Credentialing and Licensing Excellence: NCSBN’s Journey

Dania Eter, MBA Associate Director, Examinations

Objectives

    NCSBN Mission – Protect the Public!

Journey into credentialing and licensing excellence NCLEX, NNAAP and MACE strengths Opportunities to further our mission

The Importance of Credentialing

 Nurses are the second largest group of licensed professionals  Over 2.5 million nurse aides are practicing in nursing facilities  700,000 nurse aide positions will need to be filled in the next 25 years  By 2030, 71.5 million will be at the age of 65 or older  68% will probably be disabled

The Importance of Credentialing

Credentialing ensures that only safe and competent nurses, nurse aides and medication aides are allowed to practice.

Protecting the Public

NCSBN Mission:

The National Council of State Boards of Nursing (NCSBN) provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.

NCSBN Background

     Thirty-two year old, not-for-profit organization consisting of 59 state and territorial boards of nursing Owner and developer of the U.S. nurse licensure examinations (NCLEX-RN ® and NCLEX-PN ® ) Owner and developer of the largest National Nurse Aide Certification Examination (NNAAP ® ) and Medication Aide Certification Examination (MACE ® ) in the U.S.

Developing exams since 1978 Administering NCLEX computer adaptive exams since 1994, to more than 3.4 million candidates

NCSBN Examinations Department Background

   19 NCSBN staff members assigned to examinations program operations Combined experience of over 80 years in nursing and testing Examinations Department:  Provides psychometric, nursing and administration expertise  Conducts RN and LPN/VN practice analyses, nurse aide and medication aide job analyses  Develops NCLEX, nurse aide and medication aide test plans

Assessment of Entry-Level Competency

  National Council Licensure Examination for LPN/VNs (

NCLEX-PN

)  National Council Licensure Examination for RNs (

NCLEX-RN

) National Nurse Aide Assessment Program (

NNAAP

)  Medication Aide Certification Examination (

MACE

)

Why is NCSBN a leader in the world of Licensing/Credentialing?

 NCLEX Facts:  NCLEX is the successor to the SBTPE, the national nurse licensure examination used by various state boards of Nursing for more than fifty years prior to 1982  NCLEX has been administered via computer exclusively since 1994 when it was converted from Paper and Pencil to CBT administration   Examinations administered continuously, on-demand in approximately 240 NCSBN approved Pearson Professional Centers around the world Both NCLEX-RN ® and NCLEX –PN ® computerized adaptive examinations are variable length,  Passing standard is evaluated every 3 years concurrent with any test plan changes

Why is NCSBN a leader in the world of Licensing/Credentialing?

 NNAAP/MACE Facts:  In 2008, NCSBN acquired exclusive ownership of the intellectual property for two certification examinations  NCSBN uses the following guidelines when developing the NNAAP and MACE exams:  Model Nurse Practice Act and Model Nursing Administrative Rules   OBRA federal regulations for nurse aide programs Model curriculum for medication aide programs  Examinations administered continuously in approximately 343 Pearson Regional Test Sites in the U.S. and offered in thousands of in-facility sites to the nurse aides that train in them  Passing standard is evaluated every 5 years concurrent with any test plan changes

Candidate Volume

     Over 200,000 candidates sit for the NCLEX-RN ® examination each year, 75,000 sit for the NCLEX PN ® examination Over three million examinations administered since 1994 32,074 examinations administered in international test centers in 2010 About 300,000 sit for the NNAAP exam each year Over 1,000 sit for the MACE each year

How is NCSBN able to protect the public?

Robust Examinations due to:  Diligent test development processes   Practice analyses/job analyses (research) Experienced Subject Matter Experts  Strong psychometric expertise to insure legally defensible exams    Top test delivery services, Pearson VUE High security measures Prompt customer services

Exam Development Process

1. Practice Analysis 2. Test Plan 3. Item Writing and Item Review 4. Subject Matter Expert (SME) Panel Review 5. Editorial Review 6. Building Test Forms 7. Setting the Passing Standard 8. Pretesting of Items 9. Administering Examinations

NCLEX ®, NNAAP ® and MACE ® Exam

Item Writing Practice Analysis Board of Nursing DIF Review (NCLEX) Committee Review (NCLEX) Test Plan Item Review Sensitivity Review

How the Process Works

Practice Analysis  Conducted every three years for NCLEX and every five years for NNAAP and MACE  Ensures that the content of the exams reflects the practice of entry-level nurses, nurse aides and medication aides Test Plan  The test plan provides guidelines for:  Candidates preparing for the exam   Direction for item development Facilitation for classification of exam items

How the Process Works – Continued

Exam Development Meetings

 Standard Setting  SMEs determine the passing standard based on knowledge of minimally competent professionals  Item Writing  SMEs write exam items based on their familiarity with entry-level professionals and current practice  Item Review  SMEs working directly with the professionals who have entered practice in the past 12 months review items for accuracy, currency and one correct answer  Sensitivity Panel (NCLEX)  Experts review item wording to eliminate language that could be considered elitist or stereotypical, words that have different meanings to different ethnic or geographic groups, and/or words that have an inappropriate tone

How the Process Works – Continued

     Pretest  All newly written items are administered to at least 400 first-time, U.S. educated test-takers in order to gather statistical information DIF Panel  Items that perform significantly different for a minority group are flagged for Differential Item Functioning (DIF), which indicates potential item bias Member Board Review  Member boards are invited to review sample exams and pretest items two times each year, and provide feedback (NCLEX only) NCLEX Item Review Subcommittee  The NCLEX Item Review Subcommittee (NIRSC) members consist of board of nursing representatives and the group reviews all pretest and master pool items Master Pool Review  Expert review items throughout the year in order to ensure that the exam is current

Psychometrics

Expert team of psychometricians ensure that research is done on the following:     Measurement construct – does the exam measure entry-level knowledge?

Ability – measured through practice analysis Content balancing – all areas of the test plan are represented Difficulty – ensure that item difficulty varies for every exam taken

Psychometrics - Continued

    Testing models – is ability consistent with difficulty?

Differential item functioning – are all items testing only nursing content?

Readability analysis – are candidates confused by item wording?

Standard setting – does the passing standard reflect the minimum amount of ability that an entry-level candidate must have?

Administration (NCLEX)

     Approved Pearson Professional Centers 221 in the Americas, 19 internationally On demand delivery Exam security   Ability to legally prosecute cheaters Biometric Collection ADA accommodations Stellar and prompt customer service

Administration (NNAAP/MACE)

     343 Pearson Regional Test Sites in the U.S., rural and urban locations Thousands of in-facility locations On demand examinations ADA accommodations Stellar and prompt customer service

LOOKING FOWARD

Work settings

CNAs  Long-term care/nursing home  Home health and home care  Hospital  Continuing Care Retirement Community (CCRC)  Community Based Residential Facility (CBRF) CMAs/MA-C  Long-term care/nursing home  Continuing Care Retirement Community (CCRC)  Community Based Residential Facility (CBRF)  Schools

Direct-Care Providers

 Make up one of the largest and fastest growing workforces in the U.S.

 Projected need of 700,000 nurse aide positions to be filled in the next 25 years

Challenges

   Exposure – written forms (NNAAP) Confidentiality (Social Media) Endorsement - differences in rules for applying to test and retest from state to state

Opportunities

   Enhance security with computerized NNAAP & MACE forms, robust item bank Facebook/Twitter, etc… Become the sole provider of NNAAP & MACE… to continue to further our mission in Protecting the Public!

Conclusion

 NCSBN will continue to ensures robust examinations to protect the public  NCSBN will continue to expand its nurse aide and medication aide clients to ensure consistency in practice and become the voice for long-term care in order to continue to further its mission in protecting the public

Examinations Social Media

 Have your students:  NNAAP & MACE Examinations on Facebook  NCLEX-RN & NCLEX-PN Examinations on Facebook    NCLEXInfo on Twitter Examinations information at their fingertips!

Answers to their questions!

Thank you!

QUESTIONS?