NCLEX Exam. Kirsten Woodend & Jennifer Medves: We are failing our nurses Republish

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1 PNEIG January Newsletter View this in your browser NCLEX Exam The entry to practice exam for Registered Nurses was changed in January 2015 from the Canadian Registered Nurse Exam prepared by the Canadian Nurses Association to the NCLEX -RN exam prepared by the National Council of State Boards of Nursing, Inc. (NCSBN). The exam results following administration of the exam in Canada have been the cause of concern amongst nurse educators in Canada. Nurse educators have been calling for the opportunity to examine the results, discuss the exam and exam process with a view to implementing changes for Canadian candidates. Organizations calling for this discussion include the Canadian Association of Schools of Nursing (CASN) and the Council of Ontario University Programs in Nursing (COUPN). We would like to present some of the letters that have been written by our nurse educator colleagues. Elizabeth Edwards, Member at Large for Education with the RNAO has been involved in discussion with the Education Committee which supports her. Elizabeth feels that the Provincial Nurse Educator Interest Group should be disseminating the letter published in the National Post stating, First, this is an extremely well written letter with accurate information offered. It s good for our members to know that this issue is continuing to be addressed at all levels of nursing education and practice. Second, I think that PNEIG should support these two nurse educators who put the time and effort into crafting this letter Finally, it s one more documented effort that, I hope, the CNO will see and understand that nurse educators are united in advocating for changes to a process that just doesn t work here. The second letter appeared in the Mailbag of the RN Journal in the November/December issue. The letters have been reprinted with the permission of the authors, Dr. Kirsten Woodend and Dr. Jennifer Medves. Kirsten Woodend & Jennifer Medves: We are failing our nurses Republish

2 National Post December 14, 2015 Last Updated: Dec 14 5:35 AM ET The bodies that regulate nursing in Canada have made a big mistake. Motivated by the best of intentions, they brought in a new entry-to-practice exam for Canadian nurses. It is a computer-adaptive test that offers more frequent sittings and faster results than the previous exam. Unfortunately, while the new test is more technologically sophisticated than the old pen-and-paper version, it doesn t align with Canadian nursing competencies. Canadian nursing students, their prospective employers and, ultimately, all of us who use the health-care system in this country will feel the impact. Indeed, Canadian nurses are now required to write the American licensing examination (NCLEX-RN), run by the National Council of State Boards of Nursing, in order to be registered to practice in any jurisdiction other than Quebec (which has its own system). This is a problem because, while a broken arm is a broken arm in Ottawa, Ont., or Ottawa, Ill., the drugs can be different, the measurement systems are different, the makeup of the health-care team and delegation systems are different and the laws are different. Moreover, fully half of the competencies expected of a Canadian nurse are not addressed by the NCLEX-RN. The first results of the NCLEX-RN were released in September. They clearly show the misalignment between the test and the Canadian entry-to-practice competencies and curriculum. Pass rates have dropped significantly across the country. French-speaking students have been particularly disadvantaged. At the Université de Moncton, a francophone institution, the pass rate is 30 per cent, compared to 93 per cent the previous year. That is not a typo: it went from 93 per cent to 30 per cent in one year. The drop in pass rates is not a reflection of some overnight change in the quality of Canada s nurses. Our nurses are graduates of four-year baccalaureate degree programs. They are in high demand the world over, including in the United States. The problem is with the exam. So how are the regulators responding? Are they taking their supplier, the National Council of State Boards of Nursing, to task? Are they requiring that the evident problems with the test be fixed? Sadly, they are not. Instead, what we see is a circling of the wagons and a rigid adherence to canned talking points. There are no problems with the exam, they say. There are no problems with the French translation, they say. Students are not failing the test, they say. As if saying it over and over makes it so. But the numbers don t lie. So what should be done? There is no doubt that our nursing schools can focus more on teaching to the American exam (indeed, some have done so already), so that more of our graduates can successfully pass it. But this is not a good solution for Canada or its patients: an exam that fails to address our Canadian context should not be driving the curriculum in our nursing schools. The tail is wagging the dog. According to a recent Ipsos survey, four in five Canadians think that nurses, like other Canadian health professionals, should be assessed using a test based on Canadian requirements. We agree. Canadian nurses and their patients deserve an

3 entry-to-practice exam that reflects and reinforces the high quality of Canadian nursing. We are asking the Canadian Council of Registered Nurse Regulators to work with Canada s universities, colleges, nursing students and other key stakeholders to develop a solution: a truly bilingual, entry-to-practice exam for baccalaureateprepared nurses, which reflects our Canadian context and tests candidates on Canadian competencies. National Post Dr. Kirsten Woodend is the president of the Canadian Association of Schools of Nursing. Dr. Jennifer Medves is chair of the Council of Ontario University Programs in Nursing. And from the November/December Mailbag of the RN Journal: Time for dialogue to address NCLEX concerns Re: Nursing Notes, Questions raised about new entry-to-practice exam, September/October 2015 Thank you for your attention to the issue of higher fail rates across Ontario and Canada for the NCLEX-RN. Recently released third quarter results show pass rates have fallen even further, with an average pass rate of 66 per cent in Ontario and 69 per cent across Canada (Source: Mountain Measurement Report, Nov.13,2015). The average pass rate for 53 out of 98 Canadian nursing programs was below 70 per cent, and an additional 24 programs had results between 70 and 79 per cent. Even if most graduates eventually pass on a second or third write (the College of Nurses of Ontario (CNO) confirmed on Dec. 2 that 79 per cent in Ontario have done so), the fail rate remains extremely concerning. Ontario universities are working hard to identify best practices and resources to improve graduate success rates on the exam. At the same time, we have amassed significant data to show: the French translation is inadequate; there is American content on the exam; there are challenges with temporary testing centres; and there is poor access to the exam in smaller communities. Also, we are reviewing the limited and conflicting evidence on whether the NCLEX is an appropriate test for Canadian entry-to-practice nurses. At a recent meeting of the Joint Provincial Nursing committee, CNO stood by its processes for French translation and vetting for American content. The Council of Ontario University Programs in Nursing (COUPN) has invited CNO to meet with us to share the evidence we have gathered regarding the quality issues with the NCLEX in relation to Canadian candidates, and to help identify ways forward to address these urgent issues. We welcome such a dialogue. Jennifer Medves COUPN Chair Publisher s Note RNAO would like to see Ontario s regulator establish a formal group to encourage

4 dialogue and deescalate a debate that is contributing to student anxiety. As a selfregulating profession, we need to work together in a formal way to improve the situation. Click here to read more. Upcoming Queens Park Day 2016 The Registered Nurses Association of Ontario (RNAO) will be returning to Queen s Park for the 16th Annual Queen s Park Day to be held on February 25, Members are thrilled with the opportunity to engage their elected representatives and see the political process at work. Given the positive feedback with the location change last year for Queen s Park Day, the Ontario Room in the McDonald Block will again be used for lunch and for the presentations by political party leaders and health minister/critics. Members will share information on the need for: health system restructuring to devolve the functions of CCACs to the LHINs and to primary care and to enhance the mandate of LHINs to include public health, home care and primary care; legislative amendments to support RN prescribing; the need to eliminate salary and benefit inequities between primary care NPs and NPs in other health sectors; strengthening right-to-know about exposure to toxics; and, improvements needed to social determinants of health like more affordable housing. Tours of the historic building by QP staff will again be offered. Of course, as in past RNAO Queen s Park Days, our members will attend Question Period and later in the afternoon, and hope to hear directly from the Opposition Party Leaders, the Opposition Health critics and the Premier and Minister of Health regarding their views on nursing, health care and the social and environmental determinants of health. Queen s Park Day 2016 will be busy but the experience will be very positive and worthwhile for our members. (Courtesy of RNAO.ca website) The Voice of Students After a short, but sweet, holiday break it s back to the books! Along with new and exciting course loads for many, January also brings the Canadian Nursing Students Association s National Conference. The conference will run from January in Sault Ste. Marie, Ontario. There is an open Facebook group available to

5 those interested with more information on hotel and flight bookings. Registration can be found here: In addition, the Nursing Students of Ontario (NSO) interest group is developing the RNAO Student Fees Referendum which proposes that the RNAO student membership fee be added to tuition. The NSO is also developing a professional development day to be held at Western University. Details will follow! Second to last, the NSO is working closely with the RNAO to write a student statement to present at Queen s Park regarding student views on the NCLEX exam. Finally, the leadership luncheon hosted by the NSO will be focused on mental health awareness. If you have any questions, comments, or concerns, please contact the NSO executive. Their s can be found via this link: Submitted by: Rachel Caris, PNEIG Undergraduate Representative and NSO member Region 3 Regional Activities On October 21, the Hamilton Chapter and PNEIG sponsored an event with speaker Dr. Barbara Mildon, former President of the Canadian Nurses Association and now Vice President, Practice, Human Resources and Research and Chief Nursing Executive at Ontario Shores Centre for Mental Health Sciences. Barbara spoke on Relevance, Resolve and Resiliency: Nursing in an Evolving Healthcare System. There were 30 members in attendance. Barbara pointed us to the future in nursing by looking back at key trends and reports from the last decade. From these reports she highlighted recurring themes: Nurses want to be part of the design and delivery of healthcare The potential and benefits of nurses leading nurses The growth of primary care and community care Common elements from the various studies she cited included: Roles, scope and practice Nursing human resources Nursing education Nursing regulation Common themes from the reports and commissions included: Accelerate the pace of change Measure the impact and outcomes build capacity for innovation Lead system transformation Promote healthy lifestyles Strengthen primary care

6 Share responsibility for improving current conditions This is where we have been and is relevant to the progression of nursing now in Ontario. Barbara saw the issues of the future as: The use of technology such as robots which will free time for more complex nursing functions The challenge of the staffing mix what are our roles; how do we work together, integrate and complement each other? Know and examine the factors influencing nursing and the healthcare system today Resolve to be informed and engaged Cultivate resilience in order to navigate constant change and ensure nurse remains a positive force Ask questions. Don t just criticize propose a solution. Take the lead. We were an engaged group. Good discussion after. Thanks to all. Submitted by Mary Guise Region 8 The second RNAO Interest Group Open House on campus at UOIT/DC was held Nov 12 th from 6:00 8:00pm. This event provided students with the opportunity to gain more insight into the RNAO Interest Groups including the professional and educational benefits they offer. It was an amazing turn-out from popular Interest Groups, allowing many students questions to be answered. The Guest Speaker was Carol Timmings, President-elect for RNAO and Chief Nursing Officer, Toronto Public Health who addressed leadership in nursing along with sharing insights about completing the nursing program and the future of nursing practice. She gave a heart-warming speech about her journey through nursing and offered advice from her experience to nursing students, new grads and current practicing nurses who also were in attendance. Submitted by: Kelsey Glofcheskie, RNAO Nursing Student Representative and Event Organizer Marianne Cochrane, Professor & Yr 4 Coordinator; UOIT/DC Collaborative BScN Program Region 9 Regional Representative, Erin McLean, will be participating in the Annual General Meeting of the Lanark Leeds Grenville Chapter. Please note the chapter workshop on Trauma Informed Care to be held January 29 th.

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8 Region 12 The simplicity of winter has a deep moral. The return of Nature, after such a career of splendor and prodigality, to habits so simple and austere, is not lost either upon the head or the heart. It is the philosopher coming back from the banquet and the wine to a cup of water and a crust of bread. John Burroughs, "The Snow-Walkers," 1866

9 The Lakehead Chapter of RNAO, PNEIG and the Gerontological Nurses Association held an evening of conversation and story sharing about the intersections of recollection and learning Navigating Troubling Practice Events Dr. Kristen Jones-Bonofiglio is a member of the nursing faculty at Lakehead University. She completed her doctoral degree in Kristen has a background in mental health and community nursing. From her many years of nursing, Kristen understands the power inherent in nurses recollections of everyday practice life. In her Master s degree she explored ethical dimensions of everyday nursing practice and in her doctoral degree she interviewed nurses, delving more deeply into stories of how nurses navigate troubling practice events. Kristen shared with us what she has learned about nursing ethics, moral obligations and responsibilities, and the power of stories relative to contemporary nursing practice. Our Executive for President: Priya Herne Past President: Marianne Cochrane Communications Officer: Brenda Ridley Membership and Services: Mary Guise Finance/Treasurer: Sally Dampier Policy, Practice & Political Action: Elizabeth Edwards Regional Rep. West: Deborah Kane (Windsor) Regional Rep. North: Michelle Marie Spadoni (Thunder Bay) Regional Rep. South: Madonna Martin (Brampton) Regional Rep. East: Erin McLean (Perth) Member at Large Education: Elizabeth Edwards Student Representative (NSO Interest Group): Rachel Caris (London) Do you have something to contribute to our newsletter? Please send to Mary Guise (guisem@mcmaster.ca) Newsletters are posted at: Visit our website for more information

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