The Basic Knowledge Assessment Tool (BKAT) 
For Medical-surgical Nursing
(Version Two, 2018)


    Basic knowledge in medical-surgical nursing is a body of knowledge that the 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 medical-surgical nursing and represents the foundation for job performance.

    A primary aim of in-service education 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 37 years, the BKATs have become accepted as one standard for measuring basic knowledge in various areas of critical care and medical-surgical nursing. Specifically, to date, over 21,850 critical care and medical-surgical 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.  

    BKAT for medical-surgical nursing was originally developed, in part, because of inquiries from RN educators and managers, asking if a BKAT was available for medical-surgical nursing. A subsequent review of the literature failed to locate a standardized test of basic knowledge in medical-surgical nursing. This led to the development of the MED-SURG BKAT1.

    The MED-SURG BKAT1 was an 88 item paper and pencil test that measured content related to the following areas of nursing practice: Cardiovascular, endocrine, renal, gastrointestinal/parenteral, neurological, pulmonary, skin/wounds, and an ‘other’ category. The MED-SURG BKAT1 that followed in 2010, was the first BKAT that was developed outside of the critical care setting.

The MED-SURG BKAT 2 is Developed: Validity and Reliability

    Time came for the MED-SURG BKAT1 to be revised to the MED-SURG BKAT2. A call for both members for the Panel of Experts and Data Collectors (listed at the end of this document), went out on the BKAT Webpage  


    Validity was supported in two ways.  First construct validity for the MED-SURG BKAT2 was supported through suggestions from the three-member Panel of Experts in medical-surgical nursing practice and education. The following questions were given to the members of the Panel of Experts to assist them in their evaluation of the MED-SURG BKAT1.

1.”Whether or not items continue to apply to MED-SURG Nursing (if an item does
    not apply, cross it out),
2.If an item needs rewording (please make suggestions directly next to the item), 
3.How basic an item is to MED-SURG Nursing on a scale of 1 to 5 with 1 being most
4.Items that need to be added to the test (please give the content area [or write
    the item] and rate these with a 1 to 5 number), and
5.A new content area is being added on Geriatrics, so send your ideas for new

    The responses from the Panel of Experts resulted in the following changes in the MED-SURG BKAT1.  Initially, changes were made in 17 items to remove the use of the word, Except, in these questions. In addition, the wording of 35 stems were modified to improve the clarity of the items and to better reflect current practices in medical-surgical units. In addition, 16 distractors and 7 answers were modified. Two new items were added. No items were deleted.  

    The second way validity was tested , was using the Known Group Difference technique (Polit & Beck, 2012). New graduates (grads) working in critical care units over tim have consistently scored lower on the BKAT tests (Toth, 1986,1994,2007). However, during the development of the MED-SURG BKAT1 a small sample [n=18] of new grads in a residency program were not found to be different (Toth, 2011).  

      Therefore, an independent t-test was done on this larger sample of new grads (n=45) was computed.  

        The results were t (94) = 2.8 (1 tail) , p = .003, significant, or that 
        experienced medical-surgical nurses have more basic knowledge 
        than new grads.  

    This information is important to medical-surgical educators because it means that although the new grads in this study were RNs, the national standard for safe practice, they are statistically different from experienced RNs working in medical-surgical nursing. Replication research is recommended.  


    The Kuder-Richardson Formula (KR) was used to measure reliability of the MED-SURG BKAT2 and was KR = .69 for all 96 subjects, and .74 for the 51 RNs with > 1 year of experience (both acceptable), and was KR = .54 for the new grads (low). The low KR with the new grads is a second support that the scores of new grads are lower than experienced medical-surgical RNs, because it is likely that the test was too difficult, thus reducing variability and the KR.  

Description of the MED-SURG BKAT2

    The MED-SURG BKAT2 is a 90-item paper and pencil test that measures basic knowledge in medical-surgical nursing on the following areas of medical-surgical nursing practice: Cardiovascular (18 items), endocrine (12 items), renal (10 items), gastrointestinal/parenteral ( 8 items), neurological, pulmonary, and geriatric (7 items) and other (21 items). The ‘other’ category includes the following: Infection control, pain control, and skin/wounds (3 items each), communication, drug calculation, emotional/spiritual care, and safety/falls (2 items each), and advanced directives, blood transfusion, hypothermia, and obesity (1 item each). See Figure 1 below.

Data were collected from August 1, 2016 to January 30, 2017, or over a period of 26 weeks. In all, 96 MED-SURG BKAT2 tests were returned. Data were analyzed using a Scantron-Score machine and using the SPSS computer program. Scores were computed on all 96 nurses, on the 51 experienced medical-surgical RNs with greater than 1 year experience in medical-surgical nursing, and on the 45 new grads who had one year or less clinical experience in medical-surgical nursing.  


    Experienced RNs. The average years worked in medical-surgical nursing for the experienced group of 51 RNs was 7.3 years, standard deviation (SD) = 7.1 More than half (56.9%) earned the Bachelors Degree in Nursing, with 23.5% having a Masters Degree, and 15.7% with the Associate Degree. Approximately, two-thirds worked in a community hospital (63.3%), and the remainder in a State/Government hospital (14.3%), a Military/Veterans hospital (12.2%, and a University hospital (10.2%). In addition, 82.4% were certified in medical-surgical nursing.  

    New graduate nurses. The length of time worked in medical-surgical nursing for the new grad group of 45 was 0 – 1 years, with a M = .2 years, and SD = .4 years Note: The correlation of time working in medical-surgical nursing of the new grads and their scores on the MED-SURG BKAT2 was not statistically significant.  

    A large majority, or 90.2% earned the Bachelors Degree in Nursing, and the remaining 9.8% held the Associate Degree. Two- thirds worked in a community hospital (65.1%), and the remainder in a Military/Veterans hospital (30.2%) and a University hospital (4.7%).  

Scores on the MED-SURG BKAT2

    Experienced RNs. Scores ranged from 68 – 99%, with a M = 81.9 and SD = 7.2 points. Scores from 90 to 99% were scored by 21.6% of these RNs.

    New Grads. Scores ranged from 67 – 89%, with a M = 78.2 and SD = 5.6 There were no scores in the 90 to 100% range.  

 Passing Score on the MED-SURG BKAT2

      No one is expected to achieve 100%. Rather, it is expected that following orientation, Medical-Surgical nurses will achieve an average score. 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 prevent falls is recognized as critical to know in any nursing 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 nurse administering and scoring the MED-SURG BKAT2.

Uses of the MED-SURG BKAT2

    The MED-SURG BKAT2 can be used prior to orientation classes in medical-surgical nursing to identify needed content for the classes, and as a pretest and/or a posttest to measure learning in groups of nurses. It can also be used as a dependent variable to test different teaching methods for orientation classes, and as a means to identify content for in-service education programs for currently employed medical-surgical nurses. The BKAT is only one measure of basic knowledge in medical-surgical nursing and is not to be used in screening, hiring, or firing situations. It is copyrighted  and may not be given to others, altered, added to, or used in part. Permission must be obtained to use the BKAT. No BKAT may be placed on any computer for any reason.

Requests for Copies of the MED-SURG BKAT2

    The MED-SURG BKAT2 is being provided at cost to nurses who work in medical-surgical units, as a service to nursing and to the ministry that nursing represents. A payment of $25 is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing. Permission to use the MED-SURG BKAT2 and to photocopy it can be obtained by writing to:


P. O. Box 6295
Washington, DC 20015

Panel of Experts and Contributors for the MED-SURG BKAT2

The Panel of Experts included:

Callie Gollihue, MSN, RN, CCRN, Erlanger, Kentucky
Beth Torres, PhD, RN, CCRN, Midlothian, Virginia
J. Toth, PhD, RN, BCCC, Washington, DC

       Contributors included

Marie Victoria Buffmire, MSN, RN, CCRN, RDCS, Charlottesville, Virginia
Dora Bradley,PhD, RN-BC, Dallas, Texas
Timothy Scott Darrah, II, MSN, RN, ACCNS, Charlottesville, Virginia
Ann S Rigdon MS RN OCN, Charlottesville, Virginia
Barb Trotter, RN, BSN, CMSRN, Charlottesville, Virginia

Data Collectors for the MED-SURG BKAT2

Ramona Baucham, BSN, RN-BC, Irving, Texas
Gretchen Buchmann, BS, RN-C, WCC, Nantucket, Massachusetts
Jeanine DeLucca, MSN, RN, BC, Allentown, Pennsylvania
Lynette Flynn, MCN, RN, BS-HA, CHFN, LRT, Scott, Arizona
Penny Huddleston, PhD, RN, CCRN, Irving, Texas
Justin Leppanen, BSN, RN, Minneapolis, Minnesota
Rebekah Logan, MSN, RN, Muscle Shoals, Alabama
Sara Mirghani, Capt, USAF, NC, CNS, Nellis AFB, Nevada
Hilery Mulholland, Capt, USAF, NC, CNS, Travis AFB, California
Diana Pearce, MSN, RN-BC, PCCN, La Grange, Illinois
Ruth Robert, PhD, RN-BC, FNP-C, CMSRN, PCCN, Garland, Texas
Beth Torres, PhD, RN, CCRN, Midlothian, Virginia
Mary Jean Vickers, DNP, RN, ACNS-BC, Minneapolis, Minnesota
Paul Wong, DNP, MSN, RN, CCRN, CPAN, Bethesda, Maryland

Authors of the BKAT

The initial version of the BKAT (BKAT-1) was developed for use in the adult intensive care unit and was co-authored by J.Toth, PhD, RN, MSN, CNS, BCCC, 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 BKATs Available

        BKAT-9r for Adult Intensive Care (2015)
        BKAT-9S for Telemetry/Progressive Intensive Care (2015)
        ED-BKAT3r for Adult Emergency Department (2012)
        PICU-BKAT6r for Pediatric Intensive Care Unit (2014)
        NICU-BKAT5r for Neonatal ICU (2016) 
        PEDS-ED BKAT for Pediatric Emergency Department (2011) [in revision]

Official BKAT Website: 

Selected References

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   Crimlisk, J.T., Grande, M.M., Gintas, P.K, et al. Nurse residency program designed for a large cohort of new graduate nurses: Implementation and outcomes. MedSurg Nursing. 2017:26(2): 83-87.

    Hanna, D. R., Paraszczuk, A. M., Duffy, M. M., & DiFiore, L. A. Learning about turning: Report of a mailed survey of nurses’ work to reposition patients. MedSurg Nursing. 2016:25(4): 219-223..

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

    McConnell EA, Fletcher J, Nissen JH. A comparison of Australian and American registered nurses’ use of life-sustaining medical devices in crit care & high-dependency units. Heart Lung. 1993;22(5):421-427.

    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.

   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, 8th ed. 2012. 

  Rheume, J. & Fruh, S. Retrospective case reviews of adult inpatient falls in the acute care setting. MedSurg Nursing. 2015:24(5): 318-324.

  Ritmala-Castren M, Suominen T, Leino-Kilpi H, Toth JC. ICU nurses’ knowledge assessment. American Journal of Critical Care. 2008 (in review).

  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.

  Sakallaris, BR. The ICU fellowship: An innovative orientation program for new graduates in critical care. Focus on Crit Care. 1991;18:153-157.

  Toth JC. Development of the Basic Knowledge Assessment Tool for Medical-Surgical Nursing (MED-SURG BKAT) and Implications for In-Service Educators and Managers Nursing Forum. 2011;46(21): 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.

  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. Basic Knowledge Assessment Tool for critical care nursing, Version Four (BKAT-4): Validity, reliability, and replication. Critical Care Nurse. 1994;14(3):111-117.

  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. The Basic Knowledge Assessment Tool (BKAT)—Validity and reliability: A national study of critical care nursing knowledge. W J Nurs Res. 1986;8(2):181-196.

  Toth JC. Evaluating the use of the Basic Knowledge Assessment Tool (BKAT) in critical care nursing with baccalaureate nursing students. Image: The Journal of Nursing Scholarship. 1984;16(3):67-71.

  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.

  Wynd, C. Evidence-based education and the evaluation of a critical care course. Journal of Continuing Education in Nursing. 2002;33(3):119-125.  

JT 2/20/20