Exam Development


Purpose of the NHCWA Exam

All certification programs are developed, and evaluated by industry-experienced professionals with the best education and advance degree such as MS, Ph.D., MBA, MD, DCRA, MS/Ph.D. (Nurse).

The purpose of the NHCWA examination is to ensure that healthcare professional’s demonstrate the necessary level of competence for entry into the healthcare profession. Critical to the validity of the examination process is the premise that the exam content truly reflects the nature and scope of professional practice. This vital link of assurance is established through the exam development process, which includes the job analysis study, determination of test specifications, and construction of the exam content outline.


Job Analysis

The NHCWA Job Analysis is defined as a very detailed job description, which determines the knowledge and skills that are tested for certification.  A profession can be “… broken down into performance domains which broadly define the profession being delineated. Each performance domain is then broken down into tasks, which help define each performance domain. In turn, each task is delineated further and broken down into knowledge and skill statements which further elaborate on each task”. Among the outcomes of the job analysis study is a table of specifications, or blueprint, for the exam. These specifications include a categorical breakdown of the content used in the test and the percentage of weight assigned to each domain. This percentage determines the number of questions within each section of the exam. All of the knowledge and skills must first be verified through an educational process, and must be taught and evaluated by an instructor or preceptor.

The testing process serves as a second verification of the acquisition of knowledge and skills, providing an evaluation through a performance assessment and a written exam.


Exam Development /Written questions

The NHCWA retains a consultant to provide assistance in the development of the exams. The consultant is from a research and development firm that serves certification bodies by planning, developing, and administering assessment procedures and programs designed to measure professional competence.

The exam questions are written by the NHCWA Examination Committee specially trained healthcare professionals an expert panel of the NHCWA, practicing healthcare professionals, and educators under the guidance of the consultant to assure comprehensiveness and validity. The exam question pool is updated on a regular basis to reflect current knowledge. Individual questions are modified or deleted based on statistical analysis of the exam.


About Examinations/Format

There is only one (1) examination required for each certification. Each examination consists of 100 multiple-choice questions. Each test question presents the candidate with four (4) options of which only one option is correct. Candidates are permitted a total of 2 hours in which to complete the examination.

NHCWA’S examinations are administered in the following formats:

  1. Paper and pencil
  2. School administered, computer-based
  3. Commercial test center computer-based


What is the passing score? The score is reported on a scale where 70% is the passing score. A scaled score of 70% or higher is passing.

Exam Scoring

The passing score is determined by using the modified Angoff Method, where groups of subject matter experts rate each question on how likely a competent, but entry-level, student would answer it correctly. Based on the assumption that not all competent students will get every question right, but that each question should be clear and relevant enough to be answered correctly by most entry level students, the raters give each question a score based on how many competent students out of 100 would choose the correct answer. These scores are averaged to determine the passing score. This is a standard process used to set passing scores on many certification exams. The NHCWA Board has the final authority to determine the passing score, and may adjust the score upward or downward by one Standard Error of Measurement if they feel that the raters have judged the exam too harshly or leniently.

Because each question has a rating, and each form of the exam contains an assortment of questions from the Item Bank, the raw score (number of correct answers out of 100 questions) may vary slightly for each form of the exam. The forms currently in use have passing raw scores from 77-80, or approximately 80% correct answers. Reporting the score on a scale where 75 is the passing score allows a comparison of the passing or failing scores on different forms of the exam. For example, on an exam where the passing score is 77, a score of 78 would pass. On an exam where the passing score is 80, the score of 78 would not pass. A score below the passing score will be reported as a scaled score of 69 or lower, a score right at the passing score will be reported as a scaled score of 70, and a score above the passing score will be reported as 71 or higher.

NHCWA’s Schools Performance Report

The NHCWA will send an performance report of each exam section to the program director, exam coordinators or authorized school personnel the report identifies the group’s strengths and weaknesses based on the student’s scores from the NHCWA exam.  In this way, program directors can find out which topics they cover well and which topics might need further instruction in order to best prepare the students.  The student will also receive of their performance from each exam section at the end of the exam. Therefore, the NHCWA exam report system can benefit the instructors, as well as the students that he or she instructs. The program director or authorized school administrator will have access to log in and review their schools performance reports at any time.