Official Languages Committee on May 9th, 2017

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

What can we, in the federal government, do to help you?

[Suzie Durocher-Hendriks]

You can talk to our governments.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Yes, okay.

[Pierre Godbout]

You can enforce the Official Languages Act.

[Suzie Durocher-Hendriks]

Yes, you can enforce the act and give francophones the same opportunities as anglophones.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Very good.

The lack of French-language preparatory materials is indeed shameful, just terrible.

Have you spoken to the Government of New Brunswick?

[Suzie Durocher-Hendriks]

Yes.

[Pierre Godbout]

The process is under way.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

What's the answer?

[Suzie Durocher-Hendriks]

In fact, we did it previously as well, right from the beginning.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

It didn't work, then?

[Suzie Durocher-Hendriks]

No.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

We are in a crisis. Governments really need to make a decision.

[The Chair, Liberal, Denis Paradis]

Thank you very much, Mr. Samson.

Many thanks to all of you. You have given the Standing Committee on Official Languages some excellent insight. Thank you for being here and for providing your input. It was great.

We will now take a quick break before we bring in our next panel.

[The Chair, Liberal, Denis Paradis]

I now call the meeting to order, once again.

We are delighted to have joining us two representatives from the College of Nurses of Ontario: Deborah Jones, director of communications; and Brent Knowles, director of analytics and research.

Also with us today are two representatives of the Nurses Association of New Brunswick: Laurie Janes, executive director; and Jennifer Whitehead, manager of communications and government relations.

Each organization will have about five minutes for its opening remarks, after which, we will move into questions and answers.

Welcome to the committee.

Who would like to start? The Ontario representatives will go first, then.

Mr. Knowles, we're listening to you.

[Brent Knowles, Director, Analytics and Research, College of Nurses of Ontario]

Good afternoon. Thank you for the invitation to share on this important issue.

The mandate of the College of Nurses is the regulation of nursing in the public interest. We are in a unique position nationally, as we are currently the only nursing regulator responsible for the regulation of all nurses in the province, namely, practical nurses, registered nurses, and nurse practitioners.

A component of this mandate is establishing entry requirements, including approving nursing programs in the province and approving an entry exam. In 2015, the college, along with other registered nurse regulators, excluding Quebec, approved the NCLEX-RN as the entry to practice exam for RNs.

I should mention that the exam tests whether a candidate has the basic knowledge, skills, and judgment needed to provide safe nursing care to the public. Examples of this include how you assess the need for pain management or how you perform a comprehensive health assessment. Again, it's not an American or Canadian exam; it's a nursing regulation exam.

The NCLEX is also a different type of exam. It's a computerized adaptive test. Research indicates that, when the format and delivery methods for an exam change, you would expect to see a temporary decrease in the performance of test takers.

We provided you with data to reference during the presentation.

If you look at table 1 in the handout, it shows the first attempt pass rate on the NCLEX for graduates from Ontario's registered nursing programs. In 2015, you will notice that, when we introduced the NCLEX, the first attempt pass rate dropped to 69.4% from 84.7% in 2014 with the previous exam. For 2016, the pass rate was 80.3%, returning it to the range of pass rates we had previously observed, which really showed us that the phenomenon we expected to happen through research occurred.

However, when we look at the language in which the exam was taken, we see a significant difference in the pass rates for graduates who wrote in English versus French. In 2015, 34.8% of writers who attempted the NCLEX exam in French passed. This increased slightly to 37.5% in 2016. This pass rate concerns us and the issue seems to be confounded by a number of other factors. One is that historically, we have seen lower first attempt pass rates for graduates writing in French. As you see, from 2011 to 2014 with the previous entry exam, there was a significant difference in pass rates in three of those four years.

We are also seeing a lower percentage of graduates from our French programs writing in French. Prior to 2015, the majority of graduates from French programs wrote the entry exam in French. However, since 2015, the majority have chosen to write it in English. This makes it difficult to get a clear picture of how graduates of French programs perform on the exam.

One of the things we looked at was how graduates of French programs were performing overall on the NCLEX exam. Table 2 in the handout provides this information. It highlights that in 2015, the average first attempt pass rate for French programs was lower than the average for all programs. However, in 2016, the average first attempt pass rate for graduates of French programs was about 78.3%, which is virtually the same as all programs.

The other interesting thing we've noticed is that the first attempt pass rate for those graduates of French programs who take the exam in English is higher than the overall Ontario pass rate.

We also looked at rates of registration for graduates from French programs in comparison to graduates of English programs. We saw no difference in the rates of registration or rates of entry to practice for these groups. This demonstrates that in the short term there has been no impact on the availability of French-speaking nurses to the health care system in Ontario since the introduction of the NCLEX exam.

To confirm our confidence in the exam translation, we conducted an extensive review of the exam provider's process. The results reaffirmed the rigour of the translation. In addition, an independent review of the French translation was conducted by the translation bureau of Service New Brunswick and found, "The content of the message is accurately translated." The reviewer's overall conclusion was "the quality of the French translation of the exam I reviewed was satisfactory given that there are no major errors in meaning or major language errors, and the level of French was appropriate."

However, having said that, we continue to be concerned with the low pass rates for candidates who choose to write in French. This year we will be meeting with educators in our French education programs to discuss this issue and to gain greater insight. In addition, we will be conducting research with exam candidates who graduate from a French program to gain a better understanding of their experience with the exam and what influences their choice of exam language. Some of the factors we plan to explore include the mix of English and French courses in the program, the availability of French language clinical placements in Ontario, and the language skills of the cohort.

As I have already mentioned, the college continues to look at the low pass rates of candidates who choose to take the exam in French. I want to emphasize that this has not resulted in a decrease in the availability of French-speaking nurses to the health system in Ontario, and the college remains committed to ensuring that the public in Ontario continues to have access to nursing services in both official languages.

Thank you.

[The Chair, Liberal, Denis Paradis]

Thank you, Mr. Knowles.

We'll now hear Laurie Janes. Go ahead.

[Laurie Janes, Executive Director, Nurses Association of New Brunswick]

Thank you for inviting us today, honourable Mr. Chairperson and committee members. My name is Laurie Janes. I represent the Nurses Association of New Brunswick, NANB. We are the regulators of nursing in New Brunswick as well as an association.

We're here today to discuss the continued delivery of safe, competent nursing in New Brunswick and the introduction of a new exam and the impact of that exam in our province.

New Brunswick is a small, rural province with a population of only 750,000. Approximately 30% of New Brunswick residents are francophone. We have two health regions. One delivers services primarily in English, the other primarily in French. Our French health region is the only health system offering all services solely in French outside of Quebec. Many residents served by this health authority speak only the French language.

The Nurses Association mandate is to regulate nurses to provide safe, competent, and ethical care in the interest of our public. We believe that safety is optimized when nurses can provide services in the patient's language of choice. In fact, in New Brunswick the language of choice is a right; we are the only bilingual province in Canada. All public service is mandated to be bilingual, that is, to be delivered in either French or English, as the patients and their families wish.

In 2012, all jurisdictions in Canada signed a contract for a new entry-to-practice exam, the results of which would determine whether our nursing graduates could become licensed to work as registered nurses. Representing the sole bilingual province, NANB requested that French-language resources be supported during an RFP process for the new exam. When the exam provider was named, there were no French resources included in the proposed contract.

In 2015, the first year the exam was written in Canada, the exam provider published a new online resource for nursing students. We were advised of this by a student studying for the new exam. It was published in English only. Later, in September 2015, NANB was advised that only 32% of the francophone nursing graduating class had passed the exam. The 2016 results were not much improved.

There was a resource provided through the previous exam for French-language students. There are some resources provided now. We don't believe resources or translation is the issue.

The NCLEX exam, as our new exam is named, has been written in the United States for 20 years. There is a host of published evidence clearly indicating that non-English and minority groups do not do as well as students who have English as their primary language. Further literature informs us that these same students are often held back from graduating or drop out because of progression policies implemented by nursing programs that must meet performance targets in order to receive continued funding.

New Brunswick's population is a small one to draw on for our French-speaking nurses. Because of this, French students may meet, but may not succeed, required university admission criteria. Additionally, they must concurrently study language while also studying the requirements of a nursing degree. For some graduates, this translates into lower academic achievement than is required to succeed in passing NCLEX, and this is the experience faced by non-English-speaking and minority groups in the United States.

New Brunswick is hearing anecdotal information that in some areas of Canada, our indigenous nursing graduates are also having difficulty in passing NCLEX. This is a matter of concern in a country that welcomes diversity.

We have explored, and explored intensively, the opportunity that Quebec might afford us to partner with them. However, l’Ordre des infirmières et infirmiers du Québec is currently in a transition in their exam. They're moving to a computer-based exam and are looking at a different blueprint, as it's called, for their exam.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

In French?

[Laurie Janes]

Yes.

We felt that they would be a good fit because the exam is offered in English and French and the resources are offered in English and French. However, there are some legislative barriers, and because they're in transition, they're not able to assist us at this time. Perhaps there is some opportunity in the future, but not for the next three years.

The impact of the results of the exam is serious in New Brunswick. Many of our French graduates have had to do multiple writings to attain a passing grade. That places a significant economic burden on many of them. There are few French-language resources available that compare to those commercially produced by the current exam provider.

Our French health region is concerned about a future French language nursing force. We know that this year there are 12 nursing graduates who, unless they pass the exam by the end of this month, will no longer be able to contribute to nursing care in the northern part of our province. We are very concerned.

The Nurses Association of New Brunswick believes in measuring nursing graduate knowledge and skills to assure safe, competent, and ethical care. This is our mandate. However, we are troubled by the impact of this new exam in Canada, especially in New Brunswick.

Therefore, in conclusion, NANB has three requests for the committee.

First, we request that the committee offer recommendation and support for immediate availability of French-language study resources by the exam provider. We have been making this request for two years.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

You have?

[Laurie Janes]

Yes.

We ask that a Canadian nursing group be struck immediately to complete a thorough evaluation of the impact of the implementation of NCLEX in Canada, especially for graduates whose primary language is not English and other minority groups.

We ask that the committee recommend that the results of the above-mentioned evaluation inform the feasibility of continuing to use this exam as the requirement to entry to nursing practice in Canada.

Thank you.

[The Chair, Liberal, Denis Paradis]

Thank you very much, Ms. Janes.

I want to let the committee members and witnesses know that each member will have four minutes for questions and answers, and I will be strictly enforcing that time limit. The four-minute block covers both questions and answers.

You will start us off, Mrs. Boucher.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Good afternoon.

I'd like to thank the witnesses for being with us today.

There are no words to express how deeply shocked I was to learn that every provincial professional association—other than Quebec's—came to an agreement to adopt an American exam that was developed in English. This is the year 2017. Canada has a francophone population as well. It's rather insulting to us, francophones, to see how unconcerned the provinces are about the fact that francophone students don't even have access to study materials in their language, while anglophone students have all the resources they need. That's unacceptable. This is 2017, and all of us here, on all sides, are fighting to make Canadians understand that we have two official languages. What you are describing is unthinkable.

I would like to know whether you have francophones in your associations who know how difficult it is to receive service in French. Indeed, it was the professional associations who agreed amongst themselves to adopt the American exam. Did you consult people or organizations other than professional associations? Why did you decide not to keep the Canadian exam? It was working quite well before, but you decided to go with an American exam. I would like to know why.

Why did you not demand that French-language resources be made available?

[The Chair, Liberal, Denis Paradis]

Who would like to answer?