New Ontario nursing exam administration worries Lakehead student

A nursing student at Lakehead University says she worries about her final nursing registration exam.

It's because a new company, from the U-S, is administering the test for the first time that she says requires knowledge of medical policies from two countries.

CBC news has agreed to protect the identity of the 4th-year nursing student, because shefears hercomplaints could impact her academic career.

She says the exam was onceadministered by the Canadian Nursing Association, but now it's taken online, and is administered byan American company.

The student says during a recent prep course, the administrator warned students to brush up on their knowledge of US practices.

"When we went into this prep course for the exam, the first thing they said was, 'you have to know American content.' So, for all of us that paid the $350 or so, we were like, 'when are we going to learn that?'"

She is fretting over the kinds of questions that will be posed.

"If they ask you a question regarding delegation, you are the RN, you're going to delegate to the RPN, you have to think like an American nurse. If you're going to hang a blood product, you have to think like an American nurse. You have to know Obamacare."

Determining curriculum gaps

The director of the nursing school at Lakehead said some aspects of the exam have been "Canadianized, such as using the metric system.

Karen Poole added the school will closely review the results.

"What I know we do is we always bring that back to our curriculum and see if our curriculum has gaps, and if it can be strengthened."

"There are many, many resources available for the writers to the N-CLEX exam, to give them practice with the different kinds of questions. Becuase not only as I said is it a computer-based exam, there will be question formats that are different than your standard multiple-choice question."

"We've been integrating this into some of their tests and exams right now, and we've done some workshops with the students so that they won't be surprised by different formats of questions."

The student CBC news talked to for this story said she is concerned that if the test has too many American questions, and students fail, next year's review may be too late.

"What if I don't know all the standards? What if the reason I fail, in the end, is due to the American content. And, their response was, 'well, at the end of 2015, we're going to audit all of the Canadian nurses that were tested and see and check, and do statistical analysis of it, and if it turns out that yes there was too much American content, we will have to adjust the testing questions.' So, does that help the individual? No.

Nursing skill does 'not vary between borders'

This is the first year the test has been administered for Ontario by the company, which has been doing nursing tests in the US for years.

Students can take the test three times in Ontario to become a registered nurse.

In an email to CBC News from the College of Nurses of Ontario, it said Canadian nurses, nursing educators and regulators have been, and will continue to be, involved in the development of the NCLEX [the test in question] to ensure that the exam tests Canadian entry-level competencies.

The purpose of this exam is to test nursing skill, knowledge and judgment. These do not vary between borders. (For example, how a nurse treats a broken arm in Canada is the same as how a nurse in the U.S. would treat it.), wrote the Colleges communications specialist Bill Clarke.

This exam does not test the writers' knowledge of different legislation or policies, cultural values or health care environments. It only tests what is required for entry-level nursing practice, and helps ensure that applicants will be able to provide safe care as they begin their nursing careers.

He noted the NCLEX-RN is used around the world, and is acknowledged as a valid, psycho-metrically sound and legally defensible nursing exam.

The exam is reviewed to make sure that any cultural, jurisdictional, language or gender-related biases that could impede a writers' success are removed, Clarke said.

For example, if a question on the exam refers to a medication that has different names in Canada and the U.S., both names are provided.