Best Practices Issue - May 2023

The mission of ACEN is to recognize nursing education programs that have been found to meet or exceed nursing education quality standards, and the goals of ACEN include strengthening that quality and fostering equity and access. The purpose of this article is to communicate the ACEN’s position regarding the use of high-stakes testing in nursing education programs.

The ACEN definition of high-stakes testing is, “The use of a single test or examination (written, electronic, or demonstration) used to determine an important outcome such as a student passing a course or graduating” (2023 ACEN Glossary). Program-reported data in the 2022 Annual Report, which will be available this summer in the 2022 Report to Constituents, reflect that 83% of all ACEN accredited programs use some form of standardized testing, including over 90% of associate, diploma, and practical programs. Further, 54% of ACEN-accredited programs use standardized testing for the evaluation of student learning, and 14–25% of these pre-licensure programs indicated that they use standardized testing as a progression or graduation requirement. The data revealed that 861 students were delayed or prevented from graduating because the standardized examination was high stakes. As noted in the 2021 Report to Constituents, the ACEN does not endorse or oppose the use of standardized testing. However, if used, standardized testing should only be used for the purpose for which it was developed. The use of high-stakes testing for students’ progression or completion of a nursing program is not a best educational practice. Therefore, nursing faculty must consider whether, or the extent to which, the use of standardized examinations as high-stakes testing negatively impacts the progression and graduation of students.

The National League for Nursing (NLN) Presidential Task Force on High-Stakes Testing developed the Fair Testing Guidelines for Nursing Education (2012, 2020), which provides several recommendations for a fair testing environment. The ACEN supports the NLN’s Fair Testing Guidelines, including the recommendations related to high-stakes testing. Faculty and administrators of ACEN-accredited programs should review these guidelines to ensure fair testing within nursing education programs.

It is not uncommon for faculty to consider policy changes, including high-stakes testing policies, due to concerns about the actions a board of nursing or accrediting agency may take in response to a decline in licensure examination pass rates. Faculty should consider changing policies and/or processes within the nursing education program to promote student success. However, any policy changes should not be in lieu of curriculum review, including instructional strategies and student support services, which are the responsibility of nursing faculty. Standardized testing, when used properly, can provide faculty with valuable assessment data on individual student performance as well as data for summative program level assessment and evaluation. Data from standardized examinations may be used by faculty to ensure the curriculum, classroom, laboratory, and clinical experiences assist students to achieve the course and end-of-program student learning outcomes and program outcomes as well as to prepare for the licensure examination. If faculty determine that students are routinely performing poorly on a standardized examination, the data must be carefully analyzed and should include a review of the program’s curriculum and educational practices. The NLN’s Fair Testing Guidelines remind faculty that across the country, there are highly successful programs with diverse student populations that have exceptional pass rates, a high retention rate, and do not use high-stakes testing.

A significant change in the 2023 ACEN Accreditation Standards and Criteria includes how nursing education programs demonstrate compliance with the ACEN’s benchmark for licensure examination pass rates. ACEN Standard 5 Outcomes, Criterion 5.3a, provides flexibility for programs to demonstrate compliance with licensure examination pass rates while still maintaining quality expectations. With the implementation of the 2023 Standards and Criterion 5.3 specifically, faculty should feel more confident implementing strategies to facilitate student learning and preparation for licensure and practice, without relying on high stakes testing policies or using standardized examinations in a progression or graduation policy.

First-time licensure examination pass rates are an indicator of program quality, and this has not changed with the 2023 ACEN Standards. However, the ACEN recognizes that a first-time pass rate is only one metric of program quality. There may be a variety of reasons why students are unsuccessful on their first attempt on the licensure examination unrelated to program quality. Most nursing faculty members can remember a situation where the faculty member and the student were certain the student would pass on the first attempt, and the predictor score even supported this belief; however, that student required a second attempt to obtain licensure. ACEN-accredited programs that have had challenges with first-time pass rate, even over the last few years with the pandemic, have continued to demonstrate a high ultimate pass rate, suggesting that quality programs may have a first-time pass rate problem rather than a true pass rate problem. Unfortunately, when standardized testing is used in a high-stakes manner in response to a decline in first-time pass rates, this may prevent otherwise prepared students from having the opportunity to progress and/or complete the program of study, which negatively impacts the program’s completion rate. Additionally, a student who does not complete the program of study cannot take the licensure examination, and the profession loses the knowledge, skills, and abilities of that student.

More research is needed to better understand the causes of failure on the first attempt at the licensure examination. Understanding the causes would assist faculty in the development of evidence-based actions to assist graduates to be successful on their first attempt. Until then, it is important that faculty continue to strive for program quality with high program completion rates as well as high licensure examination pass rates (in accordance with ACEN Criterion 5.3) without the use of high stakes testing.

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