Have you ever wondered how the National Certification for School Nurses (NCSN) exam for school nurses is developed? Well, it’s a tough nut to crack open, but here it is in a nutshell!

Every five years, NBCSN surveys school nurses from across the country to find out what they actually do and how much time they spend doing it! This job task analysis sets the percentage of questions on the exam from the following five domains: health appraisal (26%), health problems and nursing management (27%), health promotion/disease prevention (20%), special health issues (14%), and professional issues (13%) – which is essential to exam development and helpful for candidates to know when studying for the test. 

To build the NCSN exam, NBCSN partners with a psychometric testing company, Prometric, whose test development team are experts in the science of putting together fair, valid, and reliable exams that reflect competency in school nurse specialty practice at the national level. But did you know that the NCSN exam is written by school nurses for school nurses?! YES!

Every year, a group of NCSN subject matter experts (SMEs) is recruited to write evidence-based practice (EBP) questions, or items, for the exam test bank. All item writers complete a virtual training on how to compose good test questions before being assigned to write items for the test domains in which they consider themselves experts. NBCSN helps to provide SMEs with the EBP materials they need from the exam prep resource list. After the SMEs submit new items, item writing review sessions are held by Prometric and NBCSN for SMEs to review and revise the newly written test questions according to these criteria: structure, accuracy, correctness, grammar, validity, relevance, differentiation level, cognitive level, difficulty, and appropriate reference material. After robust discussion, the SME’s either agree that an item is strong and usable on the exam, or they might reject the item altogether. 

Prometric test developers assemble three new “forms” of the exam each year, using items from the test bank that have been shown to preform well on previous exams (scored items) and new items that have been approved by our SMEs. Each test form contains 175 scored items, with 25 new items added as unscored pretest items (but test takers can’t tell which is which). This allows us to gather psychometric statistics on the new items (unscored) without impacting a candidate’s score. 

Before the exam is given, another panel of SMEs meet, under the direction of our Prometric test developer, to examine every item on each of the three test forms AGAIN! The SMEs also check to see that there is no overlapping content or that the answer to one question isn’t given away by or contradicted by another question. Finally, the exam is ready and published by Prometric to be taken by NCSN candidates. 

But wait – there’s more! After the close of each of the testing windows (spring, summer, and fall), Prometric runs a statistical analysis of the exam scores to determine how items performed within an acceptable range. Items that perform less well statistically are flagged to be reviewed by yet another (!) panel of SMEs during a Problem Item Notification (PIN) call. The SME panel may decide to retain the item, put the item back for further editing and pretesting again, or archive the item from the bank. So that’s why candidates have to anxiously wait a while after the testing window closes to receive their scores. 

So, you see that the development of the NCSN exam is a lot of work – but also a lot of fun! SMEs get to meet nurses from all over the country and work as a team to create a quality exam. We are ever grateful for our many SMEs who volunteer for this very interesting and important work. If you haven’t already joined in on the fun – please consider becoming a valued SME and apply by visiting https://www.nbcsn.org/community/committees/. You will be and we will be glad you did! 

Robin Shannon and Eden Donahue,

NBCSN Examination Committee Co-chairs