As many people have now heard, last week it was announced that as early as 2014 or 2015 the CRNE will be replaced with the NCLEX.
You can read about this here:
http://www.cna-aiic.ca/CNA/news/releases/public_release_e.aspx?id=307
In other words, starting in a few years, in order to become a nurse in Canada you will need to write the American nursing examination!
While the reasons for this change are unknown, this has ignited a hot debate within the Canadian nursing community. The Canadian Nursing Association feels this change will pull Canadian educated nurses to the United States, making it easier for nurses to travel and obtain work south of the border.
Certainly it seems there is a risk of this, which is particularly contentious in current climate of a Registered Nursing shortage.
While we haven’t been able to find a statement from the licensing organizations yet (such as nursing colleges or provincial associations), there are likely various reasons they have decided to move to the NCLEX.
While it may seem the switch to the NCLEX is an easy option, the NCLEX is a very different exam from the CRNE.
Interestingly at PRIMED we find that many Canadian educated nurses struggle more with the NCLEX and many internationally educated nurse struggle more with the CRNE.
Here is a breakdown on some of the differences between the CRNE and the NCLEX.
NCLEX | CRNE | |
Administration | Anytime- Students book through the testing centre Via computer- Students write the exam on computer | 3 times/ year: the CRNE is administered winter, fall and spring yearly Via paper/ pencil: papers are marked |
Number of Questions | Exam ends when students reach passing or failing mark. May end after 60-80 questions. Questions can have multiple correct answers and students may be instructed to “choose all that apply” | 200-220 questions. 200 questions, all are marked. Students also have 20 test questions on top of the 200. Mark is based on 200 questions. Each question has 1 correct answer. |
Cognitive Domains | Uses Bloom’s taxonomy for cognitive domain- Describes the majority of the examination as being “higher level of cognitive ability”. Unclear if exam also covers affective domain. | Outlines 3 taxonomy levels: Cognitive Domain 1. Knowledge comprehension 2. Critical Thinking Affective Domain 1. Attitudes and Judgments |
Content of exam | NCLEX is organized into “Client Need” categories: 1. Safe & Effective Care Environment 2. Health Promotion and Maintenance 3. Psychosocial Integrity 4. Physiological Integrity | CRNE is organized into 4 Competencies: 1. Professional Practice 2. Nurse-Client Partnership 3. Health & Wellness 4. Changes in Health |
Here is an example, taken from the NCLEX development website of an NCLEX sample question. This question can easily illustrate some of the differences between the Canadian and American exams.
“The nurse is caring for a client in a long term care facility. The client’s spouse asks the nurse a question regarding the client’s treatment plan. Which of the following responses would be most appropriate for the nurse to make?
a. I cannot give you information on any client.
b. Can you verify the clients date of birth?
c. Let me ask the primary health care provider to speak with you
d. You should speak directly to the client about the treatment plan.
The NCLEX states that the correct answer is:
a. I cannot give you information on any client
Many Canadian educated nurses might struggle with this question.
While we are taught that we cannot provide confidential client information to other people, we are also taught from a model of family centered care in which we try to share “complete and unbiased information whenever possible”. In the CRNE this question would likely be worded differently, with an option for the nurse to extend a more family centered care perspective to the patients spouse. The nurse who has prepared for the CRNE might expect to see something like:
“I’m unable to give you confidential information on your partner, but let me speak with your spouse so I can determine what he/she would like me to share with you”
Another difference is that much of the content covered in the NCLEX guides can fit within one of the Canadian competencies- the “Changes in Health” competency. This is seen through an increased number of questions that are more clinically or process focused. The NCLEX seems to offer fewer questions on communication and aspects of nurse-client partnership as outlined by the Canadian competencies.
The change from the Canadian RN exam to the NCLEX leaves many nurses, educators and students with outstanding questions.
1. How will Canadian content be included or accounted for in the exam
2. Will curriculums need to be altered to ensure students achieve success on the licensing exam?
3. What will the cost of the new exam be to students?
4. Will this exam draw more Canadian nurses to the USA as the CNA fears
5. How will this change be implemented
6. How do we ensure Canadian nurses continue to meet the standards of practice for Canada when we are not examining on these standards?
PRIMED Educational Associates will continue to offer CRNE preparation and continue to monitor this situation as it develops. We will update our students on the conversation as it unfolds.
In the meantime, we wish everyone continued success with their education and for those students writing the CRNE this winter 2012- time to get studying!
Happy Holidays,
PRIMED Education
