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NBCOT Public Response to Requests for Test Administration Modifications

As a result of the COVID-19 pandemic, NBCOT’s test administration partner, Prometric, has temporarily closed its test centers. NBCOT examinations have been evaluated as essential, which means that our candidates can resume testing on May 1. We are aware that this initial suspension of testing resulted in students experiencing delays in taking the certification exams and, due to adherence to social distancing guidelines, there will likely be continued delays after test centers reopen. We understand and empathize with the stress, anxiety, and financial hardship that this situation is causing new graduates. Since the outset of the pandemic, we have been actively investigating every available option for assisting candidates to test in a timely manner.

Some of the solutions we have been exploring include delivering the NBCOT national certification exams online via remote proctoring, administering the certification exams at university testing centers, and administering paper-based versions of the exams in large-scale administrations around the country. Below, we outline some of the key challenges and considerations that make each of these potential options for delivery difficult. We will also share information about a solution we are actively pursuing that we hope will allow candidates to test more quickly.

Why Can’t NBCOT Administer the Certification Exams via Remote Proctoring, at University Test Centers, or via Paper Format?

Clinical Simulation Test (CST) Items

One of the primary barriers to administering the NBCOT certification exams in different settings is the clinical simulation test (CST) items used on the NBCOT OTR® Certification Examination. These items require specialized software to display and administer them properly. The remote proctoring organizations we have spoken with do not have the capability to deliver CST items, nor would university testing centers. CST items are also not amenable to paper-based delivery. NBCOT has considered whether it would be possible to develop a version of the OTR exam without CST problems. However, our policies and procedures require that all new versions of an exam undergo extensive reviews by committees of subject matter experts to ensure that they are valid and fair, among other criteria. Because NBCOT is accredited by third-party accreditation agencies, we are not in a position to quickly change our policies and procedures to circumvent key steps in our exam development process.

Exam Security

Exam security is the cornerstone of any high-stakes certification program, and as such, it is one of NBCOT’s foremost concerns. Several of the options we have explored pose exam security risks. For instance, remote proctors, like many other employees during this time, are largely working from their own homes and using their own equipment to proctor exams. This type of proctoring may be appropriate for lower stakes exams but does not offer sufficient security for high-stakes exams like the NBCOT national certification exams, which state boards rely on to provide accurate information with which to make licensure decisions. Additionally, there are many critical security concerns associated with storing, mailing, and administering paper versions of exams.

COVID-19 and Logistical Challenges

Ordinances from local, state, and federal governments and recommendations from the CDC present unique challenges for implementing new test administration solutions during this pandemic. With mass gatherings restricted across the nation, large facilities that could be used for exam administration closing or being reserved for emergency use, and travel being restricted, planning a large-scale administration of the certification exams is not feasible.

Fairness and Bias

Any solution that NBCOT implements to remove barriers to testing must be available and accessible to all candidates. There are always fairness and bias concerns associated with any test administration method that significantly reduces standardization in the testing process. For example, with respect to remote proctoring, not all candidates have access to high-speed internet, a computer that meets the technology requirements for remote proctoring, or a quiet, private space in their home in which to take the test. Similarly, not all university testing centers are open currently or have plans to open in the near future. In addition, over 200 candidates with disabilities who have been approved to test with accommodations—as well as many others who have yet to apply or are awaiting approval—would not be fairly and equitably treated by the introduction of remote proctoring or a paper-based administration, as many of these candidates could not be accommodated under these methods of test administration, particularly those requiring the use of specialized technology.


NBCOT has an established scoring process whereby scoring files are securely transferred from NBCOT’s testing partner on a prescribed schedule. These files must include very specific content and need to be formatted in a particular way to be compatible with our established scoring system. For any new exam delivery option, we must consider the ability to securely transfer the necessary score data in the correct format to enable us to accurately score the exams and complete all of our exam security and quality assurance processes.

What Is NBCOT Doing to Help Candidates Test More Quickly?

NBCOT is committed to finding a solution to assist candidates affected by the COVID-19 pandemic to test as soon as possible. In addition to the seats available with our current test delivery vendor, we are actively pursuing other options for supplementing our seat capacity. We are working as swiftly as possible to implement this solution, which will increase the number of appointments available to candidates while also ensuring the capacity to administer CST items, deliver required scoring files, offer testing accommodations to candidates with disabilities, and ensure exam security. The challenges posed by the COVID-19 pandemic are trying for our entire community, and much remains unknown about the coming weeks and months. We sincerely appreciate your patience and support as we continue our work to find a solution for administering our exams in a fair, standardized, and secure manner that does not compromise the health and safety of our candidates.