The growth of new health information technologies is spurring on a communication revolution pointed towards delivering better health care and encouraging proactive health strategies. With these developments comes a series of questions surrounding the acceptance and implementation of new technologies, which affect diverse businesses and perspectives.

Defining eHealth Terms

Headlines on the eHealth revolution contain certain building blocks that should be defined to better understand the current state of the technologies: EMR, EHR, and PHR. Pinpointing the meaning behind these three acronyms portrays how daunting the responsibility to design effect eHealth communication tools is given the array of stakeholders sharing interest in the technology’s success (patients, providers, medical practitioners, insurance carriers, policy makers).

The National Alliance for Health Information Technology offered the following definitions in Defining Key Health Information Technology Terms (2008).

EMR – Electronic Medical Record – “An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.” (Bell et al, 2008) It is important to note that information on an EMR cannot necessarily be exchanged between organizations.

EHR – Electronic Health Record – “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.” (Bell et al, 2008) Given the industry’s push towards nationally recognized interoperability standards, EMRs will be phased out and replaced by EHRs.

PHR – Personal Health Record – “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.” The key difference here is the consumer, or patient, holds control over managing how the information is used and accessed. For a record to be considered a PHR, the individual must hold personal responsibility for disseminating the information.

The short of the definitions comes down to EMRs and EHRs being tools for medical providers. PHRs on the other hand focus on involving the consumer in personal health initiatives to enhance wellbeing.

Current PHR Affairs

By fostering an individual’s interaction through documenting, tracking and evaluating their health conditions a PHR can lead to better informed health care decisions, superior health status, and thus, reduced health-related costs and superior quality of care. (Bell et al, 2008) With all of these benefits, where are PHRs falling short for today’s consumer markets? Developing a widely accepted technology warranting frequent interactions from a colossal population base is challenging for any marketer. But, put the jeopardy of individuals’ lives on the line and the stakes rise to an all-time high.

Communication proves a challenge for current PHRs. Although considered an emerging technology in the United States, PHR initiatives have been implemented in other nations. The successes and failures of countries such as Englad, Germany, Canada, Denmark and Australia serve as guidelines for realization of PHRs in the US. (Deutsch et al, 2009) Kreps and Neuhauser suggested new directions in which to take PHRs nationally in their article Rethinking Communication in the e-Health Era:

1. Enhance interactivity between consumer and caregiver –Medical guidance counselors should have collaborative lines of communication with which to share feelings and beliefs regarding treatment. Delivery of medical information can intimidate or discourage adoption of advice. (Neuhauser et al, 2008). Internalizing instructions occurs when recipients have an active role in the collaboration phase.
2. Increase interoperability of PHRs – Being able to send and receive health records in a timely fashion is of utmost importance; however, little progress has been made to develop national standards that would enable seamless use of PHRs.
3. Create dynamic and engaging communications – Capturing and holding an individual’s attention generates more challenges than ever before while crossing communication barriers such as literacy, language, culture, or disability will be no small feat. Capitalizing on the social networking frenzy may further the acceptance of the new technology.
4. Cost effect design control – Creating a personalized PHR feel without the personalized web-development cost is paramount. Interpersonal approaches to past health communication outcomes have proven to be more successful than targeting the mass media. The wealth of information available on the internet for free prohibits the typical consumer from justifying the purchase of a PHR. The time docked creating or using a free PHR may even seem like to much of an investment. Therefore, cost of the systems must be kept low.

Two other barriers prohibiting the use of PHRs are privacy and security. Ethical concerns surrounding privacy or confidentiality remain a hot topic for debate. All parties interested in PHRs have legal or ethical responsibilities to keep patient information confidential. However, many PHR companies do not feel obligated to follow HIPPA Privacy regulations.

The possibilities surfacing from standardized PHRs are seemingly endless…

• Web-cam Doctor Consultations
• Electronic Prescription Approval
• Personalized, Free Health & Wellness Plans

Consumers, medical professionals, and health care organizations would benefit from the additional information gleaned from a comprehensive and well-maintained PHR. Improved patient safety and health outcomes could be the result of PHRs for business stakeholders, while patients could benefit from more comprehensive health care and possibly healthier lifestyles.

Interested in learning more?

Bell, K. & Bradford, A. (2008). Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. Department of Health & Human Services.

Deutsch, E., Duftschmid, G. & Dorda, W. (2010). Critical Areas of National Electronic Health Record Programs – Is Our Focus Correct? International Journal of Medical Informatics (79), 211-222.

Neuhauser, L. &. Kreps, G. (2003). Rethinking Communtion in the e-Health Era. Journal of Health Psychology (8), 7-22.
 

High Point, NC (Vocus/PRWEB ) March 25, 2010 — Amistaff Healthcare Technology, Inc. – leader in healthcare competency – continues to raise standards of validated exam development with their NurseTesting.com service releasing the new Registered Nurse Medical/Surgical Exam and Registered Nurse Pharmacology Exam. Utilizing a new validation process never before applied to healthcare competency exams, hospitals and healthcare staffing firms receive access to exam content linked directly to specific job functions and requirements. Assisting with hiring and retaining the most qualified personnel for healthcare positions directly correlates to improving quality of patient care.

The new exams augment NurseTesting.com’s extensive exam library which follows standards set forth by The Joint Commission (a national healthcare standards organization). The new content validation process takes the Uniform Guidelines on Employee Selection Procedures (1978) and applies them to the development of these assessments.

We are confident that with the use of our newly validated exams, a more accurate assessment of healthcare professionals will be available, empowering the employer to select the best candidate for the position, thereby improving the quality of care being delivered to patients across the country.

The two phase development process starts with an in-depth Job Analysis where Subject Matter Experts (SMEs) provide a series of ratings for key job/duties/tasks and specific knowledge, skills, and abilities expected of healthcare professionals on the first day of the job. Then SMEs develop a test plan and begin writing items for exams.

During both phases statistical data is collected and analyzed (i.e. inter-rater reliabilities and Angoff ratings) yielding final recommendations for which items to include in the assessments. The data collected affords the opportunity for assigning initial unmodified Angoff Cutoff Scores. Widely-used arbitrary cutoff scores leave hospitals and staffing agencies wide-open for adverse impact claims. Amistaff’s validation process helps minimize legal responsibility for hospitals and staffing agencies from the use of pass/fail cutoff scores.

Overseeing the implementation of the research and revision system, Chief Nursing Officer, James Ostmann Sr. RN, MBA, states, "We are confident that with the use of our newly validated exams, a more accurate assessment of healthcare professionals will be available, empowering the employer to select the best candidate for the position, thereby improving the quality of care being delivered to patients across the country."

Amistaff will continue utilization of this rigorous content validation process on future exams in an effort to provide high caliber pre-screening assessment tools for the healthcare industry. Implementing pre-screening standards aimed at hiring and retaining the best qualified healthcare professionals attests to facilities’ and staffing agencies’ commitment to improving quality of patient care.

About Amistaff Healthcare Technology – Amistaff Healthcare Technology was founded in 2004 as a healthcare staffing solutions provider. Amistaff creates products and services that help hospitals and healthcare staffing firms improve recruitment, retention and placement of caregivers. Amistaff includes a team of IT professionals, RN’s and former recruiters allowing Amistaff to base their products on an in-depth understanding of each client’s unique staffing requirements. All of the Amistaff products, including Prophecy Health, NurseTesting.com, and BlueSky Medical Staffing Software, are web-based solutions designed to simplify workflow and increase efficiency. Visit www.amistaff.com for additional information.

Christine P. Carrington, President of NurseTesting Creative Solutions, has been recognized by Cambridge Who’s Who for demonstrating dedication, leadership and excellence in healthcare consulting.

March 3, 2010 — Christine P. Carrington, President of NurseTesting Creative Solutions, a has been recognized by Cambridge Who’s Who for demonstrating dedication, leadership and excellence in healthcare consulting.

As the president of NurseTesting Creative Solutions, Ms. Carrington is responsible for consulting with

healthcare staffing organizations and preparing them for national certification by The Joint Commission. Her services include providing cost effective clinical operations and risk management support, as well as, staffing operations start up support for new healthcare staffing organizations.

Elevating Frontline Performance-Best Practices for Improving Nursing Staff Performance.

Ms. Carrington began her career as a staff nurse in a hospital, advancing into progressive nursing management roles. Prior to working for her current company, she worked for a national healthcare staffing organization, where she was instrumental in the company being recognized as one of the leading, quality focused healthcare staffing organizations. Ms. Carrington’s experience includes clinical operations, resource allocation, workforce management, strategic sales, consultation with hospitals and health systems in the development of customized strategic staffing partnerships, and Joint Commission Health Care Staffing Services Certification. She attributes her success to her hard work, dedication, passion for her profession and her ability to establish great relationships with her clients.

Ms. Carrington received her Master’s Degree in Nursing Administration from the University of Illinois at Chicago in 1998 and is a member of the American Organization of Nurse Executives. She served as advisor to The Advisory Board Company for publication of “Elevating Frontline Performance-Best Practices for Improving Nursing Staff Performance.” She served on Joint Commission’s Healthcare Staffing Certification Advisory Council. Ms. Carrington served on the Board of Managers for InteliStaf of Oklahoma LLC, a joint venture with the INTEGRIS Health System. She intends to continue expanding the consulting division by adding additional services in other areas of healthcare as well as establishing the company as a trusted name in healthcare.

About NurseTesting Creative Solutions
NurseTesting Creative Solutions, formerly NT Consulting Services – a division of NurseTesting.com which is an Amistaff Healthcare Techology product – was founded in 2008 in response to the healthcare staffing industry’s need for consultants experienced in Joint Commission’s Health Care Staffing Services Certification. NTCS’ consulting services assist healthcare staffing firms prepare for Joint Commission certification and provide cost effective clinical operation and risk management services. NTCS also provides staffing operations start-up support for new healthcare staffing organizations. NTCS consultants are nationally experienced Nurse Executives with 20+ years of healthcare staffing experience and extensive experience and success with Joint Commission Health Care Staffing Services Certification.

For more information about NurseTesting Creative Solutions, visit http://www.nursetesting.com/consulting.

About Cambridge Who’s Who
Cambridge Who’s Who is an exclusive membership organization that recognizes and empowers executives, professionals and entrepreneurs throughout the world. From healthcare to law, engineering to finance, manufacturing to education, every major industry is represented by its 500,000 active members.

Cambridge Who’s Who membership provides individuals with a valuable third party endorsement of their accomplishments and gives them the tools needed to brand themselves and their businesses effectively. In addition to publishing biographies in print and electronic form, Cambridge Who’s Who offers an online networking platform where members can establish new business relationships and achieve career advancement within their company, industry or profession.

For more information, please visit http://www.cambridgewhoswho.com.

NurseTesting would like to congratulate their new client, Wahiawa General Hospital, for winning the 50 points raffle. Wahiawa General took advantage of NurseTesting’s Fall Special!

We appreciate all of our new clients’ interest in the raffle and look forward to working with you all as we provide the validated prescreening assessment tools for your organizations!

Amistaff Healthcare Technology will present on the new Video-Based Situational Assessments for pre-employment nurse screening at the Nursing Economics 3rd Annual Nurse Faculty/Nurse Executive Summit in December 2009, American Nursing Association’s NDNQI conference in January 2010, and the AONE annual meeting and conference in April 2010. These newly-developed assessments, measuring competencies such as stress tolerance, interpersonal skills, or teamwork skills, assist medical facilities with properly evaluating these critical abilities in nurse hiring programs.

High Point, NC (Vocus/PRWEB ) October 27, 2009 – Amistaff Healthcare Technology’s new video-based situational assessments were selected out of hundreds of entries for poster abstracts at the Nursing Economics 3rd Annual Nurse Faculty/Nurse Executive Summit in December 2009, American Nurses Association National Database of Nursing Qualifying Indicators Conference in January 2010, and to the American Organization of Nurse Executives at their 43rd Annual Meeting & Exposition in April 2010. The new video-based situational assessments have shown success at targeting competencies overlooked by traditional employment testing. With the current push to reduce costly mistakes in the Healthcare Industry, ensuring employment of the most qualified personnel is of utmost importance.

As part of a trilogy of assessments collectively known as Prophecy, the video vignettes identify caregivers with soft-skills directly correlated to successful nursing practice. Designed by industrial/organizational psychologists, four areas of critical workplace competencies are measured:

1)   Interpersonal Competence
2)   Workflow Management
3)   Teamwork
4)   Customer Service Skills

After viewing each web-based video, the applicant selects the most and least effective responses demonstrating the manner in which the candidate responds to tough situations. These situational assessments help organizations know which caregivers will make the most effective decisions in the workplace.

Jim Ostmann, Sr RN, MBA, CNO of Amistaff and co-presenter for the poster presentations, commented on how Situational Assessments by Prophecy assist organizations with reducing costly hiring mistakes:

“Most nurse hiring programs include only credential based hiring (e.g., with no additional assessments given pre-hire) and interviews. In many nurse-hiring settings, the selection process does not include an evaluation of some of the most critical nurse competencies, including patient care, physician-nurse interaction, stress management, and interpersonal/teamwork skills. Interpersonal competencies are critical to the nursing profession. For example, the Joint Commission Standards (Standard LD.03.01.01) urges, ‘Leaders create and maintain a culture of safety and quality throughout the organization. Safety and quality thrive in an environment that supports teamwork and respect for other people, regardless of their position. Disruptive behavior that intimidates others and affects morale or staff turnover can be harmful to patient care.’ Leaders are encouraged to ‘regularly evaluate the culture of safety and quality using valid and reliable tools.’ With HCAHPS becoming an increasing focus for acute care facility reimbursement, incorporating standardized ’soft-skills’ will undoubtedly impact the nurse to patient, nurse-peer, and nurse-physician interactions which all impact the level of patient satisfaction.”

Hiring qualified employees requires an investment of both time and corporate resources in order to hire honest employees, minimize ineffective hiring, and maintain a safe and secure workplace. Making the wrong hiring decision is an expensive choice that may cost more than most companies realize. However, with proper assessment tools in place, it is possible to protect company assets against the cost of a poor hire.

With the healthcare industry probing for budget cutting options and new assessments surfacing to reduce costly hiring mistakes, the interest of executives at the Faculty/Nurse Executive Summit, NDNQI, and AONE conferences will be piqued to learn more about Amistaff’s new video-based situational assessments.

About Amistaf Healthcare Technology – Amistaff Healthcare Technology was founded in 2004 as a healthcare staffing solutions provider. Amistaff creates products and services that help healthcare staffing firms and hospitals improve recruitment, retention and placement of caregivers. Amistaff includes a team of IT professionals, RN’s and former recruiters allowing Amistaff to base their products on an in-depth understanding of each client’s unique staffing requirements. All of the Amistaff products are web-based solutions designed to simplify workflows and increase efficiency. These products include NurseTesting, BlueSky Medical Staffing Software, and eSigTek Electronic Signatures. Visit www.amistaff.com for additional information.

About Prophecy – Prophecy is the aggregation of three assessment tools that work together to generate the most comprehensive employment predictor for the Healthcare Industry. Prophecy Clinical Assessments identify caregivers with sufficient job knowledge to perform successfully by targeting the most important aspects of each clinical specialty. Prophecy Behavioral Assessments identify caregivers with behavioral characteristics that predict high performance, such as Integrity and Conscientiousness. Prophecy Situational Assessments identify caregivers with soft-skills that are directly correlated to successful nursing practice. Learn more at www.prophecyhealth.com.

Having a newborn at home, I am willing to try just about anything to avoid catching the flu virus this year.  So, I figured some of you would appreciate a comprehensive list of natural methods effective at boosting your immune system against the influenza virus as well!

Let’s Start With The Obvious

1)    Wash your hands -  it seems obvious to wash your hands, but take this idea one step further. Assume that others around you may not be washing theirs because let’s face it – many aren’t! Door knobs, customer service pens, and shopping carts are havens for germs. 

• Use a bathroom paper towel to turn off faucets and open the door before leaving,
• bring your own pen to sign credit card receipts in lines, and
• wipe your cart down with a sanitary wipe before shopping.  

Quick steps along your typical day can significantly reduce the volume of germs exposed to you.

2)    Get enough sleep – The average adult can function quite well off of 7-8 hours of sleep. Without adequate sleep the body becomes weak and thus more vulnerable to infection and disease.

Side note – did you know that your body keeps a sleep deprivation bank? Although you won’t have creditors calling for payments, failure to pay off your sleep debt causes decreased mental and physical health.

Reduce stress – funny right?

3)    So maybe think of stress relieving – This may be easier than you think. Studies show that light exercise, such as walking, is a natural anti-depressant. Check out the walking trail surrounding our home office. 

Fresh air and breath taking views help the Amistaffers relax during the day!

4)    Take a yoga class or get a massage.  Now you have another excuse…oh wait – another reason…to get that massage you’ve secretly been wanting.  Yoga and message eradicate toxins and chemical waste from your body clearing the way to absorb vital nutrients. Consider it doctor’s orders, after all you don’t want to get the flu!

5)    Pick up a new hobby such as fishing or cooking. And yes men, you can have hobbies too! Not all hobbies require yarn and a needle!

Herbal Remedies

6)    Adding green tea to your diet can protect you from many strands of the flu virus each year. The UK Tea Council says that green tea aids in fighting the flu in two ways – suppressing the growth of influenza cells and killing existing influenza cells.

7)    Ginseng is an immune stimulating herb that can be taken as a supplement.

8)    Take an echinacea vitamin.  But interesting to note – Echinacea is most effective when taken every day for two weeks and then not take for seven days, then taken again for two weeks, etc.

Balanced Diet

9)    As momma always says, “Eat your fruits and veggies, or no dessert!” Vegetables, fruits, nuts and spices containing phytochemicals boost the effects of vitamins on your immune system.  Phytochemical-rich foods include blackberries, almonds, tomatoes, and rosemary.

10)    Yogurt is a great immune system enhancer with the good bacteria acting as a natural pro-biotic. So try putting a combination of fruits and yogurt in a smoothie for breakfast or a snack each day.

11)    Drink the recommended 64 ozs of water every day. Bored with plain, old tap water? Try adding a bit of lime juice, peppermint extract, or cucumber slices for a refreshing twist. Check out this list of water flavoring ideas!

Wrapping it up!

Perhaps the most controversial way to protect from the flu is getting the flu shot. Did you ever wonder why there is an annual flu vaccine, but yet other vaccines (Hepatitis B, Meningitis, Measles, Mumps, & Rubella, Polo, etc.) last a lifetime?

Well, for the answer to that question I turned to Infection Control Today’s article Researchers Examine Ways to Combat Flu Virus.  According to Suresh Kumar, assistance professor of chemistry and biochemistry:
 

"The influenza virus is ‘smart’ in that it modifies proteins on the outside so that the hosts’ body cannot recognize it…We need to be one step smarter than the virus and attack something it is not anticipating.”

Thanks to a grant from the National Institutes of Health, four researchers from the University of Arkansas will look into the ways the virus attacks host cells in hopes of developing a one-time-fights-all influenza vaccine.
 

So, I hope this list of recommendations keeps you guarded from the flu virus this season! And please share other ways to stay healthy in our comments section below!

The content validation process takes the Uniform Guidelines on Employee Selection Procedures (1978) and applies them to the development of these assessments.

The process for each assessment specialty was performed in two phases.

Phase One

The first phase involved an in depth Job Analysis that was performed using 7 subject matters experts (SME’s) from around the country for both the Physical Therapy, Occupational Therapy, and Certified Nursing Assistant assessments. The subject matter experts, through a facilitated workshop, identified the key job duties/tasks and specific knowledge, skills, and abilities that PT and OT clinicians and CNAs need to possess on the first day of the job. The panel of subject matter experts provided a series of ratings and linkages.

Phase Two

Once the Job Analysis phase was completed, the subject matter experts developed a test plan and began the item-writing phase for each assessment. This phase involved specific criteria for item writing that conforms to the recommendations from the Dept of Labor and the Uniform Guidelines on Employee Selection Procedures (1978).

During both phases, a significant amount of statistical data was collected and analyzed, such as inter-rater reliabilities and individual item Angoff ratings, yielding a final recommendation as to which items were to be included on each assessment and what the initial unmodified Angoff Cutoff Score should be for each assessment. The unmodified Angoff Cutoff score was generated by having each subject matter expert provide their rating regarding the percentage of minimally qualified applicants they believe will answer the assessment item correctly.

After detecting and removing outlier Job Experts from the data set, the unmodified Angoff Cutoff Score became the average of the Job Expert panel’s ratings for each item on the assessment. Each item’s averaged percentage rating received equal weight in calculating the unmodified Angoff.

Form A and Form B – Parallel Form Development

Parallel forms are constructed so that each form can be used independent of one other and be considered equivalent measures. Parallel forms measure comparable content and produce scores that can be interpreted the same way. The first exam form is administered to the applicant for testing. Should retesting be necessary, the applicant would be given the second form. In order to achieve equivalent reliability for both forms, Amistaff builds parallel forms based upon several components of the test item surveys that have been completed by our panel of subject matter experts (SME’s) for that particular clinical specialty.

All questions are reviewed by the SME’s to decide whether test items measure factors including, but not limited to, being correct, fair to all groups of people, measures a knowledge, skill or ability necessary on the first day of the job, necessary to be memorized, etc. After reviewing all aggregate data, test items that are “rejected” in such areas as those mentioned above may be removed from the test item bank. For example, if the SME’s do not agree that the correct answer is tagged for an item, that particular item may be removed from the total group from which parallel forms are constructed. See sample below on how test items are reviewed for these specific areas.

After removing necessary items from the item bank due to rejection in the above categories, the remaining items are collected and the average Angoff rating for each item is evaluated and sorted in descending order. All questions with an average Angoff rating of 90% or above were removed from the item bank, due to the high probability of those items having a high percentage of applicants selecting the correct answer, thus not contributing significantly to the validity and overall reliability of the exam(s). Remaining items were then equally distributed into Form A and Form B with similar average Angoff ratings, so as to create equality in both Form A and Form B. See below for an example of how items that survived the first round of scrutiny from the SME’s were removed due to a high Angoff rating. The average Angoff rating for Form A and Form B was then calculated as items were placed into each form, to assure that the unmodified Angoff score was as close to one another as possible.

For a better understanding of the Angoff Cutoff Scores, see the blog post titled New Assessment Data Allows Employers to Make Informed Scoring Decisions.

All future exam content will undergo this same development procedure so that NurseTesting can continue to provide the best prescreening assessment tools for our clients!

Beginning with the newly validated Physical Therapy and Occupational Therapy assessments, the assessment results page will provide additional information for an employer to make an informed decision regarding the applicant’s assessment score.

Angoff Cutoff Score

One of the most commonly used approaches to establishing a cutoff score is the method detailed by Angoff (1971)¹. This technique is particularly attractive in applied personnel selection settings because it is easily understood by subject matter experts (SMEs), it has high face validity to job applicants, the courts regularly endorse the technique, and it stands up to academic scrutiny.²

Although there are many variants, the classic Angoff method for setting cutoff scores
involves:

1. Select and train SMEs who are familiar with the job and have them review each test item;
2. Obtain ratings from SMEs on the percent of minimally qualified applicants who would be expected to answer each item correctly;
3. Analyze SME ratings to obtain an “unmodified” Angoff cutoff score;
4. Administer the test, and
5. Facilitate a discussion with SMEs on the impact/validity of the unmodified cutoff score.³

With each new NurseTesting clinical assessment, the initial “Unmodified” Angoff Cutoff Score will be displayed next to the applicants overall score. Based on the applicants overall score, the system will automatically compare this score to the “Unmodified” Angoff Cutoff Score and display either “PASS” or “FAIL” on the results page. This enables the recruiter the ability to quickly determine if the applicant passed that particular assessment.

It is important to note, that each assessment will have its own, unique Angoff Cutoff Score. NurseTesting does not recommend the use of “Arbitrary Cutoffs” such as the “80% rule.” Arbitrary cutoffs do not make academic or practical sense.

Furthermore, they can incense applicants who may realize that a meaningless standard in the selection process was used to make very meaningful decisions about their lives and careers.² As recently as this past April (2009), the United States Supreme Court heard the case Ricci v. DeStefano (07-1428 & 08-328) in which the use of “arbitrary cutoffs” was an issue brought before the Court.

Modified Angoff Cutoff Score

Initially, when an assessment is administered, the “Unmodified” Angoff Cutoff Score is used until a sufficient sample size of assessment data is available for analysis. Once NurseTesting has obtained a sufficient sample size for each assessment, a comprehensive analysis will be conducted to determine if a modified Angoff Cutoff Score is necessary. When it comes to best practices for developing cutoffs, there is perhaps none better than the modified Angoff method.²

The “cutoff score” will be refined / modified based on the data collected during the initial launch of the assessment to account for assessment unreliability and actual test-taker performance. NurseTesting, using the Test Validation and Analysis Program (TVAP), will refine the assessment and identify test items that might be:

• Too difficult
• Too easy
• Negative or low Point Biserials – showing how correlated the item is to the overall test score.
• Cronbach’s Alpha review once flawed items are removed
• Differential Item Functioning –test items function in different ways for different groups of test-takers

Once the modified Angoff Cutoff Score is calculated using the Conditional Standard Error of Measurement (CSEM), the assessment results page will display the “modified Angoff Cutoff Score” instead of the initial unmodified Angoff Cutoff Score. Based on statistical analysis, including an Adverse Impact analysis, the recommended modified Angoff Cutoff Score will be used for all future administered assessments. As stated before, each assessment will have its own, unique modified Angoff Cutoff Score.

NurseTesting implemented these processes to continue providing validated content for new exams that meet the Uniform Guidelines for Employee Selection Procedures.

Maintaining the integrity of the testing process is extremely important so no one gains special advantages by having improper access to test questions. The Society for Industrial & Organizational Psychology, one of the nation’s premier testing-expert organizations, says

“public disclosure of the content and scoring of most selection procedures should be recognized as a potentially serious threat to their reliability, validity, and subsequent use.”

One way to minimize potential threats to test security is to limit the number of opportunities in which the test’s integrity can be compromised. This includes minimizing the number of people who have access to the content of the exams. In 2007, NurseTesting began using a new assessment design methodology that meets the Uniform Guidelines on Employee Selection Procedures (1978).

In an effort to heighten NurseTesting’s assessment security, the newly validated Physical Therapy and Occupational Therapy job knowledge assessments will no longer display incorrectly answered questions on the assessment results page. Following the release of the Physical and Occupational Therapy assessments, a comprehensive Critical Care and Perinatal Suite of assessments, subjected to the rigourous validation process, will launch soon.

James S. Ostmann, Sr RN, MBA, Chief Nursing Officer for Amistaff Healthcare Technology states,

“With the release of NurseTesting’s updated and new clinical assessments, we have elected not to display the missed questions in order to protect the integrity of the test items. Releasing clinical competency assessment content to subscribers or test takers, in essence, nullifies the reliability of the assessment. Hence, the knowledge, skills and/or abilities the assessment was designed to measure and the inferences drawn from those results are meaningless once the assessment content has been compromised.”

For this reason, testing organizations such as NurseTesting that value the reliability and validity of the employment-selection process must take proactive measures to prevent the widespread dissemination of their testing content.