BKAT-9r © 
The Basic Knowledge Assessment Tool , (BKAT-9r) ©
For Adult Critical Care Nursing
(Version Nine, 2015)


     Basic knowledge in critical care nursing is a body of knowledge beyond that required for licensure as an RN that the critical care nurse uses in order to provide safe nursing care to patients.  Since safe practice is regarded as a moral and professional responsibility, basic knowledge is information that is necessary for entry into critical care nursing and represents the foundation for job performance.

     A primary aim of in-service education in critical care nursing is to assure that staff nurses demonstrate an understanding of this basic knowledge.  Because of on-going research studies (since 1979), publications, and the use of the BKAT over the past 34 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing.  

     To date, over 19,000  copies of a BKAT have been sent out to critical care nurse educators and nurse managers in the USA, who have requested a copy of the BKAT to photocopy for use in their practice.  Research continues to be conducted and published.  However, research support for the use of the BKATs outside the USA or Canada has not been forthcoming. 

    There are currently seven (7) different BKATs.  These are BKAT-9r for Adult ICU, BKAT-8S for Telemetry/Progressive Care, ED-BKAT2, PICU-BKAT6r, NICU-BKAT4, and MED-SURG BKAT.  These are described individually on this WebSite.

The BKAT-9r

    The most recent version of the adult BKAT is Version Nine (2015).  It is a 85-item paper and pencil test that measures basic knowledge in critical care nursing.  These items measure content related to the following areas of critical care nursing practice:  cardiovascular, pulmonary, monitoring lines, neurology, endocrine, renal, gastrointestinal/parenteral, and other.  The category ‘other’ includes such areas as infection control, hypothermia, burns, and spiritual care.

    The BKAT takes approximately 45 minutes to complete and has been administered on a supervised and unsupervised basis with no statistical difference in scores.  The total possible score is 85 points (100%).  .



​    Content for the initial version of the BKAT or BKAT-1 was identified through clinical experience, a review of the literature and interviews with staff nurses and head nurses working in critical care units, and through the suggestions from two critical care physicians and a nine member panel of experts in critical care nursing practice and education.  

    Validity for each of the subsequent versions of the BKATs (2-8) was established through a panel of experts.  Validity has also been supported through replication of research findings related to group differences, learning theory, and variables associated with (and not associated with) scores on the BKAT.  Samples of baccalaureate nursing students, new graduate nurses, and foreign nurses (not working in the USA) have been used as groups known to be different from practicing USA critical care nurses.  The mean (M) BKAT scores of the students, new graduates, and foreign nurses; were, as expected, significantly lower than the M scores of the ICU nurses.

​    Panel of Experts.  The BKAT-9r was based on the BKAT-8.  A 10-member Panel of Experts, professional experience, and  review of evidence in the literature were used to validate/update questions. These revisions included the deletion of 7 questions--with either low item to total correlations or outdated material--and the addition of two questions.  Revisions were also made to 10 stems, 8 answers, and 46 distractors.  

​    Construct validity of the BKAT-9r to measure known group differences between experienced ICU RNs and new graduate nurses showed a statistical difference between the groups [t(174)=2.7, p <.005], with experienced nurses scoring higher.


    Reliability for the eight previous versions of the BKAT for Adult ICU ranged from  an alpha of 0.78 to 0.90, on sample sizes from 74 to 528.   Reliability for the BKAT-9r is alpha 0.84 obtained on a sample of 176 nurses working in an ICU.  This is described below.


    A sample of 176 ICU RNs from the following 11 states participated in reliability testing:   Arizona, Georgia, Illinois, Kentucky, Mississippi, New Hampshire, New Mexico, North Carolina, Ohio, Nevada, and Texas.  All worked in the adult ICU.  The units were ICU (45%), ICU-CCU (20%), MICU (5%), SICU (3%), and combination units (27%).  Jobs included  staff nurses (81%), managers/supervisors (8%), educators, (7%), and clinical specialists (3%).

Uses of the BKAT

    The BKAT can be used in the following ways:

  • to identify content for orientation classes,
  • as a pretest and/or a posttest to measure learning in groups of nurses,  
  • as a dependent variable to test different teaching methods for orientation classes,
  • to identify content for in-service education programs for currently employed critical care, & 
  • for advanced placement of nurses with prior experience in critical care nursing, 

    The BKAT is only one measure of basic knowledge in critical care nursing; it is not to be used in screening, hiring, or firing situations.  It is copyrighted © and may not be altered, added to, or used in part.  Permission must be obtained to use the BKAT, and to make copies of it.  No BKAT may be put on any computer for any reason:  This is not negotiable.

Passing Score

    No one is expected to achieve 100% .  Rather, it is expected that  following orientation, critical care nurses will achieve an average score on the BKAT-9r of 82-84% correct answers.  

Requests for Copies of the BKAT-9r

    The BKAT is being provided at cost to nurses who work in critical care, as a service to nursing and to the ministry that nursing represents.  A payment of $15.00 is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing.  Permission to use the BKAT-9r and to photocopy it can be obtained by writing to Jean C Toth, PhD, RN, MSN, CNS,  BCCC, PO Box 6295, Washington, DC 20015, or sending an email to BKAT7.toth@yahoo.com.  

    Additional information related to what BKATs are available and what research is currently being conducted can be found by going to the Homepage or clicking the 'Research' bar on this Webpage.

Panel of Experts for the  BKAT-9r

    The Panel of Experts included the following critical care nurses:

Catherine Riedel, MSN, RN, ACNS-BC, CCNS, CPAN, CCRN-CSC, California
Dina Elias, MSN, RN, CNS, CCRN, California
Denise Henderson, MSN, RN, Indiana
Barbara Hissong, MSN, RN, CCRN, Florida
Jean Hunt, MSN, RN, CVRN-BC, Indiana
Marcia Ilnicki, BSN, RN, CCRN, Indiana
Rebecca Lane, MSN, RN, CCRN, CEN, Indiana
Lynn Marder, MS, RN, CNS, PCCN, California
Alex Markwell, MSN, RN, MHA/MBA, CEN Florida
Beth Torres, PhD, RN, CCRN, Virginia

    Data Collectors for the BKAT-9r  included the following critical care nurses:

Mark Bisbee, MN, RN, CCRN, Illinois
Diane Byrum, MSN, RN, CCNS, FCCM, North Carolina
Pam Cosper, MSN, RN, NEA-BC, Georgia
Jennifer Drumm, MSN, RN, Kentucky
Julia Eberwine, MSN, RN, CCRN, PCCN-CMC, Ohio
Callie Gollahue, MSN, RN, CCRN, Kentucky
Lisa Hughes, BSN, RN, Arizona
Jean Hunt, MSN, RN, CVRN-BC, Indiana
Marcia Ilnicki, BSN, RN, CCRN, Indiana 
Elizabeth Kloska-Kearney, MSN, RN, CCRN, Indiana
LCDR Eric Kulhan, MSHSA, MEd, RN-BC, BSN, Illinois
Yolanda Martin, BSN, RN, Mississippi 
Julie Miller, BSN, RN, CCRN, Texas 
Diane Muzenjak, MSN, CCRN, APRN-BC, CNS, New Mexico 
Patricia Nietrzeba, MS, RN, Nevada
Donna Proulx, MS, RN, CCRN-CSC, New Hampshire 
Mitzie Trammel, MS, RN, CCRN, North Carolina 
Angela Wilson, BSN, RN, Illinois 
Mary Zellinger, MN, RN, ANP-BC, CCRN-CSC, Georgia 

Authors of the BKAT

    The initial version of the BKAT (BKAT-1) was co-authored by Jean C Toth, RN, MSN, CNS, PhD, BCCC, The Catholic University of America, Washington, DC, and Kathleen Ritchey, RN, MSN, CNS, formerly of the Veterans Administration Medical Center, Washington, DC.  All subsequent BKATs and their versions were authored by Dr Toth. 

Other Critical Care BKATs Available:

​    BKAT-8Sr for Telemetry/Progressive Care (2009)  [in research]
    ED-BKAT2 for Adult Emergency Department (ED) (2012)
​    PICU-BKAT6 for Pediatric ICU (2014)
​    NICU-BKAT4 for Neonatal ICU (2009)   [in research]
​    PEDS-ED BKAT for the Pediatric ED (2011)

Non-Critical Care:

    MED-SURG BKAT for medical-surgical nursing (2010)

Official BKAT Website:  www.BKAT-toth.org 

Selected References

     AACN Bold Voices.  ‘Stop Sepsis’ Program reduces mortality rate 40%.  2014;6(4),9.

     AACN Bold Voices.  C Diff.   2014;6(1),10, as reported  on-line, in The Journal of the American Medical Association.

     AACN Bold Voices.  Gloves and gowns may reduce MRSA infection in ICUs.   2014;6(1),10.

    Toth, JC.  The participation of emergency nurses in the development of the Basic Knowledge Assessment Tool (BKAT) for the emergency department, the ED-BKAT2.  Journal of Emergency Nursing.  2013;30(3),238-244. 

    Alspach, J.  Editorial:  Weighing the evidence on patient safety strategies to implement now. Critical Care Nurse.  2013;33(3), 9-12

     Advance for Nurses.  C Diff.   2013;15(10),12,26.

     At the Bedside.  AACN Bold Voices.  Older patients in ICU at high risk for HAI.  2012;4(8), 16.

    Lakanmaa, R, Suominen, T, Perttila, J, Puukka, P, & Leino-Kilpi, H.  Competence requirements in intensive and critical care nursing—Still in need of definition?  A Delphi study.  Intensive and Critical Care Nursing.  2012;28, 329-336.

    At the Bedside.  AACN Bold Voices.  Safety program reduces CLABSIs by 40 percent.  2012;4(12), 9.

     Practice Alert.  AACN Bold Voices.  Catheter-associated urinary tract infections.  2012;1(12), 13.

    Burchell, PL, & Powers, KA.  Focus on central venous pressure monitoring in an acute care setting.  Nursing2011; December, 39-43.

    Stacy, KM.  Progressive care units:  Different but the same.  Critical Care Nurse.  2011;31(3), 77-83.

    LaPointe, NM, Sun, j, & Kaplan, S.  In-hospital management of patients with atrial flutter.  American Heart Journal.  2010;159(3), 370-376.

    Jacobs, I, Sunde, K, Deakin, CD et al.  Part 6:  Defibrillation 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.  Circulation:  American Heart Association.  2010;122(Suppl2),S325-S337. http://circ.ahajournals.org 

    Peate, I.  Caring for the patient with angina:  Causes and treatment.  British Journal of Healthcare Association.  2010;5(03), 65-69.

    Nottingham, F.  Diagnosis and treatment of atrial fibrillation in the acute care setting.  Journal of the American Academy of Nurse Practitioners.  2010;22, 280-287.

    Riddle, E, Bush, J, Tittle, M, & Dilkhush, D.  Alcohol withdrawal:  Development of a standing order set.  Critical Care Nurse.  2010;30(3),38-45.

    McDonough, M.  Clinical updates:  Treating ventricular tachycardia.  The Journal of Continuing Education in Nursing.  2009;40(8), 342-343.

    Helms, S, Carkhuff, M, Simmons, M. & Sutton, G.  concerted team effort:  A multidisciplinary strategy is needed to conquer VAP.  Advance for Nurses.  2009; 11(1), 15-16.

    Dill, B. Critical Care, food for thought.  Advance for Nurses.  2008;      10(26)15.

   Stravroudis, TA, Miller, MR, & Lehmann, CU.  Medication errors in neonates.    Clinics in Perinatology.  2008;35,141-161.

    Morris, LL et al.  Designing a comprehensive model for critical care orientation.  Critical Care Nurse.  2007;27(6): 37-60.

    Toth JC.  Development of the Basic Knowledge Assessment Tool (BKAT) for the NICU:  The NICU-BKAT3, its uses and effect on staff nurses.  Journal of Perinatal Neonatal Nursing.  2007;21(4):  342-348.

    Toth JC.  Follow-up Survey 10 years later:  Use of the Basic Knowledge Assessment Tools (BKATs) for critical care nursing and effects on staff nurses.  Critical Care Nurse.  2006:26(4):49-53.

    Hendrick B, Lindsay A.   Nurse residency programs.  Journal for Nurses in Staff Development.  2006;March/April:55-62.

    Collins ML, Thomas TL.  Creation of a stepdown nurse internship program.  Journal for Nurses in Staff Development.  2005;May/June:115-119.

    Ritmala-Castren M, Leino-Kilpi H, Suominen T.  Biological & physiological knowledge & skills of graduating Finnish nursing students to practice in intensive care.  Nurse Educ Today.  2004;24(4):293-300.

    Lam, BCC, Lee, J, & Lau, YL.  Hand hygiene practices in a neonatal intensive care unit:  A multimodal intervention and impact on nosocomial infection.  Pediatrics.  2004;114(5),565-571.

    Messmer PR, Jones SG, Taylor BA.  Enhancing knowledge and self-confidence of novice nurses:  The “Shadow-A-Nurse ICU program.  Nursing Education Perspectives. 2004;25(3):131-136.

    Moore, KA, Coker, K, Swett, B, & Edwards, WH.  Implementing potentially better practices for imkproving family-centered care in neonatal intensive care units:  Successes and challenges.  Pediatrics.  2003;111(4),450-460.

    Toth JC.  Comparing basic knowledge in critical care nursing between USA and foreign nurses:  An international study.  American Journal of Critical Care.  2003;12(1):41-46.

    Toth JC, Dennis MM.  The Basic Knowledge Assessment Tool (BKAT) for critical care nursing:  Its use and effect on orientation programs.   Critical Care Nurse.  1993;13(2):98-105.

    Toth JC, Ritchey KA.  New from nursing research:  The Basic Knowledge Assessment Tool (BKAT) for critical care nursing.  Heart  Lung.  1984;13(3):271-279. [Initial publication on BKAT]

JT 6/16/14