Nursing program experiences developing and implementing policies for the HESI exit exam

This descriptive phenomenological study described practices used by Associate Degree Nursing (ADN) and Bachelor of Science in Nursing (BSN) programs to develop and implement progression policies regarding the use of the Elsevier HESI^TM Exit Exam (E2) and related remediation methods. Purposive and snowball sampling methods were used to recruit 15 deans, program directors, and faculty from programs identified as using the HESI^TM E2. Semi-structured telephone interviews were conducted to discern policy practices and implementation experiences. Demographic data about the program and student populations were collected. Data analysis was accomplished using Giorgi's method of reading the transcripts as often as necessary, determining meaningful units of information, grouping these units into themes and finally determining similar meanings for the individuals. Of the 15 programs, 9 (60%) were BSN; while 6 (40%) were ADN. Three fourths of the schools were publically funded while one fourth were privately funded. Program size ranged from 135 to 684 total students. Students were predominately female (greater than 85%) although four schools had a male student population between 20% and 35%. Policy development was found to be a cyclical process initiated by Triggers for Change, followed by Policy Modification, which resulted in the final phase, Reactions to Change. This cycle was repeated whenever new triggers occurred. Participating programs had long standing policies that continually evolved based on factors affecting program outcomes and NCLEX-RN success rates. Policy changes were generally triggered by concerns regarding program outcomes, prompting faculty to examine their practices. In most instances faculty actively participated in Policy Modification either through curriculum committees or with small faculty numbers--using the faculty as a whole. Policies modified included timing of test administration, benchmark score minimums and penalties when benchmarks were not met, remediation practices, and placing value on the test score achieved. Reactions to Policy Changes reflected perceived initial resistance on the part of some students and faculty to the new policy. Resistance gave way to policy acceptance, particularly when benefits of the new policy were recognized.