Diversity in nursing and challenges with the NCLEX-RN
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.
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Another area of research that we have identified in the international literature that is not well represented in our review is related to bias, discrimination, and racism within the context of complaints, investigation, and disciplinary processes.
“Another area of research that we have identified in the international literature that is not well represented in our review is related to bias, discrimination, and racism within the context of complaints, investigation, and disciplinary processes [192,235–246].”
From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [243]
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Nursing regulation in Canada: Insights from a scoping review
Chiu, P., Thiessen, N. J., Idrees, S., Leslie, K., & Kung, J. Y. (2025) · PLOS ONE · doi:10.1371/journal.pone.0323716 · Cited by 12 · see citing works
- Authors
- Muirhead, L., Cimiotti, J. P., Hayes, R., Haynes-Ferere, A., Martyn, K., Owen, M., & McCauley, L.
- Affiliations
- Emory University (US)
- Corresponding author
- Hayes, Rose
- Venue
- Nursing Outlook
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 70
- Issue
- 5
- Pages
- 762-771
- ISSN
- 0029-6554 (ISSN-L)
- OpenAlex
- W4289755351
- Cited by
- 20
- References
- 44
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 1
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Nursing Outlook (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical Education and Admissions
- Social Sciences › Education › Teacher Education and Assessments
- Keywords
- NCLEX-RN, standardized testing, nursing licensure, diversity, equity, and inclusion, test accommodations, high-stakes testing, nursing workforce diversity, competency assessment
- MeSH terms
- Education, Nursing, Baccalaureate, Educational Measurement, Humans, Licensure, Licensure, Nursing, Prospective Studies, Students, Nursing
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