The Next Generation of Online Proctoring Helps Nursing Programs Meet Demand

Around the globe, growing numbers of nurses are studying and taking courses online. New computer-assisted proctoring technologies are enabling trainee and seasoned nurses to gain their certifications and deliver vital services. Nurses are in high demand and sought after by employers. In order to advance their career progression, they are increasingly studying and testing online. For years, distance learning has allowed nurses to enhance their qualifications and fit required certifications into busy schedules, and now, the Covid-19 pandemic is putting pressure on frontline staff and hastening this trend.  

In response to the current crisis, schools and policymakers are exploring innovative ways to ensure that nurses can graduate and get to work. Online proctoring helps shape the educational landscape in nursing, allowing candidates to book their tests whenever and almost wherever it suits. In a period of unprecedented disruption, it can enable schools to meet urgent healthcare needs.

Candidate convenience

Nursing is the largest healthcare profession in the US, with more than 3.8 million registered nurses employed in hospitals, retirement homes, and other healthcare contexts. The workforce is expected to grow by 15% between 2016 and 2026, according to the American College of Nursing. Demand is so high that employers sometimes struggle to fill vacancies, making it vitally important that an efficient educational pipeline exists to facilitate nurse training during college and beyond.

Remote learning and digital education tools have improved access to key sectors and allowed schools to serve wide areas. At Nova Southeastern, a private university in Fort Lauderdale, Florida, students come from a surrounding 150-mile radius. This large geographical reach means it is critical that students can sit exams locally, either in their own homes or in testing centers. Dr. Denise Howard is assistant dean of operations at Nova Southeastern, which has used a robust online proctoring platform called PSI Bridge since it began conducting tests online five years ago. “You’re dealing with full-time registered nurses that have a bachelor’s degree,” Howard explains. “So, for them to take time off work and take a test, that’s almost impossible. In addition, we — our courses, our curriculum — are accredited through a hybrid process, so students can take their tests at a particular hour and a particular day.”

While introductory-level courses involve in-person teaching, Nova’s more specialized qualifications are often taught partially or entirely online, in formats tailored to meet the needs of working nurses already employed. The nurse practitioner program combines clinical experience with remote learning, while the nurse educator program is taught fully online, and all testing is remote. Students pay $15 to sit a test, Howard says.

Other care professions are also benefiting from remote testing options. Respiratory care therapists are currently in high demand because Covid-19 so often attacks sufferers’ lungs. At Rock Valley College in Illinois, students usually sit their tests on campus, but in April the respiratory care program held exams online for the first time, supported by the testing company PSI, as part of a determined effort to complete the program so they can become Registered Respiratory Therapists. The exam was accredited by the Commission on Accreditation for Respiratory Care and the National Board of Respiratory Care, which has tweeted: “Respiratory therapists are rising to the challenge of Covid-19 every day — and the world needs more.”

Eliminating human error

As a leading online proctoring solution, PSI Bridge offers two main proctoring modalities: live online proctoring and record and review proctoring. In the first model, which requires state-of-the-art scheduling, a proctor keeps an eye on a small group of students as they sit an exam. In the second, which does not require a live person to proctor in real time, the exam is recorded and analyzed after the session is completed. A blended option, in which the human proctor is assisted by technology has recently become available, according to Kristin Delgado, an industrial organizational psychologist with PSI Services, the creators of PSI Bridge.

“Our newest version of the online proctoring solution has computer assistance—that is, algorithms that help to identify irregularities. They are based on machine learning and take an algorithmic approach to determine misconduct.”
Kristin Delgado, industrial organizational psychologist, PSI Services

Protecting exam content and ensuring that cheating does not occur are key concerns in online proctoring. Before beginning the test, students are asked to conduct a digital scan of the room to ensure that the testing environment complies with security requirements. A proprietary, secure browser prevents the user from copying and pasting data or accessing unauthorized websites during the exam, and test takers are not permitted to make copies of exam content or rules.

Algorithms also detect inappropriate movements on the part of the candidate, automatically flagging breaches that may include a test taker looking down at a cell phone or taking a photo of their screen. They can also sense if there are unauthorized people in the room while the exam is in process. Delgado says these technologies can surpass the accuracy of human proctors. Combining algorithms with human review makes the system both, “more accurate and more reliable, because a proctor might not be able to find everything or might look away, but a computer is constantly looking at the candidate,” she explains.

Yet some acts of misconduct are harder to judge than others, and online proctoring programs are carefully designed to be as flexible as the situation requires. A person speaking aloud may be hoping to record material from the exam to share with other students, or simply acting from nerves or out of habit. Kristin Delgado says that in these cases there is scope for understanding. “Some people might read out loud because they kind of do that — a lot of people do — but that might still warrant a warning, where it would say that’s not permitted,” she says. “So at least the candidate knows that they can’t do that. But it wouldn’t be a straight rejection for them.”

Denise Howard confirms that the Nova Southeastern nursing programs have had no problems with security. “There’s a whole process” in place, she says. And while PSI retains its recordings for a short period to allow for necessary reviews, the company is committed to student privacy and maintaining the highest standards of data protection, complying with Europe’s recent General Data Protection Regulation (GDPR).

Assessing soft skills

Digital technologies, combined with psychological research, are allowing not just schools but also employers to conduct novel forms of testing online. Delgado has developed a predictive behavioral program called NurseFit — a non-proctored assessment tool intended to help healthcare organizations figure out whether or not a nurse is likely to thrive in a particular role. It might, for instance, ask whether or not a candidate is willing to work nights. A nurse who replies “no” may not be suited to a position where night shifts are required and is likely to become disengaged or seek work elsewhere.

Selection tools may not seem useful to employers in the nursing sector who are already short on staff and very keen to hire, but for Delgado, these sorts of predictive assessments can help them make the right decisions. “In the US we do have a problem where there is nursing turnover, we have a nursing shortage. The point is, how do you keep those nurses, how do you keep that talent that you spent time developing?”

Other tests in development at PSI allow nurses to self-assess for mental health issues and burnout. Although these are critical concerns for healthcare organizations, Delgado thinks the new tests could also have a useful role in educational institutions, helping staff and students identify important strengths and weaknesses.  Throughout their careers, nurses take exams as they progress through basic training to licensure and certification in advanced competencies. PSI’s development of both academic and recruitment applications for online proctoring make it a reliable platform nurses may encounter recurrently in their professional lives.

A model for the future

The Covid-19 epidemic has shown how vital online education is to colleges of all sorts, and particularly to healthcare programs responsible for training and developing frontline practitioners. This educational model is likely to grow, and alongside digital learning, online proctoring will inevitably become more widespread. “We have already seen a huge spike in online proctoring and general online assessments,” Delgado says. “So, I see this as a huge shift, not only for online education in nursing, but for any type of testing, whether it be academic or for employment."