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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, 195o 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. It was the purpose of this survey to determine what use has been made of psychometric tests i n the nursing f i e l d and to ascertain how widely this method has been accepted for selection and guidance i n the training schools of the united States ahd Canada. Information regarding the use of tests in the f i e l d of nursing i n the United States was obtained from the accumulation of literature on the subject and by writing directly to various workers i n the f i e l d . A detailed survey was made by correspondence of Canadian schools of nursing to determine what use i s being made of psychometric tests i n the selection of their candidates and the counseling of their trainees'. Data were obtained from the Canadian Nurses Association.regarding the rate of withdrawal and the reasons for withdrawal i n Canadian training centres. Certain additional information was obtained with regard to the status of testing i n English schools of nursing. The collected data were reviewed, analyzed and the salient features noted. The value of psychometric testing to Canadian schools of nursing has been considered. The results of this study regarding the value of psychcmetic selection methods to Canadian schools of nursing are not conclusive. Although 79% of American schools of nursing employ psychometric selection techniques, the rate of elimination of nursing students in 19k7 was J)%. In Canada, where scientific selection methods have been virtually non-existent, the elimination rate was only 20# in 19U8. It Is doubted that any of the available testing devices could appreciably reduce this figure. It is concluded, however, that testing devices might be used to advantage for the guidance and counseling of nursing students in Canadian training centres and that test batteries might be employed in selection in those areas where the elimination rate appears to be abnormally high. i CHAPTER I. CHAPTER II. CONTENTS INTRODUCTION Statement of the problem Methodology REVIEW OF RESEARCH ON PSYCHOMETRIC TESTING IN THE FIELD OF NURSING Summary PAGE 1 CHAPTER III. DEVELOPMENT OF NATIONALLY ORGANIZED TESTING SERVICES IN THE UNITED STATES CHAPTER IV. REPORT OF A SURVEY IN CANADA A study of student nurse withdrawal in Canadian schools of nursing 28 33 CHAPTER V. THE PRESENT STATUS OF PRE-NURSLNG TESTING IN THE UNITED STATES, ENGLAND AND CANADA k9 CHAPTER VI. 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 in the United States i i 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 in 1932 TABLE III. Number of Accredited Training Schools in the Provinces of Canada in 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 in Canadian Schools of Nursing TABLE VI Reasons for Student Nurse Withdrawal from Training in the Provinces of Canada for the Year 19li7 i i i APPENDICES: PAGE I. Forward 74. II. Description of Tests in Pre-nursing 75. and Guidance Battery of the National League of Nursing " ' Education, New York. III. Test Battery of the Psychological 77. Corporation, New York. IV. Test Battery of the Psychometrical 78. Service Company, Canton, Ohio V. Test Battery of the Center for 79. Psychological Service, Washington, D.C. VI. Test Battery of the California Test Bureau, Los Angeles, California 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 registra-tion as graduate nurses. Of this number, 3,434 remained to graduate in 1948. 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 is 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. This is a process that is repeated in each succeeding class. In view of the present shortage of nurses, and in terms of disappointment and dis-illusionment 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. It is 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 likely to succeed. The traditional basis of selection and rejection of prospective nursing candidates is 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 is not always highly correlated with mental and emotional maturity, nor are the required references usually cr i t i c a l assessments of the individual. The interview itself is 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 is not only important that the school of nursing accurately determine^ the ability of a candidate to succeed in the schoolj i t is 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 investiga-tion been accepted in the field of nursing? It is the purpose of this survey to determine what use has been made of psychometric tests in the nursing field 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 field 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 field. 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 des-cription of the tests included in each battery will be found in 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 field. 4 A detailed survey was made by correspondence of Canadian schools of nursing to determine what use is being made of psychometric tests in the selection of their candidates and the counsel-Zing of their trainees. Data have been obtained from the Canadian Nurses Association regarding the rate of withdrawal and the reasons for with-drawal 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, is not yet available for publication. Miss Baggallay was Instrumental in 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. Certain recommenda-tions have been offered for future research. REVIEW OF RESEARCH ON PSYCHOMETRIC TESTING IN THE NURSING FIELD CHAPTER TWO A review of some of the more important , studies dealing with this subject should prove valuable as a supplement to, as well as a basis for, more accurately evaluating the results of the present survey. 1920-1930: Most of the work done i n the f i e l d during the period 1920-1930 was confined to the intelligence testing of nurses. In 1926, Earle(U9) undertook a more .ambitious, study for the purpose of discovering i f there i s a correlation between general intelligence and personality and character traits,.such.as .cheerfulness, conscientiousness, etc. The subjects considered consisted of 212 student nurses from seven, large. hospitals„.in.New„York City. The Army Alpha Group Intelligence Test Form 9 was used to ascertain.the general intelligence 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 and. two supervisors. The results obtained were, not conclusive. 6 From the seven groups, the correlations between intelligence and person-ality traits vary from -.30 to .55, four correlations being negative, two low positive and one fairly high positive. In 1927 Elwood (57) made a comparative study of the personality traits of the nurse and the college girl.— 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 traits. These scores were compared with those of girls in colleges of liberal arts. It was found that the nurses revealed far fewer signs of unhealthy emotional outlets than college girls. 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 in relation to intelligence test ratings. Of 439 student nurses,-108 left the training school for various reasons. 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 in theoretical subjects had the lowest average on the Army Alpha. Sixty-two percent (62%) failing in practice also failed in 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 Range of Reason % Scores Average Failed in 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 74-174 130 Resigned 21 58-165 124 Married 18 99-165 139 xx Date obtained from the Thirty-fourth Annual Report of the National League of Nursing Education, 1928. 8 at the age of twelve or before, and 10$ not u n t i l after twenty-five. The fact that the largest group (15$) decided at 18 signifies that they did not make up their minds u n t i l time to begin training. It is pointed out that the large numbers of persons eliminated from the training school at the end of the probation period indicates the absence of appraisal of oneself and of the occupation and the grave need for vocational guidance for nurses. study was made on the results of a battery of tests given by South and Clark (145) to sixty-eight probationers in two schools of nursing. The battery included the Ohio State University Psychological Examina-tion, the Otis Self-administering Test, the Pressey Senior C l a s s i f i c a -tion, Otis Arithmetic, Thorndike-McCall Reading and the Colgate Personal Inventory. In addition, certain measures of scholastic standard were obtained based on work in physiology, anatomy and practical work. As no satisfactory test of motor s k i l l was available, none was attempted. On the basis of the combined ratings on these different measures, ten -probationary students were dropped from the schools and fifty-eight were retained. The authors believed that a battery of tests including tests of intelligence, 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 useful i n eliminating those students who are not f i t t e d for nursing careers. However, no data(was) offered by the authors on the subsequent success i n performance by the students retained. In the same year as Kitson's report, a 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. Very few such tests were in use in 1930. 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 traits. 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, listed 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 is 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 ability 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 is given in Table II. Of the 2,280 students tested, fifty-five did not have even high school entrance. Fully half of this number had not 11 TABLE II Average intelligence test scores of Canadian student nurses as determined by the Weir Survey in 1932 Brit i s h Columbia 103.19 Quebec 101.68 Ontario 98.28 Prairie 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 less of the high school course. Weir comments on the opinion of some doctors and nurses that a very mediocre degree of intelligence i s a l l that i s requisite for success in the nursing profession. He points out that these c r i t i c s of nursing education probably f a i l to realize that a student nurse of low grade intelligence may do f a i r l y well under the supervision of her course training, but that she i s l i k e l y to prove quite incompetent as a graduate nurse on her own responsibility in private practice. A more frequent use in training schools- of standardized intelligence 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 in Canada by the interest created by the Weir publication. One study was done by Rosenstein (136) on a group of 1$6 student nurses at Indiana University who were given the American Council on Education Intelligence Test. The results were compared with those of a group of 2,358 college students who had been given the same test. The nurses were found to earn considerably more credit in their studies than did the college students of corresponding intelligence rating, the difference being more marked in the ...lower than in the higher percentile divisions. In the nurses' group, the intelligence 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 test results and efficiency records in practical work was found to be slight. 13 MacLean (91)> in a paper read at the Institute on Supervision of the Wisconsin State League of Nursing Education on June 17th, 1932, listed 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 is 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. If a student's score exceeds the 85th percentile, trouble may be expected. 5. Any candidate who cannot reach the Eighth Grade norms in reading skills, 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 color-blindness . 8. The Bemreuter Personality Test was suggested. 9. - The personal interview is futile 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 cor-relate .618 - .061 with theory grades for a group of forty-eight first 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 in 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), pre-sented 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. The superior student appeared less adaptable than the inferior. "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 in 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 Can11 Learn Anatomy, But ." (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 is not the general rule to be low in the one ability 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 in theory, but not in practice" was shown not to be founded ia'Tact. A correlation of .70 was found between grades in 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 in 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 ability of student nurses noted that the distribution of scores was quite similar to that of students in normal schools. She says,"Every level of ability found among college students is 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 ability of student nurses was done by Langhorne (87) in 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 in 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 in 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 in the four quartile divisions. Comparing those students who took the state licensing exam-ination, the majority of failures were found in groups C and D (lowest scores). The students in group B were more successful than the A group, which corroborates statement made by Potts (120) and also by McLean (91). Personality difficulties were found in a l l groups. Students in groups A and B tended to evidence a greater dislike for nursing than those in groups C and D. -Johnson (74), in 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 in their profession and having at least five years of experience comprised the fir 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 art appreciation were given. Recommenda-tions 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 is related to hard work. The report suggested the definite need of further experimentation but contained no correlations. One of the most extensive investigations in the fie 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 in the state. This committee engaged the services of the University of Minnesota Testing Bureau to conduct this research program, a final report of which was given in January, 1937. Students enrolling in 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 fi r s t year of instruction, 1 8 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 in 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 in 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 cor- relations for some of the separate schools strongly support  this contention. . . . It is difficult 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 is •probable that tests of the type used  in this study w i l l yield fairly 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 adminis-tered to the entering students of St. Luke's School of Nursing in San Francisco in 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. It 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 is 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. Dolores Marie S.H.N. (l43)> clinical 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 19AO-1950; In the opening year of this decade, Sister 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), in an article 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, artistic, musical and social service interests when compared to women in general. They are low in computational, persuasive, literary and clerical interests. The patterns of scores reported by Triggs were based upon differences which although statistically 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 abilities. Douglas and Merrill (42), found that for, j predicting success in the school of nursing, the best four factor com-'^^^M-bination 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 Douglas-Gordon 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 likely 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 in , 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 in natural science and a low interest in academic work and the household group. A slight tendency to extroversion was also found. 24 Bennett and Gordon (12), after a study of the scores of 235 student nurses on the Bernreuter and the Minnesota Person-a l i t y Scale concluded: "To the extent that i t i s possible to generalize from the findings presented in the present study, i t would appear that the type of personality test used i s of l i t t l e or no value as part of a battery of tests used in personnel selection, since i t w i l l predict neither success nor" the attitudes of colleagues or supervisors. 1' Potts (127), reached the same conclusion regarding personality tests and adds further that mechanical a b i l i t i e s are not particularly important to success in the nursing f i e l d , except in so far as teaching i s improved when those of the same dexterity are grouped. The personality test, she says, i s of least importance, except when there i s an extreme deviation. In 1946, Sartain (139) of the Southern Methodist University of Dallas, Texas found a correlation of .677 when predicting success with the Potts-Bennett tests. Addition of the other tests or high school averages yielded very small increases. Wyatt (176) has recently introduced a new note in psychological problems in the nursing f i e l d . He i s interested in how nursing affects the new student. Such exacting professional training during late adolescence, he thinks, involves problems of social and biological maturation and the conflicts which w i l l be engendered w i l l be affected by the two major experiences of apprenticeship: (1) the traditional norms or acknowledged ways i n which things are done in 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 ability 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. Marked differences were found among the different schools of nursing. 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 is 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 Illinois, 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 in test performance from those who remained in 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 is 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 intel-ligence test scores at least as high as the average high school graduate. 2. Although there is a high correlation between intelligence test scores and success in training, students in 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 in predicting nursing aptitude, but may be used with good effect in the. guidance and counseling of accepted applicants.. ..Teaching may be improved by grouping students with similar mechanical aptitude scores. 27 The best results i n prediction appear to hare been achieved by using certain nursing aptitude tests (the Moss and the Potts-Bennett), scholastic aptitude tests, tests i n reading comprehension, arithmetic tests, and tests of achieve-ment i n general science knowledge. The best 1 two-factor combination found by-Douglas and M e r r i l l was the Moss Nursing Aptitude Test and high school percentile rank. There i s a need for expert interpretation of test results, for a personal interview with a psychologist, and for a psycho-dynamic evaluation of the psychometric data. No test battery can be expected to predict 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 in the United States. The fi r s t of these, under the control of the Nurse Testing Division of the Psychological Corporation was estab-lished in 1935>. The other was organized in 19U2 by the National League of Nursing Education. The major part of the testing of nursing applicants in the United States is done by these two organ-izations although the present trend.seems to be that of 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 in the psychological measurement of student nurses. It was through her efforts that the fi r s t testing service on a national scale was developed. The Nurse Testing Division of the 2 9 Psychological Corporation, of which Miss Potts is director, maintains a testing service with its headquarters in New York. Previous to her present position which she began in 1935*, Miss Potts had been active in 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 in the spheres of educa-tion and industry. Association with research divisions i n industrial and educational fields permits many advantages such as freedom for cross-consultation, knowledge of advances in 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. Arithmetic and Reasoning s. General Information 6. Mechanical Comprehension 7. Personality Assessment (Bernreuter's Inventory) 30 Each student's report sent to the school is an estimate of her as an individual placing her score in a decile scale, giving a summary of abilities, the likelihood of ade-quate capacities for adjustment and, finally recommending acceptance or refusal. (12li) It is for each school to decide upon the level of attainment which i s essential to carry the curriculum in the particu-lar school. Results have shown that the following are most likely to succeed: 1, Those scoring in the 9th or 10th deciles (below 7th unlikely to graduate) 2# Age range between twenty-two and twenty-six years (older age groups scoring in 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 in large cities (population 5,000 or more) £. Those with, interest in 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 in 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 in forty-one states used this particular battery in 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 profession-al obligation among its leaders. "Institutions for professional pre-paration have an obligation to develop and maintain sound ethical, educational and professional standards.M (llUt) It was fe l t that a responsbility existed toward the student in 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, in 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 Pre-nursing 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 in the f a l l of 19U9. 32 and Co-operative Test Service tests. Thebattery includes: 1» A.C.E. Psychological Test. 2. The Cooperative Reading Comprehension Test C 2 3. Mathematics — adapted from the Cooper-ative Mathematics Test for grades 7,8,9. U. Cooperative General Achievement Tests II: a test of general proficiency i n the f i e l d of the natural sciences. Form T. 5. Cooperative General Culture Test, Part II: History and Social Studies, Form T. The two national schemes are run largely on similar lines. An applicant to a state accredited school which makes use of the testing service i s given a test application card signed by the nursing director, and a schedule of testing centres and dates. The prospective nurse forwards the card plus a fee of five dollars to the central office and arranges to attend the nearest centre at the appropriate date. Her receipt serves as admission to the examination. The examiners at these centres are often drawn from lo c a l psychologists and psychometrists, qualified i n administer-ing the tests. University and college departments have cooperated in providing accommodation and staff on the necessary dates. A l l answer sheets are sent to the central office for machine scoring, interpreting of results and the Issuing of records to the schools. Within ten days, the report i s sent to the school whose nursing director originally signed the card. Thus, the director i s able to have this material before her, prior to making a f i n a l decision 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 psycho-metric 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 in each province is small and i t was felt that the above method was adequate for the purposes of this surrey. Table III gives the number of training schools for each province in Canada for 19U8. The thirty French hospitals in Quebec 3k TABLE III Number of Accredited Training Schools in the Provinces of Canada in 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 in 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 is impressive, only three of the thirty training centres enrolled more than f i f t y beginning students in 19U8. In Ontario, where nursing education is under the control of a government department, the Nurses* Registration Division of the Ontario Department of Health, the desired information was not obtainable in the central office. However, a l i s t of the sixty-three training schools in the Province was obtained, together with the enrollment of each. A questionnaire with regard to psycho-metric 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 in conjunction with a special-ized hospital gives most of its training service by affiliation with other hospitals. Further information was obtained through the National Office of the Canadian Nurses' Association in Montreal. Figures were obtained regarding the total student enrollment in the hospital training schools of Canada, the rate of withdrawal from a class (the one graduating in 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 in 1932, but no such study has been done — at least, not on a national level. This survey of conditions in Canada has revealed widespread interest in 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 in consequence, the possibilities of psycho-logical tests are being seriously considered. Petry (115>), in con-nection with her recent hospital survey in British Columbia has pointed out their importance. British Columbiat Of the six schools of nursing in British Columbia, there is only one in which any kind of psychometric testing i s done. The Vancouver General Hospital gives the Otis-Self-Administer-ing Test of Mental Ability 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 in recent years has been as low as.108.9 and,as. high as 117, with an average of approximately 113. These results are encouraging, when compared with Mr. Weir's findings in 1932. The testing program in this hospital has been in 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 in Edmonton has been using the 19U7 Edition of the Psychological Exam-ination 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 in guidance i s thought to be questionable. The need for testing before entrance is recognized and the desire to experiment with a greater number of tests is expressed. The reason stated for not making greater use of the tests is Jbeeause of a sense of inadequacy in dealing with them. The need for expert in-terpretation of test results is felt. The only other training centre in Alberta employing ft testing program is the Holy Cross Hospital School of Nursing in 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. It is felt that the tests are excellent in showing the weaknesses to be found in the preliminary students and are felt to be invaluable in 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 for 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 in a blook during the students8 f i r s t week in the School. Professor Williams, of the Department of Psychology of the University of Manitoba, has cooperated in 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 is an "ideal" test for nurses, but has found that the general knowledge acquired in this way about each student to be helpful in understanding that student, Ontario; In Ontario, of the sixteen schools con-tacted, 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 in use in other schools of nursing. The Hospital for Sick Children, Toronto has used the following tests in 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 and College Form A Most of these tests had been in 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 in research in conjunction with the training school's opinion as to the suitability of the applicant to enter the field 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 is some doubt as to the advisability of accepting an applicant and this use of the tests has proven satis-factory. Health Education Tests are given to a l l students shortly after entrance in 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 in the psychometric .testing of their student nurses in 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 testsi 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 train-ing in the past year, no data are available at the present time to make any statement regarding the value of the tests. It is 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 in Quebec, only—two-have employed psychometric tests to any extent* and in these schools, such tests have been administered only after the admission of the students to the school. The H omeopathic H ospital School of Nursing in 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 Mcdll 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 in 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 is expressed in the program and the hope that definite re-sults w i l l be shown in the future through its use. The School of Nursing of the Royal Victoria Hospital in Montreal, employed the services of the Psycho-metrical Service Company for their f a l l class in 19^8. The U2 superintendent states that events since the testing have proved that the psychometric examiners."were not 100% correct" in 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 until the three years training are com-pleted, a report on the value of the testing w i l l not be available. New Brunswick: The hospitals in New Brunswick are just beginning to organize testing programs in 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 in the selection of that group. No other tests were employed. At the Victoria Public Hospital, Fredericton, intel-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 in Nova Scotia are at present using any kind of psychometric tests for either the selection, or guidance of their student nurses. The enrollment in the Nova Scotia training centres is small, averaging fifty-two students for each school in 191*8. Prince Edward Island: The Charlottetown Hospital Sehool of Nursing is the only school in Prinee Edward Island to employ psycho-logical tests. H ere, the battery of the Psychometrical Service Company is used. No candidates were accepted for 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 in the selection of Its student nurses. Table IV gives the number of schools of nursing in each province using any kind of psychometric test according to the results of the .present survey. The Charlottetown Hospital in Prince Edward Island is the only one selecting its 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 in Toronto where testing is used in selection when there is 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 in Canadian schools of nursing in 19U5, 3,339 graduated in 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 N o« o f Schools Using rrovmce . Testing Devices 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 class failed to graduate. Hence, the Canadian withdrawal rate i s comparatively low. Too l i t t l e has been done i n Canada to draw any definite conclusions regarding the efficacy of the existing testing programs. With the exception of the Hospital for Sick Children, Toronto and the Charlottetown i n Prince Edward Island, no training centre has used a test battery f o r selection 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 effect too short a time for any evalu-ation to be made. However, i t i s interesting to note (Table V) that i n those provinces where an active interest i n testing has been shown, e.g. Ontario, Alberta and Prince Edward Island, the respective elimina-\ tion rates stand at lh%, 12.8% and 1$% as opposed to 28.756 i n British Columbia where no test batteries have been employed. A break-down of the reasons for student nurse withdrawal from training i n the provinces of Canada for the year 19U7 i s shown in Table VI. I t w i l l be noted that approximately 2$% of the withdrawals are due to failure i n classwork, or i n c l i n i c a l practice. It w i l l also be noted that i n British Columbia, there were thirty-four eliminations due to failure in classwork out of a total of eighty for the whole of Canada. Moreover, the t o t a l elimination rate for British Columbia i s higher than that of any other province. Over thirteen percent of eliminations i n Canada i n 19^7 were due to "unsuitable personality" and "unhappiness Student Nurse Withdrawal from the Graduating Class of 19l*8 in 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. Spring 108 83 3 22 20.3% Fall 19U U»7 10 37 19% Total 302 230 13 59 19.52 P.E.I. Spring 11 11 _ _ Fall 22 17 - 5 22.5* Total 33 28 - 5 152 N.B. Spring 63 1*1* 19 302 Fall 178 131 2 1*5 25.22 Total 21*1 175 2 61* 26.52 Que. Spring 3UU 250 6 88 25.52 Fall 1*78 351 19 109 22.82 Total 822 601 21* 197 23.92 Ont. Spring 336 280 2 51* 162 Fall 95*9 798 21 11*0 H*.52 - Total 1295 1078 23 191*. H * . 92 Man. Spring 165 139 1 25 15.12 Fall 215 153 3 59 27.1*2 Total 1*26 335 1* 81* 22.12 Sask.. Spring 163 131 _ 32 19.62 Fall 263 201* 3 56 21.32 Total 1*26 335 3 88 202 Alta. Spring 102 89 3 10 9.82 Fall 269 225 8 36 13.32 Total 371 31U 11 1*6 12.32 B.C. Spring 192 116 9 57 29 .62 Fall 233 170 8 65 27 .82 Total U25 286 17 122 28.72 TOTAL Spring 11*81* 111*3 21* 317 21.32 Fall 2811 2196 73 51*2 19.22 Total 1*295 3339 97 859 202 *Data obtained 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 difficulties might be justifiably considered of equal importance with the group eliminated for reasons of failure in , classwork and in clinical practice. Although the present paper and pencil personality tests have proven inadequate for prediction in the nursing field, 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 in the nursing field and point up the value of improved interview methods. Approximately one f i f t h of the total eliminations in 19l*7 were lost because of "Dislike for nursing," "Marriage," and "Decision to go to college." It is possible that with improved Aethods. of interest testing, this figure might be somewhat reduced. Further study of the organization of nursing education in the various provinces would be necessary in order to definitely determine the reasons for the discrepancies in the rates of elimination. It seems highly probable, however, that "tee explanation may l i e in the precision of the selection techniques employed. TABLE VI. Student Nurse Withdrawal from Training in the Provinces of Canada for the Year 194-7 REASONS FOR WITHDRAWAL M.S. P.E.I. N.B. QUE. ONT. MAN. SASK. ALT A. B.C. TOTAL PERCENT DECISION BY HOSPITAL & STUDENT: • Failure in classwork 7 - — 22 21 34 26 11 4 125 12.7$ Failure i n c l i n i c a l 4 - 2 9 4 7 5 3 5 39 4$ Health 12 1 1 43 29 H 12 16 8 136 13.8$ Unsuitable personality — — 3 11 14 6 14 2 4 54 5.5$ DECISION BY STUDENT ONLY: Dislike for nursing 7 2 6 24 47 13 14 13 21 147 15$ , Marriage 11 - 5 17 50 6 11 19 20 139 14.1$ Home responsibilities 2 - — 13 11 6 3 2 2 39 4$ Decision to go to college — — 1 8 3 — — 1 _ 13 1.3$ Unhappiness or homesickness 8 - 5 9 15 3 1 1 — 42 4.3$ Health 3 1 3 13 8 2 2 2 9 43 4.4$ DECISION BY HOSPITAL ONLY: Failure in classwork — — 6 17 12 2 7 2 34 80 8.1$ Failure in c l i n i c a l practice 1 — — 6 4 1 1 _ 4 17 1.7$ Failure to meet regulations 3 — — 15 8 3 2 1 4 36 3.7$ Unsuitable personality 1 - 5 19 2 1 1 1 5 35 3.6$ OTHER REASONS 9 - 4 11 3 4 1 3 2 . 37 3.8$ ALL REASONS 68 4 41 237 231 102 100 77 122 982 100.0$ Total no. of schools 15 3 14 37 64 11 10 11 7 172 No. of schools replying 15 3 14 31 53 11 10 11 6 154 89.5$ No. of students represented 813 100 655 1963 3677 814 1046 1008 736 10,812 $ Withdrawal during 1947 8.4$ ¥> 6.3$ 12.1$ 6.3$ 12.6 % 9.6$ 7.7$ 16.6$ 9.7$ Date obtained from the Canadian Nurses Association. U9 THE PRESENT STATUS OF PRE-NURSING TESTING IN THE UNITED STATES, ENGLAND AND CANADA CHAPTER FT7E In the: United States; The figures used in the following presenta-tion _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 in 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. It i s presumed that the total wastage figures (32$) might.have been further, reduced i f tests had been used in these schools as part of the selection procedure. The wastage reported in 19li7- of students admitted in 19U* was 39#. 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 is at present studying the reasons for withdrawal for a l l students who entered training in 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 fi 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 schools in the United States, 972 require high sehool graduation. 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 in 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, D.C.) test battery* 5. The California Test Bureau battery. There are others used locally in a number of places. The trend seems 51 to be that of meeting local needs through a local test bureau. In the opinion of some workers.in the field in 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 in Personnel and Human Relations," New Tork, believes that a major problem in the area of nursing is a more adequate evaluation of the professional performance of nurses. This ia needed he says, in order to validate selection.tests In terms of professional performance rather than training school accomplishment. It is also needed in order to provide a better nursing service, to identify objectively the more competent persons in the field, 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 in the near future regarding the reason that people are attracted to nursing and how nursing reinforces or changes existing character patterns. H e plans to use the Thematic Apperception Test in this connection. In England: In England, l i t t l e seems to have been done until recently in 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, in 19U9, submitted *2 a study of the problem to the Education Committee of the Florence Nightingale International Foundation in 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 in psychometric selection is being carried out at St. George's Hospital, London. It was hoped that further details of this experiment might be included in this survey. Unfortunately, the fir 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 in Prince Edward Island is the only school employing a psychometric battery as a major tool in 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 is used in four schools and was previously used in one other centre. In the remaining twelve schools which employ testing devices, the test services of high schools or universities in the vicinities are utilized. The educational requirements in Canadian schools of nursing are similar to those necessary for admis-sion to nursing centres of the United States in so far as the two *3 educational systems are comparable* The majority of schools in Canada require a secondary school graduation diploma, many preferring senior matriculation students. Hence, selection in 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 in Canada with the percentage eliminated from schools in the United States might Indicate that Canada has no need for more precise methods of predicting the suit-ability of her nursing candidates. In the United States, of the class graduating in 19U7, 39$ had been eliminated. In Canada in 19U8, only 20% of the class failed to complete the course. Although the 19U7 figure for the United States is 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 in the rates of elimination. In view of the fact that 79% of American schools employ scientific selection methods, and that the educa-tional requirements appear to be virtually the same in the two countries, this discrepancy demands explanations;. The possibility arises that educational -standards in Canadian schools of nursing might be lower than those prevalent in 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 in the f a l l of 19k9. The results have been returned and the average of the graduating class in British Columbia was higher than the average of any of the graduating classes in the thirty-eight states where the examination was used. (30) Although i t i s true that the elimination rate of student nurses i s higher in British Columbia than in any other province in Canada, i t is 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 in this respect. Although nursing education is under separate control in each province, there is considerable standard-ization through a national organization — The Canadian Nurses Association, and one sees no evidence of radical differences in standards of nursing education from province to province. Consequently, in so far as i t is possible to generalize from these findings, i t would seem that educational standards in Canadian sehools of nursing are at least as high as those in the schools of the United States. Several possible explanations may be advanced for the difference in the elimination rates of the two countries.. It 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 in 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 in 19U7 might shed further light on the problem. If a similar detailed study of eliminations in Canadian schools were done and the results compared, i t might be possible to determine more accurately the reason for the discrepancy in the elimination r ates of the two countries. In the meantime, i t is futile to argue that American schools of nursing have not benefited by psychometric testing techniques. The steadily increasing patronage of the testing services is 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 in "student mortality" in certain hospitals after the Introduction of pre-nursing tests. Canada is eliminating 202 or over 800. students from every class enrolling in its 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 It cannot be assumed that the Introduction of psychometric selection methods into Canadian schools of nursing wi l l lower the present elimination rate. At no time since testing was introduced in American schools of nursing has the elimination rate in the United * 57 States been as low as 20% (11*0), and i t is 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 in Canadian schools of nursing. The wastage,rate in 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 in 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 in 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 in the course. For the.establishment of test selection methods in 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 in 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 in arithmetic. (b) Reading comprehension tests. (c) Mechanical comprehension tests. 58 ( d ) A c h i e v e m e n t t e s t s i n t h e f i e l d o f t h e n a t u r a l s c i e n c e s . ( e ) V a r i o u s p r o j e c t i v e t e c h n i q u e s . I t i s d o u b t f u l i f t h e i n c l u s i o n o f a p a p e r a n d p e n c i l p e r s o n a l i t y t e s t o r a n i n t e r e s t t e s t h a s a n y v a l u e f o r s e l e c t i o n p u r p o s e s i n t h e n u r s i n g f i e l d , b u t t h e r e s u l t s o f s u c h t e s t s c o u l d b e u s e d i n g u i d a n c e . A t t h e e n d o f t h e t h r e e y e a r t r a i n i n g p e r i o d , a n e v a l u a t i o n w o u l d b e m a d e o f t h e p r e d i c t i v e v a l u e o f t h e v a r i o u s t e s t s b y c o r r e l a t i n g r e s u l t s o n t h e t e s t b a t t e r y w i t h t h e v a r i o u s a s p e c t s o f s u c c e s s i n t h e c o u r s e . E v e n t u a l l y , n o r m s f o r C a n a d i a n s c h o o l s o f n u r s i n g w o u l d b e e s t a b l i s h e d t h r o u g h a n e x t e n s i v e u s e o f 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 o f s k i l l e d p e r s o n n e l w i t h a c c e s s t o u p - t o - d a t e e q u i p m e n t f o r a l l w o r k d e a l i n g w i t h t e s t c o n s t r u c t i o n , r e v i s i o n , a n a l y s i s a n & ^ e r p r e t a t i o n . T h e s e r v i c e s o f a p s y c h o l o g i c a l l y t r a i n e d p e r s o n n e l c o n s u l t a n t a v a i l a b l e i n t h e t r a i n i n g s c h o o l w o u l d f a c i l i t a t e t h e d e v e l o p m e n t o f t h e t e s t i n g p r o g r a m a n d t h e i n t e r p r e t a t i o n o f t e s t r e s u l t s i n g u i d a n c e a n d c o u n s e l i n g . L i a i s o n b e t w e e n D e p a r t m e n t s o f P s y c h o l o g y , e x i s t i n g t e s t b u r e a u s , a n d h o s p i t a l t r a i n i n g s c h o o l s w o u l d b e a d v a n t a g e o u s f o r t h e c o n s i d e r a t i o n o f p r o b l e m s a n d t h e i n t e r c h a n g e o f i n f o r m a t i o n . E x i s t i n g r e s e a r c h p r o j e c t s s h o u l d b e e n c o u r a g e d - — e s p e c i a l l y e x p e r i m e n t a l w o r k i n d e v i s i n g t e s t s o f i n t e r e s t a n d p e r s o n a l i t y w h i c h w i l l h a v e m o r e v a l i d i t y f o r s e l e c t i o n p u r p o s e s t h a n t h o s e n o w a v a i l a b l e . F i n a l l y , i n o r d e r t o a v o i d f a i l u r e o f t h e t e s t i n g p r o g r a m d u e t o f a c t o r s p o i n t e d o u t b y W i l l i a m s o n , S t o v e r a n d F i s s ( 1 7 0 ) , i n s t r u c t i o n m u s t b e a v a i l a b l e t o t h e h o s p i t a l t e a c h i n g s t a f f s i n a c c u r a t e m e t h o d s o f g r a d i n g a n d 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 educa-tional 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 person-ality 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 experiment-ation with projective techniques and improved interview methods might prove valuable in this connection, 2 . Wyatt ( 176, 177) has asked for research regarding the effects of the professional situation upon the worker and is 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 is also needed in 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 in the field (5>0) a major problem in nursing is a more adequate evaluation of the professional service of nurses. 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Statistical method in educational measurement. Yonkers: World Book Company, 1925. ' PETRY, LUCILLE. Letter to the writer. Sept. 20, 1947. PINTER, R. Intelligence testing; methods and results. New York: Henry Holt, 1931. POTTS, EDITH M. Practical values of mental tests in schools of •nursing. Am.J. Nurs.. 1928, 10, 1040-1045. POTTS, EDITH M. Testing the outcome of our clinical teaching. Thirty-sixth Annual Report of the Nati&aal League of Nursing  Education. 1930, 145-151. POTTS, EDITH M. When shall we test them? Am. J. Nurs.. 1931, 31, 1395-1397. POTTS, EDITH M. She can't learn anatomy but - . Am. J. Nurs.. 1933, 888-891. POTTS, EDITH M. The use of psychological tests in the selection of students. Thirty-ninth Annual Report of the National League of  Nursing Education. 1933, 174-184. POTTS, Edith M. Pre-tests for nursing school candidates. Public  Health Chats. July, 1934. POTTS, EDITH M. & GORDON, H. PHOEBE. Round pegs for round holes. Public Health Nursing Chats. March, 1939. 69 124*. POTTS, EDITH M. How expert testing simplifies the selection of nursing students. Trained Nurse and Hospital Review. 194-0,« 104-105-125. POTTS, EDITH M. The selection of student nurses. Am. J. Nurs., 1941, 41, 590-597. 126. POTTS, EDITH M. Value of psychological test in selecting student nurses. Hospital Management. 52, 1941. 127. POTTS, EDITH M. Testing prospective nurses. Occupations. 1945, 23, '328-334. 128. POWELL, MURIEL B. (Matron, St. George's Hospital, London) Letter to the writer. 129. RABIN, A.I. The efficiency of psychometric procedures in predicting success or failure in a nurses training course. Unpublished paper. 130. RABIN, A.I. St. WEINIK, H.M. The Nebraska Army Alpha-revision and the comparative strength factors V, N, and R. in nursing students. J. gen. Psychol.. 1946, 31, 197-202. 131. RAINIER, R.N., REHFELD, F.W., & MADIGAN, M.E. The use of tests in guiding student nurses. Am. J-. Nurs.. 1942, 42, 679-682. 132. RHLNEHART, J.B. An attempt to predict the success of student nurses by the use of a battery of tests. J. appl. Psychol.. 1933, 17, 277-293. 133. ROGERS, DOROTHY. Vocational guidance in schools of nursing -and nursing service. Forty-seventh Annual Report of the National League  of Nursing Education. 1941, 137-L41. 134. ROHRBACH, Q.A.W. Techniques for the selection of students. Trained  Nurse and Hospital Review. 1932, 88, 320-321. 135. ROPER, SYLVIA A. Test of interest in nursing. Unpublished Masters Thesis, Clark University, 1941. 136. ROSENSTEIN, J.L. Intelligence test ratings and training ability of nurses. J. clin. Psychol.. 1932, 21, 260-267. 137. ROUND TABLE ON NURSING TESTS. Forty-seventh Annual Report of the  National League of Nursing Education. 1941, 188-190. 138. SARBIN, T.R. & ANDERSON, H.C. A preliminary study of the relation of measured interest patterns and occupational dissatisfaction. Educ. psychol. Measmt.. 1942, 2, 23-36. 70 139. SARTAIN, A.Q. Predicting success in a school of-nursing. J. appl. Psychol.. 194-6; 30, 234-240. 140. SAWER, JEAN. Psychological tests as an aid to -the selection of nursing candidates. Report submitted to the Education Committee  of the F.N.I.F.". London. 1949. 141. ,SGRUGGS-CARRUTH, MARGARET. The predictive value of nursing school tests. Unpublished Thesisj Southern Methodist University, Dallas, Texas, 1944. 142. SEDER, MARGARET A. Introduction to testing and the use of test results. New York: Educational Records Bureau, 1940. 143. SISTER DOLORES MARIE, S.H.N. Evaluating tests in the guidance of student nurses. Forty-sixth Annual Report of the National League  of Nursing Education. 1940. 144. SOMMER, IDA B. Pre-nursing and guidance test service. Am. J. Nurs.. 1944, 44, 158-164. 145. SOUTH, E.B. & CLARK, GENEVIEVE Y. Some Uses of psychological "tests in schools of nursing. .Am. J. Nurs.. 1929, 29, No. 12. 146.' SPALDING, V.V. A study of nurse and police applicants. Delaware State' Med. J.. 1948, 20, 177-178. 1 147.' SPANEYj^ EMMA. Some basic terms in tests and measurements. Am. J. Nurs.. I946, 46, 192-193. 148. STEWART, NAOMI. A.G.C.T. scores of Army personnel grouped by occupation. Occupations. 1947, 26, 5-41. 149. STRONG, E.K. JR. The vocational interests of men and women. Palo Alto: Stanford University Press, 1940. .150. SUPER, D.E. Avocations and vocational adjustments. Character and  Personality. 1941, 10, 51-61. 151. SUPER, D.E. The Bernreuter Personality Inventory: A review of research. Psychol. Bull.. 1942, 39, 99-125. 152. SUPER, D.E. The Kuder Preference Record in vocational diagnosis. J. cons. Psychol.. 1947, 11, No. 4» 153. SYMONDS, P.M. Diagnosing personality and conduct. New York. D. Appleton Century, 1931. 154. TEIGS, E.W. Tests and measurements in nursing education. Trained  Nurse and Hospital Review. 1932, 89, 426-431. 7 1 155. Three measures of efficiency applicable to nursing schools. Trained Nurse and Hospital Review, 1931, 87, No. 6. 789-793. 156. TIFFIN, J. Industrial psychology. New York: Prentice Hall, Inc., 1942. 157. TORGERSON, T.L. Examinations are important. Am. J. Nurs.. 1944, 44, 985-987. 158. TRABUE, M.R.. Occupational ability patterns. Personnel J.. 1932 - 1933, 9, 350-351. 159. TRAXLER, A.E. The use of tests and rating devices in the appraisal of personality. Educ. Rec. Bull., 23 March, 1938. 160. TRIGGS, FRANCES 0. A study of the relation of the Kuder Preference Record scores tp various other measures. Educ. psychol. Measmt., 1943. 3, 241-354. 161. TRIGGS, FRANCES 0. Selection and guidance of students. Trained  Nurse and Hospital Review. 1943, 110-111. 162. TRIGGS, FRANCES 0. ,A further comparison of interest measurement by the Kuder Preference Record and the_-Strong Vocational Interest Blank for Women. J. Educ. Res., 1944, 38, 193-200. 163. TRIGGS, FRANCES 0. -^Rexsonnel work in schools of nursing. Philadelphia: W.B. Saunders Co., 1945. 164. TRIGGS,,FRANCES 0. The measured interests of nurses. J. Educ. Res.. 1947, 41, 25-34. 165. Studies in predicting scholastic achievement. Minneapolis: University of Minnesota Press, 1942, Parts 1-2. 166. WEIR, G.M. Survey of nursing education in Canada. Toronto: University of Toronto Press,. 1932. 167. WHEELER, CLARIBEL. The selection for schools of measurement and problems of adjustment, Am. J. Nurs., 1930, 30, 1169-1176. 168. WILLIAMSON, E.G. & DARLEY, J.G. Student Personnel Work. New York: McGraw-Hill, 1937. 169. WILLIAMSON, E.G., STOVER, R.D.* & Fiss, C.B. Testing for nursing aptitude. Am.J. Nurs.. 1937, 37, 893-895. 170. WILLIAMSON, E.G., STOVER, R.D. & FISS, C.B. The selection of student nurses. J. appl. Psychol.. 1938, 22, 119-131. 72 171. WITTENBORN, J.R., TRIGGS, FRANCES 0. & FEDER, D.D. A comparison of interest measurement by the Kuder Preference Record and the Strong Vocational Interest Blanks for Men: and Women. Educ. psychol. Measmt.. 1943, 3, 239-258. : 172. WITTMAN, PHYLLIS. Attendant selection and employee morale in hospitals for mentally i l l . Am. Psychol.. 1948, 3, P-3&4. 173. WOLF, LULU. Intelligence study and. time study. Am. J. Nurs.» 1928, 28, 1105-1107. 174. WONDERLIC, E.F. & HOVLAND, C.I. The personnel test: a re-standardized abridgement of the Otis S^ A Test for business and industrial use. J. appl. Psychol., 1939, p-685. 175. WORCESTER, D. A. Personality development. The trained Nurse  and Hospital Review. 1931, 87, 326-329. 176. WYATT, F. Guidance problems among student nurses. Am. J. 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 in training. J. appl. Psychol., 1924, 8, No. 4, 379-389. 7 3 APPENDICES DESCRIPTION OF TEST BATTERIES USED MOST EXTENSIVELY IN THE UNITED STATES 7 4 APPENDIX I. In a recent investigation, Mildred-E. 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. 4. Center for Psychological Service, Washington, D.C. 5. California Test Bureau, Los Angeles California. A description of the tests supplied by these various companies is given in the following pages. 75 APPENDIX II. 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 licence to use the American Council on Education and the Co—operative Test Service tests. The battery includes; 1. The A.C.E. Psychological Test (quantitative and l i n g u i s t i c s k i l l s ) 2 . Reading comprehension 3. Arithmetic 4. Natural Sciences 5. History and social studies (79) After students- who have taken the Pre-nursing and Guidance Examinations have been admitted into the school of nursing, the Department of Measurement and Guidance w i l l provide either the Bernreuter Personality Inventory or the Minnesota Personality Scale for them upon the request of the director. These tests w i l l be serviced and the results reported at no extra cost. The report of the National League of Nursing Education takes the form of cumulative record of testr results on which are entered the percentile scores. Comparison i s made with norms on previous nursing school applicants and l i b e r a l arts college entrants. These norms are based on 9,553 applicants to schools of nursing in thirty-seven states, Dis t r i c t of Columbia and Hawaii. Also 76 included on this record is 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 is 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 is carried out; new forms are devised and other experimental work instigated. The present battery comprises tests oft 1. Scholastic Aptitude (originally in the form of the Army Alpha) 2. 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 in a decile scale, giving a summary of abilities, the likelihood of adequate capacities for adjustment and finally recommending acceptance or refusal. It i s for each school to decide upon the level of attainment which i s essential to carry the cirrlculum in 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 is the only one of these batteries currently in use in Canadian training centres. It is used by the Charlottetown Hospital in Prince Edward Island as a major tool in selection and is used in four other training schools for guidance purposes. An attempt was made to determine the extent of the use of this battery in 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 is 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 in design and scope to those in the battery of the Psychological Corporation. The nursing aptitude test, is the Hoss (originally the Moss-Hunt). This test purports to measure: (a) judgment in 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) ability 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 in the 80 nursing course was computed, r « O.Ul. Between this test and practical nursing grades, r - 0.31 (169). The University of Minnesota studies, in 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 is sent back to the sehool with a summary of her assets and liabili 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 Nurses1 Associations 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 Lillian 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 Nurses1 Association of Nora Scotia, Alma F. Law. Executive-Secretary, The New Brunswick Association of Registered Nurses, Helen Arsenault, RN, Treasurer-Registrar. The Registered Burses1 Association of Prince Edward Island. Provincial Sanatorium, CHARLOTTETOWN, P.E.I. 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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