To address high-stakes testing in nursing education, the National League for Nursing (NLN) undertook a process in 2010 to develop - and now in 2020 to update - national fair testing guidelines to assist nurse faculty and administrators in creating and implementing ethical and evidence-based academic progression and graduation policies. The NLN recognizes the pressure faced by nursing programs to maintain strong NCLEX-RN^(R) or NCLEX-PN^(R) pass rates. However, no substantive debate has occurred about the need to protect the public through high-stakes assessment of competence using measures with robust validity and reliability evidence, such as the NCLEX-RN and NCLEX-PN exam. The American Educational Research Association (AERA), the American Psychological Association, and the National Council on Measurement in Education, in their fifth edition of the Standards for Educational and Psychological Testing (AERA et al., 2014), define a high-stakes test as, "[horizontal ellipsis]used to provide results that have important, direct consequences for individuals, programs, or institutions involved in the testing" (p. 230).

Although credentialing and licensure examinations are widely acknowledged as examples of high-stakes examinations, the term high-stakes is in reference to nursing education achievement examinations when scores from commercially available examinations are used to make important educational decisions, such as whether students may continue to progress in their programs of study or whether they are permitted to graduate, pursue licensure, and enter the workforce. It is the high-stakes use of commercially available, standardized nursing achievement exams, and specifically those exams designed as "exit exams" or "NCLEX predictor exams," to prevent program completion, graduation, or, in some other way, deny eligibility to take the licensing exam, that is most concerning to the NLN and the subject of this Vision Statement.

Certainly, standardized achievement exams are useful in numerous ways. They provide students with information about their knowledge compared to other students, using national and even program-level normative data. Standardized exams can also help faculty identify curricular strengths and weaknesses. However, requiring students to achieve a specific cut score on a commercially available standardized "exit exam" in order to graduate and eventually sit for the NCLEX, in order to ensure that program pass rates remain at state board-prescribed levels, is especially problematic for those students who have successfully passed all other components of the nursing program but struggle to achieve the established cut score on the exit exam. Students who cannot achieve the required cut score may be required to retake the exit examination repeatedly until they achieve the score; in extreme cases, without having achieved the exit exam cut score established by the program, students may be denied their degrees or authorization to take the NCLEX. While in times past, separate and distinct progression policies based on examination cut scores were more common, an approach being increasingly used is for students not achieving the required cut score on the exit exam to fail the nursing course in which the exam is administered, endangering their standing in the nursing program. Such an approach can adversely affect students and their families economically, that is, while licensing is postponed, full salary potential is in jeopardy.

Students or groups of students who have suffered negative consequences for performing poorly on standardized tests have filed suit against their nursing programs using a variety of legal bases. Grounds for litigation may include breach of contract, lack of due process, and even educational malpractice, if standardized tests were inappropriately placed in the curriculum and utilized. High-stakes testing and progression/graduation policies can also distort the intended purpose of NCLEX pass rate requirements. First-time pass rates are viewed by stakeholders as a measure of program quality. Nursing programs that achieve high first-time pass rates by allowing only the highest performing students to sit for the licensing examination illustrate the well-known effect of selection bias.

The NLN Fair Testing Guidelines (http://www.nln.org/docs/default-source/advocacy-public-policy/fair-testing-guide) for Nursing Education value students' perspectives and backgrounds and acknowledge the role of faculty in their implementation. Based on the NLN's core values of caring, integrity, diversity, and excellence and on widely accepted testing principles including, most notably, the 2014 Standards for Educational and Psychological Testing (AERA et al., 2014), this 2020 update reflects the current literature. Fairness, in this context, means that all test takers are given comparable opportunities to demonstrate what they know and are able to do so in the learning area being tested. It also means that test scores, especially scores from high-stakes exams, must only be interpreted in ways supported by sufficient validity and reliability evidence. The use of fair testing principles may provide support to faculty as they grapple with these complex issues.

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