The Effects of Eliminating Idiomatic American English From High-Stakes Nursing Examinations

Background: In the United States, English for Speakers of Other Languages (ESOL) health care providers are important to the nursing workforce but often face challenges when taking the NCLEX-RN examination. This study evaluated the effects of removing slang and words with multiple meanings from high-stakes examination questions. Method: This study used a quantitative, experimental posttest-only control group design and included a convenience sample of 169 nursing students from a college in southern Florida. Results: Nursing students performed significantly better on the experimental (M = 79.9 [7.48]) than on the control examination (M = 75.08 [10.51]), t(151.8) = 2.973, p = .003. Students with low language acculturation scores achieved significantly higher scores on the experimental (M = 81.48 [SD = 6.05]) versus the control examinations (M = 72.21 [10.09]), t(60.9) = 4.975, p = .001. Conclusion: Modifying examination questions linguistically can help ESOL nursing students perform better and aid examination creators to design bias-free tests.