Infusing Technology in a School of Nursing

February 17, 2016 Mallory Stein

Barbara Blackwell EdD, RN-BC


Nurses have several things in common, but one of the first commonalities that all nurses share is their requirement to practice and obtain a license by successfully passing the National Council Licensing Exam (NCLEX-RN). This exam has been administered in a computerized format since 1994. Despite this fact, many programs have been slow to adopt electronic testing. Our program began an initiative of computerized testing in the spring of 2014. This initiative required detailed planning and much preparation before the official introduction in the fall of 2014.

Beginning the Process 

Once the decision was made to move to an electronic testing platform, a choice had to be made as to which platform to choose. Three different testing solutions, were investigated; one within our current learning management system (LMS), another based in the testing platform we presently use, a scantron type of program, and last was a server-based software program. Faculty were very involved in the software purchasing decision. Webinars were scheduled to train faculty on each platform so that a determination could be made as to which one met our school’s needs. Of the three choices, testing within our LMS seemed to be the most logical choice. This would provide the data in the format we were most familiar with, and would not come with a high cost, as it was a part of the system that we were using. The LMS solution had many of the desirable attributes we were looking for, however it did not have the level of item analysis we wanted.  The scantron solution did have a high level of discernment, however, the ability to simulate the questions our students would encounter in the NCLEX-RN Exam was non-existent. The third choice, the server-based testing platform, was quickly ruled out, as it did not provide the ability to simulate NCLEX style questions which we felt was very important to student success. 

Trialing Electronic Testing 

Our school has a Licensed Practical Nursing program (LPN) which usually has an enrollment of approximately 40 students. This smaller program allows us to trial initiatives on a smaller scale before we roll out on the large scale to the registered nurse (RN) program, with an enrollment of approximately 110 students. The LPN program trialed two of the potential testing platforms. After a one year trial of using the LMS testing portal the decision was made to press forward and introduce this testing system into the RN program in the fall.

Electronic Testing- A change of mind 

Before we began to assign training times to the RN faculty on the LMS testing platform, I attended a conference on technology in Philadelphia. One of the conference topics was on electronic testing. Although this conference did not recommend a distinct platform, they did have suggestions on how to make a decision on which product to use. Many of the suggestions were also considerations in our decision; such as ease of use, ability to import exams from our previous platform, ability to create exam questions in the formats used on the NCLEX exam, detailed item analysis, student performance analysis, and an exam blueprint that yields actionable information for program improvement.

We found that the LMS testing platform truly did not have what we wanted. Although it did give us the ability to create exams in the NCLEX format, we would be sacrificing the level of exam and student analysis that we felt we needed.  ExamSoft offered a high level of exam analysis, the ability to create NCLEX type questions, and detailed question evaluation. After a detailed assessment of the product by our faculty, ExamSoft seemed to provide all of the things that we were looking for in a testing platform, along with a level of test security not available in the other electronic testing programs. We decided to scrap all plans to use the LMS as our testing platform and to use ExamSoft.

IPad vs Laptops 

Once the decision was made as to which platform to use, we had to determine if we would have our students test on laptops, Chromebooks, or iPads. Information Technology (IT) supplied a few Chromebooks to trial and spent a great deal of time testing the functionality with our other software programs.  A major consideration was the compatibility with a vendor that we use for curriculum alignment, active learning, and formative assessment. It was found that Chromebooks were totally incompatible with this vendor. After a further investigation with our IT department on pricing, utility and a survey with the students, we decided on an IPad Initiative for the student testing. One factor that concerned us was the ability to control student browsing during class time. IT chose a software solution that not only allowed us to control browsing on sites such as Facebook, Twitter, Snapchat, and Instagram, during school hours , it also allowed us to push content and software to all of our students.

Planning for Electronic Testing 

We began the process by creating a steering committee that would serve as the stimulus to push through the change and determine policy. This committee consisted of four faculty members, two from the senior faculty and two from the freshman faculty. The committee facilitated the decision on what items we wanted to track for accreditation purposes and helped to determine policy.

Part of the planning process included determining an approach for item writing, question approval, and the creation of the categories for the test blueprints. To ensure that everyone would start with the same knowledge base we brought in an expert in item writing and exam analysis for a one day workshop. This work shop was extremely interactive and consisted of actual question writing, question critique, and item analysis.  The class enhanced the knowledge base for all faculty.  The process toward computerized testing for us, was long and painstaking; the effort and the learning curve continue. However the outcomes and data acquired for program and student improvement have been well worth the work.

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