Content Validation Process

NurseCompetency offers current, clinically relevant, valid, and reliable exams. Based on best practices for test development, NurseCompetency exams meet psychometric [1] standards and the federal directives as outlined in the US Equal Employment Opportunity Commission’s Uniform Guidelines on Employee Selection Procedures [2]. Not surprising, because we develop our evidence-based competency tests using a rigorous six-step process:

Step 1 - Conduct the Job Analysis
NurseCompetency’s six-step process begins with a careful analysis of the most recent nationwide studies of the critical tasks, skills, and abilities required for a given health care specialty. Known as a “role delineation study,” these studies—often initiated by professional organizations or associations (e.g., American Nurses Credentialing Center, American Association of Critical-Care Nurses)—identify the essential knowledge and skills of the health care specialty and serve as the blueprint for targeted test development.

Content Validation Process

Step 2 - Create the Test Blueprint
NurseCompetency convenes a team, consisting of a Subject Matter Expert (SME)—who has a minimum of three years’ current experience in his or her clinical area, a member of our Clinical Advisory Board, and our Director of Clinical Education [3]. Using the role delineation study and data from the US Department of Labor, the team develops the test blueprint, which identifies the knowledge, skills, and abilities that are necessary for successful job performance in the clinical area that the exam will assess.

Step 3 - Develop the Items
NurseCompetency’s SME uses the test blueprint to create multiple choice test items that address the topics identified as essential for successful job performance in that position.

Step 4 - Review the Items
To ensure editorial integrity, technical accuracy, and fairness, NurseCompetency’s Director of Clinical Education and a member of our Clinical Advisory Board scrutinize the items for content, clarity, grammar, and syntax, and validate that the correct answers are, in fact, supported in the current, generally accepted professional literature of the specialty. NurseCompetency’s critical review ensures that each item measures a critical element of successful job performance, and documents why the test taker’s knowledge of the correct answer is essential for successful job performance. Our goal is to promote your continuum of competency. Consider this item from our Labor and Delivery Competency Exam:

Which of the following is a symptom of severe preeclampsia?
a. Edema of the feet and ankles
b. Epigastric pain and/or impaired liver function
c. Weight gain of one pound per week
d. Early morning headache

Validation analysis:
a) The knowledge measured by this question is the recognition of symptoms of severe preeclampsia.
b) This knowledge is important, because the L&D nurse should recognize that epigastric pain in addition to hypertension and other specific symptoms indicate severe preeclampsia. This symptom indicates liver swelling and capsular stretch and may be considered as rationale for delivery of the baby. This symptom may also be accompanied by the elevation of serum liver enzymes. (Sources: Preeclampsia and Pregnancy and Hypertension)

Step 5 - Test the Test Items
To gather statistics on each test item, NurseCompetency deploys newly created (or updated) tests on the platforms of our validation partners and collect data from test takers nationwide over a 30-60 day period. Each item is rigorously analyzed to flag troublesome test questions.

Step 6 - Evaluate and Adjust
To ensure that each item meets or exceeds psychometric standards, NurseCompetency’s measurement experts employ detailed statistical analysis. Based on the statistics and the item analysis, we update or retire the items as necessary, update the test statistics and benchmarking data, notify all current customers of any updates, and redeploy the test. Finally, to keep our tests current and relevant, we evaluate and make changes to test content at least annually, and more often when needed.

Our goal is to promote your continuum of competency.

[1] To assist NurseCompetency in the statistical analysis and interpretation, we retained Gregory J. Zarow, PhD., who trained in measurement theory and test construction at the University of California at San Diego, has published in the Journal of Neurosurgery, Neurological Research, and Magnetic Resonance in Medicine, and has co-authored the Spacelab Life Sciences Final Report for NASA. We also retained Yuhua Su, PhD., who obtained her PhD in Statistics from North Carolina State University in 2010. Dr. Su is currently a faculty member of the Nutritional Assessment of Populations program under the Department of Human Nutrition, Food, and Animal Sciences in the University of Hawaii at Manoa. Dr. Su is a member of the American Statistical Association and an editorial board member of the International Journal of Statistics and Applications.

[2] According to EEOC regulations, “the content of the selection procedure . . . represent[s] . . . important aspects of performance on the job for which the candidates are to be evaluated." 29 CFR §1607.5 (2012).

[3] Our Director of Clinical Education, Kathy Mercer, MA, MSN, RNC-OB, CNM, is an advanced practice nurse board certified in nurse-midwifery and inpatient obstetrics nursing. Ms. Mercer has worked as a clinical expert for Mosby/Elsevier, Inc., conducting literature review for and clinically editing updates on selected topics in maternal-infant care for Mosby’s Nursing Skills series in conjunction with the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN).


"The clinical exams from NurseCompetency play a key role in our talent management program—as they are used to measure and ensure that our clinical personnel are knowledgeable and competent to perform the tasks associated with their respective positions. The high level of authority among the subject matter experts consulted and the rigor in exam development both contribute to make NurseCompetency’s clinical exams among the best available anywhere for assessing competencies.”

Kellie Hodge, Director of Nursing, Omega Hospital