Advance Practice Nursing (APN) Students Use of Standardized Testing

Purpose:Advanced Practice Nurse (APN) education is expanding worldwide (i.e., Australia, Canada, Germany, Hong Kong, Mainland China, United Kingdom, and United States). In the 2014-15 academic year, the United States (U.S.) had an estimated 20,000 nurse practitioners who completed their academic programs and joined the ranks of an estimated 222,000 practicing APNs. Of the APNs in practice, approximately 49.9% hold hospital privileges and 95.2% prescribe medications. To ensure that APN graduates are prepared to provide these services and to meet state mandated regulations, certification is required. U.S. APN programs are evaluated on their graduates success in passing the certification exam and, ultimately, being licensed as APNs in their respective states. As a result, faculty members implement standardized testing to predict graduate success on the certification exam. These exams must be validated on regularly to ensure continuing predictive ability of certification exam success by varying groups of students and that revisions in the certification exams remain consistent. Standardized exit and specialty exams for the core courses of Pathophysiology, Pharmacology, and Physical Assessment (3Ps) are used. Both the specialty exams and the exit exam provide cumulative testing for the APN programs. The aim of this research was to establish the predictive validity of one set of standardized examinations for APN certification success in a national U.S. sample and to determine implementation strategies used by these facilities.

Methods: An ex post facto descriptive correlational and comparative design was used to assess the correlation of the specialty exams with the exit exam and the pass rates for each of the scoring intervals on the specialty and exit exams. Electronic surveys were mailed to directors of 114 graduate nursing schools that administered the APN exam for Family and/or Adult Gerontology to APN students during the 2009 - 2015 academic years. Data were collected regarding students APN national certification examination outcomes and the schools’ implementation strategies and policies.

Results: Certification outcomes were reported for 631 APN students. Students with scores ranging from 700 to 1168 accurately predicted certification exam pass rates 99.5% of the time. Few schools had exit policies, established benchmark scores, or included the standardized exam as part of course grades. The most frequently cited remediation strategy was tutoring either by live review courses or faculty developed review sessions.

Conclusion: Results from a national, multi-site, U.S. sample of graduate programs indicated that electronic standardized end of program assessments are highly accurate at predicting APN certification success. End of course APN specialty exams are utilized by faculty to determine their students’ standings compared to the national sample. These findings are consistent with preliminary benchmark setting studies for this APN exam which set minimum scores of 750 or higher. Testing summary reports provide faculty with an opportunity for input into curricular evaluation. Faculty’s top reported implementation strategies, steps in policy development, and strategies for curricular evaluation will be discussed.