Canadian nurses struggle with new U.S.-designed exam

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American terminology on a new accreditation exam appears to be tripping up nursing students in Canada, particularly those who speak French as a first language.

As of Jan. 1, nursing students in Canada must pass the National Council Licensure Exam for Registered Nurses (NCLEX) in order to practise nursing. Before this year students took the Canadian Registered Nurse Examination in order to practise after schooling. The NCLEX exam uses some U.S.-based terminology, some in the profession have said, and its prep materials are largely only available in English.

A national Ipsos Reid poll, in association with the Canadian Association of Schools of Nursing (CASN), found that four out of five Canadians agreed that nurses should be assessed using a test based on this country’s requirements. The CASN has previously spoken out against the move to the NCLEX exam, saying in a statement that Canada is the only non-U.S. jurisdiction to use the NCLEX to qualify nurses in their own country, and that nursing is the only Canadian health profession using a non-Canadian certification exam.

Pass rates for Canadian nursing students are coming in below the average for their American counterparts, and those in provinces with a large francophone population are being hit particularly hard. Nursing associations in the country are concerned that the low pass rates could delay the entry of new nurses into the health-care system.

“Canada has very strong nursing education programs, and graduates of these programs are providing safe and competent care,” Karima Velji, president of the Canadian Nurses Association (CNA), said in a statement. “CNA believes it is crucial to ensure Canadians have access to a sustainable and knowledgeable nursing workforce.”

The Canadian pass rate for the first half of 2015 was 70.6 per cent, about 10 per cent lower than the average rate of 78.3 in the United States. For the old version of the exam, designed in Canada, the pass rate was 84.7 per cent.

Some provinces are faring worse than others with the new test. From a period of January to June, the pass rate in Ontario was just 68 per cent. At 54 per cent, just more than half of students in New Brunswick — the province with the highest percentage of Francophone nursing students — got a passing grade on the exam.

“The drop in pass rates in New Brunswick and in other jurisdictions across the country is not a reflection of some overnight change in the quality of Canada’s nurses,” Dr. Kirsten Woodend, president of the Canadian Association of Schools of Nursing, tells Yahoo Canada News. “Our nurses are graduates of four-year baccalaureate degree programs, in high demand the world over, including in the United States. Rather, it is evidence of a broader problem.”

Some provinces showed notable improvements in scores on the exam from the first quarter of the year to the second. For example, the pass rate in Manitoba was just 42.6 per cent from January to March of 2015, but rose to 75.6 per cent from April to June. Other provinces performed above the national average for the first six months, including British Columbia, Newfoundland and Labrador and the Northwest Territories and Nunavut.

The updated exam uses some American terminology that has led to confusion. Linda Haslam-Stroud, president of the Ontario Nursing Association, told the Ottawa Citizen that some of the exam’s questions involve medications not approved for use in Canada. And Dianne Tapp, dean of the faculty of nursing at the University of Calgary, told the Globe and Mail that there were questions concerning Obamacare and the U.S. Food and Drug Administration.

The new exam also includes both metric and imperial measurements, adding to the confusion. The questions on the exam used in Canada are in metric, but the prep material uses the American standard of imperial. Canada officially began switching to the metric system in 1970.

“Fully half of the competencies expected of a Canadian nurse are not addressed by the NCLEX-RN,” Dr. Woodend says. “Left behind are important nursing activities reflecting national guidelines related to patient safety, interprofessional collaboration, client-centred care and cultural safety; each of which is an essential element of patient safety in the Canadian context.”

As for francophone students, they must deal not only with the different terminology and measurements but also translations of the exam that do not transfer well and prep materials that are only available in English.

“At the Université de Moncton, a mainly francophone institution, the pass rate was 30 per cent compared to 64 per cent at the University of New Brunswick, a mostly anglophone institution. On the previous exam, New Brunswick’s nurses performed as well as or better than the national average,” Dr. Woodend says.

The switch to a new exam came about when nursing regulating bodies, including the College of Nurses of Ontario, formed a national federation. The switch to the American-designed exam was announced in 2011 and the NCLEX is now used in every province and territory except Quebec and the Yukon.

The previous exam was paper based and administered three times annually, while the NCLEX is computer adaptive and can be taken throughout the year, prompting the switch.

The NCLEX exam is not designed to be specific to any country, Canada or the U.S., Canadian Council of Registered Nurse Regulators executive co-ordinator Beth Ann Kenny said in a release. As well, variations in test scores for nursing students across the country is normal during the adjustment period of switching to a new exam, Kenny said.

“It is important to note that the purpose of the exam is for nursing regulators to determine that nurses entering the profession have the knowledge and skills needed to ensure public safety,” Kenny said in the release.

The CNA declined to comment.