Ineligible Internationally Educated Nurse Applicant Characteristics in Relation to Application for Registration Process Outcomes

Transcription

1 Ineligible Internationally Educated Nurse Applicant Characteristics in Relation to Application for Registration Process Outcomes March 2016

2 Executive Summary The Learning from Experience: Improving the Process of Internationally Educated Nurses Applications for Registration (LFE) project sought to use evidence to increase the efficiency of the internationally educated nurse (IEN) application for registration process, while remaining committed to the principles of fairness, transparency, and above all, public safety. The project included findings from an analysis of application characteristics that contribute to success or challenges in the process. Specifically, this analysis investigated whether there were application characteristics related to IENs being deemed ineligible for registration in Alberta during the IEN application for registration process. This portion of the project sought to: 1) Identify application characteristics of ineligible applicants; 2) Quantify the volume of applicants deemed ineligible at each phase of the IEN application for registration process; and 3) Understand time spent by ineligible applicants in the IEN application for registration process. The analyses included both exploratory and confirmatory statistical analysis of complete application files received at the College and Association of Registered Nurses of Alberta (CARNA) from IENs over three study periods ranging from January 2008 to May During that time 436 applications were deemed ineligible. Exploratory analysis included descriptive statistics of characteristic and outcome variables, and process timelines; as well as cross tabulations between characteristic variables and key outcome points. Logistic regression modeling was conducted for the outcomes following a Substantially Equivalent Competency (SEC) Assessment, the national entry-to-practice exam, and compared to applicants who received an initial RN application. Contrasting applicant groups were used for comparisons in some cross-tabulations and modeling. A timeline analysis was also conducted for ineligible applicants. The majority of applicants who were unsuccessful in becoming an RN were deemed ineligible based on their SEC Assessment results. Less than ten percent were deemed ineligible due to failing the national entry-to-practice exam three or more times and less than five percent were deemed ineligible upon initial assessment or due to failing a bridging education course two or more times. Demographic differences between ineligible applicants and the total population showed higher percentages of ineligible applicants residing in Canada at the time of application and who did not have practice currency compared to the total population. On the other hand there were lower percentages of ineligible applicants who had a degree similar to an Alberta baccalaureate and who received their education where the scope of nursing practice was similar to Canada compared to the total population. Statistical modeling at the SEC Review Outcome, Exam Outcome and Outcome: RN considered all of the modeled variables in determining the relationship between application characteristics and outcomes. There was strong evidence that applicants who received their education where the scope of nursing practice is similar to Canada Ineligible Applicant Data Analysis Report 1

3 were likely to have positive results at all three outcomes. Age, education credential, practice currency, and Canadian LPN Registration were also related to positive outcomes for at least one of the three modeled outcomes. As well, experience in countries other than the country of the applicant s education country was related to being deemed ineligible at the SEC Review Outcome. The average time for ineligible applicants in the IEN application for registration process was approximately two months for applicants who were deemed ineligible upon initial assessment, one year for applicants deemed ineligible following an SEC Assessment, two and a fifth years for applicants who failed a bridging education course twice or more, and two and a quarter years for applicants who were deemed ineligible due to failing the national entry-to-practice exam. This analysis of application characteristics in relation to ineligibility, along with other LFE Project analyses investigating characteristics related to success or challenges in the IEN application for registration process will contribute to evidence-informed policies and practices at CARNA. It also provides an understanding of the volumes of applicants who are deemed ineligible at each step of the process and the amount of time expended for applicants who ultimately are not eligible for registration. The findings from this analysis may be used by other regulatory bodies, SEC Assessment Centres, educational institutions, employers and governments to inform policy development or adaptations related to the IEN application for registration process. Ineligible Applicant Data Analysis Report 2

4 Contents 1.0 Introduction Background Project Purpose and Objectives Project Research Strategies Methods Data Collection and Variables Data Analysis Exploratory Analysis Confirmatory Analysis Results Demographics Outcome Analysis Timeline Analysis Conclusion Discussion Key Limitations Impact Appendix A: File Flow Chart Appendix B: Timeline Data Analysis Appendix C: Research Team and Acknowledgments Ineligible Applicant Data Analysis Report 3

5 1.0 Introduction 1.1 Background Over the past decade, globalization and the employment of internationally educated nurses (IENs) to address global nursing shortages have resulted in increased nurse migration 1. However, health care systems, nursing education programs, and scopes of practice differ widely between countries. In Alberta, all registered nurses (RNs) are required to provide evidence of competence in the practice of the profession 2 to obtain RN registration before they can practice. Thus the diversity in the professional knowledge, skills, attributes, values and judgements (competencies) obtained abroad can present challenges in assessing the nursing competencies of IENs. The IEN application for registration process at the College and Association of Registered Nurses of Alberta (CARNA) is complex, usually involving many phases, and often takes more than eighteen months to complete. There are multiple points in the process where an applicant s competencies are assessed to identify whether there are competency gaps, whether these gaps can be addressed within the IEN application for registration process, or if the gaps cannot be addressed and the applicant is ineligible for RN registration in Alberta. The Learning from Experience: Improving the Process of Internationally Educated Nurses Applications for Registration (LFE) research project sought to use evidence to increase the efficiency of the IEN application for registration process. This included findings from an analysis of application characteristics that contribute to success or challenges in the process. A baseline data analysis was used to inform policy and practice changes at CARNA which were implemented in August The analysis also generated further research questions including this investigation into whether there were application characteristics related to IENs being deemed ineligible during the process. Findings from this analysis may inform further policy and practice changes at CARNA. The project was led by CARNA and funded by Alberta Health through Health Canada s Internationally Educated Health Professionals Initiative. The views expressed herein do not necessarily represent the views of Health Canada or Alberta Health. 1 Blythe, J. & Baumann, A (2009). Internationally educated nurses: Profiling workforce diversity. International Nursing Review, 56(2): Government of Alberta (2000). Health Professions Act. Government of Alberta: Edmonton, AB. Section 28 (2). Ineligible Applicant Data Analysis Report 4

6 1.2 Project Purpose and Objectives The LFE research project sought to improve the efficiency of the IEN application for registration process, while upholding CARNA s commitment to public safety and to the principles of fairness and transparency. The LFE project strived to: 1. Develop an evidence-informed model for assessment of IEN applications for registration. 2. Make CARNA processes as transparent, simple and efficient as possible from receipt of a complete application to eligibility for RN registration. 3. Clearly articulate requirements and expectations of applicants. 4. Build capacity and leadership in the area of nursing regulation. The purpose of the analysis of ineligible applicant data was to: 1. Identify application characteristics of ineligible applicants. 2. Understand the volume of ineligible applicants identified in each phase of the IEN application for registration process. 3. Quantify the time ineligible applicants spend in the IEN application for registration process before they are deemed ineligible. 1.3 Project Research Strategies The strategies employed in the analysis of ineligible applicants include: 1. Analyze IEN application data to identify gaps in IEN groups applying for RN registration and deemed ineligible for registration in Alberta. 2. Observe ineligible application characteristics as related to the outcomes of the Substantially Equivalent Competency Assessment and the failure of bridging education. 3. Observe ineligible application characteristics as related to failure on the national entry-to-practice exam. 4. Compare the success rates of successful applicants and ineligible applicants at key registration outcomes. 5. Measure IEN application for registration process timelines for ineligible applicants. 2.0 Methods 2.1 Data Collection and Variables Data used in the ineligible applicant analysis was collected and combined from three data sets. Due to the system changes over the years, data cleaning and consolidation were applied to align the data for analysis. The LFE Project Research Team reviewed all of the application files received from IENs during each of the following study periods: Ineligible Applicant Data Analysis Report 5

7 Baseline data complete applications (all application documentation received) received between January 1, 2008 and December 31, 2011; Pre-implementation data complete applications received between January 1, 2012 and August 26, 2013; and Post-implementation data complete applications received between August 27, 2013 and May 29, The majority of the study population was comprised of ineligible applicants from the baseline data population (71.79%), while the pre-implementation data population comprised 21.10% of the ineligible applicants and the post-implementation data population contributed 7.11%. The following inclusion criteria and considerations were also applied to all of the data sets: Internationally Educated Nurse (entry-level nursing education received outside of Canada); Assessed under the Health Professions Act; Applications that were active, assessed or lapsed (according to CARNA s policy) after the application was considered completed; and The applicant s most current data was used in place of the original application data for re-applications. Information was collected as part of routine data collection during the IEN application for registration process and was reported within the CARNA administrative database and/or paper applicant files. Each file was individually reviewed to ensure consistent data entry. The project team reviewed and cleaned the data for this analysis from May to November Data retrieval yielded 4217 complete applications received for 4165 distinct applicants between January 1, 2008 and May 29, Of these, 436 applications were deemed as ineligible. For some key outcomes (SEC Review Outcome, Exam Outcome, and Outcome: RN) data from other applicants in the study population (n = 4165) were included in the analysis as comparison groups. 2.2 Data Analysis Exploratory and confirmatory data analyses were conducted to examine the association of characteristics variables with outcomes. A timeline analysis was also conducted for ineligible applicants only. Ineligible Applicant Data Analysis Report 6

8 2.2.1 Exploratory Analysis Data analyses for ineligible applicants were conducted using the SAS 9.2 statistical program. Descriptive statistics (frequency, cross tabulation, chi-square test, variance, mean, histograms) were generated for each variable. Continuous variables were evaluated both as continuous and categorical variables as part of the exploratory data analyses. They were categorized and described by frequency and in cross tabulations. Characteristic variables represented the applicants demographic, education, external registration and external employment practice information. Variables representing outcomes, bridging education and process timelines were also analyzed. For ineligible applicants, outcomes were considered as negative. Contrasting groups of applicants who had positive outcomes were used for comparison purpose in some cross tabulations and modeling. Timeline analysis was based on date information for the phases of the IEN application for registration process and descriptive statistics (variance, mean, histograms) were generated for each timeframe. Any time interval with negative values was excluded from the analysis Confirmatory Analysis Confirmatory statistics were also conducted using the SAS 9.2 statistical program. Logistic regression modeling was used to model the association between selected independent characteristic variables and outcomes simultaneously. Only the SEC Review Outcome, Exam Outcome and Outcome: RN were modeled for ineligible applicants and the contrasting groups with positive outcomes due to relevance and sample sizes. As well, only variables identified as significant in the baseline data analysis findings were used for reporting purpose. 3.0 Results 3.1 Demographics The LFE project analyzed data from 436 applicants deemed ineligible for registration in Alberta within the study periods and at the time of data extraction. The average age of ineligible applicants was years old compared to in the total study population. As well, 82.11% of the ineligible applicants were under 40 years old at the time of application. The majority of ineligible applicants were female (80.50%), which was also similar to the total study population (81.66%). Over two-thirds (68.58%) were residing in Canada at the time of the application compared to less than a third (31.72%) of the total study population. Ineligible Applicant Data Analysis Report 7

9 The analysis of educational characteristics showed that the majority of ineligible applicants were educated in the Philippines (65.82%), India (15.82%), and Africa (7.57%). The percentage of ineligible applicants educated in these countries was higher than the overall study population for applicants educated in the Philippines (47.56%) and Africa (5.57%) but lower than the percentage of applicants educated in India (22.30%) % of ineligible applicants had a basic education credential similar to a Canadian baccalaureate degree (3-4 years post-secondary general nursing education following 12 years of primary and secondary education). This was a lower percentage compared to 28.07% of the total study population who had a degree similar to a Canadian baccalaureate. Only 19 ineligible applicants (4.36%) received their education where the scope of nursing practice is similar to Canada, which was lower than the 18.51% of the total study population. Although CARNA no longer uses thresholds for nursing education program hours in their assessment, whether or not applicants met historical thresholds was examined (medicine/surgery education hours: greater than 150 theory hours and 350 clinical hours; as well as 50 theory hours and 100 clinical hours each in obstetrics, pediatrics, and mental health). Almost half of ineligible applicants (44.96%) met the thresholds for theory and clinical hours in education, slightly higher than the total study population where 40.58% met the threshold hours. The analysis of employment characteristics indicated that more than half of ineligible applicants only had work experience in the country of their education (56.42%) while the remaining applicants had transition experience (worked in at least one additional country other than the country of their education). This is similar to the total study population where 59.76% of applicants had experience solely in the country of their education. Only 5.73% percent of ineligible applicants indicated that they were registered as a LPN in Canada at the time of application. This was similar to the total study population (4.47%). It is important to note that this variable is derived from the applicant s registration history and some applicants may not have identified LPN registration. Practice currency is defined by CARNA as having graduated or having practiced more than 1125 hours within the last 5 years. A higher percentage of ineligible applicants did not have practice currency (9.86%) than the total study population where 3.41% did not have practice currency. Almost half (48.17%) of ineligible applicants were practicing when they submitted their application, while 9.40% had been out of practice for more than 4 years. The average number of years since last practiced from the time of application was 1.15 years for ineligible applicants compared to 0.40 years for the total study population. 3.2 Outcome Analysis There are several key points during the application process where an applicant may be deemed ineligible. These points served as the basis to determine the relationship between ineligible applicant characteristics and outcomes. The outcome variables included: Ineligible Applicant Data Analysis Report 8

10 Initial Assessment Outcome: The assessment decision made by CARNA following a review of the applicant s education, registration history and nursing experience; Substantially Equivalent Competency (SEC) Review Outcome: The assessment decision made by CARNA following the review of the report from an SEC Assessment (assessment of the applicant s nursing competencies); Post-Bridging Education Outcome: Whether the applicant has successfully completed assigned bridging education; and Exam Outcome: Whether an applicant has passed or failed the national entryto-practice exam. Overall, 13 applicants (2.98%) were deemed ineligible upon initial assessment, 381 applicants (87.38%) were deemed ineligible following an SEC Assessment, 7 applicants (1.61%) were deemed ineligible due to course failure, and 35 applicants (8.03%) were deemed ineligible due to exam failure. Data analysis was also conducted at Initial RN Registration achievement between all 436 of the ineligible applicants and applicants who received an initial RN registration to identify whether there were characteristics that differentiated applicants at the end result of the process. Initial Assessment Outcome Following the receipt of a complete application, CARNA s Registration Services department reviews the application file to determine if the applicant possesses competencies, through a combination of their education and experience, which can be considered substantially equivalent to an Alberta RN. There are four primary decisions that an applicant can receive following the initial assessment (Appendix A): 1. substantially equivalent and eligible to apply for a Temporary Permit ( TP Eligible ); 2. ineligible for registration; 3. decision deferred pending further assessment therefore the applicant is referred to an SEC Assessment; or 4. eligible for the option to complete an SEC Assessment or proceed directly to a full bridging education program (10 courses). The last option was implemented as part of the LFE policy and practice changes in August Application characteristics that may have led to an ineligible decision at the Initial Assessment Outcome included: Not educated as a registered nurse or at a post-secondary level; Not licensed as a registered nurse in the jurisdiction of education due to not applying for or failure on required exams; Has not practiced as a registered nurse for 10+ years; Does not meet the good character and reputation requirement for registration; Ineligible Applicant Data Analysis Report 9

11 Has attempted a Canadian entry-to-practice exam three or more times and has not passed; or Has completed a competency assessment for another Canadian jurisdiction and CARNA determined that the assessment identified competency gaps that are too extensive to be addressed through bridging education available to CARNA applicants. At the Initial Assessment Outcome, 82.80% of ineligible applicants were referred to an SEC Assessment; 7.57% were offered a choice as to whether they preferred to complete an SEC Assessment or proceed directly to bridging education (all of whom chose the SEC Assessment in this study population); 6.65% were deemed TP Eligible; and 2.98% were deemed ineligible for registration in Alberta. Due to the small percentage of applicants who were deemed ineligible at the Initial Assessment Outcome and the defined characteristics that lead to an ineligible decision, characteristic variables were not modeled. However cross tabulation results indicated that age, residence in Canada at the time of application, graduate education, education where the scope of nursing practice is similar to Canada, number of countries of experience other than country of education, and practice currency may be significant factors in the Initial Assessment Outcome. The cross-tabulations indicated that the highest percentage of applicants deemed ineligible at the Initial Assessment Outcome were age (7.89%) and none were residing in Canada at the time of application. As well, none of the applicants who were deemed ineligible at the Initial Assessment Outcome had completed graduate education at the time of application or received their education in an area where the scope of nursing practice is considered similar to Canada. A higher percentage of applicants who had experience in additional countries other than their country of education were deemed ineligible (4.21%) compared to the percentage of applicants who only had experience in their country of education (2.03%). As well, a higher percentage of applicants without practice currency were deemed ineligible (13.95%) compared to those with practice currency (1.78%). SEC Review Outcome After an applicant completed an SEC Assessment, CARNA reviewed their SEC Assessment results and application documents to determine whether an applicant could be deemed 1) TP Eligible; 2) ineligible for registration; or 3) required bridging education. The majority of the ineligible applicants who completed an SEC Assessment were deemed ineligible following the assessment (96.70%) however some applicants were referred to bridging education (3.30%). None of the applicants in the ineligible study population who completed an SEC Assessment were deemed TP Eligible following the assessment. Statistical modeling analyzed the 381 applicants who were deemed ineligible following an SEC Assessment contrasted to the 810 applicants in the total population who were Ineligible Applicant Data Analysis Report 10

12 referred to bridging education or TP Eligible following an SEC Assessment. After adjusting for other variables, applicants whose Education was Received Where the Scope of Nursing Practice is Similar to Canada and who were Registered as an LPN in Canada were three to four times more likely to be referred to bridging education or be deemed TP Eligible rather than being deemed ineligible. Applicants Age were also more likely to be referred to bridging education or TP Eligible than be deemed ineligible. Alternatively, there was evidence to suggest that applicants with work experience in additional countries other than their education country were more likely to be deemed ineligible compared to applicants who only had work experience in the country of their education. Post-Bridging Education Outcome The successful completion of bridging education leads to an applicant being determined to have substantially equivalent competencies and eligible to proceed with the remaining requirements. However, if an applicant fails any course two or more times the applicant will be deemed ineligible for registration. 13 ineligible applicants had completed bridging education at the time of data extraction. Of these, 7 applicants (53.85%) failed a course two or more times and were deemed ineligible while 6 applicants (46.15%) completed all their courses and were deemed TP Eligible before being deemed ineligible later in the process. A statistical model for the Post-Bridging Education Outcome was not analyzed since TP eligibility or ineligibility is related solely to passing or failing bridging education at this stage. Cross-tabulation results also showed that none of the characteristics examined were significant factors in the Post-Bridging Education Outcome. Exam Outcome Applicants are required to pass the national entry-to-practice exam within three attempts to proceed with the registration process. On some occasions applicants may be granted an additional writing however applicants who failed the exam after their last attempt (third or fourth attempt) are deemed ineligible. Of the 35 ineligible applicants who wrote the national entry-to-practice exam, 34 applicants (97.14%) wrote the exam three times and 1 applicant (2.86%) wrote the exam four times. All 35 of the applicants in the ineligible study population (100.00%) who wrote the national entry-to-practice exam failed the exam and were deemed ineligible. Considering the pathway to writing the national entry-to-practice exam, 29 of the applicants who were deemed ineligible following the exam were deemed TP Eligible, and thus eligible to write the exam, following an initial assessment (82.86%), and 6 applicants (17.14%) were deemed TP Eligible after completing bridging education. For comparison purposes, statistical modeling analyzed the 35 applicants who were deemed ineligible following the national entry-to-practice exam with the 756 applicants who passed the national entry-to-practice exam in the total population. After adjusting for other characteristics, applicants whose Education was Received Where the Scope of Ineligible Applicant Data Analysis Report 11

13 Nursing Practice is Similar to Canada were times more likely to pass the national entry-to-practice exam than fail three or more times and be deemed ineligible. Outcome: RN In total, 436 applicants were deemed ineligible at some point during the IEN application for registration process. Data from the 696 applicants who received an initial RN registration was used as a contrast group for statistical modeling. After adjusting for other variables, there was strong evidence to show that applicants whose Education was Received Where the Scope of Nursing Practice is Similar to Canada were nine times more likely to receive their initial RN registration than be deemed ineligible. Applicants with Practice Currency, an Education Credential (Degree), and Registered as LPN in Canada were also more likely to obtain their initial RN registration than be deemed ineligible. Summary of Significant Variables Applicant characteristic variables were modeled across three points of the registration process: SEC Review Outcome, Exam Outcome and Outcome: RN. For each outcome, ineligible applicants were modeled against applicants in the total population who had successful results at those outcomes. Table 1 depicts the modeled variables for all three outcomes. Bold numbers with an asterisk denote variables that were statistically significant (p < 0.05). Education Received Where the Scope of Nursing Practice is Similar to Canada was the only variable that was significantly related to all three outcomes, with applicants who received their education where the scope of nursing practice is similar to Canada being more likely to have positive outcomes. Applicants who held Canadian LPN registrations were also more likely to have positive outcomes at the SEC Review Outcome and Outcome: RN. Table 1: Overview of Significant Variable Effects on Outcomes SEC Review Exam Outcome Outcome: RN Outcome Age (Baseline = 45+) ( ) 7.54 ( ) 1.20 ( ) * ( ) 7.68 ( ) 1.66 ( ) ( ) 5.11 ( ) 1.86 ( ) ( ) 1.94 ( ) 1.82 ( ) ( ) 1.64 ( ) 1.41 ( ) Gender (Baseline = Male vs. Female) 1.16 ( ) 1.42 ( ) 1.22 ( ) Education Credential 1.14 ( ) 1.97 ( ) 1.98* ( ) (Baseline = Diploma vs. Degree) Practice Currency (Baseline = No vs. Yes) 1.35 ( ) 1.71 ( ) 2.75* ( ) Registered as LPN in Canada 3.03* ( ) 2.53 ( ) 1.83* ( ) (Baseline = No vs. Yes) Educated with Similar Scope of Nursing 3.97* ( ) 15.79* ( ) 9.15* ( ) Practice (Baseline = No vs. Yes) Countries of Experience Other than Country of Education (Baseline = Education Country Only vs. Additional Countries) 0.60* ( ) 0.45 ( ) 0.99 ( ) Ineligible Applicant Data Analysis Report 12

14 3.3 Timeline Analysis The average timeframes for ineligible applicants reflect similar findings to other analyses showing the time required to complete an SEC Assessment, complete bridging education, apply for a TP and write the national entry-to-practice exam to be the longest portions of the process. Appendix B provides an overview of the timeline analysis flowchart. On average, the 13 applicants who were deemed ineligible at the initial assessment outcome spent 55 calendar days in the IEN application for registration process. The average time for the 381 applicants who were deemed ineligible following an SEC Assessment was 366 calendar days. Applicants who were deemed ineligible following bridging education spent 808 calendar days in the IEN application for registration process. While applicants who were deemed ineligible furthest into the process, after failing the national entry-to-practice exam three or more times, spent an average of 819 calendar days in the process. It is important to note that timelines do not factor in the period of time required for the applicant to obtain, or for the source organization to send, all the supporting application documentation and for some applicants to meet the English language requirement. This period may range from several days to multiple years. 4.0 Conclusion 4.1 Discussion The analysis of application characteristics in relation to ineligibility supports the larger understanding of characteristics related to challenges in the IEN application of registration process as analyzed in the LFE Project. As well, it provides an understanding of the areas where applicants are deemed ineligible and the investment of time for applicants who ultimately are not eligible for registration. The majority of applicants (87.38%) were deemed ineligible following the completion of an SEC Assessment indicating that the competency assessment is the primary phase of the IEN application for registration process for confirming ineligibility. This suggests that the SEC Assessment is a valuable tool to determine if an applicant has such extensive competency gaps that bridging education is insufficient to prepare them to practice safely in Alberta. There were demographic differences between ineligible applicants and the total population with almost double the percentage of ineligible applicants residing in Canada at the time of application (68.58%) compared to the total population (31.72%). As well, the percentage of applicants who were not current was almost three times higher for ineligible applicants (9.86%) compared to the total population (3.41%), suggesting that Ineligible Applicant Data Analysis Report 13

15 the time spent in the immigration or relocation process may contribute to difficulties in the registration process. Conversely, there were lower percentages of ineligible applicants who had a degree similar to an Alberta baccalaureate (13.99%) and who received their education where the scope of nursing practice was similar to Canada (4.36%) compared to the total population (28.07% and 18.51% respectively). This suggests that comparability of the nature or type of entry-level education, health care context and nursing scope of practice similarities are important factors in the ability to gain registration in Alberta. Statistical modeling of the SEC Review Outcome, Exam Outcome and Outcome: RN provided evidence that Education Received Where the Scope of Nursing Practice is Similar to Canada was strongly related to positive results at all three outcomes. At the SEC Review Outcome, Age and Canadian LPN Registration were also related to being referred to courses or being deemed TP Eligible. Experience in countries other than the country of the applicant s education country was related to being deemed ineligible. This seems to refute a commonly held notion that experience in another country prior to application in Alberta is helpful in preparing the applicant for registration. At the Outcome: RN, Education Credential (Degree), Practice Currency, and Canadian LPN Registration were also related to obtaining an initial RN registration rather than being deemed ineligible. 4.2 Key Limitations The data analyzed in this study was collected from an active database as part of routine data collection during the IEN application for registration process. As data collection was not designed for research purposes, the data were not entered and cleaned in isolation however the Research Team, Data Entry Clerks and Data Analyst thoroughly reviewed and cleaned the data. CARNA transitioned to a new client management database with different functionality and coding in May A new data query was developed to extract the project data and, as the LFE Project data in this analysis spanned both databases, an alignment of data codes was required. Similar to other timeline analyses in the LFE Project, the data in this timeline analysis did not include the period prior to the applicant s complete application which may be months to years. As well, the timeline analysis did not include any information past the Exam Outcome decision point since all of the applicants had been deemed ineligible by that point. 4.3 Impact Findings from this analysis of ineligible applicant characteristics related to outcomes in the IEN application for registration process may be used in conjunction with findings from other LFE Project data analyses to inform evidence-based changes to policies and Ineligible Applicant Data Analysis Report 14

16 practices at CARNA. The learnings may also be used to inform policy development or adaptations for other regulatory bodies, and other IEN application for registration stakeholders such as SEC Assessment Centres, educational institutions, employers and governments. Ineligible Applicant Data Analysis Report 15

17 Appendix A: File Flow Chart Ineligible Applicant Data Analysis Report 16

18 Appendix B: Timeline Data Analysis Complete Application/ Ready for Assessment Assessment Time (83 days) Initial Assessment Notification SEC Time (288 days) SEC Review Time (5 days) CARNA, Applicant, Source Organizations SEC Results Received Applicant, SEC Assessment Centre, Government CARNA TP Application Time (174 days) Applicant, Employer, Government First TP Application Date TP Approval Time (11 days) First TP Approved Date Additional TPs CARNA TP Eligible Group 1: Following Initial Assessment Group 2: Following SEC Review Group 3: Following Bridging Education Completion Date of First Exam Additional Exams Exam Result Time (median=364, mean=354) Exam Start Time (300 days) Applicant, Exam Centre, Government Exam Result Date Applicant, Exam Centre Notification of Decision after SEC Bridging Education Time (413 days) Applicant, Educational Institution(s), Government Bridging Education Results Received TP to RN Time (n/a) Applicant, Exam Centre, CARNA, Employer, Government Post-Bridging Review Time (30 days) CARNA RN Application Date RN Approval Time (n/a) CARNA Notification of Decision after Bridging Education RN Approved Date NOTE: Days represent calendar days and are the average time calculated for all applicable applicants. Ineligible Applicant Data Analysis Report 17

19 Appendix C: Research Team and Acknowledgments Jennifer Kwan, LFE Project Manager Mengzhe (Maggie) Wang, Data Analyst College and Association of Registered Nurses of Alberta Cathy Giblin, Registrar/Director, Quality Assurance Loreta Suyat, Deputy Registrar Nan Horne, RN Consultant Nancy MacPherson, RN Consultant Roxanne Ferrier, RN Consultant Barry Bissoondatt, Manager Operations, Registration Services Gillian Lemermeyer, RN Policy Associate Crystal Komanchuk, Communications Coordinator Mount Royal University Dr. Pam Nordstrom, Director, School of Nursing and Midwifery University of Alberta Dr. Greta Cummings, Professor, Faculty of Nursing ACKNOWLEDGEMENTS The LFE Research Team would like to acknowledge the dedicated work of our Data Entry Clerks over the course of the project and Jessica Schaub in the development of this report. We would like to thank the CARNA Registration Services Department and Information Technology Department for their ongoing support, access and advice. Finally, we would like to thank the CARNA Leadership Team for their guidance. The Learning from Experience: Improving the Process of Internationally Educated Nurses Applications for Registration project was funded by Alberta Health through Health Canada s Internationally Educated Health Professionals Initiative. The views expressed herein do not necessarily represent the views of Health Canada or Alberta Health. Ineligible Applicant Data Analysis Report 18