CEU Course Development Guide
Development Instructions for Nursing CEU Course Authors


Welcome to Corexcel! We are an education and training company for health professionals located in Wilmington, Delaware. We are delighted that you are interested in joining website faculty as a continuing education course author. We strive to provide nurses with informative and interesting website programs that meet the criteria established by both ANCC and IACET for continuing education credit.

Our course development staff looks forward to working with you to ensure success in developing your course(s) and having them accredited for continuing nursing education. With that goal in mind, Corexcel has developed a CEU Development Guide full of resources to assist you through the entire process of nursing web content development.

Once you have developed a draft of your course and submitted it to Corexcel on an agreed upon date, we forward it to our pilot testers. These are nurses who have agreed to review your course content, take the accompanying post test and complete a written evaluation. The pilot testers also estimate the time it takes them to complete your program. Program completion time is averaged and contact hours and/or CEUs are then applied to your course content. Some pilot tester evaluation comments may indicate the need for content revision on your part. Once the final draft is approved by you, our developers will format the course for our website, assign a price and add it to our existing catalog of nursing continuing education courses.

The pilot testing process usually takes approximately 2 weeks. Program formatting and website placement generally takes another 2-3 weeks.

The Corexcel staff is available by phone at 1-888-658-6641 to assist you as you proceed. You may also request assistance using our contact form.

Again, we are excited that you are interested in how to create a CEU course for Corexcel. After reading this nursing CEU course development guide for authors, let us know how we can help you or if you have additional questions.


Corexcel President's Signature

Sue Bowlby,
Corexcel President

How to Begin

To begin the development process you can email, mail or fax us your resume with a cover letter explaining the topic you are interested in writing about and why you feel qualified to write about it.

Our mailing address is:

201 Webster Building
3411 Silverside Road
Wilmington, DE 19810

Phone: 302-477-9730
Fax: 302-477-9744

Once our staff has reviewed and approved your qualifications to write for us on this topic, we will send you a copy of our Writer Agreement for you to review and sign. The agreement outlines payment terms and guidelines for resale of the program.

We encourage you to contact us at our toll free phone number 1-888-658-6641 regarding any questions or concerns you may have regarding this agreement.

Once we have received your signed the agreement, we can proceed to the Phases of Program Development.

Content Development Phases

Learning Objectives:

The criteria for nursing continuing education for credit requires program writers to identify objectives for the learner who will be completing the program. The usual "rule of thumb" as to how many objectives should be identified for any given program varies according to the time the writer feels it will take the learner to complete the program. It is generally acceptable to identify 2-3 learner objectives for every hour the writer estimates it will take the learner to complete the program. Therefore, if it takes a learner 3 hours to complete a program, the writer may have identified 6-9 learner objectives.

You will find additional details regarding Learner Objectives in that section.

To assist authors in choosing appropriate action verbs to use while developing learner objectives, Corexcel has provided an extensive list of action verbs categorized according to the level of learning you would like the learner to achieve. You can access this list of action verbs on our Action Verb Page.

Content Outline:

Authors are required to develop a written content outline from the identified learner objectives. Suggestions for content outline development can be accessed under our Content Outline section.

Course Content:

Course content should logically evolve from the identified content outline. Suggestions for course content development can be accessed under Program Content section.


References should be current and reflect a variety of sources. Suggestions for a comprehensive program bibliography can be accessed under the Bibliography section.

Post Testing:

In order to determine if learning has occurred in a cognitive program such as those appearing on Corexcel's web site, pre and post testing is strongly advised. Both tests may be the same items, just sequenced differently. Suggestions regarding pre and post test construction can be accessed under our Post Test Development section.

Program Format Example:

Corexcel has the ability to allow you to review one of our current web programs to see how a final program appears once it has been placed on our web site. You can access these programs in our Nursing CEU Course Catalog.

Learner Objectives

Learner objectives are statements that specify what learners will know or be able to do as a result of a learning experience or activity. Learner objectives are usually expressed as either knowledge, skills or attitudes. Learner objectives usually are listed at the beginning of a program. In general, a web program will have 2-3 learner objectives for every hour it takes the web learner to complete the program.

The terms learning outcome or objective mean the same thing; however, objectives are called by different names such as: behavioral objectives, instructional objectives and course objectives. Corexcel has chosen to use the term learner objectives to represent the outcomes of instruction, that is, what the learners will accomplish by completing the program. Example: After completing the program on Learner Objectives, the learner will be able to correctly name all three (3) types of objectives.

Knowledge objectives are also called cognitive objectives or outcomes. Cognitive means to know. These objectives deal with knowing, using and applying information in a problem solving situation.

Skills objectives are also known as psychomotor objectives. These objectives involve learning experiences that require some physical ("hands on )coordination such as in role playing, putting on a dressing, using a keyboard, performing a venipuncture, etc.

Attitude objectives are also known as affective objectives and include values, attitudes, feelings and interests. These objectives are not always observable; hence, they are difficult to measure. However, these objectives should not be ignored as attitudes, feelings, etc. impact the learning environment as well as the culture in which new learning will be eventually applied.

Note: Corexcel activities only have knowledge (also called cognitive) objectives because our programs are informative in nature. Our programs are not designed to teach "hands on" skills nor or they designed to instruct the learner in desirable attitudes, values and behaviors. If desirable attitudes, etc. result as a consequence of our programs it is an added benefit, not the purpose of the web program itself. Our programs are developed to provide information to the learner about a particular subject. The information may be new, updated or a review for the learner.

Learner objectives should result from a needs assessment. The needs assessment should determine the gap between an existing condition and a desired condition. Learner objectives are statements which describe the desired condition…that is, the knowledge, skills or attitudes needed to fulfill the need. They represent the solution to the identified need or issue.

Learner objectives have three (3) distinguishing characteristics:

  • The specific action of the learner must be observable (in knowledge objectives, we must be able to see the learner list, write, identify, recall, select, differentiate, point out, etc. via pen and pencil testing.
  • The specific action of the learner must be measurable (test results).
  • The specific action must be done by the learner.

If the action taken by the learner as stated in the learner objective cannot be assessed or evaluated, it most likely does not meet all three of the above characteristics.

A learning experience or activity must focus on the learner. What the learner does is more important than what the presenter or instructor does. It is the learner's behavior that is to be changed, and the learner who is to demonstrate the attainment of the learner objectives.

Therefore, every learner objective must contain an action verb which will describe the kind of behavior the learner is expected to demonstrate as a result of the learning experience. In the objective stated: the learner will be able to list the three (3) types of learner objectives, list is the action verb. The action verb chosen must be observable and measurable in some way for the instructor to verify that each learner has achieved the learner objective. Some types of measurement are post testing, skill checklists, and direct observations of behaviors. Corexcel web programs use post testing to determine if the learner has met the knowledge objectives of the program.

Action verbs designate a behavior on the part of the learner such as write, list, describe, analyze or discuss, etc. The instructor's choice of the action verbs that are used in the learner objectives determines the degree of thinking required of the learner. Benjamin Bloom (1956) established a hierarchy of thinking skills known as Bloom's Taxonomy. He identified six (6) levels of thinking skills, which were revised in the 1990s. Each level requires a higher level of thinking than the preceding level. The higher the level an instructor moves up the taxonomy with learners, the higher the level of thinking required of the learners.

Bloom's Taxonomy
Progressing from lower order to higher order thinking skills:

Below is an explanation of each revised level:

Remember: The lowest level, the possession of information. Basically something remembered, recognized, or recalled almost exactly as it was originally presented.

Understand: A level of understanding beyond mere memorization. It requires learners to translate…to say in their own words, perhaps even give an example. In these activities, the individual interprets information.

Apply: This category gives an individual practice in the transfer of education or training. It is a higher level of learning where the learner takes knowledge and understanding and applies it in a new situation.

Analyze: This is the ability to take something apart and look at it. It involves seeing relationships and making inferences. An important part of analysis is the ability to categorize information.

Evaluate: This level involves bringing together knowledge to be able to present and defend opinions, judging information or measuring quality based on learned criteria.

Create: This is the highest level of thinking. The learner compiles information into new patterns or proposes new solutions or methods.

Click Here for suggested verbs for use in each level of thinking. We hope it is helpful.

Content Outline

Once you have written your program learner objectives using Corexcel's recommendations, you are ready to develop your program content outline. Program content outlines need to be based upon the program learner objectives. Please do not include information in the content outline that does not directly relate to program learner objectives. Doing so would be confusing to the learner.

Corexcel program evaluations have indicated that our learners prefer program content outlines with numbers. Please follow the traditional format (I, A, 1, a) when developing your outlines. Optimally, your program content outline should be developed before you write actual program content. Program content should logically evolve from the content outline. Corexcel suggests that you add enough detail to the content outline so that the reader can readily determine what the program will be about.

Program Content

Now that you have written your program content outline, you are ready to develop the program's actual content. Corexcel recommends using either the American Psychological Association (APA) or the Modern Language Association (MLA) format.

Title your program so that it will attract the eye of the nurse who is browsing through Corexcel's menu of program titles. This means that your title may need to be "trendy", "quirky" or a bit "outlandish" but it is just that kind of title that will motivate a customer to choose your program more often than not! Examples of such titles are: "OBTLC: Obstetrics With Tender Loving Care","Bugs of the New Millennium: Are You Ready for 'Em?" and "Service Through the Customer's Eyes?"

To motivate learner interest, Corexcel recommends the use of an introductory paragraph in which you briefly tell the learner what will be included in your program. You may want to select a unique way of presenting your introduction with an example, newspaper article reference, etc.

It is our belief that our readers like to be kept interested while learning. We suggest that you write as you would speak to your reader. To do so, you may have to spice up your content meaning that we would like you to be creative in how you write your content. If you would use overheads in a presentation on your topic, then include those same overheads in this program's content. Jokes, cartoons, quotes, quips, one liners, etc. are welcome as long as credit is given when required. Case studies, real-life events, etc. have instant appeal.

Our Webmaster will work with you to create a format that will showcase your creativity. Remember, our customers will recommend your program to others if they are pleased. We have found that our customers want to enjoy their on-line learning experience just as much as they want to gain something that they can use immediately in their nursing practice.

Finally, Corexcel recommends including a conclusion paragraph at the end of your program in which you can review with the reader what you have taught him. Referring to the program objectives and asking the reader to recall how they have been met through your program's content is one way you can conclude. Again you may want to conclude in a unique manner. Perhaps you have introduced your program with a case study and now you can add the final outcome in the conclusion of your program. Use your imagination to create a suitable ending for your program.

Post Test Development

In order to determine if learning from a program has occurred post testing is included in programs on the Corexcel web site. Corexcel requires a seventy percent (70%) on a post test in order for contact hours to be granted. An individual may take a post test three (3) times to successfully pass it.

Corexcel accepts only multiple choice test questions. The nursing licensure exam and ANA certification exams are written in that format so most nurses are very familiar with this type of testing approach.

Wording of a test question requires attention to detail and an understanding of the fact, concept or principle being tested. Before you begin writing your post test questions, become familiar with some of the terms used in test question writing:

  • Stem: the part of the test question that asks a question or makes a statement before asking a question
  • Alternatives: Possible answers to a test question that are usually lettered as A, B, C, D
  • Distractors: Incorrect alternatives

There are seven (7) suggested steps in writing a test question:

  1. Select test question topics from program learner objectives.
  2. Determine the exact knowledge or ability to be tested.
  3. Collect and use supporting information.
  4. Determine what you want the examinee to do.
  5. Write the test question stem.
  6. Write the correct answer.
  7. Write the distractors.

Although it looks like the process is complicated and intricate, it really isn't. To assist you in your test question writing, Corexcel has included the following information on each step in the process:

Select a Test Question Topic:

The primary source for test item topic ideas are in the program learner objectives. They identify the key outcomes or results you would like program reviewers to gain from completing your Corexcel web site program. You should be able to construct 1-2 questions from each learner objective. Do not develop test items from anything other than program objectives. Doing so would mean that the learner objectives were not important enough to be tested upon. How confusing for the learner!

Determine the Exact Knowledge or Ability to be Tested:

Now that you are focused on your program's learner objectives, you need to select an important fact, concept, principle, or skill within the program content related to that objective. Write down in sentence form the knowledge or ability you wish to test.

Collect and Use Supporting Information:

Support information can help you clarify information about the knowledge to be tested. It can help you decide what needs to be included in the test question stem. Moreover, it may suggest other correct answers to the same question; thus giving you information that you could use to develop a second test question about the same knowledge.

Also, support information may prevent you from developing a test question without a single best answer.

And lastly, it can be very useful in formulating distractors (incorrect alternatives).

Determine What You Want the Examinee's to Do:

Now that you have gathered all of the necessary support information, you need to determine just how you can test the examinee's ability to apply program knowledge just as he or she would do in actual nursing practice. The best way to do this is to look at how you worded the particular learner objective you intend to test. Most program objectives test a learner's memory (past experience) or reasoning (logical thinking) abilities.

Knowledge of facts is usually tested by questions requiring the learner to define, identify, recognize or recall(action verbs) particular facts about the knowledge you are testing. Concepts are usually tested by requiring the learner to classify, illustrate, give examples, or differentiate (action verbs) information about the knowledge being tested. Principles can be tested by having the learner predict, generalize or conclude (action verbs) from a given principle.

Write the Stem:

To write a test question that measures a learner's memory for facts, concepts or principles, the stem should consist of just the fact that you want examinee to recall. To do that you can use either a question or a statement such as:

  • What are the three symptoms of Diabetes that begin with a P?
  • The three symptoms of Diabetes that begin with a P are:

To write a test question that measures a learner's ability to reason, add a second component to the stem that provides the examinee with additional information that can be used to choose the correct answer. This additional information is usually comes before the actual test question or statement. It may be a diagnosis, reactions to prior treatment, compliance to prescribed medications, etc.

If you want the examinee to evaluate information, make a nursing diagnosis, determine a drug calculation or differentiate essential from non essential data, than you could add irrelevant information into the stem to make the question more challenging to answer.

Note: Post tests should test how experienced RNs can apply the information your program will provide them rather than simply how much they can remember. This will require you to write test questions that involve a considerable amount of reasoning which includes analysis, evaluation, and problem solving.

Testing for recall facts is acceptable at the beginning of a test as a motivator but remember these types of questions do not test higher level thinking or reasoning ability which requires the examinee to translate facts into a real life situation and then problem solve to make a decision.

The following questions show the difference between recall of facts and the ability to reason:

Recall question:

Control of diabetes can be negatively affected by:

  1. Emotional stress
  2. Exercise
  3. Excess weight
  4. The patient's sex

Reasoning question:

Why can emotional stress negatively affect control of Diabetes?

  1. Stress inhibits pituitary function which decreases bioavailability of insulin.
  2. Stress stimulates epinephrine production which stimulates glucogenesis.
  3. Stress stimulates thyroid activity.
  4. Stress increases production of ADH.

Write the Correct Answer:

This is the easiest part of test question writing! Write a correct answer that is as brief as possible. There is a tendency to write a correct answer that is longer than the other answers. Examinees will quickly pick up on this tendency and could correctly answer an item based on its length alone.

Write the Other Distractors:

This is the most challenging part of test question writing! Distractors should look like they are possible correct answers. Some suggestions for incorrect distractor writing are:

  • Omit an important fact.
  • Include an irrelevant fact.
  • Include a distractor for each type of error you think the examinee might make.
  • Use incorrect answers from pilot testing questions to students (if that is possible).

Listed below are some testing topics and types of questions with suggested phrasing that could be used to test your program learner objectives.

Nursing Actions or Interventions:

Wording of test items can be done using the following phrases to determine if the examinee can correctly choose the first, next, best or most appropriate action or intervention.

  • The nurse should:
  • The nurse should first:
  • The nurse's first action should be to:
  • The initial nursing action would be to:
  • The most appropriate initial action is:
  • The next action should be to:
  • The most appropriate nursing intervention wold be to:
  • It would be most appropriate for the nurse to:
  • The best course of action would be to:
  • The correct action would be to:

Signs and Symptoms:

If the examinee needs to identify the signs and symptoms associated with a condition or diagnose a condition based on the signs and symptoms given in the test question stem, the following respective phrases could be used:

  • The signs and symptoms associated with this condition would most likely be:
  • The diagnosis would most likely be:

If the examinee needs to make an assessment, further assessment or judge a severity level based on signs and symptoms given in the test question stem, the following phrases could be used:

  • The nurse should assess for:
  • The nurse should further assess for:
  • The nurse determines that the level of severity is:

Underlying Considerations:

If the examinee needs to relate a specific example to an underlying principle, the following phrases could be used:

  • When...the nurse should consider that:
  • When...the most important consideration is:


If the examinee needs to prioritize nursing actions or assessments, the following phrases could be used:

  • The most important assessment would be:
  • The nurse's first priority would be to:

Nurse Questions:

If the examinee needs to determine the question that best elicits information needed for an assessment or evaluation or which question will best fulfill a nursing role, the following phrases could be used:

  • Which of the following questions would best elicit information about...?
  • The nurse could best elicit information about...by asking:
  • The nurse's first question should be:

Nurse Responses:

If the examinee needs to determine the best or most appropriate response to a client/patient/customer question, complaint, request, etc., the following phrases could be used:

  • The nurse's best response would be to:
  • The nurse should respond by:

Client / Patient / Customer Knowledge:

If the examinee needs to evaluate client/patient/customer knowledge by choosing an option that best demonstrates that a client/patient/customer meets a knowledge requirement specified in the test question stem, the following phrases could be used:

  • Which of the following statements or behavior by a client/patient/customer would best indicate that the client/patient/customer needs...?
  • A client/patient/customer would best indicate an understanding of...by:

Client / Patient / Customer Teaching:

If the examinee needs to indicate correct content of client/patient/customer teaching related to client/patient/customer teaching related to client/patient/customer conditions, care, etc., the following phrases could be used:

  • Clients/patients/customers who...should be taught to:
  • The nurse should advise the client/patient/customer to:
  • The nurse should recommend that the client/patient/customer:
  • Client/patient/customer teaching about...should include the information that:

Client / Patient / Customer Identification:

If the examinee needs to determine or identify the client or patient who is at the greatest risk or has the greatest need, based on characteristics given in the options, the following phrase could be used:

  • Which of the following clients/patients/customers would be in need (or at risk) of...?

Primary Reasons or Purposes:

If the examinee needs to identify the primary reason for or purpose of a particular course of action, the following phrases could be used:

  • The primary reason for a nurse to...is to:
  • The usual reason for...is to:
  • The main purpose of...is to:

Means to an End:

If the examinee needs to identify or determine the best means to accomplish a goal, the following phrases could be used:

  • In order to...the nurse should (or must):
  • The best approach (or way) to...is to (or can best be accomplished by):

The following are other types of test items you may want to consider writing. Now that you have seen examples of phrases, Corexcel challenges you to practice writing some for each of these testing types.

Prerequisite Actions:

If the examinee needs to determine what action is required before an action stated in the test question stem can be accomplished or explain why a prerequisite action is necessary.

How To:

If the examinee needs to specify the proper steps or methods of performing nursing procedures.


If the examinee needs to explain the physiological basis of client/patient/customer conditions, signs, or symptoms; predict physiological changes caused by conditions or actions required by physiological changes.


If the examinee needs to determine what client/patient/customer activities or nursing actions are appropriate to client/patient/ customer age or stage of development.

Once you have written your test items based on your program learner objectives, you may want to evaluate them against the following final criteria:

  • Include in the stem all information needed to answer the question correctly. The examinee should not have to review the answer alternatives to understand what the stem is testing.
  • Avoid putting information in the stem that is not necessary in answering a question except when you want to test an examinee's ability to differentiate important from unimportant information.
  • Use medical or nursing terms as appropriate.
  • Avoid uncommon words. Choose words that you would use when talking to the examinee; usually these are one and two syllable words only.
  • Do not use words like "adequate" or "acceptable" as they mean different things to different people.
  • Try to write brief stems. Use commas, semicolons to break up long, detailed stems so that the examinee can read them with ease.
  • Remember to end all stems appropriately with either a question mark or a colon depending on whether it is a question or a statement.
  • Be cautious in using the phrase "Which of the following….." The stem's wording must be compatible with that of the answer alternatives. For example: if you are testing for signs and symptoms, then you wouldn't want to write an alternative that is a nursing diagnosis or one about a medicine.
  • Avoid abbreviations unless you can be sure that they are standard and very well known.
  • When you are using numbers, make them simple; avoid the use of complicated fractions or decimals to test calculation skills or knowledge of related principles.
  • Underline key words such as not, least, except, opposite or any other word that would result in an incorrect answer (distractor) if it were ignored.
  • Avoid using absolute terms like "never" and "always." Very few things are absolutes and a good test taker will know this is a distractor.
  • Avoid using long alternatives.
  • Put alternatives in logical order. Go from the lowest to highest number or percents. In listing medicines, alphabetize them.
  • Vary the location of the correct answer in each test item. In one question, the correct answer might be A and in the next question it might be B, etc.
  • Alternatives should not overlap…each one should be distinctive in meaning so as not to be confusing to the examinee.
  • If more than one alternative is correct, use a combined response format such as:
    A, B, and C
    B and D only
    B, C and D
    A, C and D
  • Words or phrases that appear in all alternatives can be included in the question's stem as well. For example: If the first words in the alternatives are "The best initial action would be to", then the last phrase of the test question stem would be "The best initial action would be to".

Bibliography Development

Continuing education activities should have at least 8-10 references which would include but are not limited to textbooks, journal articles, the internet and well known speaker presentations on your topic.

References should be current and reflect the most up-to-date information on the program topic you have chosen to write about for inclusion on our web site. To that end, Corexcel has developed the following guidelines for you regarding your bibliographic choices:

  • Textbooks should be within 10 years of publication from the current calendar year.
  • Journal articles should be within 5 years of publication from the current calendar year.
  • Web sites should be referenced with attention to accuracy in site documentation.
  • Speakers should have presented within the last 2 calendar years. Include specific information regarding date, place of presentation, name of event and sponsoring organization.