Hello, Mr. Chair and committee members.
My name is Cynthia Baker and I am the executive director of the Canadian Association of Schools of Nursing, the CASN. The CASN represents 94 Canadian nursing schools that offer bachelor or graduate nursing programs.
During my presentation, I will provide an overview of the problem, its source, and possible solutions. My colleagues can then briefly outline the impact of this problem on their respective schools and regions.
Let us begin with the problem.
We are here today to discuss the threat to French-language nursing training outside Quebec and the resulting impact on the care and services offered in French in minority communities.
The source of the problem is the adoption of the U.S. nursing entry-into-practice exam, the NCLEX-RN, and specifically the problems with its translation and the lack of related preparatory material in French.
Starting in January 2015, regulatory bodies across Canada excluding Quebec adopted the U.S. nursing entry-to-practice exam, the NCLEX-RN. This exam replaced the bilingual Canadian exam, which was created a long time ago by the Canadian Nurses Association.
The reason the professional boards cited for this change was that the Canadian exam was a paper-and-pencil exam, whereas they wanted to have an exam that could be administered electronically, a computerized adaptive test, so it could be administered more frequently and results would be available more quickly.
The adoption of this exam has had certain consequences.
First, the pass rate among francophones plummeted and has remained abysmal. In 2015, just 27% of francophones passed the exam. The year before that, the pass rate for the Canadian exam at the Université de Moncton was 93%, well above the national average. Its pass rate then dropped to 30% in 2015.
Graduates who have already written the exam in French warn students about the poor French translation of the exam. As a result, those students are now choosing to write the exam in English. They are also making that choice as a result of the lack of preparatory material in French.
Graduates feel therefore that they have no other choice than to write the exam in English. Some have even stated to the media that if they had known that they would have to write the exam in English in order to pass, they would have studied in English. They would have enrolled in an English-language nursing program.
The NCLEX-RN is no doubt affecting the number of students in French-language nursing programs and in turn the number of new francophone nurses who can serve the francophone public.
This is a vicious circle. The poor translation of the exam and the lack of preparatory material for the French-language exam result in a low pass rate. As a result, fewer francophone nurses are entering the francophone labour market. The reduced number of new francophone nurses offering health care services in French inevitably impacts health care services for francophones.
We recognize that the training, education, provision of care, and regulation of nursing care fall under provincial and territorial jurisdiction. We consider this to be a national problem, however, related to the provisions of the Canadian Charter of Rights and Freedoms. Moreover, the Consortium national de formation en santé or CNFS, a national health care training consortium, has made significant investments in French-language nursing programs outside Quebec in order to support the provision of care and services in French to francophone communities.
That summarizes the consequences.
Let us talk about the translation now.
The U.S. suppliers of the exam, the National Council of State Boards of Nursing, or NCSBN, had the exam translated by Geo Group Corporation, located in Madison, Wisconsin, in the United States. This group translates documents into more than 150 languages. It must be noted that producing a suitable translation of a high-stakes exam such as this is a complex process, requiring adaptation rather than translation, and we have that expertise here in Canada.
The CASN analyzed the translation of the NCLEX-RN exam. Our analysis identified serious weaknesses in the design and the process. For instance, there is no preparatory material in French. Yet a great deal of student preparation is needed to pass the NCLEX-RN exam. To make sure students pass, the schools in the U.S. invest large sums of money in the huge commercial industry that sells preparatory material in English. The NCSBN is major player in this commercial industry. There is tremendous need for that kind of preparatory material, and it is even greater in Canada than in the United States. In fact, two-thirds of the skills required for certification in Canada are not assessed by this exam or are only partially assessed. Moreover, from 17% to 23% of the exam questions assess nursing care based on the American health care context.
Since the francophone market is much too small to be of interest to the industry that produces the preparatory material, no resources are available in French.
Although the pass rate among anglophones dropped from 87% to 69% in 2015, the investments in the various preparatory resources have really paid off. The pass rate among anglophones has risen since most schools started purchasing commercial preparatory resources. Unfortunately, the francophone candidates do not have access to those resources.
I will now turn to the solutions.
Multiple national and provincial groups in Canada have written to the executive director of the NCSBN to suggest solutions, such as providing exam questions in English and in French, translating the preparatory resources into French, or developing a complete glossary, because the current glossary is truly appalling. The executive director refuses to acknowledge the problems related to this exam, denies the need to find a solution, and offers a different version of the facts. It is therefore unlikely that he will make an effort to solve the problem.
Last November, the 94 schools across Canada that belong to the CASN passed a unanimous resolution stating that the situation is unacceptable and that it is contrary to Canadian values and the interests of Canadians.
It is our understanding that the professional bodies have begun negotiations to renew their contract with the NCSBN, which expires in December 2019.
The CASN members are calling for the development of a Canadian and bilingual entry-into-practice exam. The CASN would be pleased to work with the professional bodies and to provide its expertise in the development of that exam.