Four In Five Canadians Believe Our Nurses Should Be Assessed Using a Test Based On Canadian Requirements

Most reject the notion that Canadian nurses must write a non-Canadian entry-to-practice exam

OTTAWA, Oct. 13, 2015 /CNW/ - According to a recent national poll, conducted by Ipsos Reid, four in five Canadians (80%) believe that nurses, like other Canadian health professionals, should be assessed using a test that is based on Canadian requirements.

Half (53%) of Canadians agree that it is not appropriate that Canadian nurses practicing in Canada must write a non-Canadian entry-to-practice exam, while a further quarter (21%) do not know if this requirement is appropriate. Only one in four (26%) agree that it is appropriate for Canada's nurses to write a non-Canadian exam, and yet, that is the current situation in this country

Since January of 2015, Canadian nursing students outside Quebec, which has its own system, have been required to write the NCLEX-RN in order to be registered to practice in Canada. The NCLEX-RN is run by the American organizations that are responsible for licensing nurses in the United States (the National Council of State Boards of Nursing). The new entry-to-practice exam was chosen in 2012 by the Canadian organizations that license nurses in Canada. Canada is the only non-American jurisdiction that uses the NCLEX to qualify its nurses to practice in their own country; and nursing is the only Canadian health profession to have a non-Canadian entry-to-practice exam.

The first results of the NCLEX-RN were released last month. National pass rates in Canada were lower than in the USA and lower than on the previous Canadian test in most jurisdictions. Pass rate were especially low where there are more French speakers. Those who would defend the new test and dismiss the significance of the drop in pass rates try to point the finger at the nursing schools or at the nurses themselves. But the quality of Canadian nursing education and Canadian nurses did not suddenly fall with the introduction of this new test.

Canadian nurses are in demand the world over (including in the United States) and are recognized for the quality of their training and education. Canadians agree. Four in five (81%) say that Canadian nurses provide high quality care to patients, three in five (59%) agree that other countries seek to hire Canadian-trained nurses (31% say they don't know). Only one in ten (10%) think that American nurses are better trained than Canadian nurses.

"However the pass rates, troubling as they are, are just a symptom. They validate concerns about the broader issue – the poor fit of the NCLEX-RN with the Canadian context," states Dr. Kirsten Woodend, President of the Canadian Association of Schools of Nursing (CASN).

The Canadian Association of Schools of Nursing (CASN) has done a careful and validated mapping of the entry-to-practice competencies required of new nursing graduates in Canada against the NCLEX-RN specified test areas.

"One third of the competencies expected of a Canadian nurse are not addressed at all by the NCLEX-RN and over a quarter are only partially tested. This represents more than half of the competencies," explains Dr. Cynthia Baker, Executive Director of CASN. "Examples of what is missing include 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. By the same token, many activities listed in the NCLEX-RN test plan aren't among the required entry-to-practice competencies."

Pass rates can and will go up as schools adapt their teaching to the new exam, and that is what is more troubling. Indeed, three in five Canadians (58%) agree they are concerned that Canadian nursing students and schools will have to focus more on preparing for this new test than on learning the competencies identified by nursing bodies in Canada (only 5% disagree that this is a concern, 22% don't know).

Canadians are right to reject the notion that Canadian nurses must write an American entry-to-practice exam. Canadians are right to embrace the idea of a test that is based on Canadian requirements. Canadian nurses and their patients deserve an entry-to-practice exam that reflects and reinforces the high quality of Canadian nursing.


SOURCE Canadian Association of Schools of Nursing

For further information: or to request an interview with Dr. Kirsten Woodend, President of CASN, or Dr. Cynthia Baker, Executive Director of CASN, please contact: Alexandra Evershed, 613-293-5700,

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