continue with 200 NCLEX style computerized test questions per week with rationales.
The rest of the graduates have started off strong with a 100% initial pass rate so far. Just what the Nurse Practitioner ordered!
As an instructor, I think HESI is great. It has been studied (nursing research and evidence-based practice - don't you love it??? ) and it has been shown to have more than a 95% correlation to passing the NCLEX if the scores are above 850.
Yes, it is all about pass rates and accreditation, but those are the things that allow me and my program to continue teaching more hopeful nursing students. The State Board is very interested in assuring the public that the students who complete our program will be well-prepared to enter the profession.
My suggestion is to raise the bar earlier in the program - even in admission and selection - and to pass along only those students who attain 75% or greater in testing and comprehensive final examinations. Require students to begin early using computerized NCLEX style testing programs and to provide written and referenced rationales for every incorrect answer on every test they take in your program - don't provide it for them! "What the nurse does for the patient makes the patient strong", and likewise, what the teacher does for the student makes the teacher strong.
Here's hoping for a continued 100% NCLEX pass rate!

The exit exam practice is being increasingly questioned in nursing education. What happens is students who may actually pass the NCLEX are never given the chance to take it because of a HESI (or another exit exam) score.
HESI is good at predicting NCLEX success because it sets the pass score so high. HESI is NOT good at predicting NCLEX failure. A majority of the students who do not attain an 850 who are allowed to take NCLEX actually PASS.
This is documented in the August 2006 issue of Nurse Educator
Schools have this crazy policy because they want to have a good pass rate. So if the students have even a small chance of failing the school prevents them from taking the test and protects their pass rate.
It is not fair to the students to let them spend their time, money, and hard work for two to four years and then deny them the opportunity to fulfill their dream of being a nurse. It is the school's responsibility to prepare the students throughout their nursing program to succeed on the NCLEX.
Several states are looking into this practice. New York State has already banned it.
There is a lot of money to be made by the testing companies (more than 247,000 took NCLEX RN and PN in 2006). Profit seems to be fueling this practice.
Perhaps the students who were denied graduation should get together and seek legal advice, or at least register a complaint with your state board of nursing or NLNAC.