Introduction

The NCLEX-RN (National Council Licensure Examination for Registered Nurses) is the standardized licensing exam that all nursing graduates must pass to practice as registered nurses in the United States and Canada. The HESI (Health Education Systems Inc., now part of Elsevier) and ATI (Assessment Technologies Institute) are not competing certifications — they are proprietary nursing education platforms that include readiness assessments designed to predict NCLEX-RN pass probability and help nursing programs evaluate student preparedness. Many nursing programs require students to pass a HESI or ATI exit exam as a graduation requirement. This comparison explains how these three assessments relate to each other and how they serve different purposes in a nursing student’s journey.

Comparison Table

Key Differences

Purpose and Stakes

• •NCLEX-RN is the single high-stakes licensing exam. Failure means you cannot practice as an RN.
• •HESI and ATI are low-to-moderate stakes program assessments. They predict NCLEX readiness and may be used for program accreditation, but they are not licensing exams. Some programs require a minimum HESI/ATI score to graduate.

Computer Adaptive Testing

• •NCLEX-RN uses a Computer Adaptive Test (CAT) algorithm that adjusts question difficulty based on your performance. The exam ends when it determines with 95% confidence whether you’ve passed or failed (or after max questions).
• •HESI and ATI use fixed-form or question-bank-based exams that do not adapt in real time.

Content Breadth

• •All three cover similar nursing content areas, but the NCLEX-RN follows the NCSBN test plan (updated regularly with a detailed blueprint).
• •HESI and ATI mirror NCLEX content areas but are designed by their respective companies with their own emphasis and item styles.

Predictive Validity

• •Both HESI and ATI claim high predictive validity for NCLEX-RN pass rates. Published research generally supports moderate-to-good predictive value, though exact accuracy varies by study.
• •HESI Exit Exam score ≥900 is widely cited as correlating with NCLEX-RN pass rates of 95%+.
• •ATI Level 2–3 on the Comprehensive Predictor is cited as correlating with ~95%+ NCLEX pass rates.

Student Cost

• •NCLEX-RN costs $200 to register, plus additional state licensing fees (varies by state; some states charge $50–200+).
• •HESI and ATI costs are typically bundled into nursing program tuition. Students rarely pay out-of-pocket unless taking retakes.

Program Choice

Students do not typically choose between HESI and ATI — their nursing program selects one platform. Some programs use HESI, others use ATI, and a few use both or neither. When evaluating nursing programs, it’s worth asking which platform is used, as preparation quality and study resources vary.

How They Work Together

The typical nursing student journey:

1. Throughout nursing school: Take HESI or ATI specialty exams (fundamentals, med-surg, OB, peds, psych, etc.) after each course
2. Final semester: Take the HESI Exit Exam or ATI Comprehensive Predictor
3. After graduation: Register for and take the NCLEX-RN

The HESI/ATI exams serve as checkpoints along the way, while the NCLEX-RN is the final gate.

Which Is Right for You?

Since these are not competing credentials but rather sequential assessments:

For nursing students:

• •Focus on passing your program’s required HESI or ATI assessments
• •Use your HESI/ATI scores to identify weak areas and target NCLEX preparation
• •Dedicate 4–8 weeks of focused NCLEX preparation after graduation using NCLEX-specific review resources (UWorld, Archer, Mark Klimek, etc.)
• •Treat the HESI Exit Exam or ATI Comprehensive Predictor seriously — programs often won’t let you graduate without passing

For nursing program administrators:

• •Choose HESI or ATI based on faculty preference, accreditation alignment, and student outcomes data
• •Set reasonable passing thresholds that encourage preparation without creating unnecessary barriers

Sources

• •National Council of State Boards of Nursing (NCSBN) — ncsbn.org
• •NCSBN NCLEX-RN Test Plan — ncsbn.org/nclex
• •Elsevier HESI — hesievolve.com
• •ATI Nursing Education — atitesting.com
• •Spurlock, D. (2020). “The HESI Exit Exam: Predictive Validity.” Nurse Education Today.
• •Uitto, M. et al. (2022). “NCLEX Predictor Validity Studies.” Journal of Nursing Education.