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A survey of psychometric testing in the field of nursing Erskine, Helen 1950

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g f s >• A SURVEY OF PSYCHOMETRIC TESTING IN THE FIELD OF NURSING by HELEN ERSKINE  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  IN THE DEPARTMENT of PHILOSOPHY AND PSYCHOLOGY  THE UNIVERSITY OF BRITISH COLUMBIA APRIL,  19  5o  SUMMARY OF TH ES3S "A SURVEY OF PSYCHOMETRIC TESTING IN THE FIELD OF NURSING" SUBMITTED TO THE DEPARTMENT OF PHILOSOPHY AND PSYCHOLOGY AT THE UNIVERSITY OF BRITISH COLUMBIA. IN PARTIAL FULFILMBJ T OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS. I t was the purpose o f t h i s survey to determine what use has been made of psychometric  tests i n the  nursing f i e l d and t o ascertain how widely t h i s method has been accepted f o r s e l e c t i o n and guidance i n the t r a i n i n g schools of the united States ahd Canada. Information regarding the use o f t e s t s i n the f i e l d of nursing i n the United States was obtained from the accumulation  o f l i t e r a t u r e on the subject and by w r i t i n g  d i r e c t l y to various workers i n the f i e l d .  A d e t a i l e d survey was  made by correspondence of Canadian schools of nursing to determine what use i s being made of psychometric  t e s t s i n the s e l e c t i o n of  t h e i r candidates and the counseling of t h e i r trainees'. Data were obtained from the Canadian Nurses Association.regarding the r a t e of withdrawal and the reasons f o r withdrawal i n Canadian t r a i n i n g centres. Certain a d d i t i o n a l information was obtained with regard to the status of t e s t i n g i n English schools of nursing.  The c o l l e c t e d data were  reviewed, analyzed and the s a l i e n t features noted. psychometric  The value o f  t e s t i n g to Canadian schools of nursing has been  considered. The r e s u l t s o f t h i s study regarding the value o f psychcmetic  s e l e c t i o n methods to Canadian schools o f  nursing are not conclusive. nursing employ psychometric  Although 79% o f American schools o f selection techniques, the rate of  elimination of nursing students i n 19k7 was J)%.  In Canada, where  scientific selection methods have been virtually non-existent, the elimination rate was only 20#  i n 19U8.  It Is doubted that any of  the available testing devices could appreciably reduce this figure. It i s concluded, however, that testing devices might be used to advantage for the guidance and counseling of nursing students i n Canadian training centres and that test batteries might be employed i n selection i n those areas where the elimination rate appears to be abnormally high.  i CONTENTS CHAPTER I.  INTRODUCTION  PAGE 1  Statement of the problem Methodology CHAPTER II.  REVIEW OF RESEARCH ON PSYCHOMETRIC TESTING IN THE FIELD OF NURSING Summary  CHAPTER III.  CHAPTER IV.  DEVELOPMENT OF NATIONALLY ORGANIZED TESTING SERVICES IN THE UNITED STATES  28  REPORT OF A SURVEY IN CANADA  33  A study of student nurse withdrawal i n Canadian schools of nursing CHAPTER V.  CHAPTER VI.  THE PRESENT STATUS OF PRE-NURSLNG TESTING IN THE UNITED STATES, ENGLAND AND CANADA CONSIDERATION OF THE VALUE OF PSYCHOMETRIC TESTING TO CANADIAN SCHOOLS OF NURSING Conclusions and suggestions Suggestions for further research APPENDICES Description of test batteries used most extensively i n the United States  k9  ii TABLES TABLE I.  One Hundred and Eight Student Nurses Grouped According to Reasons for Leaving Training and the Average Score for Each Group on the Army Alpha Intelligence Test  TABLE II,  Average Intelligence Test Scores of Canadian Student Nurses as Determined by the Survey of G.M.Weir i n 1932  TABLE III. Number of Accredited Training Schools i n the Provinces of Canada i n 19^8 TABLE 17.  Number of Canadian Training Schools finploying Any Kind of Psychometric Test  TABLE V.  Student Nurse Withdrawal from the Graduating Class of 19U8 i n Canadian Schools of Nursing  TABLE VI  Reasons for Student Nurse Withdrawal from Training i n the Provinces of Canada for the Year 19li7  iii  APPENDICES:  PAGE  I.  Forward  74.  Description o f Tests in Pre-nursing and Guidance Battery of the National League of Nursing ' Education, New York.  75.  III.  Test Battery of the Psychological Corporation, New York.  77.  IV.  Test Battery of the Psychometrical Service Company, Canton, Ohio  78.  V.  Test Battery of the Center for Psychological Service, Washington, D.C.  79.  VI.  Test Battery of the California Test Bureau, Los Angeles, California  II. "  81.  1 A SURVEY OF PSYCHOMETRIC TESTING IN THE FIELD OF NURSING  CHAPTER ONE INTRODUCTION. Statement of the Problem: In 1945> Canadian schools of nursing admitted  4*295 students to begin the three year course necessary for registration as graduate nurses. in 1948.  Of this number, 3,434 remained to graduate  Thus, 859 students, or twenty percent of the total enrollment  were eliminated from the one class during the three year period. On the basis of these figures, i t i s apparent that over eight hundred and f i f t y prospective nurses' were lost to the profession out of the original four thousand odd enrolled in 1945. i s a process that i s repeated i n each succeeding class.  This  In view of the  present shortage of nurses, and in terms of disappointment and disillusionment on the part of the rejected students, and in light of the financial loss on the part of the hospitals concerned, this wastage  constitutes an important problem.  I t i s clearly to the advantage of  schools of nursing to be able to predict with as great accuracy as possible, the future success of an applicant and to admit only those who are l i k e l y to succeed. The traditional basis of selection and rejection of prospective nursing candidates i s the personal interview, together with consideration of educational level, age, a certificate of physical fitness and the required testimonials.  It has been pointed out that  these criteria are not particularly valid in the selection of student nurses.  Although an applicant has obtained a high school diploma,  she may be from the lowest quartile of her class and ." few students from this group make satisfactory nurses; chronological age i s not always highly correlated with mental and emotional maturity, nor are the required references usually c r i t i c a l assessments of the individual. The interview i t s e l f i s not always a situation to which the reactions are normal, and the interviewer must be highly trained to interpret the reactions of the applicant correctly. (108) It i s not only important that the school of nursing accurately determine^ the a b i l i t y of a candidate to succeed in the schoolj i t i s also important that some valid means be available for the guidance and counselling of those applicants accepted. In many fields during the Last few decades, increasing interest has been shown in more objective means of personnel selection and counselling.  The value of reliably designed, standardized  tests whose predictability can be utilized to-advantage has been realized  by many branches of business, industry, education and the armed services. How has this contribution of twentieth century psychological investigation been accepted in the f i e l d of nursing? It i s the purpose of this survey to determine what use has been made of psychometric tests in the nursing f i e l d and to ascertain how widely this method of selection has been accepted by the training schools of the United States and Canada. Methodology: In general, the information presented in this paper regarding the use of psychometric tests in the f i e l d of nursing in the United States has been obtained from the accumulation of literature on the subject. Additional data has been obtained by writing directly to various workers in the f i e l d . A l i s t of the test batteries used most extensively in the United States (as determined by a recent survey by Mildred M. McCullough (97) of the Los Angeles County Hospital) was made available through the cooperation of the California Test Bureau. The companies supplying the above test batteries were contacted and sample tests obtained from each. A description of the tests included in each battery w i l l be found i n the appendix. The collected information on the psychometric testing of nurses in the United States was reviewed and analyzed and a summary made of the more significant points arising out of research in the f i e l d .  4 A detailed survey was made by correspondence of Canadian schools of nursing to determine what use i s being made of psychometric tests in the selection of their candidates and the counselZing of their trainees.  Data have been obtained from the Canadian Nurses  Association regarding the rate of withdrawal and the reasons for withdrawal in Canadian training centres. The collected material has been analyzed and the salient features noted. Additional information with regard to the status of .testing in England was obtained through the assistance of Miss Olive Baggalay, Nurse Consultant to the United Nations Health Organization.  It was hoped to include some data on an experiment cur-  rently in progress at St. George's Hospital, London. The preliminary report of the study, unfortunately, i s not yet available for publication. Miss Baggallay was Instrumental i n obtaining a report on the need for psychometric testing in English schools of nursing, which was submitted to the Education Committee of the Florence Nightingale International Foundation in 1949 by Miss Jean Sawer. (140) Finally, the value of psychometric testing to Canadian Schools of nursing has been considered and suggestions have been made on the basis of a l l the data collected. tions have been offered for future research.  Certain recommenda-  REVIEW OF RESEARCH ON PSYCHOMETRIC TESTING IN THE NURSING FIELD  CHAPTER TWO  A review of some o f the more important , studies dealing with t h i s subject should prove valuable as a supplement to, as w e l l as a basis f o r , more accurately evaluating the r e s u l t s of the present survey. 1920-1930:  Most o f the work done i n the f i e l d during the period nurses.  1920-1930 was confined t o the i n t e l l i g e n c e t e s t i n g o f  In 1926, Earle(U9) undertook a more .ambitious, study f o r  the purpose of discovering i f there i s a c o r r e l a t i o n between general i n t e l l i g e n c e and p e r s o n a l i t y and character traits,.such.as .cheerfulness, conscientiousness, etc.  The subjects considered consisted of 212  student nurses from seven, large. hospitals„.in.New„York C i t y .  The Army  Alpha Group Intelligence Test Form 9 was used to ascertain.the general i n t e l l i g e n c e of the nurses. . The. personality and .character t r a i t s such as cheerfulness and conscientiousness .were, rated.by three judges from ..each hospital..and. included .the. superintendent The r e s u l t s obtained were, not conclusive.  and. two supervisors.  6  From the seven groups, the correlations between intelligence and persona l i t y traits vary from -.30 to .55, four correlations being negative, two low positive and one f a i r l y high positive. In 1927 Elwood (57) made a comparative study of the personality traits of the nurse and the college g i r l . — A group of student nurses were given a standard intelligence test and the Colgate Mental Hygiene Tests - Schedule Q2 for introversion-extroversion and Schedule Bj? for psychoneurotic t r a i t s .  These scores were compared with  those of g i r l s in colleges of l i b e r a l arts.  It was found that the nurses  revealed far fewer signs of unhealthy emotional outlets than college g i r l s . The average nurse was more stable than 77$ of the arts students and more extrovert than 94$ of a l l women entering colleges. In 1928 In the Thirty-Fourth Annual Report of the National League of Nursing Education, Metcalfe (104) published some rather interesting figures regarding the achievements of nurses i n relation to intelligence test ratings. school for various reasons.  Of 439 student nurses,-108 l e f t the training  The students were grouped according to the  reason for leaving and the mean score of each group on the Army Alpha Intelligence Test was calculated.  Table 1 gives the results of the study.  The 25/6 who failed i n theoretical subjects had the lowest average on the Army Alpha. Sixty-two percent (62%) f a i l i n g in practice also failed i n theory. Kitson (82) in 1929 published the results of a survey concerning the age at which nurses choose their profession. In a group of 130 nurses, 50$ decided on their careers between the ages of sixteen and twenty-one. Ten percent (10%) were attracted or decided  7  TABLE I 108 Student Nurses Grouped According to Reasons for Leaving Training and the Average Score of Each Group on the Army Alpha Intelligence Test xx  Reason  %  Range of Scores  Average  Failed i n nursing theory  25  64-139  99  Failed in practice  12  82-152  111  Personality  10  66-139  116  Social conduct  16  88-120  127  111 health  16  Resigned  21  58-165  124  Married  18  99-165  139  xx  74-174  130  Date obtained from the Thirty-fourth Annual Report of the National League of Nursing Education, 1928.  8 a t the age o f twelve or before, and 10$ not u n t i l a f t e r twenty-five. The f a c t that the largest group (15$) decided a t 18 s i g n i f i e s that they d i d not make up t h e i r minds u n t i l time t o begin t r a i n i n g . I t i s pointed out that the large numbers of persons eliminated from the t r a i n i n g school a t the end of the probation period indicates the absence of a p p r a i s a l of oneself and of the occupation and the grave need f o r vocational guidance for nurses. In the same year as Kitson's report, a study was made on the r e s u l t s of a battery of tests given by South and Clark (145) t o sixty-eight probationers i n two schools of nursing. The battery included the Ohio State U n i v e r s i t y Psychological Examinat i o n , the O t i s Self-administering Test, the Pressey Senior C l a s s i f i c a t i o n , O t i s Arithmetic, Thorndike-McCall Reading and the Colgate Personal Inventory.  In addition, c e r t a i n measures o f scholastic standard were  obtained based on work i n physiology, anatomy and p r a c t i c a l work. As no s a t i s f a c t o r y t e s t of motor s k i l l was a v a i l a b l e , none was attempted. On the basis of the combined ratings on these d i f f e r e n t measures, ten probationary students were dropped from the schools and f i f t y - e i g h t were retained.  The authors believed that a battery o f tests including t e s t s  of i n t e l l i g e n c e , reasoning, speed, accuracy, errors, reading a b i l i t y , motor s k i l l s and personal t r a i t s should prove u s e f u l i n eliminating those students who are not f i t t e d f o r nursing careers.  However, no  data(was) offered by the authors on the subsequent success i n performance by the students retained.  9 At the beginning of the next decade, much interest was expressed in one way or another about the desirability and importance of measuring certain non-intellectual traits. tests were in use in 1930.  Very few such  Those specifically mentioned in a survey  done by McPhail and Joslln in October, 1930 were: 1.  Colgate Index B 2 and C 2  2.  Rorschach Test  3.  Neyman-Kohlstadt Test  4.  Pressey X-0  5.  MacQuarrie  No tests especially designed to measure nursing aptitude were reported in the survey.  The Moss and Hunt Nursing Aptitude Test was available  for the f i r s t time in 1930.  It was modelled after the Medical Aptitude  Test. (94) In a study of the dismissals from the training schools of ten states in 1930, Wheeler (167) pointed out the need for some means of testing character t r a i t s .  She mentions two girls  with university degrees who were dismissed — one, because she resented authority and the other, because she was unable to organize her work. An average of 46% of the students studied in the ten states were dismissed or resigned. In the same year, Muse (108), Assistant Professor of Nursing at Columbia University, New York, l i s t e d the following as the average criteria used in the selection of nursing  10 candidates: 1.  Academic requirements  2.  Age  3.  Certificate of physical fitness  4-.  Testimonials  5.  Personal interview  She points out that the educational standards of high schools vary and that few students in the lower quartile of their high school class make good nurses.  Age, she states, is not always highly correlated with  mental and emotional maturity and the required testimonials are often only a gesture.  Speaking of standardized tests of nursing aptitude,  she says, "the value of such a diagnostic measure i s so great as to warrant the loyal cooperation of the entire profession." Hyman and Dreyfous (72), in a study entitled "How Intelligent Should Our Nurses Be?" found that probationers made twenty points higher'than seniors on the Otis and Thurstone Cycle Omnibus Test.  They ask: "Does nursing dull the a b i l i t y called for on  these tests?" In 1932, the Honorable George M. Weir published his "Survey of Nursing aad Education in Canada.,''(166) An intelligence test (he does not indicate what test was used) was given to 2,280 students registered in 109 hospital training schools in Canada. The average score was 98.3.  The average score for each of his five  groups i s given in Table II. Of the 2,280 students tested, f i f t y - f i v e did not have even high school entrance.  Fully half of this number had not  11  TABLE II  Average i n t e l l i g e n c e t e s t scores of Canadian student nurses as determined by the Weir Survey i n 1932  B r i t i s h Columbia  103.19  Quebec  101.68  Ontario  98.28  P r a i r i e Provinces  97.23  Maritime Provinces  91.75  12 passed beyond Grade VI of the elementary school. Two hundred and nine (209) students had completed one year or l e s s of the high school course. Weir comments on the opinion of some doctors and nurses that a very mediocre degree of i n t e l l i g e n c e i s a l l that i s requisite f o r success i n the nursing profession. He points out that these c r i t i c s of nursing education probably f a i l to r e a l i z e that a student nurse of low grade i n t e l l i g e n c e may do f a i r l y w e l l under the supervision of her course t r a i n i n g , but that she i s l i k e l y to prove quite incompetent  as a graduate  nurse on her own r e s p o n s i b i l i t y i n private p r a c t i c e . A more frequent use i n t r a i n i n g schools- of standardized i n t e l l i g e n c e tests i s recommended. Several other studies of the problem were made-in the same year that the Weir survey was publishedj studies which were probably eclipsed i n Canada by the i n t e r e s t created by the Weir publication. One study was done by Rosenstein (136) on a group of 1$6 student nurses a t Indiana U n i v e r s i t y who were given the American Council on Education Intelligence Test.  The r e s u l t s were compared  with those of a group of 2,358 college students who had been given the same t e s t .  The nurses were found to earn considerably more c r e d i t i n  t h e i r studies than d i d the college students of corresponding i n t e l l i g e n c e r a t i n g , the difference being more marked i n the ...lower than i n the higher percentile d i v i s i o n s .  In the nurses' group, the i n t e l l i g e n c e ratings  were of considerable value i n predicting t r a i n a b i l i t y , though the correspondence  between the t e s t r e s u l t s and e f f i c i e n c y records i n  p r a c t i c a l work was found to be s l i g h t .  13 MacLean (91)> in a paper read at the Institute on Supervision of the Wisconsin State League of Nursing Education on June 17th, 1932, l i s t e d the following points as important in the selection of nursing candidates: 1.  Health  2>-  The candidates should be chosen from the upper third or half of the high school class. However, this i s not a good criterion in ' small schools, because schools vary in their standards.  3.  Age should not be a criterion.  4.  The candidates* score on an intelligence test should not be below 110. McLean prefers the Ohio State University Psychological Examination. Scores for nursing applicants should be between the 55th and 85th percentiles. I f a student's score exceeds the 85th percentile, trouble may be expected.  5.  Any candidate who cannot reach the Eighth Grade norms in reading s k i l l s , English usage and arithmetical computation should be refused.  6.  An interest test is'recommended— preferably , the Strong Interest Blank.  7.  Finger s k i l l and muscular coordination tests should be_used and perhaps tests for colorblindness .  8.  The Bemreuter Personality Test was  9.  -  suggested.  The personal interview i s f u t i l e without a battery of tests. For the establishment of a selection program at a specific school, Dr. McLean suggests giving the battery of tests to three or four hundred of the graduates from the school for the purpose of obtaining norms for the school in question. He suggests further that the applicants should be charged a fee of five dollars for the administration of the tests and that the services of the university in the vicinity should be utilized.  u Rhine^hart (132), In 1933 made an attempt to predict the success of student nurses by the use of a battery of tests. /  The American Council on Education Intelligence Test was found to correlate .618  - .061 with theory grades for a group of forty-eight f i r s t  year student nurses. The Stanford Revision of the Binet, the Moss Social Intelligence Test and the Moss Nursing Aptitude Test did not show any significant correlation with either theory or practice grades.  Student  nurses tended to score higher on the Bernreuter Personality Inventory in neurotic tendencies and lower i n self-sufficiency and dominance when compared with college women.  i In the Thirty-Ninth Annual Report of the  National League of Nursing Education, Edith Margaret Potts (121), presented her findings from an experiment with a battery of tests begun in 1932.  The battery included the Revised Army Alpha Form 5, the McQuarrie  Test for Mechanical Aptitude and the Bernreuter Personality Inventory. Alpha scores and the scores on Bernreuter emotional sensitivity were found to correlate .58. than the inferior.  The superior student appeared less adaptable  "Perhaps," says Po'tts, "we need to consider the  nature of the situation to which we have asked her- 'to adapt.  Some  aspects of the situation should not be adapted to, but changed." (Tests were administered to 1,500-2,000 students i n schools of a l l sizes and in different parts of the country.) Another interesting study was published by Potts in the same year entitled, "She Can 1 Learn Anatomy, But 1  ."  (120) "In this study she reports a correlation coefficient of .22 between  !5 the Army Alpha and the McQuarrie Test for Mechanical Aptitude.  From  this positive correlation, she draws the conclusion that i t i s not the general rule to be low in the one a b i l i t y and high in the other.  "Aren't  we keeping poor nurses>" says Miss Potts, "on the supposition that they are a willing, obedient, steady and controllable source of routine work?" Potts correlation of .22 may be somewhat low to substantiate a definite conclusion.  However, the same point was brought out in a study done at  the Rhode Island Hospital Training School with,more conclusive results. "Good i n theory, but not in practice" was shown not to be founded ia'Tact. A correlation of .70 was found between grades i n theory and practice. Studies In the selection of student nurses in Pittsburgh (Jones and Iffert)(75)» showed that intelligence test scores did not correlate at a l l closely with ratings used as the criteria of success in the practical work of a training course. They correlated somewhat better with the grades made i n theoretical subjects. Jones and Iffert recommend their use as one of several aids in selecting candidates, together with high school achievement tests and a special test of aptitude for nursing. Bregman (19), in an extensive survey of the mental a b i l i t y of student nurses noted that the distribution of scores was quite similar to that of students i n normal schools. She says,"Every level of a b i l i t y found among college students i s to be found among students of nursing, but there are relatively fewer nurses at the higher levels and the average college student surpasses the average nurse—in-training in the qualities measured by an intelligence test."  16 Another study of the mental a b i l i t y of student nurses was done by Langhorne (87) i n 1935*  Scores on the  American Council on Education Psychological Examination were found to be higher: 1.  for university freshmen, than for student nurses,  2.  for student nurses i n university hospitals, than for students in non-affiliated nursing schools,  3.  for the preceding groups, than for negro student nurses.' South and Clarke published a further study  in 1935. Four hundred and eight students i n nine schools of nursing were given the Ohio State University Psychological Examination.  On the basis  of the scores on the test the students were grouped i n the four quartile divisions.  Comparing those students who took the state licensing exam-  ination, the majority of failures were found i n groups C and D (lowest scores).  The students i n group B were more successful than the A group,  which corroborates statement made by Potts (120) and also by McLean (91). Personality d i f f i c u l t i e s were found i n a l l groups.  Students in groups A  and B tended to evidence a greater dislike for nursing than those i n groups C and D.  Johnson (74), i n 1935, published the results  of a study of the comparative scores on a number of tests of two groups of graduate nurses. Thirty graduate nurses known as successful i n their profession and having at least five years of experience comprised the f i r s t group.  The second group were chosen on the same basis except for  the length of experience. Tests measuring accounting aptitude, engineer-  17  ing aptitude, tweezer and finger dexterity inductive reasoning, creative ?  imagination, ward knowledge and a r t appreciation were given. Recommendations for the type of individuals that should be admitted to nursing j J( ^ ^ schools were the major results of the study. The work of O'Connor and associates (112), published in 1936, consisted of a two year follow-up of fifty-eight student nurses. The fifty-eight members*of a probationary class were given a battery of tests.  This report was based on their success during  the f i r s t two years of the course and included recommendations for future testing.  An English vocabulary testj especially when combined with one  of word checking furnished an excellent prediction of classroom success, and there was some evidence that the Wiggly Block Test i s related to hard work. The report suggested the definite need of further experimentation but contained no correlations. One of the most extensive investigations i n the f i e l d was the work of Williamson, Stover and Fiss. (169) In 1934 the Minnesota League of Nursing Education appointed a committee on testing to supervise a program of research designed to yield improved methods of selecting students to the schools of nursing i n the state.  This committee  engaged the services of the University of Minnesota Testing Bureau to conduct this research program, a f i n a l report of which was given i n January, 1937. Students enrolling i n some twenty schools in the f a l l of 1934, the winter of 1935 and the f a l l of 1935 were tested with a large battery of tests. At the end of the f i r s t year of instruction,  18  these tests were correlated against each student's grades in the various subjects of instruction. The measures employed were: 1.  College Aptitude Test (Cooperative Vocabulary)  .2.  Moss Nursing Aptitude Test  3.  Cooperative General Science Test  4«  Cooperative English Test (usage and spelling)  5.  Otis Test of Mental Ability  6.  Gordon's Nurses' Fractions Test  7i  Minnesota Vocational Test for Clerical Workers  8.  Munro Fractions Test  9«  High school percentile rank.  The five criteria of success used were: 1.  Average grade i n science courses, i.e. anatomy, physiology, bacteriology and chemistry.  2.  Average grade in practical courses, i.e. principles and practices of nursing.  3.  Average grade i n clinical courses, i.e. medical and surgical nursing, obstetrics and pediatrics.  4.  Average grade in a l l courses in the f i r s t year of instruction.  5»  Total score on~an objective examination covering a l l the subjects of instruction in a l l schools in the f i r s t year.  -  A l l the correlations obtained were surprisingly low. In general, the schools that had the best distribution of grades had the highest correlation coefficients. In the authors' conclusion they  19  state:  "Throughout the entire study, there are many indications that unstandardized and haphazard grading; may be the cause of the low correlations between tests and criteria. The higher correlations for some of the separate schools strongly support this contention. . . . I t i s d i f f i c u l t for one to expect more accurate identification of successful students unless and Until major reforms are instituted in educational practices in schools of nursing;. Instructors in nursing must be taught how to make better class examinations and how to do a more accurate and thorough job of assigning grades to students. Moreover, drastic revisions must be made in the rating of • efficiency-in the so-called practical nursing; courses. Under such•conditions. i t i s •probable that tests of the type used in this study w i l l yield f a i r l y accurate identification of potentially successful students." -  In general, the four tests: Moss Nursing Aptitude Test, College Aptitude Test, Cooperative English Test and the Cooperative General Science Test yielded the best results. In 1939,  Hilgard.(69) of Stanford University  did a study of Strong Vocational Interest scores at completion of training in a school of nursing. The Strong Vocational Interest Blank was administered to the entering students of St. Luke's School of Nursing in San Francisco i n order to determine the extent to which scores for nursing interest would predict both continuance in training and success in training. The tests were not scored until two years of training had elapsed in order to avoid a spurious influence of suggestion by the councilors. I t was found that those with ratings below "A" in nursing showed l i t t l e likelihood of completing the nurses' training course. Of those with "A" ratings who did not continue, the largest proportion dropped out because of low grades. The interest scores of.those remaining in service did not predict either grades in probationary courses or ratings in practical work on the wards. For these predictions, an intelligence test was more serviceable than the  20  interest test. Low interest test scores predicted chiefly those who would leave training in spite of their ability to do the intellectual work required. In the same year, Garrison (60) of the State College, University of North Carolina published a lengthy study on the use of psychological tests in the selection of student nurses.  He  concludes that intelligence test scores, mechanical aptitude scores and reading test scores are indicative of both theoretical and practical work. Case studies showed that these were valuable in forecasting ability in the direction for which the tests had been designed. A study of individual profiles revealed-that extreme traits may be most desirable when associated with other traits in a pattern that presents a desirable one.  A careful analysis of the individual's psychograph w i l l oft-times  show the nature of the personality pattern that i s a hindrance to the adequate development of the student nurse. Poorer nurses were found to be more introverted, more submissive and more self-conscious according to scores on the Bernreuter Personality Inventory. 19AO-1950; In the opening year of this decade, Sister Dolores Marie S.H.N. (l43)> c l i n i c a l psychologist at Marylhurst College, Oregon, published an article in defence of the psychometric testing of nursing students. She quotes Dr. Safari of the South Methodist University, Dallas, Texas as stating, "In using the Otis Self-Administering Intelligenc Test, McQuarrie Mechanical Aptitude Test, the Bernreuter, the Potts-Bennett Nursing Aptitude Test, the results showed that the battery did not justify  the time and energy spent on i t . "  Sister Dolores Marie points out that  such tests are not magic devices as some seem to think they should be, but are major keys in the hands of the expert. In 1941 > Super (150), i n an a r t i c l e dealing with .the Kuder Preference Record in vocational diagnosis, reports on an occupational scoring formula for nurses designed by Triggs.  Trlggs worked with 826 nurses taken as a group and treated  also according to specialties such as public health, nursing, and supervision, the sub-groups varying in size from 144 to 196.  According  to Trigg's data, nurses are significantly higher in scientific, a r t i s t i c , musical and social service interests when compared to women in general. They are low i n computational, persuasive, literary and clerical interests.  The patterns of scores reported by Triggs were  based upon differences which although s t a t i s t i c a l l y reliable, are not great enough to make counselling individuals on the basis of profiles a generally satisfactory procedure.  On the other hand, they are great  enough to make counselling based on an "occupational index", such as Trigg's, combination of weighted scale scores, quite practical. The Kuder Preference Record was shown to have more validity for women than Strong's Women's Blank. In 1942, Ranier, Rehfeld and Madigan (131) gave eighty student nurses the Iowa Reading Test. The students averaged in the third quartile for college freshmen, but f e l l below average in the rate of reading section.  Correlations with course grades in nursing  school were .43 for high school average, .42 for the American Council  2 2  Psychological Examination,  .33 for the Iowa Reading Comprehension Test,  and .18 for the Iowa Silent Reading Scores.  They point out that i f a l l  nursing candidates below average in one respect were eliminated, the student body would be unduly reduced. Guidance must be employed to lead each individual to make the most of her a b i l i t i e s . Douglas and M e r r i l l (42), found that for, j predicting success in the school of nursing, the best four factor com-'^^^Mbination appeared to be from their study: high school marks (percentile rank), scores on the Moss Nursing Aptitude Test, scores on the Cooperative General Science Test Part I, and scores on the DouglasGordon Fraction Test.  This combination yielded a multiple correlation  of .77. The best two factor combination yielding a multiple correlation of .75 was the Moss Nursing Aptitude Test score and high school ' percentile rank. They point out that conclusions from their study are not l i k e l y to apply without modification toother institutions, and that a combination of entrance measures does not necessarily remain the best possible combination over a period of years. McPhail and Bernard (93), in 1943, • published the results of a study carried on over approximately ten years.  It dealt with data obtained from the application of the Brown  University Psychological Examination to four hospital training schools in Rhode Island over a period of ten years.  Some 1,500 cases were  studies!. Major conclusions derived were: 1.  In only two of the four hospitals were significant differences found between those who ultimately graduated and those who did not.  23  2.  Correlations ranging from .42 to .60 were found between intelligence test scores and •and preliminary grades.  3.  Only slight differences were found between the mean- test scores of the various schools.  4.  Those accepted for training were only slightly superior to general high school girls i n , intelligence test scores and are very inferior to f i r s t year liberal arts women.  5.  Students under-twenty-one years of age at entrance, pass, f a i l , and withdraw in the same proportion as those twenty-one years of age and older.  Grider (34), in 1943, described a program which "has been used to select nursing trainees and which has reached i  the point where the problem of failure has been largely eliminated." The selection devices used, include the Otis Test, a reading test, the Strong Interest Blank, and the Bell Adjustment Inventory, a personal interview by a psychologist, and another by the director, a physical examination, high school record, and a rating by an acquaintance. The Strong and Bell scales were found to contribute l i t t l e .  The intelligence,  reading and arithmetic tests discriminated between good and bad risks. Emphasis was placed upon the importance of the psychological interview and the need for the" psychodynamic evaluation of the psychometric data. Further work on the interest patterns of nurses was done by Commins (32), assistant professor of Psychology at the Catholic University of iAmerica.  He reports that the interest patterns  exhibited on the Cleeton Interest Inventory show a high interest i n natural science and a low interest i n academic work and the household group. A slight tendency to extroversion was also found.  24 Bennett and Gordon (12), a f t e r a study of the scores of 235 student nurses on the Bernreuter and the Minnesota Persona l i t y Scale concluded: "To the extent that i t i s possible to generalize from the findings presented i n the present study, i t would appear that the type of personality t e s t used i s of l i t t l e or no value as part of a battery of tests used i n personnel s e l e c t i o n , since i t w i l l predict neither success nor" the a t t i t u d e s of colleagues or supervisors. ' 1  Potts (127), reached the same conclusion regarding personality t e s t s and adds further that mechanical a b i l i t i e s are not p a r t i c u l a r l y important to success i n the nursing f i e l d , except i n so f a r as teaching i s improved when those of the same dexterity a r e grouped.  The personality t e s t , she says, i s of l e a s t  importance,  except when there i s an extreme deviation. In 1946, Sartain (139) of the Southern Methodist University of Dallas, Texas found a c o r r e l a t i o n of .677 when predicting success with the Potts-Bennett t e s t s .  A d d i t i o n of the  other t e s t s or high school averages yielded very small increases. Wyatt (176) has recently introduced a new note i n psychological problems i n the nursing f i e l d . interested i n how nursing a f f e c t s the new student.  He i s  Such exacting  professional t r a i n i n g during l a t e adolescence, he thinks, involves problems of s o c i a l and b i o l o g i c a l maturation and the c o n f l i c t s which w i l l be engendered w i l l be affected by the two major experiences o f apprenticeship: (1) the t r a d i t i o n a l norms or acknowledged ways i n which things are done i n nursing and (2) the experience with sickness  .25  and disability and their psychological manifestations.  He asks for  research on the effects of a professional situation upon the worker and into the psychological pattern of a profession at large. In 1947, Nahm (109) constructed a test to measure a b i l i t y to understand and apply mental hygiene principles since no satisfactory test of this type was available.  The test was admin-  istered to 422 senior students in twelve schools of nursing in Minnesota. ly Many students seemed to be serious/deficient in a knowledge of mental hygiene.  Of particular importance Is their lack of appreciation of the  importance of home background in producing personality maladjustments and their confidence in the efficacy of good advice. were found among the different schools of nursing.  Marked differences Pre-hursing college  work did not seem as important as the place that- work had taken.  Scores  on the Mental Hygiene Test did not correlate to any marked degree with general scholastic aptitude. A sociometric study was done in 1947 by Sister Theophahe Dwyer (44) , Catholic University of America on a group of forty students.  Use of the technique i s suggested in the training  of nurses as a means of providing guidance for socialization of the "least preferred" and leadership opportunities for the "most preferred." Berg (13), of the University of I l l i n o i s , in the same year did a study of 110 student nurses using a test battery consisting of the American Council on Education Psychological Examination George Washington series of nursing tests, Kuder Preference Record and Harrower-Erickson Multiple Choice Test.  About one half of the eventual  26 poor scholastic group could hare been eliminated because of low test performance.  Those nurses who quit training show few significant  variabilities i n test performance from those who remained i n training It was concluded that admission standards must be lowered or the physical demands and routine tasks imposed on nurses changed, i f the number of graduate nurses i s not to decrease. Summaryt Since 1923, much experimental work In the testing of nursing candidates has been done In the United States. In general, the results of these studies show that a combination of psychometric measures can be used to predict the suitability of nursing candidates with sufficient accuracy to make the use of such devices practical to the school of nursing. Some of the more significant points arising out of this accumulation of research are the following: 1.  Nursing candidates should have i n t e l ligence test scores at least as high as the average high school graduate.  2.  Although there i s a high correlation between intelligence test scores and success i n training, students i n the higher percentile groups do not usually do as well In the training school as those with somewhat lower intelligence test scores.  3«  Interest, mechanical aptitude and paper and pencil personality'test scores are of l i t t l e value i n predicting nursing aptitude, but may be used with good effect i n the. guidance and counseling of accepted applicants.. ..Teaching may be improved by grouping students with similar mechanical aptitude scores.  27 The best r e s u l t s i n p r e d i c t i o n appear t o hare been achieved by using c e r t a i n nursing aptitude t e s t s (the Moss and the Potts-Bennett), scholastic aptitude t e s t s , t e s t s i n reading comprehension, arithmetic t e s t s , and tests o f achievement i n general science knowledge. The best two-factor combination found byDouglas and M e r r i l l was the Moss Nursing Aptitude Test and high school p e r c e n t i l e rank. 1  There i s a need f o r expert i n t e r p r e t a t i o n of t e s t r e s u l t s , f o r a personal interview with a psychologist, and f o r a psychodynamic evaluation of the psychometric data. No t e s t battery can be expected to p r e d i c t e f f i c i e n t l y i n schools of nursing where grading.is unstandardized or haphazard.  28 DEVELOPMENT OF NATIONALLY-ORGANIZED TESTING SERVICES IN THE UNITED STATES  CHAPTER THREE  At the present time, there are two nationally-organized services for the testing of student nurses i n the United States.  The f i r s t of these, under the control of the  Nurse Testing Division of the Psychological Corporation was established i n 1935>. The other was organized i n 19U2 by the National League of Nursing Education.  The major part of the testing of  nursing applicants i n the United States i s done by these two organizations although the present trend.seems to be that o f meeting local needs through a local test bureau. Edith Margaret Potts R.N., M.A, has been a unique and important contributor to the entire field of research i n the psychological measurement of student nurses.  It was  through her efforts that the f i r s t testing service on a national scale was developed. The Nurse Testing Division of the  29  Psychological Corporation, of which Miss Potts i s director, maintains a testing service with i t s headquarters i n New York.  Previous to her  present position which she began i n 1935*, Miss Potts had been active i n the study of entering student nurses at Teachers' College, Columbia University.  The Nurse Testing Division i s now one of five  specialized divisions within the Psychological Corporation which has an overall concern with applied psychology i n the spheres of education and industry. Association with research divisions i n industrial and educational fields permits many advantages such as freedom for cross-consultation, knowledge of advances i n psychological work of a l l kinds within the country, and access to the most up-to-date testing equipment. The relatively long period of extensive service has made possible the study of nonns on at least Uj>,000 applicants.  Constant testing of the tests themselves has been car-  ried out, new forms devised, and weak items discarded.  The present  battery comprises tests of: 1.  Scholastie Aptitude (originally the Army Alpha)  2.  Science  3.  Reading Comprehension  a. s.  Arithmetic and Reasoning  6.  Mechanical Comprehension  7.  Personality Assessment (Bernreuter's Inventory)  General Information  30  Each student's report sent to the school i s an estimate of her as an individual placing her score i n a decile scale, giving a summary of a b i l i t i e s , the likelihood of adequate capacities for adjustment and, f i n a l l y recommending acceptance or refusal. (12li) I t i s for each school to decide upon the level of attainment which i s essential to carry the curriculum i n the particul a r school.  Results have shown that the following are most likely to  succeed: 1,  Those scoring i n the 9th or 10th deciles (below 7th unlikely to graduate)  2  Age range between twenty-two and twenty-six years (older age groups scoring i n lower deciles are l i a b i l i t i e s , as a large proportion are chronic occupational misfits.)  #  3.  -  Members of large families.  lu  Those brought up i n large c i t i e s (population 5 , 0 0 0 or more)  £.  Those with, interest i n mathematics, science, and social-studies.  Potts feels that potential classroom failures have an adverse effect on the other students by absorbing a disproportionate amount of the instructor's time, thus preventing the mediocre.students from becoming reasonably good and the adequate from being outstanding. (126) The increase i n the number of schools of nursing making use of the service of the Psychological Corporation points to the need and value of such a program. Three hundred and forty-six schools i n forty-one states used this particular battery i n  31 l°lt5" and well over 10,000 applicants were tested. (110) In 19li2, the National League of Nursing Education organized i t s own test service due to a sense of professiona l obligation among i t s leaders.  "Institutions for professional pre-  paration have an obligation to develop and maintain sound ethical, educational and professional standards. (llUt) M  It was f e l t that a  responsbility existed toward the student i n protecting her as far as possblle from disappointment, disillusionment and waste of her time due to failure after admission to_.a chosen profession; towards society, by protecting i t against inefficiency due to inadequate standardsj and towards the profession Itself, i n avoiding economic wastage through failure to discriminate between potentially adequate and inadequate standards. Beside the pre-nursing battery, the National League Department of Measurement and Guidance provides three other^ services:  an Achievement Test Service for measuring the results  of instruction; the State Board Test Pool. Examination Service used for licensing purposes*; and a Graduate Test Service for graduate nurses seeking admission to colleges and universities for degree work. In 19U7, 9,000 applicants were tested by the National League's Prenursing battery, an< increase of 22% over 1°U6. (£8) The Department of Measurement and Guidance of the National,League has special license to use the A.C.E. *  Employed by British Columbia Schools of .Nursing for classes graduating i n the f a l l of 19U9.  32 and Co-operative Test Service t e s t s .  Thebattery includes:  1»  A.C.E. Psychological Test.  2.  The Cooperative Reading Comprehension Test C 2  3.  Mathematics — adapted from the Cooperative Mathematics Test f o r grades 7,8,9.  U.  Cooperative General Achievement Tests I I : a t e s t of general p r o f i c i e n c y i n the f i e l d of the n a t u r a l sciences. Form T.  5.  Cooperative General Culture Test, Part I I : History and Social Studies, Form T. The two n a t i o n a l schemes are run largely  on s i m i l a r l i n e s .  An applicant to a state accredited school which  makes use of the t e s t i n g service i s given a t e s t a p p l i c a t i o n card signed by the nursing d i r e c t o r , and a schedule of t e s t i n g centres and dates.  The prospective nurse forwards the card plus a fee of  f i v e d o l l a r s to the c e n t r a l o f f i c e and arranges to attend the nearest centre a t the appropriate date. the examination.  Her receipt serves as admission to  The examiners at these centres are often drawn  from l o c a l psychologists and psychometrists, q u a l i f i e d i n administering the t e s t s .  University and college departments have cooperated  i n providing accommodation and s t a f f on the necessary dates.  All  answer sheets are sent to the c e n t r a l o f f i c e f o r machine scoring, i n t e r p r e t i n g of r e s u l t s and the Issuing of records to the schools. Within ten days, the report i s sent to the school whose nursing d i r e c t o r o r i g i n a l l y signed the card.  Thus, the d i r e c t o r i s able to  have t h i s material before her, p r i o r to making a f i n a l d e c i s i o n about the applicant.  33 REPORT OF A SURVEY OF TESTING IN CANADIAN SCHOOLS OF NURSING  CHAPTER FOUR  A surrey has been done in Canada to determine what testing techniques are employed by Canadian schools of nursing.  The surrey was begun by contacting, by correspondence,  the directors of the various Provincial Registered Nurses Associations.  In many cases, the Association was able to state  definitely which hospital training sehools were employing psychometric testing techniques.  The hospitals were then written to  directly for more detailed information regarding their programs. With the exception of Quebec and Ontario, the number of training schools i n each province is small and i t was f e l t that the above method was adequate for the purposes of this surrey.  Table III  gives the number of training schools for each province i n Canada for  19U8. The thirty French hospitals i n Quebec  3k  TABLE III Number of Accredited Training Schools i n the Provinces of Canada i n 1°1*8  PROVINCE  NUMBER OF SCHOOLS ..  Nova Scotia  15  Prince Edward Island  3  New Brunswick  lk  Quebec:  English  7  French  30  Ontario  63  Manitoba  11  Saskatchewan  10  Alberta  11  British Columbia  6  35  -  were not contacted on the grounds that selection i n these hospitals presents a somewhat different problem to that confronting the training schools of Canada as a whole, most of the available testing devices being standardized on English-speaking populations. Moreover, although the large number of schools i s impressive, only three of the thirty training centres enrolled more than f i f t y beginning students i n  19U8. In Ontario, where nursing education i s under the control of a government department, the Nurses* Registration Division of the Ontario Department of Health, the desired information was not obtainable i n the central office.  However, a l i s t of the  sixty-three training schools i n the Province was obtained, together with the enrollment of each. A questionnaire with regard to psychometric testing devices used was sent out. to each training school having an enrollment of one hundred students or more. Of the sixteen schools contacted, thirteen replied.  The three schools not replying  were comparatively small training centres having enrollments of 1U6, 133 and 121 students.  One school, being i n conjunction with a special-  ized hospital gives most of i t s training service by a f f i l i a t i o n with other hospitals. Further information was obtained through the National Office of the Canadian Nurses' Association i n Montreal. Figures were obtained regarding the total student enrollment i n the hospital training schools of Canada, the rate of withdrawal from a class (the one graduating i n 19U8), and a break-down of the reasons  36 for withdrawal.  An attempt was made to discover i f any study had been  done on the intelligence test scores of student nurses since Weir s ,  survey i n 1932, but no such study has been done — at least, not on a national level. This survey of conditions i n Canada has revealed widespread interest i n psychometric testing of student nurses. Although a certain amount of scepticism has been expressed, the dominant feeling seems to be that better methods for the selection and guidance of students are needed and i n consequence, the possibilities of psychological tests are being seriously considered. Petry (115>), i n connection with her recent hospital survey i n British Columbia has pointed out their importance. British Columbiat Of the six schools of nursing i n British Columbia, there i s only one i n which any kind of psychometric testing i s done. The Vancouver General Hospital gives the Otis-Self-Administering Test of Mental A b i l i t y to each student one month after admission to the School of Nursing.  The tests are administered and interpreted by  a member of the Bureau of Measurements of the Vancouver School Board. The class median i s calculated and compared with that of Vancouver Junior Matriculation students.  The median I.Q. of some classes i n  recent years has been as low as.108.9 and, s. high as 117, with an a  average of approximately 113.  These results are encouraging, when  compared with Mr. Weir's findings i n 1932.  The testing program i n  this hospital has been i n effect for the past sixteen years.  37  Albertat  7xi Alberta, there has recently been expressed a desire to institute a Province-wide project of doing intelligence and personality tests on nursing students entering the various training schools.  However, at the present time, of eleven  training centres, only two have employed psychometric devices. The Royal Alexandra Hospital i n Edmonton has been using the 19U7 Edition of the Psychological Examination for College Freshmen  (A.C.E.).  The instructors administer  the test to the students and also score them. Spelling and arithmetic tests are also given. Previously, a Silent Reading Test was given, but proved of l i t t l e value.  The present program has been used for the  last three preliminary classes, and i t s value i n guidance i s thought to be questionable.  The need f o r testing before entrance i s recognized  and the desire to experiment with a greater number of tests i s expressed. The reason stated for not making greater use of the tests i s Jbeeause of a sense of inadequacy i n dealing with them. The need for expert i n terpretation of test results i s f e l t . The only other training centre i n Alberta employing ft testing program i s the Holy Cross Hospital School of Nursing i n Calgary.  Here, they have used the battery of the  Psychometrical Service Company of Canton, Ohio (see Appendix) for the past four terms.  The tests are given to the preliminary students after  entrance, and are used for guidance purposes.  Mr. Dent, Test Consultaat  of the Psychometrical Service Company, administered the f i r s t battery  38 himself, and since that time, the teats have been given by the Science Instructor.  The Company Interprets the teats and returns a f u l l  report on each student to the Training School. Saskatchewan; Of ten schools of nursing i n Saskatchewan, two employ psychometric testing devices.  The Regina Grey Nuns* School  of Nursing and St. Paul's H ospital School of Nursing, Saskatoon both employ the battery of the Psychometrical Service Company. I t i s f e l t that the tests are excellent i n showing the weaknesses to be found i n the preliminary students and are f e l t to be invaluable i n the teaching program.  They are not, however, used as selection devices.  Manitoba; Iii Manitoba, eight of the eleven schools of nursing replied to a request f o r information regarding psychometric testing techniques sent out to them by the Executive Secretary of the Manitoba Association of Registered Nurses.  Of the eight schools which  replied, only two are using any formal test or tests and one other i s currently seeking advice with respect to tests which they might use. One school began giving testa to the students of the January Class of 19U7.  The tests are given i n a blook during the students f i r s t week  in the School.  8  Professor Williams, of the Department of Psychology  of the University of Manitoba, has cooperated i n giving the tests and also a member of the Board of Education of the City of Winnipeg. The American Council on Education Psychological Examination and the Iowa Silent Reading Test are used.  No mechanical dexterity, personality  39 nor emotional adjustment tests have been tried.  In the other school  employing testing devices, the Wechsler-Bellevue  Intelligence Test has  been used.  The School does not feel that i t i s an "ideal" test for  nurses, but has found that the general knowledge acquired i n this way about each student to be helpful i n understanding  that student,  Ontario; In Ontario, of the sixteen schools contacted, thirteen replied.  Of these thirteen schools, only three are  using any sort of testing devices.  Four hospitals expressed a desire  for information regarding.the availability, cost etc. of tests now i n use i n other schools of nursing. The Hospital f o r Sick Children, Toronto has used the following tests i n Its School of Nursing: 1,  Kuder Preference. Record  2  Moss-Hunt Aptitude Test for Nursing  #  3.  Otis Test of Mental Ability  U,  Bell Adjustment Inventory  £.  Health Education Test Grade 7-12 College Form A  and  Most of these tests had been i n use up to five years previous to the last war, when at that time the practice had to be discontinued due to a lack of personnel to evaluate the tests properly. When in use, the tests were used i n research i n conjunction with the training school's opinion as to the suitability of the applicant to enter the f i e l d of nursing, but the results were unsatisfactory due to a lack of  ho cooperation on the part of the students.  Since that time, the tests  have been used only when there i s some doubt as to the advisability of accepting an applicant and this use of the tests has proven satisfactory.  Health Education Tests are given to a l l students shortly  after entrance i n order to acquaint the Training School with the students' knowledge of health_education. The Victoria Hospital School of Nursing, London, Ontario has made a start i n the psychometric .testing of their student nurses i n the past year.  The. majority of the testing has  been conducted by the Department of Psychology of the University of Western Ontario and the tests have been of their selection.  They  have been using the following tests i 1.  Otis Quick-scoring Test of Mental Ability — Gamma Test  2.  Study Habit. Inventory  3.  George Washington Series. Aptitude Test for Nursing  U.  George Washington University Pre-test Arithmetic for Prospective Nurses.  Since these tests have been used for students who have entered training i n the past year, no data are available at the present time to make any statement regarding the value of the tests.  I t i s hoped  that at a later date they might be used for both selection and guidance purposes. St. Joseph's Hospital School of Nursing, Toronto is using a Health Education Test, "Knowledge and Application,"  Ul published by the Acorn.Publishing.Company,  Rockville Centre, New  York, but employs no other testing devices. Quebect Of the seven English language Schools of Nursing i n Quebec, only—two-have employed psychometric tests to any extent* and i n these schools, such tests have been administered only after the admission of the students t o the school. The H omeopathic H ospital School of Nursing i n Montreal has employed a testing, program for preliminary students for the past two and a half years.  The tests are administer-  ed by Dr. Edward C. Webster, Consulting Psychologist and member of the Department of Psychology at M c d l l University.  The tests used are the  followingi 1.  Otis Self-administering Test of Mental Ability.  2.  Kuder Preference Record.  3.  Humm-Wadsworth Temperament Scale  h»  Achievement Tests i n Vocabulary, Arithmetic and General Science  The test results are used by instructors to give special help and guidance to certain students who are shown to require i t . Much interest i s expressed i n the program and the hope that definite results w i l l be shown i n the future through i t s use. The School of Nursing of the Royal Victoria Hospital i n Montreal, employed the services of the Psychometrical Service Company for their f a l l class i n 19^8.  The  U2 superintendent states that events since the testing have proved that the psychometric examiners."were not 100% correct" i n their estimates of the students and feels that high school grades and a personal interview yield sufficiently reliable indications of the ability of the student.  Two years ago, the new. students of the Royal Victoria  School were tested for emotional stability by the Hospital's Psychiatric Institute, but u n t i l the three years training are completed, a report on the value of the testing w i l l not be available. New Brunswick: The hospitals i n New Brunswick are just beginning to organize testing programs i n their Schools of Nursing.  At the-Moncton  Hospital, through the cooperation of the  Moncton High Sehool Vocational Guidance Instructor, Intelligence Tests (Otis) were done on a l l 19k9 students.  The testing was done  for the purpose of evaluating the mental capacity of the preliminary student as a guide i n the selection of that group.  No other tests  were employed. At the Victoria Public Hospital, Fredericton, i n t e l ligence testing of three preliminary classes has been carried out by a member of the Psychology Department of the University of New Brunswick, using the Clapp Young Self-marking Test.  Two other schools,  the Saint John General and the Ghipman.Memorial Hospital, were working on plans for the f a l l classes of 191*9. Nova Scotia:  . None of the fifteen schools of nursing  i n Nova Scotia are at present using any kind of psychometric tests for either the selection, or guidance of their student nurses. The  enrollment i n the Nova Scotia training centres i s small, averaging fifty-two students for each school i n 191*8. Prince Edward Island: The Charlottetown Hospital Sehool of Nursing i s the only school i n Prinee Edward Island to employ psychological tests.  H ere, the battery of the Psychometrical Service  Company i s used.  No candidates were accepted f o r the f a l l class of  19U8 or for the winter class of 19l*9, who were not recommended by their results on the tests.  Hence, the Charlottetown Hospital bears  the distinction of being the only training school for nurses In Canada which gives a test battery a major place i n the selection of Its student nurses. Table IV gives the number of schools of nursing i n each province using any kind of psychometric test according to the results of the .present survey.  The Charlottetown Hospital i n  Prince Edward Island i s the only one selecting i t s student nurses on the basis of the results of a battery of tests.  In a l l the other  schools which employ tests, such devices are used merely for guidance purposes, with the exception of the Hospital for Sick Children i n Toronto where testing i s used i n selection when there i s some doubt as to the suitability of a candidate. A Study of Student Nurse Withdrawal from Canadian Schools of Nursing: Of U,295 students entering training i n Canadian schools of nursing i n 19U5, 3,339 graduated i n 19U8 (Table V).  Thus, 8£6 or 20% failed to graduate.  In the United States  hh  TABLE TJ Number of Canadian Training Schools Pound from this Survey to be Employing Any Kind of Psychometric Test  Province rrovmce  « Schools Using . Testing Devices N o  o  f  Nova Scotia  0  Prince Edward Island  1  New Brunswick  k  Quebec: English H ospitals  2  Ontario  3  Manitoba  2  Alberta  2  British Columbia  1  1.5 i n 19k7,  39% of the c l a s s f a i l e d to graduate.  withdrawal rate i s comparatively  Hence, the Canadian  low.  Too l i t t l e has been done i n Canada to draw any d e f i n i t e conclusions regarding the e f f i c a c y of the e x i s t i n g t e s t i n g programs.  With the exception of the Hospital f o r Sick  Children, Toronto and the Charlottetown i n Prince Edward Island, no t r a i n i n g centre has used a t e s t battery f o r s e l e c t i o n purposes.  The  battery used by the former school i s only employed when there i s some doubt as to the s u i t a b i l i t y of a candidate, and i n the l a t t e r case, the program has been i n e f f e c t too short a time f o r any ation to be made.  evalu-  However, i t i s i n t e r e s t i n g to note (Table V) that  i n those provinces where an active i n t e r e s t i n t e s t i n g has been shown,  \  e.g. Ontario, Alberta and Prince Edward Island, the respective elimina-\ t i o n rates stand at lh%,  12.8%  and 1$% as opposed to 28.756 i n B r i t i s h  Columbia where no t e s t b a t t e r i e s have been employed. A break-down of the reasons f o r student nurse withdrawal from t r a i n i n g i n the provinces of Canada f o r the year 19U7  i s shown i n Table VI.  I t w i l l be noted that approximately  2$% of the withdrawals are due to f a i l u r e i n classwork, or i n c l i n i c a l practice.  I t w i l l also be noted that i n B r i t i s h Columbia, there were  t h i r t y - f o u r eliminations due to f a i l u r e i n classwork out of a t o t a l of eighty f o r the whole of Canada.  Moreover, the t o t a l elimination rate  f o r B r i t i s h Columbia i s higher than that of any other  province.  Over t h i r t e e n percent of eliminations i n Canada i n 19^7 were due to "unsuitable p e r s o n a l i t y " and "unhappiness  Student Nurse Withdrawal from the Graduating Class of 19l*8 i n Canadian Schools of Nursing*  Province  Glass Students Number Graduation Number of Percent of Admitted Actually Postponed Withdrawals Withdrawals in 19l*5 Graduated  19U8  N.S.  P.E.I.  Spring Fall Total  108 19U 302  U»7 230  Spring Fall Total  11 22 33  11 17 28  Spring Fall Total  63 178 21*1  131 175  2 2  Spring Fall Total  3UU 1*78 822  250 351 601  6 19  Spring Fall Total  336 95*9 1295  Spring Fall Total  83  3  10 13  _  22 37 59  20.3% 19% 19.52  _  5 5  22.5* 152  19 1*5 61*  302 25.22 26.52  21*  88 109 197  25.52 22.82 23.92  280 798 1078  2 21 23  11*0 191*.  51*  162 H*.52 H * . 92  165 215 1*26  139 153 335  1 3  25 59  1*  81*  15.12 27.1*2 22.12  Spring Fall Total  163 263 1*26  131 201* 335  _  32 56 88  19.62 21.32 202  Spring Fall Total  102 269 371  89 225 31U  3  11  10 36 1*6  9.82 13.32 12.32  B.C.  Spring Fall Total  192 233 U25  116 170 286  9 8 17  57 65 122  29.62 27.82 28.72  TOTAL  Spring 11*81* 2811 Fall Total 1*295 *Data obtained  N.B.  Que.  Ont.  Man.  Sask..  Alta.  1*1*  -  3 3  8  21* 317 111*3 21.32 2196 73 19.22 51*2 202 3339 859 97 from the. Canadian Nurses Association  U7 and homesickness.  B  This figure represents over one hundred students  with possible personality problems.  It might also be expected that  some failures apparently due to poor health or inability to do the theoretical or practical work, involved, might primarily be eaused by faulty adjustment patterns.  Thus, the percentage of eliminations  due to personality d i f f i c u l t i e s might be justifiably considered of equal importance with the group eliminated for reasons of failure i n , classwork and in c l i n i c a l practice. Although the present paper and pencil personality tests have proven inadequate for prediction i n the nursing f i e l d , i t does not seem reasonable that such a major reason for failure should be ignored.  These findings suggest the necessity  for further experimentation with projective techniques i n the nursing f i e l d and point up the value of improved interview methods. Approximately one f i f t h of the total eliminations i n 19l*7 were lost because of "Dislike for nursing," "Marriage," and "Decision to go to college."  It i s possible that  with improved Aethods. of interest testing, this figure might be somewhat reduced. Further study of the organization of nursing education i n the various provinces would be necessary in order to definitely determine the reasons for the discrepancies i n the rates of elimination.  It seems highly probable, however, that "tee  explanation may l i e i n the precision of the selection techniques employed.  TABLE V I . Student Nurse Withdrawal from T r a i n i n g i n the Provinces of Canada f o r the Year 194-7 REASONS FOR WITHDRAWAL M.S. P.E.I. N.B. QUE. ONT. MAN. SASK. ALT A. B.C. TOTAL DECISION BY HOSPITAL & STUDENT: • F a i l u r e i n classwork Failure i n c l i n i c a l Health Unsuitable personality DECISION BY STUDENT ONLY: D i s l i k e f o r nursing Marriage Home r e s p o n s i b i l i t i e s Decision to go to college Unhappiness or homesickness Health  7 4 12  —  7 11 2  2  —  8 3  1 3 1  OTHER REASONS  T o t a l no. of schools No. of schools replying No. of students represented $ Withdrawal during 1947  1  —  DECISION BY HOSPITAL ONLY: F a i l u r e i n classwork F a i l u r e i n c l i n i c a l practice F a i l u r e t o meet regulations Unsuitable personality  ALL REASONS  -  —  -  —  1  — — —  —  2 1 3 6 5  —  1 5 3 6  22 9 43 11  21 4 29 14  34 7 H 6  26 5 12 14  11 3 16 2  4 5 8 4  125 39 136 54  12.7$ 4$ 13.8$ 5.5$  24 17 13 8 9 13  47 50 11 3 15 8  13 6 6  14 11 3  21 20 2  3 2  1 2  13 19 2 1 1 2  9  147 139 39 13 42 43  15$ , 14.1$ 4$ 1.3$ 4.3$ 4.4$  12 4 8 2  2 1 3 1  7 1 2 1  2  34 4 4 5  80 17 36 35  8.1$ 1.7$ 3.7$ 3.6$  3  4  1  3  37  3.8$  100  122  982  100.0$  10 11 7 10 11 6 1046 1008 736  172 154 10,812  89.5$  —  5  9  -  17 6 15 19  4  11  68  4  41  237  231  102  15 15 813  3 3 100  37 14 14 31 655 1963  64 53 3677  11 11 814  8.4$  ¥>  — —  —  _  1 1  77  _  —  2.  6.3$ 12.1$ 6.3$ 12.6 % 9.6$ 7.7$ 16.6$  Date obtained from the Canadian Nurses Association.  PERCENT  9.7$  U9 THE PRESENT STATUS OF PRE-NURSING TESTING IN THE UNITED STATES, ENGLAND AND CANADA  CHAPTER FT7E  In the: United States; The figures used i n the following presentation _hav.e-been quoted by Sawer (U4.O) and were selected from tables compiled by the National League of Nursing Education. '  Of the 1,271.state accredited schools of  nursing i n the United States in 191*6, 19% were using pre-nurslng tests. Of this total, 2J>0 used state or individual batteries/ while the rest patronized one of the two national test services. Two hundred and sixty-seven schools did not use any pre-nursing test.  I t i s presumed  that the total wastage figures (32$) might.have been further, reduced i f tests had been used i n these schools as part of the selection procedure. was 39#.  The wastage reported i n 19li7- of students admitted i n 19U*  50 The complete results of the most recent study are not available as yet.  The Department of Studies of the  National League of Nursing Education i s at present studying the reasons for withdrawal for a l l students who entered training i n 1°U7« Only the figures for the f i r s t and second six month periods are now available.  During the f i r s t six months, 15.72  were eliminated;  during the second six months, 8.32, to make a total of 2k% during the f i r s t year. :In 193U, before pre-testing was started, 232 had been withdrawn by the end of the f i r s t six months. (70) Of 1,221 require high sehool graduation.  schools i n the United States, 972  Forty-six percent of nursing schools  take only the upper one-third of the high school class, hh% take only the upper one-half of the high school class, and 102 make no such requirement. In a recent investigation, McCullough (97) found that the following test batteries were the most frequently used for the selection of student nurses i n the^United States: 1.  The National League of Nursing Education test battery.  2.  The Psychological Corporation Test Battery*  3.  The Psychometrical Service Company test battery.  I*.  Washington University (Washington, test battery*  5.  The California Test Bureau battery.  There are others used locally i n a number of places.  D.C.)  The trend seems  51 to be that of meeting local needs through a local test bureau. In the opinion of some workers.in the f i e l d i n the United States, the problem of providing suitable nurses for our hospitals has been approached from the wrong angle•  Mr,  Harold A, Edgerton (50), Vice-President of Richardson, Bellows, Henry and Company, "Scientific Methods i n Personnel and Human Relations," New Tork, believes that a major problem i n the area of nursing i s a more adequate evaluation of the professional performance of nurses. This i a needed he says, i n order to validate selection.tests In terms of professional performance rather than training school accomplishment. It i s also needed i n order to provide a better nursing service, to identify objectively the more competent persons i n the f i e l d , and to find those who should be trained for supervisory duties. Dr. Frederick Wyatt (176), Chief Clinical Psychologist at the Cushing Veterans Administration Hospital, Framingham, Massachusetts, i s planning another study i n the near future regarding the reason that people are attracted to nursing and nursing reinforces or changes existing character patterns.  how  H e plans  to use the Thematic Apperception Test i n this connection. In England: In England, l i t t l e seems to have been done u n t i l recently i n the.matterof pre-testing of nursing students (S,  lUO).  The wastage rate stands at 36-37# for general hospitals,  57% tor infectious disease hospitals, 6h% for tuberculosis sanitorla, and 80-82$ for mental hospitals. Miss Jean Sawer, i n 19U9, submitted  *  2  a study of the problem to the Education Committee of the Florence Nightingale International Foundation i n which she strongly advocates the use of psychological tests for selection and guidance, and the development of testing services.  ' \, ; ...  At present, a small, but carefully planned experiment i n psychometric selection i s being carried out at St. George's Hospital, London. I t was hoped that further details of this experiment might be included i n this survey.  Unfortunately, the  f i r s t report of the study had only just reached completion at the time of writing (October, 19k9) and was not yet available for publication. (128) In Canada: In Canada, the Charlottetown H ospital i n Prince Edward Island i s the only school employing a psychometric battery as a major tool i n selection.  In those schools employing  tests for guidance purposes, the battery of the Psychometrical Service Company, Canton, Ohio, has the most extensive use.  At the present  time, i t i s used in four schools and was previously used i n one other centre. In the remaining twelve schools which employ testing devices, the test services of high schools or universities i n the vicinities are utilized. The educational requirements i n Canadian schools of nursing are similar to those necessary f o r admission to nursing centres of the United States i n so f a r as the two  *3 educational systems are comparable*  The majority of schools i n  Canada require a secondary school graduation diploma, many preferring senior matriculation students.  Hence, selection i n the two countries  might be expected to present the same problems.  CONSIDERATION OF THE VALUE OF PSYCHOMETRIC TESTING TO CANADIAN SCHOOLS OF NURSING  CHAPTER SEC  A comparison of the percentage of students eliminated from schools of nursing i n Canada with the percentage eliminated from schools i n the United States might Indicate that Canada has no need for more precise methods of predicting the suitability of her nursing candidates.  In the United States, of the  class graduating i n 19U7, 39$ had been eliminated. only 20% of the class failed to complete the course.  In Canada i n 19U8, Although the  19U7 figure for the United States i s somewhat high (of the 19U6 class, 32% had been eliminated from American schools) there s t i l l remains a striking difference between the two countries i n the rates of elimination.  In view of the fact that 79% of American  schools employ scientific selection methods, and that the educational requirements appear to be virtually the same i n the two countries, this discrepancy demands explanations;. The possibility arises that educational standards i n Canadian schools of nursing might be lower than those prevalent i n most American schools. Yet this would seem not to be the case.  The State Board Test Pool Examinations of the National  League of Nursing Education of the United States were given as the licensing examination to a l l British Columbia students who were to  55" graduate i n the f a l l of 19k9.  The results have been returned and  the average of the graduating class i n British Columbia was higher than the average of any of the graduating classes i n the thirtyeight states where the examination was used. (30)  Although i t i s  true that the elimination rate of student nurses i s higher i n British Columbia than i n any other province i n Canada, i t i s not as high as the elimination rate in the United States, and there appears to be no indication that British Columbia nurses are a particularly select group i n this respect. Although nursing education i s under separate control i n each province, there i s considerable standardization through a national organization —  The Canadian Nurses  Association, and one sees no evidence of radical differences i n standards of nursing education from province to province.  Consequently,  i n so far as i t i s possible to generalize from these findings, i t would seem that educational standards i n Canadian sehools of nursing are at least as high as those i n the schools of the United States. Several possible explanations may be advanced for the difference i n the elimination rates of the two countries.. I t may be that the educational demands of our high schools are working to eliminate greater numbers who would be potential failures as nursing students, or i t may be that because of greater occupational opportunities i n other fields i n the United .States, American student nurses are not as highly motivated to complete the training course. The completion of the withdrawal study  56 currently being conducted by the Department of Studies of the National League of Nursing Education on the class which entered i n 19U7 might shed further light on the problem.  If a similar detailed  study of eliminations i n Canadian schools were done and the results compared, i t might be possible to determine more accurately the reason for the discrepancy i n the elimination r ates of the two countries. In the meantime, i t i s f u t i l e to argue that American schools of nursing have not benefited by psychometric testing techniques.  The steadily increasing patronage of the testing  services i s probably the greatest testimonial to the value of the American program. Several objective studies have also been done.  In  an issue of the Nurse Testing News (110), Potts reports a reduction from h0% to 252 i n "student mortality" i n certain hospitals after the Introduction of pre-nursing tests. Canada i s eliminating 202 or over 800. students from every class enrolling i n i t s schools of nursing.  Would  i t be to the benefit of the Canadian nursing profession to consider the possibilities of psychometric testing seriously? Conclusions and Suggestionst .The results of this study show that I t cannot be assumed that the Introduction of psychometric selection methods into Canadian schools of nursing w i l l lower the present elimination rate.  At no time since testing was introduced i n  American schools of nursing has the elimination rate i n the United  * 57 States been as low as 20% (11*0), and i t i s doubtful that any of the existing testing devices could appreciably reduce this figure. H owever, neither can i t be assumed that selection devices have no place i n Canadian schools of nursing. The wastage,rate i n certain provinces, e.g. New Brunswick, Quebec, Manitoba and British Columbia are considerably higher than those of the other provinces, and i t might well be the case i n these instances that a carefully planned selection program might reduce the present rate of withdrawal.  Moreover, the establishment of test norms,  applicable to Canadian schools would be an invaluable aid i n the guidance and counseling of accepted candidates.  Even though such  tests were not used for the selection of candidates before admission they would make possible the earlier discovery of those students with the least likelihood of success i n the course. For the.establishment of test selection methods i n those instances where such a program seems warranted, and for the determinationsof norms applicable to Canadian training centres, the following suggestions are made on the basis of the results of this study: 1.  The introduction of test selection methods i n a few chosen hospitals and the administration of a test battery consisting of devices which have proven to predictive value.  2.  Based oh the findings of this survey, the measures employed might well include: (a) Tests of intelligence, verbal and non-verbal with sub-tests i n arithmetic. (b) Reading comprehension tests. (c) Mechanical comprehension tests.  58 ( d )  A c h i e v e m e n t  t h e  n a t u r a l  ( e )  I t  V a r i o u s  i s  a n d t e s t i n  h a s  t h e  s u c h  A t  b y  a n y  t e s t s  t h e  t h e  i  c o u l d  e n d  o f  a n  t h e  f i e l d  f o r  b e  t h e  u s e d  i n  o f  a s p e c t s  o f  t h e  w o u l d  t h e  t e s t i n g  d e v i c e s  s e l e c t e d .  T h e  p r o v i s i o n  w o r k  d e a l i n g  r e v i s i o n ,  T h e  s e r v i c e s  t r a i n i n g  s c h o o l o f  L i a i s o n  a n d  t h e  t h e  o f  o f  r e s u l t s  t e s t  m o r e t h a n  F i n a l l y ,  i n  t h e  t e s t i n g  o u t  b y  h o s p i t a l  b e o f  a n d  t h o s e  o r d e r  a d v a n t a g e o u s  m u s t  g r a d i n g  b e  f o r  i n  a n d  w h i c h  s e l e c t i o n  t o  f a i l u r e  o f  f a c t o r s  p o i n t e d  a n d  F i s s  a v a i l a b l e  s t a f f s  - —  d e v i s i n g  a v a i l a b l e .  a v o i d d u e  t h e  e n c o u r a g e d  p e r s o n a l i t y  S t o v e r  b e  a n d  E x i s t i n g  w o r k  n o w  t o  p r o g r a m  P s y c h o l o g y ,  p r o b l e m s  s h o u l d  v a l i d i t y  t e a c h i n g o f  a n d i n  h o s p i t a l  i n f o r m a t i o n .  W i l l i a m s o n ,  i n s t r u c t i o n  o f  a n d  e x p e r i m e n t a l  p u r p o s e s  m e t h o d s  p r o g r a m  o f  w o u l d  i n t e r e s t  h a v e  t h e t h e  t e s t i n g  D e p a r t m e n t s  p r o j e c t s  e s p e c i a l l y  l  t r a i n e d  i n  f a c i l i t a t e  b u r e a u s ,  s c h o o l s  r e s e a r c h  t e s t s  a v a i l a b l e  c o n s i d e r a t i o n  i n t e r c h a n g e  l  c o u n s e l i n g .  t e s t  t r a i n i n g  a  c o n s t r u c t i o n ,  w o u l d  b e t w e e n  e x i s t i n g  w i t h  f o r  p s y c h o l o g i c a l l y  i n t e r p r e t a t i o n  g u i d a n c e  w i l l  a  o f  a n & ^ e r p r e t a t i o n .  c o n s u l t a n t  d e v e l o p m e n t  f o r  o f  b e u s e  p e r s o n n e l  e q u i p m e n t  t e s t  a n a l y s i s  p e r s o n n e l  t h e  w i t h  i n  f o r  e x t e n s i v e  s k i l l e d  t e s t s b a t t e r y  s u c c e s s  a n  o f  o f  o f  t e s t  n o r m s  n u r s i n g  u p - t o - d a t e  m a d e  v a r i o u s  t h r o u g h  t o  p u r p o s e s  t r a i n i n g b e  o f  E v e n t u a l l y ,  p a p e r  g u i d a n c e .  t h e o n  a  i n t e r e s t  r e s u l t s  y e a r  r e s u l t s  s c h o o l s  t h e  w o u l d  v a l u e  o f a n  s e l e c t i o n b u t  t h r e e  v a r i o u s  o r  e s t a b l i s h e d  a c c e s s  o f  t e c h n i q u e s .  t e s t  e v a l u a t i o n  c o u r s e .  C a n a d i a n  t h e  i n c l u s i o n  f i e l d ,  c o r r e l a t i n g  t h e  t h e  v a l u e  p r e d i c t i v e  w i t h  f  p e r s o n a l i t y  n u r s i n g  p e r i o d ,  i n  p r o j e c t i v e  d o u b t f u l  p e n c i l  t e s t s  s c i e n c e s .  i n  t o  ( 1 7 0 ) , t h e  a c c u r a t e  r a t i n g .  5*9  Since the publication in 19U8 of Brown's book, "Nursing for the Future" (21) there has been much discussion regarding changes in the fundamental organization of the field of nursing. Brown suggests the public support of nursing education. She recommends an increase in the number of "practical nurses" to do the routine work in the hospital and the raising of the educational requirements for registered nurses. University training comparable to that required of medical students would be necessary for registration. Such reorganization would require radical changes in the existing methods of testing nursing candidates. . In the meantime, there is much that might be done to improve our present testing techniques —  improve-  ments which could no doubt be used to advantage should Brown's recommendations be brought about.  The following suggestions are  based on the findings of this survey: 1,  The existing paper and pencil personality tests have proven inadequate as predictive devices in the nursing field. Yet personality would seem to be a large factor in determining the effectiveness of an individual in the hospital situation. Further experimentation with projective techniques and improved interview methods might prove valuable in this connection,  2.  Wyatt ( 1 7 6 , 177) has asked for research regarding the effects of the professional situation upon the worker and i s interested in how nursing reinforces or changes existing training during late adolescence involves problems of social and biological maturation. Further study along these lines might suggest improvements in our present methods of personality testing.  60 Increased efficacy i s also needed i n the matter of the testing of the interests of nursing applicants. The reason why girls enter training has as yet been unexplored. Finally, as suggested by some workers i n the f i e l d (5>0) a major problem i n nursing i s a more adequate evaluation of the professional service of nurses. This point i s inherent in Weir's observation that, although a student may do reasonably well under the supervision of her course of training, she may riot prove as competent on her own responsibility*  61  BIBLIOGRAPHY 1.  ADKLNS, D.C. & KUDER, G.F. The relation of primary mental a b i l i t i e s to activity preferences. Psychometrika, 194-0, 5 , 2 5 1 - 2 6 2 .  2.  AIJIIPORT, G.W. Personality; a psychological interpretation. Nev York: Henry Holt, 1 9 3 7 .  3.  ANDERSON, MARIE H. & MCMANUS, LOUISE R. Interests of nursing candidates. Am. J. 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BENNETT, G.K. & GORDON, H. PHOEBE. Personality test scores and success in the f i e l d of nursing. J . appl. Psychol., 1944., 2 8 , 2 6 7 -  278.  13.  BERG, I.W. A study of success and failure among student nurses. J. appl. Psychol.. 1 9 4 7 , 3 1 , 3 8 9 - 3 9 6 .  14.  BERKSHIRE, J.R. (et al) Test preferences in guidance centres. Occupations. 1 9 4 8 , 2 6 , 3 3 7 - 3 3 8 .  15.  BERNREUTER, R.G. The present status of personality t r a i t tests. Amer. counc. Educ. Record. Supplement No. 1 3 , 1 9 4 0 , 2 1 , 1 6 6 .  62  16.  BINGHAM, W.V. Aptitudes and aptitude testing. New York: Harper & Bros., 1937.  17.  BRADLEY, LENORE H. What price selection of students? Am. J. Nurs., 1933, 33, 557-559.  18.  BERGMAN, ELSIE 0. The-performance of student nurses on intelligence. Nursing Education Bulletin, New Series, Bulletin I I , Dept. Nursing Educ.-, Teachers' College, Columbia University, 1933*  19.  BREWER, J.M. Classification of items in interest inventories. Occupations, 1943, 31, 448-451.  20.  BROOKS, ESTHER. The value of psychological testing." Am. J. Nurs.,  21.  BROWN, E.L. Nursing for the future. New York: Russell Sage Foundation, 1948.  22.  BURGESS, MAY-A. More tests for-the entering class. Am. J. Nurs.,  1937, 37, 885-890.  .  .  •  1931,-31, 1031-1033.- .  23.  BURGESS, MAY A. What makes a good nurse. Am. J. Nurs..1932. 32 1239-1240.  24.  BURR, MARY. The McQuarrie Test for mechanical ability. Am. J . Nurs., 1934, 34, 378-381.  25.  CARTER, H.D. Development of vocational aptitudes. J. consult. Psychol.. 1940, 185-191.  26.  CHURCHMAN, C.W. & ACKOFF, R.L. Toward an experimental measure of personality. Psychol. Review, Jan. »47, Vol. 54.  27. *"  CHUTE, WINNIE L. The use of vocational psychology in selecting nurses for a training school. The Canadian Nurse. 1926, 22, 471-473.  28. *  29.  CLARK, GENEVIEVE Y. & SOUTH, E.B. Some suggestions for measuring nursing aptitude. Am. J. Nurs., 1935, 35, 865. .  .  .  .  CLARKE, WINNIFRED R. A study of tools of selection. The Trained Nurse and Hospital Review. 1938, 101, 319-321.  30. . GOLUMKILLE, THE REV. SISTER, DIRECTOR OF NURSES ST. PAUL'S HOSP., VANCOUVER. Interview with the writer, October, 1949. 31.  COMMINS, W.D. Principles of educational psychology. Ronald Press, 1937.  63  32.  COMMINS, W.D. The interest patterns of nurses.  33.  CRAWFORD, .A.B. & BURNHAM, P.S. Forecasting college achievement. Yale University" Press, 1946.  34.  CRIDER, B. A. school of nursing selection program. J. -appl. Psychol.,  35.  CRESSEY, W.J.E. & DANIEL, W.J. Vocational interest factors i n women. J. appl. Psychol.. 1939, 23, 488-494.  36.  CRIST, ALICE L. The Ohio State cooperative testing program in nursing education. Educ. Research Bull., Feb., 1939, Vol. 18, No. 2.  37.  CRONBACH,' L.J. A validation design for qualitative studies of personality. J . consult. Psychol.. Vol. 12, No. 6, Nov. & Dec. '48.  38.  CUNNINGHAM, BESS V. Psychology for nurses. New York: D. Appleton Century Co. Inc., 1946.  39*  DARLEY, J.G. Testing and counselling in the high school guidance program. Chicago: Science Research Associates, 1943*  40.  DEMING, DOROTHY (et al) Progress i n the merit system unit examination. Publ. Health. Nurs.. 1947, 39, 73-79.  41.  DENSFORD, KATHERINE J. How shall we select and prepare the undergraduate nurse? Am. J . Nurs.. 1932, 32, 557-566.  42.  DOUGLAS, H.R. & MERRILL, R.A. Prediction of success i n the f i e l d of nursing. Univ. Minn. Predict. Scholast. Achievmt., 1942, 2,  1943, 21, 387-388.  Occupations,  1943, 27, 452-457.  17-31.  43»  DVORAK, B.J. Differential occupational a b i l i t y patterns. Employment Stabilization Research Bulletin. No. 8, III, University of Minnesota Press, 1935.  44.  DWYER, SISTER M. THEOPHANE. A sociometric study among a selected group of students i n nursing. Washington, C.L.: Catholic University of America Press, 1947.  45.  EADS, LAURA K. 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Intelligence study and. time study. 1928, 28, 1105-1107.  174.  WONDERLIC, E.F. & HOVLAND, C.I. The personnel test: a restandardized abridgement of the Otis S^A Test for business and industrial use. J. appl. Psychol., 1939, p-685.  175.  WORCESTER, D. A. Personality development. and Hospital Review. 1931, 87, 326-329.  176.  WYATT, F. Guidance problems among student nurses. Ortho^Psychlat.. 1947, 17, 416-425.  177.  WYATT, F. Letter to the writer, Sept., 1949.  178.  YOUNG, H.H. Intelligence ratings and success of nurses i n training. J. appl. Psychol., 1924, 8, No. 4, 379-389.  Am. J. Nurs.»  The trained Nurse Am. J .  7 3  APPENDICES  DESCRIPTION OF TEST BATTERIES USED MOST EXTENSIVELY IN THE UNITED STATES  7 4  APPENDIX I .  In a recent investigation, MildredE. McCullough of the Los Angeles County General Hospital School of Nursing found the following to be the most popular sources of nurse testing batteries in the United States: 1.  National League of Nursing  Education,  New York. 2.  Psychological Corporation, New York.  3.  Psychometrical Service Company, Canton, Ohio. Center for Psychological Service, Washington, D.C.  4. 5.  California Test Bureau, Los Angeles California. A description of the tests supplied  by these various companies i s given in the following pages.  75 APPENDIX I I . DESCRIPTION OF TESTS IN THE PRE-NURSING AND GUIDANCE BATTERY OF THE NATIONAL LEAGUE OF NURSING EDUCATION. The Department of Measurement and Guidance of the National League of Nursing Education has special l i c e n c e t o use the American Council on Education and the Co—operative Test Service t e s t s . The battery includes; 1.  The A.C.E. Psychological Test (quantitative and l i n g u i s t i c  skills)  2.  Reading comprehension  3.  Arithmetic  4.  Natural Sciences  5.  History and s o c i a l studies (79)  After students- who have taken the Prenursing and Guidance Examinations have been admitted i n t o the school of nursing, the Department of Measurement and Guidance w i l l provide e i t h e r the Bernreuter Personality Inventory or the Minnesota Personality Scale for them upon the request o f the d i r e c t o r .  These t e s t s w i l l be serviced  and the r e s u l t s reported at no extra cost. The report of the National League o f Nursing Education takes the form of cumulative record of testr r e s u l t s on which are entered the p e r c e n t i l e scores.  Comparison i s made with  norms on previous nursing school applicants and l i b e r a l a r t s college entrants.  These norms are based on 9,553 applicants to schools of  nursing i n thirty-seven states, D i s t r i c t  of Columbia and Hawaii. Also  76 included on this record i s information on Interest and activities, attitide to nursing, and social relations together with educational and occupational record.  Charting space for results on later  achievement tests and the graduate nurse test battery i s also included on the record.  77 APPENDIX III. TEST BATTERY OF THE PSYCHOLOGICAL CORPORATION.  The relatively long period of service of the Norse Testing Division of the Psychological Corporation(since  1935) has made possible the study  of norms on at least  U5,000  applicants*  Constant testing of the tests themselves i s carried out; new forms are devised and other experimental work instigated.  The present battery  comprises tests oft  1. 2.  Scholastic Aptitude (originally i n the form of the Army Alpha) Science  3.  Reading comprehension  1*.  Arithmetical processes and reasoning  5.  General Information  6.  Mechanical comprehension  7.  Personality assessment (Bernreuter's Inventory)  Each student's report, sent to the sehool i s an estimate of her as an individual, placing her score i n a decile scale, giving a summary of abilities, the likelihood of adequate capacities for adjustment and f i n a l l y recommending acceptance or refusal.  I t i s f o r each school to  decide upon the level of attainment which i s essential to carry the cirrlculum i n the particular school.  78 APPENDIX 17. TEST BATTERY OF THE PSYCHOMETRICAL SERVICE COMPANY CANTON, OHIO. The test battery of the Psychometrical Service Company. Canton, Ohio i s the only one of these batteries currently i n use i n Canadian training centres.  I t i s used by the  Charlottetown Hospital i n Prince Edward Island as a major tool i n selection and i s used i n four other training schools for guidance purposes.  An attempt was made to determine the extent of the use of  this battery i n the United States, but the Company was unwilling to divulge this information. The battery comprises: 1.  Mental Health Analysis (Thorpe, Clarke and Tiegs)  2.  Washburne S-A Inventory  3.  California Capacity Questionnaire  V  Medical Aptitude Science Test  5".  Chemistry Test  6.  Spelling Test  7.  Reading Comprehension Test A report similar to that of the Psycho-  logical Corporation i s sent to the school, giving a summary of the student's abilities and recommending acceptance, conditional acceptance or refusal.  79 APPENDIX V TEST BATTERY OF THE CENTER FOE PSYCHOLOGICAL SERVICE WASHINGTON, D.C. The George Washington Series of nursing tests i s supplied by the Center for Psychological Service, Washington, D.C.  The battery comprises of: 1.  Reading Comp rehenslon  2.  Arithmetic  3.  General Science  U.  Interest  £.  Nursing Aptitude The Reading Comprehension, Arithmetic  and General Science Tests are similar i n design and scope to those i n the battery of the Psychological Corporation.  The nursing aptitude  test, i s the Hoss (originally the Moss-Hunt). This test purports to measure:  (a) judgment i n nursing situations, (b) memory of an  anatomical diagram studied during the test, (e) information on general subjects related to nursing interest, (d) scientific vocabulary, (e) a b i l i t y to understand and follow directions with reference to f i l l i n g in a typical nurse's report form. The norms for a l l parts of the complete tests have been computed from a study on five hundred nurses from twelve hospitalsin the eastern states, the coefficient or correlation between scores on this aptitude test and academic grades i n the  80 nursing course was computed, r « O.Ul. nursing grades, r - 0.31 (169).  Between this test and practical  The University of Minnesota studies,  i n 19U2, reported the multiple regression coefficient of the Moss Aptitude Test with high school percentile rank to be 0.75 (i|2)«  81 APPENDIX ?I TEST BATTERY OF THE CALIFORNIA TEST BUREAU The test battery of the California Test Bureau had been given to approximately four thousand nurse candidates by October, 19lt9, according to information received at that time.  The battery includes: 1.  The California Test of Mental Maturity  2*  Progressive Reading Tests (Tiegs and Clark)  3.  Lee-Thorpe Occupational Interest Inventory  U*  California Test of Personality Secondary, Form A  £•  Mental Health Analysis (Thorpe, Clark and Tiegs), Secondary Series, Form A. A profile of each student's test  results i s sent back to the sehool with a summary of her assets and l i a b i l i t i e s and the recommendations of the Bureau regarding acceptance or rejection*  NAMES AND ADDRESSES OF PERSONS CONTACTED IN COLLECTING DATA FOR THE ACCOMPANYING THESIS IN CANADA: 1, Registrars of the various Nurses Associations 1  Miss Muriel Archibald, RN, Canadian Nurses' Association, National Office,  Hiss Alice L. Wright, RN, Executive Secretary, Registered Nurse Association of British Columbia,  Hrs. Clara Van Dusen, RN, Registrar, Alberta Association of Registered Nurses,  K.W. E l l i s , Registrar, Saskatchewan Registered Norses' Association, 10U Saskatchewan Hall, University of Saskatchewan, SASKATOON, Sask. Hiss L i l l i a n E. Pettigrew, RN, Executive Secretary, Manitoba Association of Registered Norses,  Florence H. Walker, RN, Secretary-Treasurer, Registered Nurse Association of Canada,  Edith R. Dick, RN, Norse Registration Branch, Ontario Department of Health, TORONTO, Ont.  Margaret M. Street. Secretary-Registrar, The Association of Nurses of the I^ovince of Quebec.  Nancy H. Watson, EN, Registrar. , Registered Nurses Association of Nora Scotia, 1  Alma F. Law. Executive-Secretary, The New Brunswick Association of Registered Nurses,  Helen Arsenault, RN, Treasurer-Registrar. The Registered Burses Association of Prince Edward Island. Provincial Sanatorium, CHARLOTTETOWN, P.E.I. 1  Direotors of Horsing Education. Emily L. Nelson. Assistant Director of Nursing Education. The Vancouver General Hospital of Nursing, VANCOUVER, B.C. Sr. L. Mongrain, Director of Nurses, Holy Cross Hospital, GALGART, Alta. J. Mackie, Nursing Arts Instructor, Royal Alexandra Hospital, EDMONTON, Alta. Sr. St. Rudolphe S.M.R.N., Superintendent of Nurses, Misericordia Hospital, EDMONTON, Alta. Sister A. Ste. Croix, S.G.M., Direotor, Sehool of Nursing, St. Paul's Hospital School of Nursing, SASKATOON, Sask.  Sister Alice Brodeur, RN, Director of Nursing, Regina Grey Nans' Hospital, REGLNA, Sask. Sister M. Ursula, Superintendent, St. Joseph's School of Nursing, Mountain Blvd., HAMILTON, Ont. Constance E. Brewster, Superintendent of Norses, Hamilton General Hospital, HAMILTON, Oat. If. Both Thompson, Director of Nursing, Victoria Hospital, LONDON, Ont. Sister Both, Direotor of Norses, Saint Joseph's School of Horsing, LONDON, Ont. E. Gertrude Ferguson, RN, Direotor of Nursing, Ottawa Civic Hospital, OTTAWA, Ont. Gladys Barker, RN , Director of Nursing, Grace Hospital,  Sister R. Tetrault, Superintendent, Hotel Dieu School of Nursing, WINDSOR, Ont. Louise D. Acton, Director of Horsing, Kingston General Hospital, KINGSTON, Ont. Miriam L. Gibson, Instructor of Horses, The Hospital for Sick Children,  Sister Mary Kathleen. Superintendent of Nurses, , St. Michaels Hospital, TORONTO, Ont. Verona Smith, KN, Health Supervisor, St. Joseph's Hospital, Sehool of Nursing, TORONTO 3, Ont.. Blanche McPhedron, Direotor of Nursing Education, The Toronto Western Hospital.  Mary E. Macfarland, Superintendent of Nurses, Toronto General Hospital. TORONTO, Ont. Que.  Marjorie G. Russel, Direotor of Nursing, The Homeopathic Hospital of Montreal.  F. Monroe. Superintendent of Nurses, Royal Victoria Hospital, MONTREAL 2, P.Q. P.E.I.  Sister M. Stanislaus, RN, Director of Nurses, Charlottetown .Hospital. CHARLOTTETOWN, P.E.I. 1. In the United States. Elizabeth L. Kemble, RN, Director, Department of Measurement and Guidanee, National League of Nursing Education, Edith Margaret.Potts, Direotor, Nurse Testing Division. The Psychological Corporation,  Frederick Wyatt, Ph. D., Gushing Veterans Administration Hospital, Framington, Mass* Albert I. Rabin, Ph.D., Associate Professor and Director of Clinic, Michigan State College, EAST IAKSING, Mich. George V. Mendenhall, Test Consultant, California Test Bureau, Mildred K. McCullough, School of Nursing, Los Angeles County General Hospital LOS ANGELES 32, Calif. Harold A. Edgerton, Vice President, Richardson, Bellows, Henry and Company,  Iacile Petry, Chief Nurse Officer, Federal Security Agency, Public Health Service WASHINGTON 25, B.C. Professor E.L. Dent, M.A., Psychometrical Service Company, CANTON, Ohio. Elsewheret Olive Baggallay, Nurse Consultant, United Nations World Health Organization, GENEVA, Switzerland. Hiss Jean Sawer, St. Andrew's Hospital, NORTHAMPTON, England. Muriel B. Powell, Matron, St. George's Hospital, LONDON S.W. 1, England*  

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