Are NCLEX® Testing Policies Culturally Insensitive?

Q: I am a Muslim nurse who wears a religious headscarf (hijab). I would like to bring to your attention two negative experiences that happened to me while taking the exams for LPN and RN licensure in the state of New York. The incidents occurred at two different Pearson Professional Centers (PPC) testing sites. PPC is the organization that is contracted to conduct the NCLEX® licensure examinations on behalf of the National Council of State Boards of Nursing (NCSBN) across the United States.

In July 2004, I went to the Pearson VUE testing center in Lower Manhattan to take the NCLEX-PN exam for LPN licensure. Upon signing in, I was asked to remove my headscarf “for identification purposes,” even though I had presented my N.Y. state driver’s license, which has my photo with my scarf on. I explained to the Pearson staff that because I am a Muslim, my head covering is a religious mandate that has been routinely accepted by all other authorities without a single objection. I pointed out that all of my photo IDs picture me with my scarf on and that all NCLEX candidates are fingerprinted, which is another official identification method.

The testing center staff insisted that I remove my scarf, arguing that I might be hiding audio equipment or notes under it. In response, I volunteered to be searched by a female staff member in a private place; the staff declined my offer. I refused to take off my head covering, because I did not want to compromise my religious beliefs and because I felt that, as an American citizen whose freedom is protected under the Constitution, I had the right to keep my scarf on. The staff then informed me that if I attended the examination with my scarf on, they would file a report with the NCSBN documenting my refusal to remove my scarf.

I took the examination with my scarf on, worrying about the possible outcomes of being reported and whether the anxiety I was now experiencing would affect my performance on the exam. You can imagine my condition after spending a very stressful 20 or 30 minutes struggling to enter the examination room just because of my scarf!

When I inquired about the results of my exam several days later, I found out that my result was unavailable. After making numerous phone calls over the next two weeks to Pearson and the NCSBN, I finally learned what was causing the problem. The “Incident Report” that the Pearson center staff had sent to the NCSBN documenting my refusal to take off my headscarf was causing the delay, because this report had to be reviewed by the New York State [Education Department’s] Office of [the] Professions before my examination result could be released. I also learned that the incident report would be a permanent part of my file at the NCSBN. Needless to say, this situation affected me personally, because it caused a delay in receiving my license and being able to seek employment as a nurse.

Thankfully, my efforts ended with good news. I passed my LPN board exam and was finally granted the N.Y. state nursing license. Initially, I decided to ignore this unpleasant experience, thinking that it was probably an isolated case. Perhaps the staff of this particular Pearson center was not culturally sensitive or was being affected by the post-9/11 negative public sentiment toward Muslims.

However, in April 2005 I went to take my NCLEX-RN examination. I purposely selected a different Pearson’s testing center in Islandia, N.Y. to avoid the problems I had experienced the last time. But after checking in and providing my photo ID that showed me wearing my headscarf, the exact same thing happened again. I reacted the same way: I refused to remove my scarf. The center’s staff refused to accept my offer to undergo a body search.

This time, I requested to speak to the center manager. The manager threatened me, saying that he would write an incident report to document my refusal to remove my scarf. Once again I refused to give in and I proceeded to take the exam with my scarf on.

After this second negative incident, I was angry. I was determined to speak up about what I had experienced. Immediately after finishing the exam, I called the NCSBN and explained what had happened. They were very understanding and I was promised that nothing would block the release of my examination result. Later on, I was surprised to receive a phone call from the NCSBN offering their condolences for what had happened to me!

I also decided to do some research to see if the NCSBN has any formal written policy on this issue. I went back to my copy of the NCLEX Examination Candidate Bulletin, where I found the following statements:

• (On page 10, under the heading “Test Center Regulations”): “Hats, scarves and coats may not be worn in the testing room or while your photograph is being taken.”

• (On page 11, under the heading “Grounds for Dismissal or Cancellation of Results”): The third bullet states: “Failing to follow testing regulations or the instructions of the test administrator.”

This makes it clear that the “no scarves” policy originates with the NCSBN, and that the Pearson centers’ role is to enforce the NCSBN’s policy. I find it amazing that the NCSBN failed to consider any religious or health reasons that candidates may have for wearing a head covering and that it refuses to make any exceptions in these special cases.

Today, every profession, including nursing, is required to be culturally sensitive. However, the policies that govern the nursing licensure examinations apparently are not. Therefore, I am writing to you, as an expert in the field, to bring this situation to your attention so that other Muslim nurses taking a career examination will not have to go through the anxiety and discrimination that I encountered. I am also planning to send a letter to the NCSBN and I have already contacted the Council on American-Islamic Relations (CAIR) asking them to look into my case. Hopefully, one day we will all be more tolerant of each other’s cultural differences.

–Nicole Berti, RN, LPN

 

A: I am very sorry to hear about what happened to you at the test centers, especially since sitting for a licensing examination is a stressful enough experience in itself. I strongly believe that this situation should have never been allowed to happen to you, or to any other Muslim candidate. I admire your strength and courage in fighting for what you believe as well as taking the risk of possibly having to give up your dream of becoming an LPN or RN. In fact, I consider you a leader and a pioneer for all Muslim nurses as well as anyone else who believes they have the right to practice their own religious faith in this free country.

 

I notice that in the 2006 NCLEX Examination Candidate Bulletin (which can be viewed online at the NCLEX candidate Web site, www.pearsonvue.com/nclex), the dress code policy under the “Test Center Regulations” heading now states only: “No hats or coats.” The reference to “no scarves” has been removed. So congratulations! By standing up for what you believe and by having the courage to speak out about the unfair treatment you received, you have actually made a difference in helping to change this culturally insensitive policy.

While I am sure the original policy did not intend to deliberately discriminate against Muslims, I certainly believe that what you experienced at these two NCLEX testing centers was discrimination, whether intentional or not. For example, I am questioning why you and your headscarf were singled out for the accusation that you might be hiding audio equipment or notes. Any candidate can hide many things under their long sleeves, pants, shirts, necktie, etc. Singling out Muslims–or any other religious, cultural or ethnic group–is unacceptable and should not be tolerated in this day and age. There is no question that the staff at these testing centers were lacking in cultural sensitivity and in need of diversity training to increase their awareness and understanding of cultural differences.

I also believe that changing the clothing policy to just “no hats and coats” is a good start, but it does not go far enough. What about candidates who wear other types of religiously mandated head coverings that could be defined as “hats”–such as Orthodox Jews who wear yarmulkes, Sikhs who wear turbans or nuns who wear habits? What about individuals who have to cover their heads for medical reasons, such as having a thick dressing as a result of head surgery or injury, cancer patients who lost their hair because of chemotherapy, or persons with an infectious head or scalp disease? In my opinion, the NCSBN needs to further broaden its policy by adding language such as “no hats and coats except for those worn for religious or medical reasons.” As long as this rigid policy continues to be applicable to all candidates without any exceptions, the potential for more discrimination, such as the situation you experienced, will continue.

Finally, I believe the NCSBN and Pearson Professional Centers need to improve their incident reporting and complaint filing procedures to make them more fair and open to examination candidates. Specifically, I am suggesting that:

1. If any incident report is filed against a candidate at a Pearson testing center, a copy should be given to the candidate before sending it to the NCSBN. The candidate must have a fair chance to know what was documented against him or her. In America, even people who are arrested have the right to know the charges against them. Why shouldn’t professionals taking a certification exam have the same right?

2.

3. NCLEX candidates must be provided with clear guidelines on how to submit a complaint if they believe they have been treated unfairly. The current 2006 Candidate Bulletin contains virtually no information about this process. It would also be helpful for these guidelines to clearly explain to candidates how the complaint review process works, including the time frame for receiving a response and resolution from the NCSBN or PPC. It may even be beneficial for the NCSBN to create a standardized complaint form or checklist to help candidates focus on the facts, with room for writing in additional comments. The complaint process guidelines should clearly state that this form is available to candidates on request.

As nurses, we have an obligation to ensure not only that all patients we care for are treated with cultural sensitivity and respect but also that our fellow nurses–especially those who are entering the profession–are treated fairly and equally, regardless of their race, ethnicity, religion, gender, age or cultural background. I encourage every nurse who is concerned about fostering diversity, inclusion and respect within the nursing profession to write to the National Council of State Boards of Nursing (NCSBN)–and secondarily, to the corporate headquarters of Pearson Professional Centers and to your state Board of Nursing–about the need for NCLEX testing policies that are more inclusive and sensitive to cultural differences.

Specifically, we should urge the NCSBN to carefully review its current testing center regulations in order to identify and eliminate any potential for cultural bias (citing specific examples such as those mentioned in this article). We should also encourage both NCSBN and Pearson to recognize the need for testing center staff to be culturally aware and sensitive to the needs of examination candidates from diverse backgrounds, and to provide appropriate cultural competency training where needed.

It is time to recognize that America today is a truly multicultural society. We are also a country with a severe nursing shortage, and we need all the licensed nurses we can get. Now is the time for the nursing profession to re-examine our old, outdated, rigid policies and make sure they are sensitive to the cultural needs and basic civil rights of all American nurses.