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Letter to the Editor

Published:January 11, 2023DOI:https://doi.org/10.1016/j.outlook.2022.101915
      We are writing this letter in reference to the recent article by Dr. Muirhead and colleagues (
      • Muirhead L.
      • Cimiotti J.P.
      • Hayes R.
      • Haynes-Ferere A.
      • Martyn K.
      • Owen M.
      • McCauley L.
      Diversity in nursing and challenges with the NCLEX-RN.
      ) in the September/October issue entitled “Diversity in nursing and challenges with the NCLEX-RN.”We applaud the authors for the many important issues they raised that need to be addressed in order to advance diversity, equity, and inclusion within the nursing profession in relationship to standardized testing. What we see as missing from this important discussion is a lack of challenge to the paradigm that delineates first time NCLEX pass rates as the metric of a quality academic program. First-time pass rates were developed as a metric of quality nursing education programming when paper and pencil licensure testing were performed twice a year. It has been acknowledged by the National Council of State Boards of Nursing (NCSBN) that this metric has limited evidence as a quality measure and is one “only supported by opinion and not by high-level evidence” (
      • Spector N.
      • Hooper J.L.
      • Silvestre J.
      • Qian H.
      Board of nursing approval of registered nurse education programs.
      , p.28). Yet, schools of nursing (and faculty leaders) continue to make program admission and progression decisions related to the data derived from first time pass rates and are held accountable to this metric by state boards of nursing, many times implementing stricter admission and progression policies if pass rates drop below the state standard (
      • Loftin C.
      • Reyes H.
      • Hartin V.
      • Rice L.
      A closer look at first-time pass rates as the primary measure of program quality.
      ). In a study of Oregon first-time pass rate data over a 3 year period, Dr. Noone and colleagues identified that 95.3% of first-time testers passed within 6 months and 96.1% passed by the second attempt (
      • Noone J.
      • Ingwerson J.
      • Kunz A.
      An analysis of licensure testing patterns of Oregon registered nursing graduates.
      ). We recommend that such data be reported nationally and that metrics and NCLEX results be reported similarly to

      Canadian Council of Registered Nurse Regulators (2019). NCLEX-RN 2019: Canadian and international results. Retrieved from http://www.ccrnr.ca/assets/ccrnr-nclex-rn-report-2019-en.pdf. (Accessed 9 January 2023).

      , which reports pass rates by cohorts in the initial year they tested. Their data overwhelmingly demonstrates that candidates pass within the first year of eligibility to test. What is also unknown is how students of color fare compared to White students on first-time pass rates since the NCSBN does not disaggregate NCLEX-RN pass rates by race and ethnicity for public viewing. While we also applaud NCSBN for implementing efforts to reduce linguistic bias in test items, we support public disaggregation of pass rates by race and ethnicity, as recommended by Muirhead and colleagues, as such information can help nurse educators and regulators better understand what cultural biases may be associated with this standardized, high-stakes test.
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      References

      1. Canadian Council of Registered Nurse Regulators (2019). NCLEX-RN 2019: Canadian and international results. Retrieved from http://www.ccrnr.ca/assets/ccrnr-nclex-rn-report-2019-en.pdf. (Accessed 9 January 2023).

        • Loftin C.
        • Reyes H.
        • Hartin V.
        • Rice L.
        A closer look at first-time pass rates as the primary measure of program quality.
        Journal of Professional Nursing. 2020; 36: 707-711https://doi.org/10.1016/j.profnurs.2020.09.011
        • Muirhead L.
        • Cimiotti J.P.
        • Hayes R.
        • Haynes-Ferere A.
        • Martyn K.
        • Owen M.
        • McCauley L.
        Diversity in nursing and challenges with the NCLEX-RN.
        Nursing outlook. 2022; 70: 762-771https://doi.org/10.1016/j.outlook.2022.06.003
        • Murray T.
        • Noone J.
        Advancing diversity in nursing education: A groundwater approach.
        Journal of Professional Nursing. 2022; 41https://doi.org/10.1016/j.profnurs.2022.05.002
        • Noone J.
        • Ingwerson J.
        • Kunz A.
        An analysis of licensure testing patterns of Oregon registered nursing graduates.
        Journal of Nursing Education. 2018; 57: 655-661https://doi.org/10.3928/01484834-20181022-05
        • Nye C.M.
        • Tengelin E.
        • Somayaji D.
        Developing a theory of norm-criticism in nursing education.
        ANS. Advances in nursing science. Advance Online Publication, 2022https://doi.org/10.1097/ANS.0000000000000440
        • Spector N.
        • Hooper J.L.
        • Silvestre J.
        • Qian H.
        Board of nursing approval of registered nurse education programs.
        Journal of Nursing Regulation. 2018; 8: 22-29