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Opinions vary about best way to use nursing exam under fire at Duquesne University

Ben Schmitt
| Thursday, June 8, 2017, 11:20 p.m.
Duquesne University campus is shown, Thursday, June 8, 2017.
Andrew Russell | Tribune-Review
Duquesne University campus is shown, Thursday, June 8, 2017.

A former high-ranking employee of the developer of a controversial test given to Duquesne University nursing students said the exam shouldn't be a student's sole graduation requirement.

UPMC executives and a Robert Morris University nursing school dean on Thursday defended Duquesne's use of the test, saying the school produces well-prepared nurses who save lives and advocate for patients.

The Uptown school found itself in the middle of a controversy this week as officials blocked the graduation of more than 20 students who failed to meet benchmark scores on a standardized test called HESI (Health Education Systems Incorporated). HESI aims to prepare students for the board exam needed for nursing licensure, the NCLEX.

The former head of consulting for the company that owns and sells the HESI test, Elsevier, wrote a blog post for its website addressing the use of standardized exams.

“Standardized tests should not be used as the single evaluation method to determine students' ability to sit for the NCLEX exams,” wrote Susan Sportsman, former director of consultation services for Elsevier. “However, to insure that students take the test seriously, their results should be a significant factor in the course grade for selected courses.”

An Elsevier spokesman, Christopher Capot, acknowledged Sportsman's blog post and her opinion about standardized testing, adding, “It's up to nursing schools to set whatever policy it believes is appropriate for its progression or graduation standards.”

Sportsman retired in May and works as a consultant, according to her LinkedIn profile.

Elsevier describes itself as “a global information analytics company that helps institutions and professionals progress science, advance health care and improve performance for the benefit of humanity.” Capot said the company, headquartered in Amsterdam, distributes HESI exams to hundreds of nursing schools across the United States.

Duquesne on Thursday responded that it is confident in its policies.

“The School of Nursing has selected this means of assessing learning and the passing score for this course, based on evaluation data and its nursing expertise,” said spokeswoman Bridget Fare, adding its goal is “to assist students in acquiring the requisite knowledge to successfully pass the NCLEX-RN and practice safely as a professional nurse.”

Duquesne required students to score 925 on the HESI exit exam before graduating. This resulted in 34 of 156 students not meeting graduation requirements. Duquesne then lowered the cut-off score to 900, which allowed nine more to graduate. Another student won an appeal and graduated.

UPMC Chief Nurse Executive Holly Lorenz said she believes tests like HESI are strong indicators of how a student will perform on NCLEX.

“I think the schools that use standardized testing help produce people who are more likely going to pass the state board,” she said. “That's what we all want. If this was my child, that's what I would want.”

UPMC has 14,000 nurses system-wide and hires 2,000 new nurses a year.

Lorenz said of Duquesne, “They produce an outstanding graduate. We're lucky to have them in our pipeline.”

Another nursing school dean also sided with Duquesne and its use of HESI.

Valerie Howard, dean of Robert Morris University's School of Nursing and Health Sciences, said some students might resist the test but it is effective.

“We do this to make sure our patients are safe and care delivered by nurses is safe,” she said. “The good news is that it works.”

Robert Morris requires an exit HESI exam score of 900.

Howard said students take HESI tests throughout their time in nursing school. During the last semester they are given two chances to achieve a 900 score. If they do not, they take a remedial course and a different standardized test, produced by Kaplan, as part of work to meet a benchmark, Howard said. This year, she said, 49 students all graduated without needing re-mediation courses.

Fare said Duquesne nursing students have several opportunities to take the HESI test, including once early in the year to give students the ability to work on any deficiencies. Following that, they must take the test twice and meet the benchmark at least once.

The National League for Nursing echoed some of Sportsman's thoughts on standardized testing, writing in a 2012 report: “It is the prevalent use of standardized tests to block graduation or in some other way deny eligibility to take the licensing exam that is most concerning to the NLN.”

Some Duquesne University nursing students have launched an online petition to protest the university's use of HESI.

“The students have maintained all along that being tested is fine,” said Paul Furiga, of WordWrite Communications, who is serving as a spokesman for some affected families. “What's not fine is making one single test a barrier to sitting for the nursing board exam. This blog post (by Sportsman) and a lot of scientific research demonstrates that's a very sound position.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991, or via Twitter at @Bencschmitt.

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