Developing and Implementing Policies for the HESI™ Exit Exam: A Qualitative Study

Purpose:

This phenomenological study will describe practices used by Associate Degree Nursing (ADN) and Bachelor of Science in Nursing (BSN) programs to create and implement policies and remediation practices regarding the use of the Elsevier HESI™ Exit Examination (E²).

Methods:

Purposive and snowball sampling was used to recruit a specific population of educators. Elsevier provided a database of over 600 nursing programs that used the E²from 9/1/2009 to 8/31/2010 for initial recruitment. Snowball sampling was used to recruit additional participants from ADN and BSN programs. The final sample was comprised of 15 deans, program directors, and faculty from nine different states.  

Results:

Policies are living documents that evolve and change over time. NCLEX-RN^® scores were the primary reason that schools made changes to their exit exam policy. This study found that the E² is not a graduation criterion at 87% (n=13) of the schools. A benchmark of 850 was set for success at 66% (n=10) of the schools. All of the schools in this study used some form of remediation. Giving value to the E² Exit Exam was essential to most of the study schools. Both students and faculty were found to be accepting to the changes applied as new polices were written and student E² Exit Exam success increased.

Conclusion:

Policy changes are in a constant state of evolution. A negative trigger initiates a need, forcing a change that stimulates improvements. In most instances faculty are responsible for planning the policy change unless another policy making body hands down a decision regarding what a new policy.  Following a policy change, there may be resistance on the part of students and faculty that eventually resolves into acceptance of the new policy. The status quo then remains in place until the next negative trigger occurs, beginning the process all over.