NCLEX-RN readiness: HESI Exit Exam validity and nursing program policies

The HESI® Exit Exam (E2) has been used to assess student readiness for the NCLEX-RN® examination for over two decades. In this study, we examined the relationship between students' average E2 scores and their first time NCLEX-RN pass or fail outcomes to understand the validity of the E2 as a predictor of NCLEX-RN readiness. In addition, we examined the relationship between policies governing E2 use in programs and success on the NCLEX-RN. Over 40 programs across the United States participated in the study, providing NCLEX-RN outcome information for 3686 students that took the E2 in 2018–2019 and information about policies. Students who achieved an average E2 score of 850 and above had a NCLEX-RN first-time pass rate (FTPR) of 96.33%. The NCLEX-RN FTPR was 97.29% for students whose average E2 score was 900 and above. Policies such as test preparation requirements and remediation for the E2 were associated with statistically significantly higher student NCLEX-RN FTPR. This study builds upon past evidence about the validity of the E2 and extends research in new directions by demonstrating the role of specific E2 policies in supporting students' success on the NCLEX-RN. •Student performance on the HESI Exit Exam is associated with first-time NCLEX-RN pass rates.•Nursing program policies impact students' HESI Exit Exam performance, which in turn predicts their success on the NCLEX-RN.•HESI Exit Exam benchmark scores of 850 and 900 predict students' success on the NCLEX-RN.•Test preparation and remediation policies impact students' success on the NCLEX-RN.