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Studying to Be a Canadian Nurse or Studying to Take an American Exam?

Canadian nursing students concerned with continued use of controversial American entry-to-practice exam.

Press Release: In January 2015, the Registered Nurses (RN) entry-to-practice exam used in Canada for decades, the Canadian Registered Nurses Exam (CRNE), was replaced with the NCLEX-RN®, a computer adaptive exam developed by the National Council of State Boards of Nursing (NCSBN), a US-based exam developer and provider. This exam was originally created to test American nursing students’ competencies. After one year of implementation, the first-time pass rate was 69.7% nationally, and 27.1% for francophone writers, compared to a previous national pass rate of 87% with the CRNE exam: a shocking discrepancy for newly graduated students.


Many individuals who have written the test reported coming across American specific content and context. Many Canadian nursing organizations have since questioned the tests validity when it comes to testing unique Canadian competencies such as social determinants and indigenous health to name a few. The Canadian Association of Schools of Nursing has reported that 1/3 of Canadian competencies are not tested on this exam and another 1/4 of them are minimally tested, which leaves over half of our Canadian nursing competencies not fully tested. The issues within the exam have created even further concerns when schools of nursing were asked if their educators could start preparing their students for the exam. This results in invaluable learning opportunities, classes and clinical being reduced from the curriculum to make way for this exam preparation.


The unfortunate reality is, after two years of implementation, these issues continue to exist and have not been resolved. For instance, all the exam preparatory materials are based on American context and contents. Not only is there a severe lack of preparatory materials available in French, leaving francophone students stranded when preparing for their entry-to-practice exam, but a poor translation of the French exam is still causing confusion amongst francophone writers. Passing rates have yet to return to the previous exams rate; and the number of students who report their curriculum changing and preparatory sessions replacing important content in their curriculum has been constantly increasing. The financial, emotional, and psychological burdens related to the implementation of this exam remain to be addressed. Furthermore, there is no published evidence that passing this test predicts safe practice within Canada, as stated by the past President of the Canadian Association of Schools of Nursing (2016), Dr. Kirsten Woodend.


The exam contract was set to expire in December of 2019. According to said contract, unless it is voided 3 years in advance, an automatic annual renewal will take place. Which means we can now expect this exam to continue to at least December of 2020. The question is: until then, what is being done to remediate these issues?


The Canadian Nursing Students’ Association is taking action to ensure accountability of nursing regulators asking them for urgent remediation of the concerns and issues associated with this examination. Asking nursing regulators to consider its impact before renewing the NCLEX-RN® contract with NCSBN when evidence suggests that this exam is not appropriate as it stands.


At their upcoming 2017 National Assembly in Winnipeg, Manitoba, over 400 nursing students and professionals from across Canada will gather and bring light to these issues by asking provincial and national regulators and stakeholders to recognize these concerns and take action. They will be discussing current issues, such as American vs. Canadian competencies, Canadian nursing curriculum, and French language issues. CNSA is asking for your support to ensure that our future Registered Nurses receive the highly-recognized education Canada is acclaimed for, as well as a just, and appropriate entry-to-practice exam that ensures the safe delivery of holistic care to the unique needs of Canadian patients.


2016-2017 Board of Directors
Canadian Nursing Students’ Association
Resolution Statement: Support for urgent remediation of NCLEX-RN® issues

Resolution Statement: Support for urgent remediation of NCLEX-RN® issues