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Standing her ground

New nursing graduate questions relevancy of licensing exam

Teaching and Learning

By Marcia Porter

As a bachelor of nursing student in the School of Nursing (SON), Megan Carey was no shrinking violet.

The energetic Ms. Carey was active in the school’s nursing society, the Canadian Nursing Students’ Association and in a myriad of other activities.

Young woman in nursing uniform stands in the learning resource centre at the MUN School of Nursing
Megan Carey says the NCLEX exam has little relevancy in a Canadian health-care system.
Photo: Mike Ritter

She’s got pluck and presence. Just the right person to take on the nursing establishment. Or, at least question the wisdom of having graduates of nursing programs in Newfoundland and Labrador write the National Council Licensing Examination (NCLEX).

The entry-to-practice exam is largely controlled by regulators in the United States, which all would-be registered nurses (RN) in this province and across the country must pass.

‘Hearing the negative’

Ms. Carey is a full time master of nursing (MN) student working as a registered nurse (RN) at St. Clare’s Hospital in St. John’s. This past summer she stood before leaders of the Association of Registered Nurses of Newfoundland and Labrador during their annual general meeting and presented a motion that led to heated discussion.

Carefully crafted, thoughtful and fine-tuned, the motion asked that the association, which regulates nursing practice in the province, explore other options besides the controversial NCLEX to determine nursing competencies for new graduates.

“A lot of people in the room had 10-15 (some with more than 30 and 40 years) of experience, and they were looking at me as if to say, ‘You are very young to be asking for change.’” — Megan Carey

Options, for example, that could include school accreditation — over the past 21 years Memorial’s School of Nursing has achieved the gold standard in accreditation among Canadian nursing schools.

“I was putting myself out there and listening to people’s strong opinions and I really thought it wasn’t going to pass,” said Ms. Carey, an alumna from the Class of 2015, the first group of SON students to write the NCLEX exam.

“A lot of people in the room had 10-15 (some with more than 30 and 40 years) of experience, and they were looking at me as if to say, ‘You are very young to be asking for change.’ I was hearing only the negative.”

Close-up of young woman in white nursing uniform standing in the School of Nursing learning resource centre
Megan Carey received support from students, alumni and work colleagues after presenting her motion.
Photo: Mike Ritter

Despite the exchange, her motion passed, adding momentum to the growing number of voices questioning validity of the NCLEX exam for Canadian students.

In fact, Ms. Carey was inspired to present her motion after Nova Scotia passed a similar one.

“I had a lot of people reach out to me since I presented that motion,” she said. “And I had support too from my workplace nurses. I think this is going to be something that spreads.”

Strong opposition

Ms. Carey might be correct.

Recently, New Brunswick followed suit, with nurse educators in that province recommending the NCLEX be discontinued.

Why such strong opposition to the NCLEX exam among Canadian nursing students and educators?

“A big concern for all of us is the relevancy to our practice,” Ms. Carey said. “There were so many questions of relevance to American practice, but not to a Canadian system. We had to spend so much time learning things that only apply to the United States and that will have no reflection on how we’re going to practice.”

Canadian nurse educators from schools at the University of Toronto and the University of Ottawa recently published an article in the journal International Nursing Review that identified several areas of concern about the NCLEX, including issues such as appropriate examination translation (i.e. to French and other languages), access to appropriate test preparation materials, assurance that the exam reflects distinctive aspects of a country’s health-care system and the need for stakeholder engagement.

“We want to develop nursing in Canada for health needs in Canada.” — Dr. Alice Gaudine

The authors also warned that the NCLEX exam has “. . . significant policy implications for nursing in Canada and globally.”

“What I find most worrisome is that we are relying on an exam that is valid within the American context,” said Dr. Alice Gaudine, dean, School of Nursing, and one of many nursing educators across the country with serious concerns about the NCLEX.

“We want to develop nursing in Canada for health needs in Canada. Nursing graduates in some countries including the United Kingdom and Australia do not write a high stakes, entry-to-practice exam such as the NCLEX and there is no evidence that their public receives less safe care.”

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