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Diversity in nursing and challenges with the NCLEX-RN

      Highlights

      • Standardized tests have been shown to disadvantage under-represented minority groups.
      • Nursing continues to use high-stakes, standardized testing for licensure.
      • No agency is publishing sufficient demographic data surrounding the NCLEX-RN.
      • We must determine if nurses are experiencing testing outcomes disparities.
      • NCLEX-RN is one tool out of many to determine nursing competency.

      Abstract

      High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.

      Keywords

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      References

      1. American Association of Colleges of Nursing (AACN) (2021). The essentials: Core competencies for professional nursing education. Americannursing.org. https://bit.ly/3GxY4rf

      2. AACN (2020). Promising practices in holistic admissions review: Implementation in academic nursing. Americannursing.org. https://bit.ly/2WLgyD2

      3. Altman, S.H., Butler, A.S., & Shern, L. (2016). Assessing progress on the Institute of Medicine report, the future of nursing. National Academies of Science, Engineering, and Medicine. https://www.ncbi.nlm.nih.gov/books/NBK350166/

      4. American Nurses Association (1991). Retired position statement: Cultural diversity in nursing practice. ANA Nursing World. https://bit.ly/3rYTy0P

      5. Au, W. (2010). The idiocy of policy: The anti-democratic curriculum of high-stakes testing. Critical Education, 1 (1),1–16. doi: https://doi.org/10.14288/ce.v1i1.182239

        • Au W.
        Hiding behind high-stakes testing: Meritocracy, objectivity and inequality in U.S. education.
        The International Education Journal: Comparative Perspectives. 2013; 12: 7-19
        • Banks J.
        • McCullough E.
        • Ketner D.
        • Darby R.
        Tailoring NCLEX-RN indicator assessments for historically Black colleges and universities: Literature review.
        Journal of Professional Nursing. 2018; 34: 331-345
        • Belasco A.S.
        • Rosinger K.O.
        • Hearn J.C.
        The test-optional movement at America's selective liberal arts colleges: A boon for equity or something else?.
        Educational Evaluation and Policy Analysis. 2015; 37: 206-223https://doi.org/10.3102/0162373714537350
        • Bell D.A.
        Brown V. Board of Education and the Interest Convergence Dilemma.
        in: Crenshaw K. Gotanda N. Peller G. Thomas K. Critical Race Theory: The Key Writings That Formed the Movement. The New Press, New York, NY1995: 518-533
      6. Bergey, R., Movit, M., Baird, A.S., & Faria, A.M. (2018). Serving English language learners in higher education: Unlocking the potential. American Institutes for Research. https://bit.ly/3xl2kW1

        • Berliner D.C.
        Effects of inequality and poverty vs. teachers and schooling on America’s youth.
        Teachers College Record. 2012; 116: 1-26
      7. Budiman, A. (2020). Key findings about U.S. immigrants. Pew research center. https://pewrsr.ch/3oJqsRb

        • Casad B.J.
        • Bryant W.J.
        Addressing stereotype threat is critical to diversity and inclusion in organizational psychology.
        Front Psychol. 2016; 7https://doi.org/10.3389/fpsyg.2016.00008
        • Chisholm-Burns M.A.
        • Spivey C.A.
        • Byrd D.C.
        • McDonough S.L.K.
        • Phelps S.J.
        Examining the association between the NAPLEX, Pre-NAPLEX, and Pre- and Post-admission factors.
        American Journal of Pharmaceutical Education. 2017; 81: 86
        • Croft S.J.
        • Roberts M.A.
        • Stenhouse V.L.
        The perfect storm of education reform: High-stakes testing and teacher evaluation.
        Social Justice. 2015; 42: 70-92
        • Crow C.
        • Handley M.
        • Morrison R.S.
        • Shelton M.
        Requirements and interventions used by BSN programs to promote and predict NCLEX-RN Success: A national study.
        Journal of Professional Nursing. 2004; 20: 174-186
      8. Cunningham, J. (2018)., Missing the mark: Standardized testing as epistemological erasure in U.S. schooling. Power and Education. Power and Education. 11(1),111-120. doi: https://doi.org/10.1177/1757743818812093

      9. Dewsbury, B., & Brame, C.J. (2019). Evidence-based teaching guide: Inclusive teaching. Life Science Education. https://bit.ly/31NeFZl

        • Dreher H.M.
        • Smith Glasgow M.E.
        • Schreiber J.
        The use of “high-stakes testing” in nursing education: Rhetoric or rigor?.
        Nursing Forum. 2019; 54: 477-482https://doi.org/10.1111/nuf.12363
        • Eich M.
        • O’Neill T.
        NCLEX delay pass rate study.
        National Council of State Boards of Nursing, Inc. (NCSBN), 2007 (4: 1-5)
      10. FairTest (2011). Racial justice and standardized educational testing. National Center for Fair and Equitable Testing. https://bit.ly/3ENdAPo

      11. FairTest (2021). More than 1830+ schools do not require ACT/SAT scores from current high school seniors applying for fall 2022. FairTest: The National Center for Fair and Open Testing. https://bit.ly/398Jew8

      12. FairTest (2022). Test optional growth chronology: 2005-2022. FairTest: The National Center for Fair and Open Testing. https://bit.ly/3xwJZZD

      13. Gates, M. (2019). A civil rights challenge to standardized testing in college admissions. Harvard Civil Liberties Law Review. https://bit.ly/3ynVjFe

      14. Georgia Board of Nursing (2022). Georgia Board of Nursing. Ga.gov. https://sos.ga.gov/georgia-board-nursing

      15. Hakkinen, M. (2015). Assistive technologies for computer-based assessments. ETS R&D Connections. https://bit.ly/3xwslW1

        • Hope D.
        • Adamson K.
        • McManus I.C.
        • et al.
        Using differential item functioning to evaluate potential bias in a high stakes postgraduate knowledge based assessment.
        BMC Med Educ. 2018; 18https://doi.org/10.1186/s12909-018-1143-0
        • Huguet P.
        • Regner I.
        Stereotype threat among schoolgirls in quasi-ordinary classroom circumstances.
        Journal of educational psychology. 2007; 99: 545-560https://doi.org/10.1037/0022-0663.99.3.545
        • Hunsicker J.
        • Chitwood T.
        High-stakes testing in nursing education: A review of the literature.
        Nurse Education. 2018; 43: 183-186https://doi.org/10.1097/NNE.0000000000000475
      16. Idaho Board of Nursing, (2022). Idaho Board of Nursing. Idaho.gov. https://ibn.idaho.gov/

      17. Institute of Medicine (IOM) (2011). The future of nursing: Leading change, advancing health. doi: https://doi.org/10.17226/12956

        • Jeffreys M.R.
        Nursing student retention: Understanding the process and making a difference.
        Springer, New York, NY2012 (2nd ed.)
        • Jung D.
        • Latham C.
        • Fortes K.
        • Schwartz M.
        Using holistic admissions in pre-licensure programs to diversify the nursing workforce.
        Journal of Professional Nursing. 2021; 37: 359-365https://doi.org/10.1016/j.profnurs.2020.04.006
        • Kaddoura M.A.
        • Flint E.P.
        • Van Dyke O.
        • Yang Q.
        • Chiang L.C.
        Academic and demographic predictors of NCLEX-RN pass rates in first- and second-degree accelerated BSN programs.
        Journal of Professional Nursing. 2016; 33: 229-240https://doi.org/10.1016/j.profnurs.2016.09.005
      18. Kendi, I. X. (2016). Why standardized tests have standardized postracial ideology. AAUP. https://bit.ly/3aw9em9.

        • Kendi I.X.
        There’s something wrong with the exam school tests-Not with Black and Latinx children. The Boston Globe, 2020
        • Kentucky Board of Nursing
        Welcome.
        Nursing. 2021;
        • Knoester M.
        • Au W.
        Standardized testing and school segregation: Like tinder for fire?.
        Race Ethnicity and Education. 2017; 20: 1-14https://doi.org/10.1080/13613324.2015.1121474
        • Ladson-Billings G.
        • Tate IV W.F.
        Towards a critical race theory of education.
        Teachers College Record. 1995; 97: 47-68
        • Lai S.A.
        • Berkeley S.
        High-stakes accommodations: Research and practice.
        Learning Disabilities Quarterly. 2012; 35: 158-169
      19. Learning Disabilities Association of America (n.d.). Adult learning disability assessment process, (2020). https://ldaamerica.org/info/adult-learning-disability-assessment-process/

        • Li C.
        • Kruger L.J.
        • Beneville M.
        • Kimble E.
        • Krishnan K.
        The unintended consequences of high-stakes testing on English-language learners: Implications for the practice of school psychology.
        School Psychology Forum. 2018; 12: 79-90
        • Lucey C.R.
        • Saguil A.
        The consequences of structural racism on MCAT scores and medical school admissions: The past is prologue.
        Academic Medicine. 2020; 95: 351-356https://doi.org/10.1097/ACM.0000000000002939
        • Luckowski A.
        The lived experience in the clinical setting of nursing students with disabilities.
        Nurs Educ Perspect. 2016; 37: 256-261https://doi.org/10.1097/01.NEP.0000000000000063. PMID: 27740556
        • Manchanda E.C.
        • Vogel L.D.
        • Kass D.
        • Rouhani S.A.
        Best practices for lactation support at conferences and standardized testing centers.
        Obstetrics & Gynecology. 2020; 135: 475-478https://doi.org/10.1097/AOG.0000000000003661
      20. Maury, L. (2021). Disability isn't taken seriously at Hopkins. The Johns Hopkins News-Letter. https://bit.ly/3dMS1m5

        • McNally K.
        • Metcalfe S.E.
        • Whichello R.
        Interventions to support diversity in nursing education.
        J Nurs Educ. 2019; 58: 641-646https://doi.org/10.3928/01484834-20191021-05
        • Moore L.C.
        • Goldsberry J.
        • Fowler C.
        • Handwerker S.
        Academic and non-academic predictors of BSN student success on the HESI exit exam.
        Comput Inform Nurs. 2021; 39: 570-577https://doi.org/10.1097/CIN.0000000000000741
      21. National Academies of Sciences, Engineering, and Medicine (NASEM) (2021). The Future of Nursing 2020-2030: Charting a path to achieve health equity. https://doi.org/10.17226/25982

      22. NCSBN (2020). NCLEX Conference: NCLEX testing security and accommodations. NCLEX 2020 Conference.https://bit.ly/3qh829L [Presentation], https://www.ncsbn.org/15831.htm [Conference]

      23. NCSBN (2021a). 2021 NCLEX pass rate. Exam Statistics and Publications. https://www.ncsbn.org/14664.htm

      24. NCSBN. (2021b). Quarterly examination statistics: Volume, pass rates & first-time internationally educated candidates’ countries. NCLEX Examinations. https://www.ncsbn.org/Table_of_Pass_Rates_2021_Q4.pdf

      25. New York Office of the Professions. (2022). Welcome. Ny.gov. http://www.op.nysed.gov/prof/nurse/

      26. NLN (2010). Reflection & dialogue #7: High-staked testing, December 2010. https://bit.ly/3KQWKlJ

      27. National Forum of State Nursing Workforce Centers. (2012), 2021. Nursing minimum dataset surveys available for download. https://nursingworkforcecenters.org/dataset/

      28. North Carolina Board of Nursing (2021). Request testing accommodations. North Carolina licensure by examination. https://bit.ly/3uPoHFc

      29. National League for Nursing [NLN] (2021) The fair testing imperative in nursing education: A living document from the National League for Nursing. https://bit.ly/3zWbSII

      30. Oregon State Board of Nursing (2020). Request for testing accommodations. Oregon.gov. https://bit.ly/3uPhsNv

        • Pace A.
        • Luo R.
        • Hirsh-Pasek K.
        • Golinkoff R.M.
        Identifying pathways between socioeconomic status and language development.
        Annual Review of Linguistics. 2017; 3: 285-308https://doi.org/10.1146/annurev-linguistics-011516-034226
        • Phillips J.M.
        • Malone B.
        Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity.
        Public Health Reports. 2014; 129 (Suppl 2): 45-50
      31. Pennsylvania State Board of Nursing (2017). Request form for testing accommodations. Pa.gov. https://bit.ly/3jLxLnX

      32. Reeves, R., & Halikias, D. (2017). Race gaps in SAT scores highlight inequality and hinder upward mobility. Brookings. https://brook.gs/3jgev1p

      33. Rosenberg, G. (2020). The racist and classist roots of standardized testing found a home at Stanford—And they still endure today. The Stanford Daily. https://bit.ly/3rUHPOY

      34. Rowlands, S. (2019). I've been made homeless twice: How universities let disabled people down. Vice. https://bit.ly/3hLCNk1

      35. Rosales, J., & Walker, T. (2021) The racist beginnings of standardized testing. NEA. https://bit.ly/3bZnJir

        • Rubright J.D.
        • Jodoin M.
        • Barone M.A.
        Examining demographics, prior academic performance, and United States medical licensing examination scores.
        Academic Medicine. 2019; 94: 364-370https://doi.org/10.1097/acm.0000000000002366
        • Sitzman K.L.
        Diversity and the NCLEX-RN: A double-loop approach.
        J Transcult Nurs. 2007; 18: 271-276https://doi.org/10.1177/1043659607301302
        • Smiley R.A.
        • Lauer P.
        • Bienemy C.
        • Berg J.G.
        • Shireman E.
        • Alexander M.
        The 2017 National Nursing Workforce Survey.
        Journal of Nursing Regulation. 2018; 9: S1-S88https://doi.org/10.1016/S2155-8256(18)30131-5
        • Spencer S.J.
        • Logel C.
        • Davies P.G.
        Stereotype threat.
        Annual Review of Psychology. 2016; 67: 415-437https://doi.org/10.1146/annurev-psych-073115-103235
        • Spurlock D.R.
        • Hunt L.A.
        A study of the utility of the HESI Exit Exam in predicting NCLEX-RN outcomes.
        Journal of Nursing Education. 2008; 47: 157-166
        • Steele C.M.
        • Aronson J.
        Stereotype threat and the intellectual test performance of African Americans.
        Journal of personality and social psychology. 1995; 69: 797-811https://doi.org/10.1037//0022-3514.69.5.797
      36. Sullivan, L.W. (2004). Missing persons: Minorities in the health professions, a report of the Sullivan Commission on diversity in the healthcare workforce. The Sullivan Commission. https://bit.ly/3ycYZdA

        • US Department of Justice
        Justice Department reaches settlement with Old Dominion University to resolve disability discrimination complaint.
        Justice News, 2021
        • Utzman R.R.
        • Riddle D.L.
        • Jewell D.V.
        Use of demographic and quantitative admissions data to predict performance on the National Physical Therapy Examination.
        Physical Therapy,. 2007; 87: 1181-1193https://doi.org/10.2522/ptj.20060222
        • Wightman L.F.
        LSAC National Longitudinal Bar Passage Study.
        LSAC Research Report Series. Law School Admission Council. 1999;
      37. Winston, A. (2021). Scientific racism and North American psychology. Oxford Research Encyclopedia of Psychology. https://bit.ly/3jdveCw

        • Woo A.
        • Wendt A.
        • Weiwei L.
        NCLEX pass rates: An investigation into the effect of lag time and retake attempts. JONA's Healthcare Law.
        Ethics, and Regulation. 2009; 11: 23-26
      38. Wozolek, B., & Shafer, A. (2021) Time to shift away from standardized testing? Association for Supervision and Curriculum Development. ASCD. https://bit.ly/3O9alWq

        • Yeo H.L.
        • Dolan P.T.
        • Mao J.
        • Sosa J.A.
        Association of demographic and program factors with American Board of Surgery Qualifying and Certifying Examinations Pass rates.
        JAMA Surgery. 2019; 155: 22-30https://doi.org/10.1001/jamasurg.2019.4081