Relevance of the test content of the Korean Nursing Licensing Examination to nursing job

Purpose: This study aimed at identifying if there is a relevance of content of the Korean Nursing Licensing Examination (KNLE) revised in 2014 to nursing job. It will be able to provide the validity of revised content of the KNLE. Methods: From October 13 to November 13, 2015, print version of 8 duties with 49-tasks, 155-job item questionnaires were distributed to 1,305 hospital nurses and 202 nursing faculties in Korea. Results were treated by descriptive statistics and comparison analysis. There were responses from 946 nurses or professors (72.5%). Results: The relevance of test content of KNLE to nursing job was shown to be valid with over 3 points out of 4 point Likert scale in all items: from 3.23 at lowest to 3.64 at top. Conclusion: Above results showed that the revised version of KNLE in 2014 was valid to test the nursing students’ knowledge for job performance.


Introduction
Studies on the improvement of the Korean Nursing Licensing Examination (KNLE) have been carried out several times [1,2]. However, an analysis on relevance of the test content of the Korean Nursing Licensing Examination to nursing job was not done. Korea Health Personnel Licensing Examination Institute (KHPLEI) revised the contents of test items of KNLE according to job description in 2014 [3]. This study aimed to analyze the relevance between the nurse's job and the content of KNLE. Based on the results, the study will draw validity of the recently revised contents of KNLE.
http://jeehp.org J Educ Eval Health Prof 2016;13: 23 • http://dx.doi.org/10.3352/jeehp.2016.13.23 the derived nursing knowledge as questions, carrying out some preliminary research, and making up for the problems. The questionnaire consists of 155 items and each one is measured on a 4-point Likert scale, from 'not reasonable at all' 1 point to 'very reasonable' 4 points. Questionnaire was a nursing knowledge developed for KNLE [4]. Subjects marked each items from 1 to 4 points according to the degree of relevance to nurse' s job.
The questionnaire was analyzed after integrating data into 8 duties with 49 tasks out of 155 items.

Statistical analysis
The collected data was analyzed using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). The validity of the knowledge according to each task is obtained by percentage, averages, and standard deviation. The validity difference of the knowledge according to working periods is obtained by t-test and ANOVA. A Scheffè test is carried out to do a post-investigation.

Ethical approval
This study was approved by the institutional review board of Nursing College of Chungnam National University before collecting the data (No. 2-1046881-A-N-01-201410-HR-048). Only those who consented to participate signed the written consent from on the first page of the document and answered the questionnaires.

The working years of the subjects
The average teaching experience of the university professors

The degree of knowledge validity according to the duties and tasks
The average and standard deviation was obtained in the degree of the knowledge validity according to their duties and tasks. The category was divided into three groups such as registered nurses, university professors, and all subjects ( Table 1). Dividing their job into 8 duties, the degree of validity was compared (Table 1). While 'management of potential risk factors' was the highest at 3.55 points ( ± 0.45), 'nursing management and staff development' was the lowest at 3.44 points ( ± 0.40). The degree of the total task validity ranged from 3.22 points ( ± 0.52) to 3.63 points ( ± 0.51) ( Table 1). While 'health system guidance' and 'collaboration with other health professionals' showed a relatively low point, 'recording of nursing care' , 'shift report' , 'emergency care and management' , 'circulatory care' , and 'prescription management' indicate a higher degree of validity. A similar result was indicated in the validity degree depending on working places evaluated by the registered nurses and university professors.

The degree of duty validity according to working periods
There were meaningful differences in all 8 duties in the degree of duty validity according to working periods ( Table 2). In the case of 'nursing management and staff development' , nurses who had worked for over 21 years rank the first and those 11 to 20 years, under 5, and 6 to 10 were followed in that order (F = 17.385, P < 0.001).
Nurses working for over 21 years most highly evaluated the validity in 'safety and infection control' , and those 11 to 20 and 6 to 10 years showed meaningful differences (F = 13.197, P < 0.001). In 'management of potential risk factors' , nurses working for over 21 years also ranked that first, and there were remarkable differences depending on each working period (F = 9.387, P < 0.001). Likewise, the first for those working for over 21 years in 'basic nursing and caring' , and those 11 to 20 years and 6 to 10 were followed, showing meaningful differences (F = 9.031, P < 0.001). In 'maintenance of physiological integrity' (F= 8.924, P< 0.001), 'medication and non-oral treatments' (F = 8.196, P < 0.001), 'maintenance of socio-psychological integrity' (F = 5.405, P = 0.001), and 'maintenance and improvement of health' (F = 5.059, P = 0.002), the validity evaluation of those working for over 21 years was the highest and showed a statistically meaningful difference to that of those with other working periods.
The results connected the nurses' jobs and nursing knowledge (learning goals and the range of questions). According to the survey on the connection validity of the nurses' jobs and nursing knowledge, the validity degree of all the items were over 3 points, and so 155 items are accepted as valid.

Discussion
This study, being design to understand the changes in learning objectives, connected the range of the KNLE by nursing jobs and completed a table connecting nurse job-learning objective-knowledge. Being categorized by nursing jobs based on the 2nd analysis [4], the nursing knowledge area related with the duty of 'nursing management and staff development' were 40 areas integrated from an overlapped 47. There were 13 areas at the duty of 'safety and infection control' , and 18 nursing knowledge areas at the duty of 'management of potential risk factors' . Twenty three nursing knowledge areas were closely related at the duty of 'basic nursing and caring' , 20 nursing knowledge areas at 'physiological integrity' , 22 at 'medication and non-oral treatments' , 29 at 'maintenance of socio-psychological integrity' , and 36 nursing knowledge areas related with the duty of 'maintenance and improvement of health' . This result shows that, at the time of performing the nurse jobs, knowledge of nursing is required to be integrated rather than used individually by majors.
Since 2004, the National Council Licensure Examination for Registered Nurses (NCLEX-RN) of the United States has run integrated test subjects and has evaluated their capability to carry out the duties depending on nursing courses. The number of exam question categories of the NCLEX-RN is 4. The contents of each category are on safe and effective care environment (management of care 17%-23%, safety and infection control 9%-15%), health promotion and maintenance 6%-12%, psychosocial integrity 6%-12%, and physiological integrity (basic care and comfort 6%-12%, pharmacological and parenteral therapies 12%-18%, reduction of risk potential 9%-15%, physiological adaptation 11-17%) [5].
In comparison with National Council of State Boards of Nursing (NCSBN) of the United States, the 2nd analysis of nursing jobs categorized to 8 job ranges and was mostly coincident with that of USA in content except minor differences in terms. However, when it goes to setting test ranges, KNLE still consist of 7 subjects with mainly the learning objectives of the majors. KHPLEI has previously reviewed the possibility of integrating the subjects for the development of the KNLE, with which 52.5% of professors majoring in nursing science in Korea have acknowledged its necessity [6]. They say integration could minimize the overlaps among the subjects, enhance the problem-solving ability of the nurses in the field, and promote http://jeehp.org J Educ Eval Health Prof 2016;13: 23 • http://dx.doi.org/10.3352/jeehp.2016.13.23 holistic and comprehensive care for their patients.
There have been studies for the integration of KNLE, though this is virtually the first one to connect the range of possible questions, and nursing jobs. This will eventually make the paradigm shift of the standard of making items of KNLE from the learning objective of nursing major subjects to nursing jobs, and to the nursing knowledge necessary for each nursing job. This means the standard of setting the KNLE will make the paradigm shift from knowledge verification for each major subject, to knowledge verification mainly for the jobs performed in nursing fields. Also, this will show KNLE should be able to verify the correct knowledge areas relevant to performing proper duties in the fields. The most important one is that content of KNLE should be in compliance with on-site duties. It is suggested to change the standard of setting the KNLE to, as drawn in this study, a task-centered paradigm of nursing job-nursing knowledge, and integrate the seven exam subjects and unite into a single nursing subject.
The comparison and analysis on this study is limited as to category and domain for the nursing learning objective, and 8 duties and 49 tasks for the nursing jobs. We suggest the study to draw more concrete and practical nursing knowledge comparing the content of nursing learning objective with the task elements of nursing jobs.