Americanizing Canadian Nursing: Nursing Regulation Drift

A comparative analysis of NCLEX pass rates: Nursing health human resources considerations

“…While first‐time NCLEX‐RN pass rates were alarmingly low at under 70% across Canada in 2015, they have consistently improved nationally over the three years that the examination has been offered, currently standing at 82%. Yet, after three years, they remain lower than the 86.8% pass rate achieved on the previous Canadian examination (MacMillan et al, ). Despite this, the improvements seen reflect the implementation of a vast array of curricular changes and supports for students by individual nursing schools in Canada.…”

“…Canadian nurse regulators worked with the NCSBN to implement the NCLEX‐RN, without involving any other stakeholders in the country (Canadian Association of Schools of Nursing, ; MacMillan, Oulton, Bard, & Nicklin, ). In 2009, regulators initiated NCSBN‐led practice analyses in two provinces, comparing entry‐level RN practice in the United States to Ontario and British Columbia, Canada.…”

“…While the NCLEX‐RN examination is offered in 10 countries around the world for the purpose of domestic licensure by nurses who wish to work in the United States, Canada's adoption of it is “the first time that the test has been used for the purpose of licensure in another country” (National Council of State Boards of Nursing, ). Communication between the regulatory bodies and educators/other stakeholders in nursing in Canada related to adoption and implementation of the NCLEX‐RN had been poor (Canadian Association of Schools of Nursing, ; MacMillan et al, ; McGillis Hall, Lalonde, & Kashin, ). The results of the first round of Canadian examinations showed an unprecedented decrease in pass rates on the nurse licensing examination across Canada, with a pass rate of only 69% (Canadian Council of Registered Nurse Regulators, ).…”

“…In efforts to prepare students for this U.S. examination, schools of nursing made curricular adjustments, in some cases dropping programme content that could impact patient safety and care. Recent reports suggest that Canada's nursing schools may have modified their curricula to ensure that students are better prepared to pass the examination (MacMillan et al, ). Curricular changes, described as “teaching to the test,” include increasing content that is commonly found in acute care hospital settings and reducing home, primary and mental healthcare content, as the NCLEX‐RN examination is known to focus on hospital‐based practice.…”

Author response to Dickison, P. et al. 2018 Letter to the Editor re McGillis Hall, L. et al. 2018. Changing nurse licensing examinations: media analysis and implications of the Canadian experience. International Nursing Review 65, 13–23

“…The authors are aware that individual readers interpret materials differently; however, more recent publications on this topic identify similar challenges to those that emerged in this analysis, specifically from a policy perspective (MacMillan et al 2017;Salfi & Carbol 2017).…”