A Canadian version of the US Licensure Examination, eh? by Nickie Snyder RN

Late last year, 10 of Canada’s nursing regulatory bodies selected an American organization, the National Council of State Boards of Nursing, to develop a new examination for entry-to-practice which will replace the current Canadian exam by 2015. The NCLEX (National Council Licensure EXamination) is the name of the exam currently used in the United States.

There has been a lot of talk lately about the NCLEX coming to Canada. To be honest, when I first heard about it my thought was, “that doesn’t sound completely terrible”.

I have taken both the Canadian Registered Nurse Examination (CRNE) and the NCLEX and I have to say that the NCLEX was a much harder exam, yet easier to study for. The CRNE is very psycho-social based, whereas the NCLEX is more pathophysiology based. Questions on the CRNE can often be argued to have more than one answer, whereas the NCLEX requires a clear answer…. you just have to know what it is.

I have long thought that we need to reform the CRNE. There is an urban legend within nurses that a group of professionals (lawyers, engineers, etc) took the Examination and 60-70 per cent of them passed. While this may or may not be true, it suggests that the CRNE does not do justice to the specialized body of knowledge that nurses have.

The major criticism being leveled against this new plan is that the content will not be Canadian. Quite frankly, anyone who believes that the NCLEX is going to be implemented “as is” in Canada is being naive and foolish. The exam will have to reflect Canadian content in order to license nurses in Canada, and the licensing bodies that have chosen to pursue this option know that. For example, one area of the exam that would absolutely need to be edited would be lab values, due to the different units of measurement used in some of the U.S. lab work (e.g. blood glucose).

When it comes to content, I have heard concerns about the differences between private versus universal healthcare. While payment for healthcare does differ between Canada and the U.S., the structures of primary health care and hospitals are quite similar. Besides, I cannot remember a single question on the exam or in any of my studying that contained information on insurance options or payment (if anyone has a different experience, please note it in the comments below).

There are many advantages to bringing an NCLEX style exam to Canada.

  1. It is computerized. There would be no need to print out hundreds of exams, or organize testing spaces (already established testing facilities would likely be used). Furthermore, content could be updated faster to reflect current research and practices.
  2. Flexibility. Nurses would be able to take the exam whenever a testing facility had an open space, rather than the four arbitrary days that are currently available. Nurses would no longer have to wait another three months to take the exam if they are unable to make it on a particular day.
  3. The exam is “smart”. A computerized smart exam is more effective at determining a nurse’s competency because it will continue to ask questions until it knows within a certain statistical certainty that the writer does, or does not, know the content.

So, do I want the NCLEX to become the standard for testing Canadian nurses? Absolutely not! Do I want a computerized, pathophysiology-based, difficult exam which reflects nurses’ unique knowledge? Absolutely!

Rather than fight this process, let us use it as an opportunity to reform the exam and ultimately have it reflect our amazing profession.

The views and opinions expressed in this post do not necessarily reflect the views and opinions of the ARNBC.

ABOUT NICKIE SNYDER

Nickie Snyder is an ICU RN for Fraser Health and also helps with their new graduate nurse workshops. A dual Canadian/US citizen, Nickie lives in the US, works in Canada, completed her undergraduate degree in nursing in Canada and is currently enrolled in a combined Masters and Doctorate of Nursing Practice program at the University of Washington.  Nickie plans on becoming a Nurse Practitioner, and hopes to teach nursing as well. Dynamic, energetic, and passionate about nursing, Nickie loves to share about her experiences and advocate for the nursing profession. She is also a social media addict and can be found at www.twitter.com/missnickie

25 thoughts on “A Canadian version of the US Licensure Examination, eh? by Nickie Snyder RN

  1. Ali

    Thanks to all who have posted–has been an interesting read so far!

    I am a recent graduate (April 2015) and failed the NCLEX-RN this year. Apparently, my school acquired a lower pass rate with the NCLEX than with the CRNE. This is quite possibly related to the education offered in our nursing program. Our schooling has not catered toward the ins and outs of the NCLEX test structure. I have noticed that NCLEX prep courses (what I have been taking outside of my nursing program) prepare students for writing to the style of the NCLEX questions. The NCLEX has a specific tone, as did the CRNE. At my school, we quite possibly were still getting educated to take the CRNE–the curriculum did not adapt to the changes. Now, that I have been engaging in some fantastic NCLEX prep courses, I feel more confident that I will tackle questions in a more accurate way. Folks who fail are less capable of critically thinking their way through questions, it is that we were/are possibly not prepared, warmed up, ready for the endurance race that is the NCLEX. I have now learned some great ways to break down questions: what are they really asking, algorithms. In school, I encountered one after-school session where an instructor brought this to life.

    Throughout the four years, we seldom received NCLEX prep during school time with support and direction of faculty (faculty were not familiar with the NCLEX and therefore how to troubleshoot). At the second to last semester in fourth year, some instructors would bring out 10 question quizzes before class would begin. They were American content quizzes, for at the time appropriate Canadian content was not accessible (or the instructors did not know)? When questions would come up about unregulated care providers’ skill sets or other providers’ scopes, hospital revenue, cultural variances and health insurance etc, no one knew how to answer to the tone of the NCLEX or if these questions would be a part of the exam. On my exam (265 questions), I encountered roughly 15 questions that seemed to resemble American content.

    My successes and failures are not the responsibility of the instructors, solely; it certainly is joint. However, I wish there would have been more support to the schools/faculty to then better support students. I have heard that in the US where this exam has been rooted for a long time, nursing programs will teach to the exam. Perhaps, this will come to be for Canadian nursing schools in future years. Unfortunately for me, and many of my peers, we carry the burden of being the guinea pig year, where little preparation via the educational institutions, and support to instructors to have the understanding/training to then support their students was present. I am bitter for I have worked extremely hard for the position that I am in, and I am so thankful for this amazing education I received (my university used to be one of the higher scoring schools on the CRNE, nationally). It is/will be challenge managing a second exam fee and overnight travel to one of the few testing centers in the province, and the pressure of losing registration (on a second failed attempt).

    Lessons learned for the years to follow and be successful.

    Reply
  2. anon ymous

    The nclex is a joke. I feel like it is setting us up for failure. I’ve written it and failed and it tests on areas that we aren’t expected to know (without specializing). The medications were medications we do not use in canada. How is that fair whatsoever? If you’re going to make us write the exam in Canada, it is only fair to adjust it so we have a fair opportunity to pass.

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    1. Trisha Hrynkow

      They do not want Canadian nurses, why do you think you can t even have your document evaluated by a BON in the states , most of them with out a SSN. YES MANY OF THE QUESTION not all are for emerg nurses and ICU nurses and lots on anti terrorism and bio terrorism and way more on maternity and pregnancy than the Canadian exam. Further testament is the fact that although the body hasn’t changes in years the text and American nursing literature keeps forcing students to buy new materials U.S based every year. Canada has an open door policy to accepting foreign nurses and embracing their knowledge .. the U.S is treating Canadian nurses poorly. i went through the NCLEX before the end of CRNE and it wouldn’t have mattered BECAUSE in the end they still will find as many loop holes to deter Canadian nurses from migrating south. i think fair is fair and if they don’t acknowledge the history and contributions of our nurses especially since we use many of their text then I am starting a site or blog to bring light to how and what is happening!! God bless you

      Reply
  3. Ashton College

    Great post examining the benefits of introducing the NCLEX exam in Canada!

    Now that the exam is being offered, it will be interesting to see the effect (if any) on exam pass rates, as well as individual school pass rates.

    Reply
  4. Camilla Artwell

    I am from Jamaica, I will be sitting my NCLEX Exams soon in the States. I would like to know after doing the exams, will I be able to practice in Canada without doing any exams?

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  5. Amy

    So does this mean that there will no longer be a limit on how many times Canadian Graduates can write the exam?

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  6. Tiffany

    Would Canadian NCLEX be accepted in U.S when we start the NCLEX exam in 2015, in that way Canadian Nurse can go across the border to work without redoing the exam all over again. If this Canadian version of NCLEX will be accepted across the border, I think it would be a good idea.

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  7. narathiri bijoy

    I did both exam and i find NCLEX is testing the real knowledge of a nurse in all area the computer set accordingly for example if a nurse did wrong in some questions in maternity the computer will give more questions from the same area and they clearly assess us as a nurse but in CRNE i don’t think it assess real knowledge mainly it give preference to psychological. I have one question that .. is it possible that who has NCLEX RN can work as a nurse here in canada?.one of my friend got NCLEX RN and i know her knowledge in each area because we worked so many years together and we all used to say she is an asset for us and the hospital and more over she used to teach us.. but she could n’t clear CRNE. but some other friends who don’t have the knowledge could go through it …so, i am asking for her is she can use her NCLEX here in canada.?

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  8. Nurse Vitals

    I have also written both exams, and I must say, the NCLEX was way less ambiguous than the CRNE, especially with all those psychosocial questions. Besides, on the NCLEX, your passing score is not based on how everyone else did; and you don’t have to wait weeks to get your results, and it is entirely multiple choice-no case scenarios. Another advantage of the NCLEX was, I finished in 45 minutes. It didn’t take 4 hrs as it did with the CRNE. The computer shuts you off based on how many ques you answer correctly or incorrectly.

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  9. Beverly OMalley

    ” I believe that nurses around the world are trained to think critically, …”
    In this belief you are wrong.
    there are many many countries in the world where nurses are not taught to think at all but rather to follow orders without question.

    As a nursing educator who has worked with nurses from all over the world who are preparing for licensure in Canada I can tell you that thinking critically is the major challenge for many IEN’s. It is not that they are not capable…just that they have not had the experience of perfecting this cognitive skill in the role of the nurse.

    This often makes it difficult to achieve the same level of success on the CRNE as domestically educated nurses. IEN’s are often looking to recognize the correct answer rather than reason it out.

    The pass rate for IEN’s is consistently about 30% lower that those candidates who took their education in Canada.

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  10. Susan Fox

    Does anyone know if this story is true, or is it another urban myth. i hear that some guys who had degrees in other professions wrote the nursing exam and passed. people say it’s a joke. is it ture?

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  11. MDaly

    I am very pleased about the prospect of the exam being made available at multiple sites at multiple times per year. I understand the new test will also be harder to cheat on. I realise that there is concern about an American vendor, but can someone tell me how nursing in Canada differs from nursing in the US? CNA I am sure is upset about this decision, and rightly so. I imagine this was an important revenue stream for them.

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  12. Sarah J

    thanks to everyone for a gooddiscussion. I think that people should look more closely at CNA’s financial affairs. Why do you think that RNs get so much from them for about $40 year (the magazine, big staff, etc.)? They get half their budget from the poor new graduates who write the CNRE. Think about the people who write it two times or more before they pass…. the whole profession has paid for the CNA by puting the cost on the backs of these poor people who have hugh student loans when the graduate! this is mostly about $$$$…. as things often are. i bet the new exam is going to be way cheaper

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  13. Paddy Rodney

    Thanks to all for some important (and lively!) discussion on the RN exam issue. At the ARNBC we are following this issue closely and will continue to provide updates in our News section.

    I wanted to add that even if the CNA was unsuccessful in a bid to “host” the exam, the fact that the decision to go with a US company and a completely different format still OUGHT to have been discussed more with nurses across Canada. In other words, the CNA’s involvement in the bid doesn’t mean that their critique is wrong.

    Thanks for “listening”!

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  14. Jerrymacrn

    The RN regulators issued an open RFP (Request for Proposals), and Assessment Strategies, Inc. (ASI), the CNA’s wholly-owned for profit subsidiary, was invited to submit a proposal. However, this was a competitive bid process, with all the proposals subjected to an objective and rigourous analysis, and ASI’s proposal was not the successful one. It’s as simple as that.

    Reply
    1. Alison S.

      Thanks Jerrymacrn. That’s the information I don’t think the CNA is being forthoming about. They bid. They lost. A person could assume that they lost because their bid wasn’t as good.

      Maybe instead of joining their sour grapes campaign, we should first ask them to show us the bid they submitted. Or ask the regulators why they chose as they did.

      Why are we all assuming that this campiagn is anything less than sour grapes on behalf of a losing bidder? It stands to reason that the CNA bid was either inadequate or overpriced.

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  15. Alison S.

    There must be a reason why the regulators decided not to have the CNA administer the exam anymore. I feel like the CNA isn’t telling the whole story.

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  16. Sally Thorne

    I have really appreciated these perspectives, and the dialogue has confirmed that BC nurses really do want information that will help them reflect on issues and alternatives, rather than simply polarizing into “for” and “against” positions. These are complex and changing times for professional regulators, and as a profession that values self-regulation, it is very much in the interests of nurses to stay informed. In BC, the CRNBC has the mandate to make these decisions on behalf of the government, following principles and guidelines for good practice that are shared with other health professions. As individual registrants, it is right and appropriate for us to ask questions so that we can fully understand the basis for major changes in direction. And if nurses want further input into the decision making in that regard, they have opportunities to involve themselves in the CRNBC by stepping forward to participate in committees or on the board. As this issue unfolds, I hope we’ll all keep our eye on the main goal, which would be to ensure that our professional registration exams operate with the kind of integrity and contextual relevance that we have come to expect and rely on in this country, even as they evolve into formats that meet the needs of the future.

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  17. Shona Johansen

    While I agree with many of the comments written so far about the CRNE vs USA NCLEX my comments are less concerned with the exam format or even content, but with the process used to arrive at the decision.

    The CRNE has been the trademark of success for every Canadian Nurse. The culminating event of several years of hard work and little play. Before you suggest that this might be some sentimental drivel coming from one who graduated 38 years ago, I can assure you it is not. In comparing samples of the two exams, I would argue that regurgitating information that requires primarily a process of recall and a good memory does not a sound practitioner make. As well, the structure of the USA health care system clearly delineates the pecking order of its caregivers that in my opinion, leaves less room for autonomous practice or critical thinking (I am sure that many will disagree with this statement). The Canadian nurse is required to work in a system that is less proscribed and the expectation of thinking critically has become, rightly or wrongly, a given for most nursing educational institutions.
    I am wondering if the 10 regulatory bodies forgot that Canadian nurses can think for themselves and are taught to make decisions based on evidence and best practice.
    Where is the evidence that this is a good thing to do? Has there been consultation with nurses who are experienced exam writers, experts in psycho metrics and bedside nurses with good common sense? I find the process to be misguided and insulting to all Canadian nurses.

    Reply
    1. Nickie

      Thank you so much for your comments Shona. Here is a link to the CNA website which has some history to how this decision came about http://www.cna-aiic.ca/CNA/nursing/rnexam/history/default_e.aspx

      I will respectfully disagree about your perception of Canadian nurses needing to critically think more. I believe that nurses around the world are trained to think critically, however some nurses are better at using those critical thinking skills. Personally, I did not find that the CRNE addressed those critical thinking skills. In fact, while studying with my classmates, we would often get the same practice questions wrong BECAUSE we were trying to critically process through them and in the end, that was not what the question wanted us to do.

      I realize that some of the questions on the NCLEX seem like “regurgitation” style questions, but there are MANY that are not and require intense analysis. I do think that some of these questions are necessary though. While it is important for nurses to understand therapeutic communication and how to provide comfort to a patient experiencing an MI (I found many of the CRNE questions to focus on this type of content), this knowledge is useless if you cannot recognize the signs and symptoms of an MI in the first place!

      I wholeheartedly agree with your comments about evidence! I do not know what evidence the 10 regulating bodies used to select this testing method, and think that would be an interesting question to ask them.

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    2. Melody

      I am a Canadian LPN studying RN in the US and in both programs on both sides of the border we are taught to both think critically and follow evidence based practice while following the nursing process. Next June I will be writing the NCLEX in the US with a fee of $75. If I wish to pursue writing the CRNE it will cost upwards of $3000 to cover skills assessment, application fee, exam fee and license. Why the big $$ difference, I hope when the time comes the province will accept my US license.

      Reply
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  19. Abigail Wright

    I’m trying to understand how this will work. Will the US company administer the exam and collect the data? Is there any danger in that? My health authority won’t even let us use Survey Monkey or respond to surveys that are made on Survey Monkey because of the fear that it’s an American compay and all that information they gather is accessible to all sorts of people. I think there are parts of the Patriot Act that make data collected usable by other government organizations? I would think it could be potentially a problem to have Canadian data in the hands of the American government. How will they use it? If every single Twitter in the world is saved in the Library of Congress, I can’t imagine they won’t be keeping this information somewhere. What are the long-term implications? The exam aside, and the convenience of it aside, could our privacy be in jeopardy because of this? The laws aren’t the same between our two countries around data collection. Does anyone know?

    Reply
    1. Nickie

      Abigail – my understanding is that the American company has been hired/contracted to write the test, but that the test has to reflect Canadian content. My guess is that they will use some questions that are used on the NCLEX and then write others that relate directly to Canadian content.

      As for the “data”, I’m not sure what the US government could really collect. The test is generally administered in the US through Pearson Vue, a testing facility that gives hundreds of tests, including other licensing tests and grad school entrance tests such as the GMAT. They would likely require name and address from the people wishing to take the test, as well as approval from the licensing body that the person is eligible to take the test. For example in BC, the new nurse would still apply through the CRNBC for licensure and submit their academic records/confirmation showing eligiblity. The CRNBC would then indicate to Pearson Vue that the student can take the test.

      Since Pearson Vue is a private company, I don’t see them handing over info to the government, but I could be wrong. The only “data” Pearson Vue would have would be name, address, and your grade…. but it just seems to me that these would remain confidential.

      Reply
  20. Sarah

    I took the CRNE and the NCLEX as well and I much prefer the format of the NCLEX too. I think there is an ambiguity in the CRNE that can be resolved if it’s format is changed to the NCLEX format. Certainly the uniqueness of the Canadian nursing system must be addressed within the exam’s questions but a computerized format would be more suitable in assessing and evaluating the competencies of our nurses. Also, bonus, finding out the results after 2 days is also a really great feature.

    Reply

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