The validity of a new test of nursing competence

Clinical decision making competence is critical to the safe practice of professional nursing. Decisions about who is competent to practice as a registered nurse (RN) are based on the National Council of State Boards of Nursing Licensure Examination (NCLEX-RN{dollar}sp{lcub}rm TM{rcub}{dollar}), a 300 item, multiple choice question (MCQ) test. It is frequently argued that the MCQ format is not flexible enough to capture the essential components of clinical competence.; Computerized Clinical Simulation Testing (CST{dollar}sp{lcub}rm TM{rcub}{dollar}) is uncued by questions or answer options and may provide more authentic measures of decision making competence than those obtained from MCQs. The purpose of this study is to explore the validity of CST.; A sample of 231 volunteer nurse licensure candidates (155 graduates of two-year Nursing (ADN) programs and 76 graduates of four-year Nursing (BSN) programs) was used. The Rasch Partial Credit Model (RPCM) was used to obtain person measures and item calibrations. Fit statistics were used to investigate the fit of the data to the model. Most disturbances in item fit were explained by problems with the simulation system and scoring keys. As a result, some items were rescored.; Recalibration of cases following rescoring of items resulted in indices of test accuracy, and item and person fit and spread, which support the validity of CST. Reliability estimates for cases ranging from.88 to.95 were obtained.; Interitem correlations ranging from.65 to.69 and correlations of performance on one case with the composite of other cases ranging from.73 to.76 gave support to unidimensionality of the construct within and across cases. Consistency between judge ratings of CST performance and CST scores supported the validity of the CST scoring system. Low correlations between performance on CST and MCQ NCLEX, as well as contradictory CST and MCQ NCLEX pass/fail decisions, suggested divergence of constructs. And, as expected, BSNs out-performed ADNs suggesting that CST is sensitive to differing levels of competence.; In conclusion, these findings provide evidence which suggests that CST is a valid assessment of clinical decision making competence. If future studies expand these inquiries and replicate these findings, CST holds great promise for the future of nursing competence assessment.