Failing our nurses
The bodies that regulate nursing in Canada have made a big mistake. Motivated by the best of intentions, they brought in a new entry- to- practice exam for Canadian nurses. It is a computer- adaptive test that offers more frequent sittings and faster results than the previous exam. Unfortunately, while the new test is more technologically sophisticated than the old pen- and- paper version, it doesn’t align with Canadian nursing competencies. Canadian nursing students, their prospective employers and, ultimately, all of us who use the health- care system in this country will feel the impact.
Indeed, Canadian nurses are now required to write the American l i censing examination ( NCLEX- RN), run by the National Council of State Boards of Nursing, in order to be registered to practice in any jurisdiction other than Quebec (which has its own system). This is a problem because, while a broken arm is a broken arm in Ottawa, Ont., or Ottawa, Ill., the drugs can be different, the measurement systems are different, the makeup of the healthcare team and delegation systems are different and the laws are different. Moreover, fully half of the competencies expected of a Canadian nurse are not addressed by the NCLEX- RN.
The first results of the NCLEX- RN were released in September. They clearly show the misalignment between the test and the Canadian entry- to- practice competencies and curriculum. Pass rates have dropped significantly across the country. French- speaking students have been particularly disadvantaged. At the Université de Moncton, a francophone institution, the pass rate is 30 per cent, compared to 93 per cent the previous year. That is not a typo: it went from 93 per cent to 30 per cent in one year.
The drop in pass rates is not a reflection of some overnight change in the quality of Canada’s nurses. Our nurses are graduates of four- year baccalaureate degree programs. They are in high demand the world over, including in the United States. The problem is with the exam.
So how are the regulators responding? Are they taking their supplier, the National Council of State Boards of Nursing, to task? Are they requiring that the evident problems with the test be fixed? Sadly, they are not. Instead, what we see is a circling of the wagons and a rigid adherence to canned talking points. There are no problems with the exam, they say. There are no problems with the French translation, they say. Students are not failing the test, they say. As if saying it over and over makes it so. But the numbers don’t lie.
So what should be done? There is no doubt that our nursing schools can focus more on t eaching to t he American e xam ( i ndeed, some have done so already), so that more of our graduates can successfully pass it. But this is not a good solution for Canada or its patients: an exam that fails to address our Canadian context should not be driving the curriculum in our nursing schools. The tail is wagging the dog.
According to a recent Ipsos survey, four in five Canadians
Canadian nurses are now required to pass an American exam that doesn’t take into account the differences in our health-care systems
think that nurses, like other Canadian health professionals, should be assessed using a test based on Canadian requirements. We agree. Canadian nurses and their patients deserve an entry- topractice exam that reflects and reinforces the high quality of Canadian nursing.
We are asking the Canadian Council of Registered Nurse Regulators to work with Canada’s universities, colleges, nursing students and other key stakeholders to develop a solution: a truly bilingual, entry- to- practice exam for baccalaureate- prepared nurses, which reflects our Canadian context and tests candidates on Canadian competencies.