HESI T
A H
E
-B
R
H
AND
H
The Health Education Systems, Inc. (HESI) Exit Exam (E
2
) was originally developed using sound educational principles. In an effort to ensure product quality and to scientifically address the development of new HESI testing products, these principals continue to be practiced today, thereby adding to the evidence-based testing science and significantly contributing to the scholarship of educational practice. This review sequentially presents the evidence related to the E
2 by study details and outcomes and sets the stage for the continued work presented in this supplement to the Journal of Professional Nursing . (Index words: HESI; Health Education Systems, Inc.; Standardized testing; Exit
Exam; E2; Validity) J Prof Nurs 29:S2
–
S4, 2013.
© 2013 Elsevier Inc. All rights reserved.
S
INCE THE INCEPTION of Health Education Systems, Inc. (HESI) in the early 1990s, evidence-based research has driven the development of HESI testing products. Following Elsevier's acquisition of HESI in
2006,
1 this research-focused practice has continued to be the guiding force behind ongoing product evaluation and new product development. HESI's mission has always been to provide students with psychometrically sound standardized testing and review materials that address individual students' remediation needs, which are identified by their exam scores. As faculty expand their understanding of how to best implement standardized testing within their particular environment and how to use the exam findings to enhance students' remediation efforts, they are better able to help students who are seeking careers in nursing or other health professions achieve licensure or certification success.
This introduction provides a historical perspective of the previously published research related to HESI testing.
The first exam developed by HESI — the HESI Exit Exam
(E
2
)
— is the subject of nine validity studies conducted
*Vice President, Review and Testing/HESI, Elsevier Health Science,
Houston, TX.
†
Founder of HESI, Nurse Consultant, Houston, TX.
Disclosure Statement: Dr. Nibert is employed as Vice President of HESI
Review & Testing. Dr. Morrison is the founder of Health Education
Systems, Inc., which was acquired by Elsevier in 2006, and currently serves as a consultant to Elsevier.
Address correspondence to Dr. Nibert: 11011 Richmond Avenue,
Suite 450, Houston, TX 77042. E-mail: a.nibert@elsevier.com
(A. Nibert), smorrison13@gmail.com
(S. Morrison)
1
HESI
™ is the trademark granted to Elsevier at the time Health
Education Systems, Inc. products were acquired by Elsevier.
8755-7223/12/$ - see front matter
S2 http://dx.doi.org/10.1016/j.profnurs.2012.06.004
over the past 13 years ( Adamson & Britt, 2009; Langford
& Young, 2013; Lauchner, Newman, & Britt, 1999;
Lewis, 2005; Newman, Britt, & Lauchner, 2000; Nibert &
Young, 2001; Nibert, Young, & Adamson, 2002; Young
& Willson, 2012; Zweighaft, 2013 ). These studies
investigated the accuracy of the E
2 in predicting success on the National Council Licensure Examination for
Registered Nurses (NCLEX-RN). Based on a total student sample of 49,115, the E
2 was determined to be between
96.36% and 99.16% accurate in predicting NCLEX-RN success. Each of the nine validity studies also investigated one or more additional variables related to HESI testing, for example, the effects of monitoring, the predictive accuracy of repeated testing with parallel versions of the
E
2
, and the impact of administering HESI Specialty
Exams throughout the nursing curriculum.
Figure 1
describes the findings of the E
2 validity studies. Data analysis for the tenth validity study and data collection for the eleventh validity study are currently underway.
The historical accuracy of the E
2 in predicting NCLEX-
RN success is an outcome of the conceptual framework used to design the research studies. The model for writing critical thinking test items, the ongoing item analysis of all exams returned to Elsevier for scoring, and the application of the HESI predictability model to the test scoring algorithm are described in this conceptual framework
( Morrison, Adamson, Nibert, & Hsia, 2004; Morrison &
Free, 2001; Morrison, Nibert, & Flick, 2006 ).
HESI testing products were originally designed and produced for undergraduate and advanced practice nursing students, as well as newly hired hospital employees and licensed nursing professionals in specialty units within acute care settings. After the acquisition of HESI by Elsevier, HESI testing was expanded to offer standardized testing to students preparing for certification in other health care professions, such as
Journal of Professional Nursing, Vol 29, No. 2S (March/April), 2013: pp S2
–
S4
© 2013 Elsevier Inc. All rights reserved.

HESI
—
HISTORICAL PERSPECTIVE S3
Figure 1
. History of HESI Exit Exam Validity Studies.

S4 NIBERT AND MORRISON emergency medical technicians, radiographers, and medical assistants. More than 50 research studies have been published describing the use of HESI testing within nursing, health care settings, and other health care professions. A reference list of HESI-related research is available online (
Elsevier, n.d.
).
The Review and Testing division of Elsevier and the editors of Journal of Professional Nursing partnered to develop this supplement because nurse researchers believe that the assimilation of HESI-related research within one resource can benefit those who wish to launch new research efforts and can therefore help expedite dissemination of knowledge related to HESI testing. The articles selected for this supplement have undergone the same rigorous peer review process as required for all manuscripts submitted to the Journal of Professional
Nursing . It is our hope that the new research findings presented in this supplement and in the reference list provided on the Elsevier Web site will inspire another generation of researchers to further expand the science supporting these products and the dissemination of knowledge surrounding standardized testing as used by nursing and health professions.
Adamson, C., & Britt, R. (2009). Repeat testing with the HESI
Exit Exam
—
Sixth validity study.
CIN: Computers, Informatics,
Nursing , 27 , 393 – 397.
Elsevier. (n.d.). HESI Assessment Advantage: HESI Research.
Available from http://www.elsevieradvantage.com/article.jsp?
pageid=11887 .
Langford, R. & Young, A. (2013). Predicting NCLEX-RN success with the HESI Exit Exam: Eighth validity study.
Journal of Professional Nursing , 29 , S5
–
S9.
Lauchner, K., Newman, M., & Britt, R. (1999). Predicting licensure success with a computerized comprehensive nursing exam: The HESI Exit Exam.
Computers in Nursing , 17 , 120 – 125.
Lewis, C. (2005). Predictive accuracy of the HESI Exit Exam on NCLEX-RN pass rates and effects of progression policies on nursing student Exit Exam scores.
Dissertation Abstracts
International, 66 , 154B (UMI No. 3195986).
Morrison, S., Adamson, C., Nibert, A., & Hsia, S. (2004).
HESI exams: An overview of reliability and validity.
CIN:
Computers, Informatics, Nursing , 22 , 220 – 226.
Morrison, S., & Free, K. W. (2001). Writing multiple-choice test items that promote and measure critical thinking.
Journal of
Nursing Education , 40 , 17 – 24.
Morrison, S., Nibert, A., & Flick, J. (2006).
Critical thinking and test item writing (2nd ed.). Houston, TX: Health Education
Systems, Inc.
Newman, M., Britt, R., & Lauchner, K. (2000). Predictive accuracy of the HESI Exit Exam: A follow up study.
Computers in Nursing , 18 , 132 – 136.
Nibert, A., & Young, A. (2001). A third study on predicting
NCLEX success with the HESI Exit Exam.
Computers in Nursing ,
19 , 172 – 178.
Nibert, A., Young, A., & Adamson, C. (2002). Predicting
NCLEX success with the HESI Exit Exam: Fourth annual validity study.
CIN: Computers, Informatics, Nursing , 20 , 261
–
267.
Young, A., & Willson, P. (2012). Predicting NCLEX-RN success: The seventh validity study of the HESI Exit Exam.
CIN:
Computers, Informatics, Nursing , 30 , 55 – 60.
Zweighaft, E. (2013). Impact of HESI specialty exams: The ninth HESI Exit Exam validity study.
Journal of Professional
Nursing , 29 , S10 – S16.