Evidence of meeting #59 for Official Languages in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was students.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Cynthia Baker  Executive Director, Canadian Association of Schools of Nursing
Pierre Godbout  Director, School of Nursing, Université de Moncton
Michelle Lalonde  Assistant Professor, School of Nursing, University of Ottawa
Suzie Durocher-Hendriks  Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton
Sylvie Larocque  Director, School of Nursing, Laurentian University
Brent Knowles  Director, Analytics and Research, College of Nurses of Ontario
Laurie Janes  Executive Director, Nurses Association of New Brunswick

12:40 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

I can start speaking to that.

First of all, this goes back a number of years. I think one of the largest misconceptions, and you continually hear it being said today, is that this is an American exam. It's not an American exam. I think there were certain requirements we had actually requested when we went to RFP, which was an open RFP process which was bid on by exam providers in a number of jurisdictions, including Canada. One of those requirements was teaching an exam that would test entry-to-nursing competencies, not cultural differences, because we fully understand that, even in the U.S., there are very specific cultural differences between Florida, California, New York, and Michigan. The exam can't be an exam that actually—

12:40 p.m.

Conservative

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

Yes, but they speak English.

12:40 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

—looks at the cultural differences even within Canada. When we looked at the exam, one of the things we looked at was to have that be in place.

Second, the exam was not purchased and then implemented without any review process; in fact, Canadians are now part of the process for developing every question now part of the exam, both francophone and anglophone nurses. With more time, we can provide a briefing around this, how the translation process occurs, but that's involved as well.

One of the other ones that's a really difficult one to speak to is around preparatory material. The position of the College of Nurses of Ontario is that the programs would prepare the students for success in the entry exam. Prep materials support that, obviously, and we understand and do acknowledge that there is a lack of preparatory materials in French.

12:40 p.m.

Conservative

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

Yet you have material in English.

12:40 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

They're only in English, but again, it's not the role of the regulator to provide preparatory materials for students in preparing to write the regulatory exams.

12:40 p.m.

Conservative

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

I realize that, but we are francophones.

12:40 p.m.

Liberal

The Chair Liberal Denis Paradis

Your time is up, Mrs. Boucher.

12:40 p.m.

Conservative

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

I want to tell the witness this: preparatory materials are available in English, but we are francophones.

12:40 p.m.

Liberal

The Chair Liberal Denis Paradis

Thank you very much, Mrs. Boucher.

It is now over to you, Mr. Lefebvre.

May 9th, 2017 / 12:40 p.m.

Liberal

Paul Lefebvre Liberal Sudbury, ON

Thank you, Mr. Chair.

Thank you for coming to this discussion with us.

Clearly, the reason you're here, as you may know, is that the government finances, subsidizes, some of the programs to offer education for health in French across Canada.

We heard of this issue, and you had heard of it before you arrived. It's a scathing report. They came to us and said that this is an emerging situation that is very, very concerning.

Unfortunately, I'm hearing two different things. Mr. Knowles, you're telling us, yes, it's an issue and you're looking at it and will study it, and it's not that pressing for you. Ms. Janes says her group has a recommendation and is asking for some help. Those are the two messages that I'm hearing.

Mr. Knowles, I think when you came in you told us that people will still have access to nurses who speak French. They may be trained, basically, but they might not write their exam. That's kind of what you're telling us.

It's kind of difficult for us here and certainly for me, as you can see, I speak English. I'm a francophone, but I can work in English as well. That being said, for people who require services in French by francophones, it's not the same thing. I'm a French lawyer. If I had not studied in French, I would not have been able to provide the proper services in French and I would probably work in English most of the time. So when you come here and say that regardless, the francophones can still provide services in French, that is very difficult for us to accept.

You heard the recommendations from Ms. Janes. Is there a possibility that Ontario...? I know you're saying that you want to further study this, but from what you've heard today and our concerns here, financing these institutions and saying, “Well, down the road who knows where we will be”, what are your comments? Is there anything from what you've heard today on how we can move forward and improve the current situation and crisis we are facing?

12:45 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

I might as well start by saying that I hope it didn't feel as if we've underplayed or not taken this issue seriously. We do, but I feel that we are in a unique position in Ontario. I think Ms. Janes actually highlighted that there are differences even in the way the program is delivered in Ontario, and it's one of the things that we have to look at, because we have to have a greater understanding of the very nature of our programs in Ontario to understand the impacts that may influence why the students are performing the way they do.

I feel one of the concerns is that we need to look at this beyond just the factor that a difference in pass rate must mean there's an issue with the exam. We're suggesting that there could be other factors at play before we move to stepping away and saying the exam itself is the only issue. That's why we want to actually have some time to take a look at how students are performing, to talk to students, and to then speak with our educational partners as well to see what some of the issues are that are at work here.

12:45 p.m.

Liberal

Paul Lefebvre Liberal Sudbury, ON

Sir, with all due respect, that didn't happen in the first place. You didn't have those conversations with your institutions, certainly the francophone ones, because we heard that clearly before, but I'm happy that you're saying we should have that conversation, because that's where it starts.

If l’Ordre des infirmières et infirmiers de l’Ontario would have that conversation with the educators, I think that's a great place to start.

12:45 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

The other thing that I think I want to share with the committee is the role of the regulator and the role of the educational institution. As you know, the role of the regulator is to determine the entry exam. It would be something of a conflict of interest to have the education community involved in certain ways with how an exam would work, that is, a high-stake exam for entry into practice. I fully understand that we want to have communications and we want to involve our colleagues, but it's difficult to have the educational institutions determining the appropriateness of an exam for entry.

That being said, there are important stakeholders involved in the conversation that we're having, and there are also important stakeholders in terms of helping us to understand the impact of the entry exam on their student population.

12:45 p.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Mr. Knowles.

We'll now go to François Choquette.

12:45 p.m.

NDP

François Choquette NDP Drummond, QC

Thank you, Mr. Chair.

The Standing Committee on Official Languages is already quite concerned about the health care services available in minority language communities across the country, meaning French-language health care outside Quebec and English-language health care within Quebec. And now, we are learning about a problem that may further undermine the availability of French-language services all over the country.

We realize that Ontario has a problem, but it isn't the only one. This affects all the other provinces, as well. Ontario isn't alone in offering nursing programs in French. My understanding is that four or five universities provide the training.

Today, we heard from witnesses representing a number of provinces where nursing programs are offered in French. They had just one recommendation for the committee. I would've thought they would come to us with two, three, four, or five recommendations, but that wasn't the case. They recommended only one thing: that the bilingual Canadian exam be restored. The witnesses told us that following through on that particular recommendation would fix all the other issues, including the lack of French-language preparatory materials.

The Standing Committee on Official Languages is very worried about this situation. We just released a report on the new official languages action plan, and health plays a central role. The government in power will certainly want to make sure that health services in the minority language are not less accessible but, just the opposite, more accessible.

Given what I've just told you, would you reconsider your decision to use an American exam, in favour of going back to a bilingual Canadian exam? We were told that it could be done, that the science existed, and that we had the skills to do it.

I'd like to hear where each of you stand on that.

12:50 p.m.

Liberal

The Chair Liberal Denis Paradis

You each have a minute.

Ms. Janes, you can start.

12:50 p.m.

Executive Director, Nurses Association of New Brunswick

Laurie Janes

Thank you, Monsieur Choquette.

Yes, in fact, New Brunswick has been working with a variety of stakeholders, including our government, for the last year and a half now. We have advised the CCRNR, the Canadian Council of Registered Nurse Regulators, that because of our situation, we may have to explore, and now are exploring, alternatives to the NCLEX.

I want to assure Madame Boucher that the exam is currently offered in both French and English. They can write it, but there are limited resources.

It is not so much the translation that concerns us, or the resources; it is the U.S. experience for the last 20 years. We have researched, and there is a large number of research articles and documents that inform us that in the U.S., where Spanish is prevalent, the Spanish students have the same experience that our French students are having.

This is very concerning, as are reports coming from northern areas of our province, where our indigenous people are also having the same experience in terms of failure rates.

12:50 p.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Ms. Janes.

Mr. Knowles.

12:50 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

One thing I think we need to look at, and we've shared it in the data we've shown you, is that this discussion centres around a Canadian exam. I would draw your attention to the data we provided. In fact previously the exam provider was a Canadian organization, and the differences we're seeing were also in place then.

That is not to say that therefore this is not a serious issue or not an issue we need to look into, but the previous examination provider that we had was a Canadian organization, and we saw a difference in pass rates: a lower pass rate for French writers of the exam versus English writers. Our current practical nursing exam is still provided by a Canadian organization, and we see significant differences there, too, except for this year, when for a very different reason that changed.

Talking about the need for moving to a Canadian provider I think goes back to understanding what the exam tests. The exam is not a test of the Canadian health care system; it is a test of nursing competencies, and nursing competencies that are stripped of any cultural differences at all. That's really the heart of the exam. If we changed the exam, we would still be moving to an exam that would be testing that.

12:50 p.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Mr. Knowles.

We go now to René Arseneault.

12:50 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Thank you, Mr. Chair.

Thank you for your input, Mr. Knowles.

Ms. Janes, thank you for giving us insight into New Brunswick's position.

Mr. Knowles, forgive me, but your naive approach to this issue baffles me. I'm going to share a little anecdote with you.

I'm a lawyer by profession. I had occasion to practise law with some colleagues from France. Even though we would be discussing the same document with the same legal objective in mind in the same language, we did not interpret the content the same way in arriving at the same goal. And yet, I speak French very well, and I did all my training in French, as did my counterparts from France. Despite that, we had to write things differently in order to achieve the same thing.

Can you appreciate that? Do you know what I mean? You realize that I am talking about nuances.

You keep saying that the exam is not an American exam, strictly speaking. However, that isn't what the committee heard from all the witnesses representing the teaching institutions that train Canada's nurses. They told us that it was an American exam, regardless of what you say.

The language of the United States is, of course, English. I want to come back, though, to my story of two lawyers who speak French but come from different countries.

Can you see how an exam written in American English might not accurately reflect the terminology used in Canadian English or Canadian French in the field of nursing? Do you see how that could be possible? I don't have much time left, so a simple yes or no will do.

12:55 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

What I can say is that the individuals who have said that they have reviewed the exam have in fact not done so. The exam, because of the high stakes nature—

12:55 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Sorry, Mr. Knowles, but my question is simple.

Can you conceive that it's possible for the English content of a nursing exam from the United States to say exactly the same thing in Canadian English or Canadian French, but not be written in the same manner, without the same expressions or same words? Is that possible in your mind, to conceive in the mind of the Ontario college, yes or no?

12:55 p.m.

Director, Analytics and Research, College of Nurses of Ontario

Brent Knowles

It's not a yes or no question you're asking. What I'm suggesting is that it's possible, unless we have a conversation on the process it's undertaken. When we have Canadians involved in all steps of the process, including the creation of the question through the translation—

12:55 p.m.

Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Then how come there was no consultation with the institutions, with the universities? How come?