ED-BKAT3r © 

The Basic Knowledge Assessment Tool (BKAT) for 
Emergency Department (ED-BKAT3rCritical Care Nursing 

(Version Three, 2020)

     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 40 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing.  To date, approximately 23,580 critical care nurse educators and nurse managers in the USA have requested and have received a copy of the BKAT to photocopy for use in their practice.  Critical care nurses in over 27 different foreign countries have also requested and received a copy of one of the BKATs.

The ED-BKAT3r  

     The ED-BKAT3r is a 78-item paper and pencil test that measures basic knowledge in Emergency Departments. The focus is on adult patients, but questions on pediatrics are also included.  These items measure content related to the following areas of ED critical care nursing practice:  Cardiovascular, neurology, pulmonary, endocrine, pediatrics, renal, gastrointestinal/parenteral, drug abuse, trauma, and other.  The category ‘other’ includes such areas as sepsis, obstetrics, psychiatric situations, rape, spiritual care, geriatrics, and mass casualty. 

     The BKAT takes approximately 40 minutes to complete and  should be administered on a supervised basis.  The total possible score for the ED-BKAT3r is 78 points.  Items on the test contain multiple choice and fill-in-the-blank questions that measure both the recall of basic information and the application of basic knowledge in practice situations.  Psychosocial aspects of critical care nursing practice are integrated into specific questions in the ED-BKAT3r.


     The ED-BKAT3r is based on the ED-BKAT2. Content was also identified through a continuing review of the literature and recommendations of a five member Panel Experts from California, Florida, Massachusetts, and Ohio. All were volunteers and contacted the author through email and the BKAT Webpage www.BKAT-toth.org.  Three held a MSN and two achieved a PhD.  All were educators/managers in the adult Emergency Department. Three were Certified Emergency Nurses (CENs). 

         Content validity.   The Panel of Experts validated what specific content on the previous ED-BKAT2 remains basic to safe nursing practice in the Emergency Department. This evaluation included the following: 

        •       Whether or not items still apply to the adult ED,
        • If an item needs rewording,
        • How basic an item is to adult ED nursing on a scale of 1 to 5 with 1
                 being the most basic, and
        • Items that need to be added to the test.

​      Items were retained if the majority of Panel Members rated them as current practice and as basic knowledge in the Emergency Department.  Items were deleted, if they were outdated.  Other items were revised.  

      Revisions included the following:  

       10 items were deleted,  
       •  3 new items, suggested by the Panel, were added, 
       •the wording of 10 stems were updated/revised, 
       •the wording of the stems of an additional 8 items was made to remove 
                the word, EXCEPT, from the stems, 
       • 8 answers were reworded for clarity, and
       •16 distractors were reworded for clarity.

         Construct validity of the ED-BKAT3r was measured during reliability testing, through the technique of known group differences. The two groups, ‘known’ to be clinically different were new graduate nurses with zero to <1 year experience (Group 1) and RNs working in the ED with 1 to 48 years working in the ED and with a Mean of 12.5 years (Group 2).  

         The Mean score of the new graduates (n=8) was 74.7% correct answers and a standard deviation of 4.5 The Mean score of the experienced RNs (n=47) was
 83.4 % and a standard deviation of 4.8.  That the scores of these two groups were statistically different.  This was also the case with both the ED-BKAT1 and the ED-BKAT2.  


       Previous ED BKATs.  The reliability of the first two versions of the ED-BKAT were measured using Cronbach’s coefficient alpha and ranged from 0.80 to 0.83

       Reliability for the ED-BKAT3r was measured using an equal computation known as the Kuder Richardson (KR) technique during the study.  It ranged from 0.70 – 0.77 KR, an acceptable level for this type of test.

     Additional revisions that were based on item to-total correlations and per-cent correct answers during reliability testing included the following: 4 distractors were changed and 22 were revised, 3 answers were modified, the order of responses was changed in 1 question, and the wording of the stem was refined in 3 questions. No questions were deleted. Also, there were no changes in the remaining 50 questions (64.1%).  

   Uses of the ED-BKAT3r

     The ED-BKAT3r can be used in the following ways:

        •prior to orientation classes to identify needed content for the classes,
        as a means to identify content for in-service education programs for 
                     currently employed ED RNs,
        •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,
        •in evidence based nursing research, and
        •for advanced placement of nurses with prior experience in ED nursing.

     The ED-BKAT3r is only one measure of basic knowledge in ED nursing and is not to be used in screening or removal from the ED, or 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 ED-BKAT3r.  No BKAT may be placed on any computer for any reason.  BKATs are not available to travel nurses or nurse agencies.

     In addition, BKATs may not be shared with others.  Managers/educators must contact BKAT to apply for their own permission to use any BKAT.  

 Passing Score

          No one is expected to achieve 100%.  Rather, it is expected that following orientation, ED nurses will achieve an average score on the ED-BKAT3r, or 83-84%.  Whether or not an average score is considered to be a passing grade depends upon which specific questions are missed; for example, being able to recognize the ECG pattern of ventricular fibrillation is critical to know in any critical care unit.  Since the BKAT is being used in a wide variety of clinical settings, which specific questions are essential to know for that setting is decided by the RN educator/manager administering the specific BKAT.

Requests for Copies of the ED-BKAT3r

    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 $25.00 is required to cover photocopying, postage, handling, and continued validity and reliability testing.  

    Questions about the ED-BKAT3r can be answered by writing to:
 J. Toth, PhD, RN, BCCC.

    To order the ED-BKAT3r, fill out the Agreement Form (see yellow button, To Order) and mail it to:

                                                 P. O. Box 6295
                                          Washington, DC 20015

Panel of Experts for the ED-BKAT3r

        The Panel of Experts included the following nurses:

        Kristie Gallagher, MSN, RN, CEN, TCRN, EMT-P, EMS-S, Toledo, Ohio
                    Christine Beattie, MSN, RN, CCRN, CEN, Panama City, FL
                                     Nancy Hassan, MSN, RN, Salem, MA
                               Rebecca Lash, PhD, RN, CEN, Pasadena, CA
                               Jean Toth, PhD, RN, BCCC, Washington, DC

Data Collectors for the ED-BKAT3r included the following nurses:

                                    Susanna Dejneka, MSN, RNC, Flemington, NJ
                                      Bryan Devinney, MSN, RN, Hendersville, NC
                             Megan DeVol, DNP, RN, ANP-C, MHA, Shelbyville, IN
                                   Jan Rhoads, MSN,RN, CEN, West Reading, PA
                                Patricia Rabbett, MSN, RN, CCRN-K, Boston, MA
                                  Suzanne Robinson, MSN, RN-BC, Richmond, VA
                                 Jeanne Zack, PhD, RN, CIC, FAPIC, St. Louis, MO

Other BKATs available:

        BKAT-9r for adult ICU (2015)
        BKAT-CC for adult Contagion Control (2020)
        BKAT-9S for Telelmetry/Progressive Care (2015) 
        PICU-BKAT6r for Pediatric ICU (2014) 
        NICU BKAT5r  for Neonatal ICU (2016) 
        PEDS-ED BKAT for Pediatric ED (2011)  [in revision]

        MED-SURG BKAT2 for Medical/Surgical Care (2018) Non-critical Care

Author of the BKAT: Each of the eight BKATs was authored by 

                        J. Toth, PhD, RN, MSN, CV-CNS, BCCC

                                            Selected References

        Whitney, G, Scaturo, N., & Allen, C., Acute management of upper gastrointestinal bleeding. Advanced Critical Care. 2018:29(4), 369-375.

        Czajka, C., Frey, A., & Schears, G., Vascular access-device stabilization and line securement. Am Nurse Today. 2018:13(12).

        Cochran, C., Effectiveness and best practice of nurse residency programs: A literature review. MedSurg Nursing. 2017:26(1): 35-57, 63.

        Tidwell, W., Thomas, T., Pouliot, J., Canonico, A., & Webber, A. Treatment of alcohol withdrawal syndrome: Phenobarbital VS CIWA-Ar protocol. American Journal of Critical Care: 2018:27(6), 454-460.

        Bone, N, Swinton, M., Hoad, N., Toledo, F., & Cook, D. Critical care nurses’ experiences with spiritual care: The spirit study. Americal Journal of Critical Care. 2018:27(3): 212-219.

        Ritmala-Castren M, Suominen T, Leino-Kilpi H, Toth JC. ICU nurses’ knowledge assessment. American Journal of Critical Care. 2012.

        Dolan, J. & Dolan L.Determinants of nurses’ use of physical restraints in surgical intensive care unit patients. American Journal of Critical Care, 2018:26(5):373-379.

        Runton NG, Toth JC. Introducing the Basic Knowledge Assessment Tool for pediatric critical care nursing (PEDS-BKAT). Critical Care Nurse. 1998;18(3):67-72.

        Toth JC. Development of the Basic Knowledge Assessment Tool (BKAT) for medical-surgical nursing (MED-SURG BKAT) © and implications for in-service educators and managers. Nursing Forum. 2011; 46(2):110-116.

        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.

        Messmer PR, Jones SG, Rosillo C. Using nursing research projects to meet Magnet recognition program standards. Journal of Nursing Administration. 2002;32(10):538-543.

         Polit, D.E,& Beck, C.T. Nursing research: Generating & assess evidence for nursing practice, 9th ed. Lippincott, Williams, & Wilkins; 2012. 

        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.

        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.

JT 02/20/20