Watchdog says nursing exam puts francophone students at a disadvantage

New Brunswick's official languages commissioner is slamming the licensing exam used to evaluate most nurses nationwide, saying it puts francophones at a clear disadvantage.

"Francophone candidates are not on a level playing field compared to their anglophone counterparts," the report by commissioner Katherine d'Entremont says.

It notes that in 2015 — the year provincial regulatory bodies outside of Quebec started using the new licensing exam, created in the United States — first-time success rates for Université de Moncton nursing graduates taking the exam fell from 91 per cent to 32 per cent. In 2016 the success rate increased slightly to 39 per cent.

The report cites two main problems. One is a lack of preparatory materials in French.

The second problem is in the exam's French translation. One independent review of the French version found that, while the questions were well-translated overall, some had flaws — likely caused by people changing the exam questions "who were not qualified translators."

D'Entremont's office investigated after two nursing graduates complained about the exam — the National Council Licensure Examination - Registered Nurse, or NCLEX-RN.

Language barrier

"It's absolutely atrocious for francophone students right now," Jayden Meville, president of the Canadian Nursing Students Association, told CBC. She's in nursing school in Saskatoon and graduates next year.

Meville said the preparatory materials for the exam help students practice mock questions and review material. Without comparable material in French, she said, francophone students face an uphill battle.

"For me as an anglophone, what if I went through my entire degree writing my exam in English, learning in English and suddenly when it came time to study for my registration exam, I have to study in French? I would be totally lost," she said. "I would not pass that exam either."

Nursing schools across the country are urging regulatory bodies to abandon the American exam and return to a Canadian one. (Quebec uses its own exam.)

The director of the school of nursing at Laurentian University in Sudbury, Ont., which has a bilingual program, said many of her francophone students are struggling through the exam in English.

"Ultimately, Ontario could face a decline in enrolment in francophone nursing programs, resulting in a decrease in health care professionals for our francophone population," Sylvie Larocque told CBC.

Ontario's regulatory body, the College of Nurses of Ontario, declined CBC's request for an interview. In an email, the college said it has no plans to abandon the current exam.

'Neither American nor Canadian'

"There is a difference in the first-attempt pass rates of those who write in English compared to those who write in French, but we cannot make a generalization about what is causing the difference," said the email.

The college states the exam translation was done by French-speaking Canadian nurses using Canadian federal standards.

It also said the American company that drafted the exam is now working on a practice version in both languages, which is set to be released in June.

"The current NCLEX-RN is neither American nor Canadian," said the college's email. "It is based on extensive reviews of the nursing practice competencies needed for new nurses in both countries."

Meville said the translation isn't the only problem with the exam. Its content doesn't suit the Canadian context either, she said.

The exam focuses on nursing care in hospitals — which is more common in the United States, Meville said — rather than primary care in family clinics or in Indigenous communities.

"When one of my friends wrote the NCLEX-RN it asked at the beginning, 'How do you self identify?' And the only option that they had to self-identify was American Indian," she said.

"There was no Metis, Inuit or Aboriginal option. And that in itself is proof on how insensitive this exam is to our Canadian culture and identity."

The contract for the current exam expires later this year. While Ontario has no plans to abandon it, d'Entremont is recommending New Brunswick's provincial nursing association make sure any translation of the exam be done by a certified translator by the fall.

In a statement, the Nursing Association of New Brunswick said it had just received the report and "we have shared this with our legal counsel and are awaiting further review to properly discuss with our Board of Directors."