HealthOctober 12, 2017

Do standardized tests have to be high stakes?

As nurse educators, we all recognize that to stay open, our programs must maintain an NCLEX® passing standard set by each school’s respective state Board of Nursing.

By Gannon Tagher EdD, MSN, RN, APRN

In recent years, to help ensure students were on track to meet benchmarks for acceptable NCLEX passing standards, many programs instituted the use of standardized testing products throughout the curriculum. Over time, many programs began to use these standardized examinations as a measure for allowing student progression and eventual graduation from the program. The use of standardized testing in this way prompted the National League for Nursing (2012) to release a fair testing policy, stating that the organization questions and does not support the practice of prohibiting graduation based on low standardized examination scores. (See

Perhaps the idea that standardized tests could predict NCLEX success was so enticing that we as nurse educators thought, “Surely, this must be the answer to our problems!”  After all, it sometimes seems as if students are not retaining information from semester to semester and that, despite our best efforts, students are not engaged with their learning. Implementing standardized examinations, however, may have caused us to focus on addressing the wrong challenge. Or, to use a healthcare analogy, we confused a tool best designed as a method of diagnosis with a possible treatment strategy. There is an inherent problem linked to using standardized testing devices to make sure that NCLEX pass rates stay high. High NCLEX pass rates do not ensure a quality program, nor are they measures of program effectiveness (Randolph, 2017). Why would we rely on the results from one standardized exit examination to tell us if our students are ready to take the NCLEX?  Should not our curricula, and the associated assessments and evaluations that are part of such curricula, ensure that we are producing high quality students capable of passing the NCLEX on the first try?  Additionally, using standardized examinations in a high-stakes manner can be detrimental to a student’s psyche. Fear of failure, physical symptoms of anxiety and stress, and isolation from friends and family are just a few of the ramifications students face in a high-stakes testing environment (Tagher & Robinson, 2015).

Standardized examinations can be useful when incorporated thoughtfully into a curriculum, not as a high-stakes measure. Using standardized tests as a formative assessment tool, or better yet combining them with other formative assessment tools, can be beneficial for students. A formative approach allows students to see where they stand on a subset of material. Students can then take reports from the examination, along with any remediation provided, and use the information to improve performance. I have heard faculty say, “They won’t take the test seriously if we don’t put any meat behind it,” meaning that the standardized test score needs to be a significant portion of the course grade or as a way to prevent program progression. It is our job as nurse educators to instill the value of formative assessment into our students. If we as faculty value formative assessment, and teach our students what to do with the information they receive, then the students will see the value of the test and there will not be the need to make it high stakes.

Based on the examination report, nurse educators should encourage students to practice questions from NCLEX review books or other NCLEX resources as soon as possible. Students should start with material in which they scored the lowest on their standardized examination. By starting with NCLEX preparation early, students become used to the types of questions they will see when they sit for the licensing examination. Furthermore, nurse educators should help students learn to maximize these resources. Simply reading rationale without understanding is of no benefit--students have to be reminded to look up any information they do not understand.  Studying to understand rationales increases the chances that deep learning takes place.  Understanding how to effectively use the resources available can help to prepare students and alleviate some of the stress associated with standardized testing.

Finally, how a student perceives a standardized examination can significantly affect the student’s performance. As nurse educators, we often forget about the “softer side” of student success. March and Robinson (2015) found when students are hopeful, they are more likely to achieve higher scores.  Helping students to see a standardized test as a challenge rather than a threat puts students in the mindset that the examination is a benefit to their learning, not an obstacle holding them back.

The program in which I teach uses standardized examinations throughout the curriculum. I have told students to envision the score they want to achieve on a standardized test, write that number on multiple note cards or sticky notes, and then put the cards/notes up everywhere. I tell them to put them on the bathroom mirror, laptop, and anywhere else they will see the number daily. I also remind them that the number is a score to reach, not a score to fear. I have had many students tell me that doing this helps them get into a positive mindset. Being supportive and positive can go a long way. Sometimes, we forget the little things!


March, A.L., & Robinson, C. (2015). Assessment of high-stakes testing, hopeful thinking, and goal orientation among baccalaureate nursing students.  International Journal of Nursing Education and Scholarship, 12(1), 1–7.

National League for Nursing. (2012). The fair testing imperative in nursing education.

Randolph, P.K. (2017).  Standardized testing practices: Effect on graduation and NCLEX pass rates.  Journal of Professional Nursing, 33(3), 224–228.

Tagher, C.G., & Robinson, E. (2015).  Critical aspects of stress in a high-stakes testing environment: A phenomenographic approach.  Journal of Nursing Education, 55(3), 160–163.

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