by Admin on January 13, 2016

in For Discussion


The entry to practice exam for Registered Nurses was changed in January 2015 from the Canadian Registered Nurse Exam prepared by the Canadian Nurses Association to the NCLEX -RN exam prepared by the National Council of State Boards of Nursing, Inc. (NCSBN).

The exam results following administration of the exam in Canada have been the cause of concern amongst nurse educators in Canada. Nurse educators have been calling for the opportunity to examine the results, discuss the exam and exam process with a view to implementing changes for Canadian candidates. Organizations calling for this discussion include the Canadian Association of Schools of Nursing (CASN) and the Council of Ontario University Programs in Nursing (COUPN). We would like to present some of the letters that have been written by our nurse educator colleagues.

Elizabeth Edwards, Member at Large for Education with the RNAO has been involved in discussion with the Education Committee which supports her. Elizabeth feels that the Provincial Nurse Educator Interest Group should be disseminating the letter published in the National Post stating,

“First, this is an extremely well written letter with accurate information offered. It’s good for our members to know that this issue is continuing to be addressed at all levels of nursing education and practice. Second, I think that PNEIG should support these two nurse educators who put the time and effort into crafting this letter…Finally, it’s one more documented effort that, I hope, the CNO will see and understand that nurse educators are united in advocating for changes to a process that just doesn’t work here.”

The second letter appeared in the “Mailbag” of the RN Journal in the November/December issue. The letters have been reprinted with the permission of the authors, Dr. Kirsten Woodend and Dr. Jennifer Medves.

Kirsten Woodend & Jennifer Medves: We are failing our nurses
National Post | December 14, 2015

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 licensing 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 health-care 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 teaching to the American exam (indeed, 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 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-to-practice 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.

Dr. Kirsten Woodend is the president of the Canadian Association of Schools of Nursing. Dr. Jennifer Medves is chair of the Council of Ontario University Programs in Nursing.

And from the November/December Mailbag of the RN Journal:

Time for dialogue to address NCLEX concerns
Re: Nursing Notes, Questions raised about new entry-to-practice exam,
September/October 2015

Thank you for your attention to the issue of higher fail rates across Ontario and Canada for the NCLEX-RN. Recently released third quarter results show pass rates have fallen even further, with an average pass rate of 66 per cent in Ontario and 69 per cent across Canada (Source: Mountain Measurement Report, Nov.13,2015). The average pass rate for 53 out of 98 Canadian nursing programs was below 70 per cent, and an additional 24 programs had results between 70 and 79 per cent. Even if most graduates eventually pass on a second or third write (the College of Nurses of Ontario (CNO) confirmed on Dec. 2 that 79 per cent in Ontario have done so), the fail rate remains extremely concerning.

Ontario universities are working hard to identify best practices and resources to improve graduate success rates on the exam. At the same time, we have amassed significant data to show: the French translation is inadequate; there is American content on the exam; there are challenges with temporary testing centres; and there is poor access to the exam in smaller communities. Also, we are reviewing the limited and conflicting evidence on whether the NCLEX is an appropriate test for Canadian entry-to-practice nurses. At a recent meeting of the Joint Provincial Nursing committee, CNO stood by its processes for French translation and vetting for American content.

The Council of Ontario University Programs in Nursing (COUPN) has invited CNO to meet with us to share the evidence we have gathered regarding the quality issues with the NCLEX in relation to Canadian candidates, and to help identify ways forward to address these urgent issues. We welcome such a dialogue.

Jennifer Medves

Publisher’s Note
RNAO would like to see Ontario’s regulator establish a formal group to encourage dialogue and deescalate a debate that is contributing to student anxiety. As a self-regulating profession, we need to work together in a formal way to improve the situation.


We invite comments on this issue. Please express your opinion below!

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