Many nursing faculty lack formal training in item writing and test construction. This integrative review synthesizes the evidence to gain a comprehensive understanding of the developmental needs and interventions employed to help nursing faculty gain skills to develop course examinations. Original research and non-research reports published since 2012 were included. Independent quality appraisals were completed based on the Johns Hopkins Nursing Evidence-based Practice Model. Data were analyzed using the constant comparison method. Nineteen reports met inclusion criteria. Themes related to test development skills were standards support practice, educational preparation, evolving technologies, and writing for clarity. Themes related to faculty development were continuous improvement, professional development plans, peer and expert collaboration, and up-to-date resources. Nursing programs need to establish methods to ensure faculty use best practices and are competent in test development. Nursing needs future research to understand optimal faculty development approaches.