As Assessment and Testing Consultant for Nursing Health and Education at Elsevier, Cheryl “Cherie” Mee helps nursing faculty integrate HESI products into their courses to assess student readiness for NCLEX licensure exams and their grasp of nursing concepts. HESI products helps students develop critical thinking skills they will need as practicing nurses. Cherie draws from her background in clinical practice and nurse education. She was an ICU and critical care nurse, later managing medical surgical units at a hospital. Before joining Elsevier in 2007, she was Editor-in-Chief of the journal Nursing, and she taught nursing for ADN students beginning their BSN degree.
Recently, Cherie received the Excellence in Nursing Education Award from La Salle University’s chapter of the Sigma Theta Tau’s International Honor Society of Nursing. Afterwards, I interviewed her about her work and how technology is transforming nursing education.
What’s special about HESI? Why isn’t it “just a test”?
HESI an extremely high quality assessment, with research supporting the exam’s predictive accuracy. The exam questions are developed at the application level and above on Bloom’s taxonomy. They’re high-level l questions requiring multilogical thinking to answer correctly. They can be very challenging for nursing students, and the (performance) data that faculty glean from the reports help them hone in on areas of potential weakness in their curriculum and provide individualized remediation for students.
So it’s much more than a test. Faculty can use it to benchmark how well students are performing and how much help they need, and make changes in their courses or curriculum to improve student outcomes. And we have a lot of research that backs that up: faculty have used HESI exam data as they make changes to courses and curriculum, and their pass rates have improved.
Where is this data coming from?
Each question is mapped back to multiple content areas. For example, NCLEX has categories like “Safety and Infection Control” and “Management of Care.” So as faculty, you can look at students’ performance on questions in that content area and say, “The past few groups scored low in ‘Safety and Infection Control.’ Do we need to look at how are we covering that in the courses and the curriculum and what can we do better?” You might add some case studies around Safety and Infection Control and related exercises in the simulation lab. Then look at the data again after the change and see if students are performing better.
So you can see how scores go up over time if people use it?
Yes, exactly. You can evaluate the data, make a change, and see if there was an improvement. You should use HESI data in conjunction with data from other assessments and not solely use HESI data. Accreditation bodies like to see that faculty are using data, identifying where they might have potential weaknesses, digging deeper into that and making changes, then reevaluating in a continuous quality improvement cycle. And nursing faculty are used to that because we use continuous quality improvement in nursing practice.
What did you did learn in clinical practice that you apply in your current role?
The concept of clinical competency for a nurse. When we talk about nursing education and the licensure exam, we want to know that the students can think critically, meaning they can go beyond memorizing facts to put that knowledge together and apply it to managing patient care. It’s really a much higher, complex level of thinking. It isn’t easy to teach or learn nursing. Students come in as “knowledge and understanding” thinkers in many ways. They’re used to the sciences and math, for example, and much of their learning was based on gaining knowledge, learning facts, and memorizing. Many did this well in school, but now they need to put all these pieces together and prioritize what’s going on with a patient. Nursing education is a demanding profession, and I respect faculty tremendously.
I remember when I first started, I wanted to be a critical care nurse so badly; it seemed exciting, and I loved figuring out what was wrong with acutely ill patients. But once I got into ICU practice, it was a bit intimidating and very demanding. I had to take a step back and say, “Wow, did I make the right decision?” I had to learn a lot, including how to manage the workload and emotional stress.
There’s that level of independence when you have to make decisions and you’re managing critically ill patients on the unit. Prioritizing care can get complex.
Now, realizing what it takes to take care of a patient helps me understand students and how we need to help them become critical thinkers so they can be good practitioners. It’s not a simple formula, but I guess that’s what I bring with me from clinical practice.
What are some of the challenges people in the field are facing, and how is technology changing the way they work?
With the technology we have in education, we have so much at our fingertips, and we can search for things fast and get answers fast. But there’s still a learning curve to use the digital products in education and embed them into your course, and there is still some preparation. But it’s just so much different than it used to be.
For nursing faculty, at one time everything was all textbook teaching. Then everybody used PowerPoint. But now, we’re trying to make the classroom interactive and getting students really into the topic and doing that higher level critical thinking as a group. And making that classroom environment stimulating is still challenging and time consuming.
We do have the tools to help faculty take the class to a new level, but there is still some up-front work to prepare your class and get those digital products working together. Getting students learning the content before class so that then the class becomes a place for discussion, dialogue and application of the knowledge makes class room time so valuable and a place for putting the pieces together. Helping students apply the knowledge to the real-life work of a nurse can be challenging. But It can very rewarding for both the educators and the students when they get to that level.
Does HESI suggest lesson plans, or do teachers come up with their own?
We have products that help prepare the students. For example, HESI develops case studies, practice tests, and patient reviews to prepare students for those high-level critical thinking questions that are on the test. There are 100 different case studies for RN students (we have them for PN students as well), and each has 25 to 30 questions. Students can review a case study as a homework assignment, and then the faculty can use that case study in a class discussion, asking students, “Why would you pick this answer?” All the answers are correct, but students need to select the best response.
Faculty can also ask “what if” questions, like “What if the patient presented with these symptoms instead?” This helps the faculty cover other concepts, and it helps the students shift their thinking and think critically like a nurse in the field.
Faculty can then see item analysis details to determine which questions were the most difficult for the group, focusing on these topics in the following class.
These types of questions mimic the questions students will get on their licensing exam.
Actually, the process of answering high-level questions helps cement your learning. There has been a lot in the literature about retrieval practice: the professor presents something, you study it— and then pulling and retrieving the pieces out of your memory to answer a high-level question helps with retention. By “retrieving” that information, you’re making it more “available” when you need that information again.
So HESI becomes part of the curriculum?
Right. HESI products prepare students for testing, assess students’ strengths and weaknesses, and provide remediation after the exam. So your students aren’t just getting those high-level questions on the test at the end of a semester. I think it’s important for faculty to start exposing students to those high-level questions from day one. We don’t have that much time with students, so we need to help them understand critical thinking early.
How does your work with Elsevier compare to what you used to do in terms of challenges and satisfaction?
Well, I loved patient care. Way back when I worked in a trauma center, we treated teen and adult patients. I remember a teen coming back to our unit for a visit after brain trauma from a motorcycle accident, time in a coma and months of rehab. Having that visit from critically ill patients, seeing them walking and talking and coming back with big smiles – there are just no words for how amazing and rewarding that was.
It was also great to manage a unit and see change and improvement in outcomes.
But now, I think helping faculty with data and using our products more effectively – and then seeing improvements in student outcomes – is exciting. It’s hard to believe I get excited about data, but I do. A lot of schools use the data: they analyze it, they made a change and then they have more students doing better in class and passing the licensing exam. I help faculty analyze the data and decide which changes are the most important so they can prioritize change to make it most effective. That’s really exciting – that’s why I keep doing it. So it’s kind of weird to be excited about data, but I am.
It’s not weird, because data means more than data; it’s an indication that you’re helping people be more successful.
Right, it’s something that you can use to make change and make improvements – as opposed to not using data and making a change, and maybe that wasn’t the right change. You want to make change where you can get the biggest bang for your buck, and the data can really help you focus your thoughts and put your energies in the right place.