A Framework for Increasing Pass Rates on High Stakes Exams

February 17, 2016 Sherri Ward

Sherri Ward, MNSc, RN, Clinical Instructor, University of Arkansas for Medical Sciences College of Nursing

Using the NCLEX-RN Blueprint as a Guide for Testing in a Baccalaureate Nursing Program

In the spring of 2014, the University of Arkansas for Medical Sciences College of Nursing (UAMS CON) requested a demonstration of ExamSoft for the baccalaureate program. We initially explored this particular testing platform because of security concerns with our current testing platform. The ability of the software to categorize exam questions and run reports both individually and longitudinally also piqued our interest, because our current testing platform could not perform to the same standards. The College of Medicine and College of Pharmacy in our Health Science Center were already using ExamSoft, and their feedback provided the College of Nursing with confidence that this solution was a reliable and useful tool.

During the demonstration, it became apparent that ExamSoft and its features might be the answer to course exam success and our goal of maintaining NCLEX-RN pass rates above 90% each year (ASBN, 2014). Three features stood out: (1) question categories, (2) the test plan blueprint, and (3) strengths and opportunities reports.

The UAMS CON faculty council voted to begin a pilot in one junior-level and one senior-level course during the 2014/2015 academic period and to report back to faculty in April 2015. The council compared the current platform with the post-pilot student surveys and voted to adopt ExamSoft by a slim margin. Faculty who opposed moving to a new testing platform were reluctant to make a change and deal with the learning curve involved in implementing new technology. Several other projects and changes were already taking place in the baccalaureate program and the prospect of adding another change was a bit overwhelming to these faculty members.

An Avenue for Student Success

UAMS CON established a subcommittee to make decisions about setting up the program’s database. Based on other student success strategies in our program, we decided to use the 2013 NCLEX-RN test plan (NCSBN, 2013, p. 4) as the framework for our own test plan structure.

We needed to determine which categories to use for our question bank. Following the example of the NCLEX-RN test, we decided to use categories based on Bloom’s taxonomy and the Client Needs framework (Atherton, 2013). The majority of items on the NCLEX-RN exam are written at the application level or higher on Bloom’s taxonomy of cognitive ability. There was much discussion about how many exam questions we should include at low and high levels in each course, and that discussion still continues.

The NCLEX-RN test plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories. This breakdown was a bit overwhelming to us, so we decided to use only the Client Needs categories that had percentages of distribution associated with them, as listed in the table below (NCSBN, 2013, p. 4). Doing so would allow us to easily compare our desired percentages to actual percentages, using the Blueprint feature provided by the software.

As an exam is constructed, the Blueprint feature identifies each category used on the exam as well as the number and percentage of questions that are in each category. This feature makes following the NCLEX-RN exam blueprint easy. Mimicking the NCLEX-RN blueprint gives our students repeated exposure to the layout of the licensure exam, contributing to student success and the overall pass rate.

The Strengths and Opportunities reporting feature  in ExamSoft allows for reports per exam and also longitudinal student reports. These reports include the categories associated with the exam, identifying the performance percentage for each category. Utilizing the longitudinal reports to gather data across the curriculum will help us identify where students need to focus their study prior to taking the NCLEX-RN licensure exam.

Identified Issues

How do we know which categories are appropriate for each question? If categories are not correctly assigned, then the purpose of using ExamSoft—to support our current pass rate—will fail. As a solution, we try to use established test banks for our exams, most of which have Bloom’s and Client Needs categories already assigned. The software provides filters for uploading these established test banks that include the categories, which solves the problem of knowing how to properly assign categories.

Where can we get additional education to ensure we are categorizing questions correctly? The National Council of State Boards of Nursing provides a Test Development and Item Writing course (NCSBN, 2015). This course was recommended to our faculty, and we all enrolled, receiving 17.5 contact hours and a wealth of information. We continue to look for educational opportunities to help us better understand how to correctly categorize questions.


The UAMS CON baccalaureate program will implement ExamSoft in all courses over the 2015/2016 school year. We will continue to survey students and utilize their feedback to improve our implementation process. We will collect data to see if the platform and its associated features impact our NCLEX-RN pass rate with future senior classes.

About the Author

Sherri Ward

Sherri Ward, MNSc, RN, is a Clinical Instructor at the University of Arkansas for Medical Sciences College of Nursing Baccalaureate Program. Prior to accepting her first position as faculty in nursing education, she worked at Arkansas Children's Hospital for 18 years, 5 of those in Nursing Informatics training, testing, building, implementing, and supporting electronic health records projects.

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