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

11:40 a.m.

Liberal

The Chair Liberal Denis Paradis

Pursuant to Standing Order 108(3), we are studying the issues related to French-language training in the nursing field in Canada.

Since we have been delayed by the vote in the House, each witness group will have 40 minutes.

We are pleased to welcome this morning Ms. Cynthia Baker, executive director of the Canadian Association of Schools of Nursing; Ms. Michelle Lalonde, assistant professor, School of Nursing, University of Ottawa; Mr. Pierre Godbout, director, School of Nursing, Université de Moncton; Ms. Suzanne Durocher-Hendriks, assistant professor, School of Nursing, Edmundston Campus, Université de Moncton; and Ms. Sylvie Larocque, director, School of Nursing, Laurentian University.

Welcome. You will have the floor for a total of about 12 to 15 minutes, time that you will have to share. We will then go around the table. That should take about forty minutes.

Let us proceed with the first presentation.

11:40 a.m.

Dr. Cynthia Baker Executive Director, Canadian Association of Schools of Nursing

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.

11:45 a.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Ms. Baker.

Mr. Godbout, you have the floor.

11:45 a.m.

Pierre Godbout Director, School of Nursing, Université de Moncton

Hello.

My name is Pierre Godbout. I am the director of the School of Nursing, which offers programs at three campuses: in Moncton, Shippagan, and Edmundston, which my colleague is representing today.

The School of Nursing is the only institution east of Quebec that offers a bachelor of nursing in French. The school has a rich tradition, having marked its 50th anniversary about two years ago. So we have been training nurses for a long time.

The last time the Canadian exam was given, the pass rate was about 93%; the rate was similar in the years prior. The pass rate was high and employers made favourable comments. In 2015, when the new exam format was introduced, the class had a pass rate of 32%. That was an insult to us since our students had worked long and hard throughout their bachelor program. In 2016, the results were similar, with a 39% pass rate. Things have not improved.

As a result, students have to write the exam several times, which is very problematic since it costs about $450 each time. Some students in the class of 2015 wrote the exam up to six times. It took two years for the pass rate of that class to reach about 88%. The students have until the end of May to complete it.

In New Brunswick, programs have to be approved by the Nurses Association of New Brunswick to ensure they meet standards. They must also be approved by the CASN. Our programs therefore meet the training requirements of both the provincial body and the national body. So this exam was a huge insult to us.

It is also very important to remember that New Brunswick is an exception, owing to its francophone population. We are working very closely with the Nurses Association of New Brunswick to find solutions. That is why we are here today.

Thank you.

11:50 a.m.

Liberal

The Chair Liberal Denis Paradis

Thank you very much.

Ms. Lalonde, you have the floor.

11:50 a.m.

Michelle Lalonde Assistant Professor, School of Nursing, University of Ottawa

Hello.

I am Michelle Lalonde, assistant professor in the French-language program at the University of Ottawa.

The University of Ottawa offers a bachelor of nursing in English, in French, and as an immersion program. We have the same admission criteria for all programs. Our programs have been approved for five years by the CASN.

Since the NCLEX-RN exam was introduced in 2015, there has been a drop in the number of francophone graduates from the University of Ottawa who have written the exam in French. The pass rate has been below 40%. In 2016, just 15.8% of our students wrote the exam in French, and the pass rate was 39%. In 2017, it is expected that 64% of students will write the exam in English.

Here are the main reasons that University of Ottawa graduates do not want to write the exam in French. They feel that the preparatory resources in French are inadequate and that the translation is poor. This has also been reported in the media. As a result, they are afraid of failing the exam. Failing the exam can result in job loss, as well as the additional cost of writing the exam again. Our second-year students are already expressing fears about the exam.

As a school and as teachers, we are afraid of the negative impact this will have on minority francophone communities.

Thank you.

May 9th, 2017 / 11:50 a.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Ms. Lalonde.

You have the floor, Ms. Durocher-Hendriks.

11:50 a.m.

Suzie Durocher-Hendriks Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton

Hello. Thank you for listening to us.

My name is Suzie Durochers-Hendriks and I am an assistant professor at the Edmundston campus of the Université de Moncton.

In 2014, 100% of students at our campus passed the entry-into-practice exam. In 2015, the pass rate was 30%, even though the students had taken exactly the same training program.

My colleague Mr. Godbout noted that our program has nonetheless been approved for seven years by the CASN and for five years by the NANB. In both cases, this is the maximum approval period possible.

After taking their training entirely in French, our students have no choice but to purchase material in English, and that in an officially bilingual province.

Several media reports partially blamed the Université de Moncton program for the francophones students' failing the NCLEX-RN exam. The number of students registered at the Edmundston campus has decreased since then. This year, we have just 12 new students. In the past, we typically had from 25 to 35 new students, and have had as many as 60.

The francophones of northwestern New Brunswick are primarily unilingual and have very limited skills in English. Attending a French-language program and then having to prepare for an exam using resources that are in entirely English runs counter to everything we know about educational methods. Our students say they spend as much time trying to understand the English as they do the content of the practical questions.

This threatens the French-language health services available to our patients, their families and our communities, in northwestern New Brunswick in particular. There is also an emotional impact on our students who cannot pass the exam.

11:55 a.m.

Liberal

The Chair Liberal Denis Paradis

Thank you, Ms. Durocher-Hendriks.

Ms. Larocque, you have the floor.

11:55 a.m.

Sylvie Larocque Director, School of Nursing, Laurentian University

Thank you.

I am the director of Laurentian University's School of Nursing, which offers a bachelor of nursing entirely in French, as well as a program in English. The French-language program is supported by the Consortium national de formation en santé. We have the same admission criteria as for the English-language program, except for an additional requirement related to French since the students study in French. Our program has been approved for the maximum of seven years.

In the past, the majority of our francophone students took the national exam in French. Some of our classes had a very high pass rate on their first try, up to 100%. We also noted that, in the past, those who took the test in English had a lower pass rate since they had studied in French for four years.

In 2015, the majority of our students decided to take the exam in English. In 2016, 100% of students took the exam in English. In 2017, just as many students will take the exam in English. Among the reasons given are the fact that the preparatory resources for the NCLEX-RN exam are available in English only. It has also been pointed out that the translation of the exam is poor. The students said they got this information from other students who had taken the exam.

The consequences of failing the exam have already been mentioned: it can lead to job loss and additional costs.

We conducted a survey among this year's graduates. We asked those who took the French-language program whether, if they could go back in time, they would still choose the French-language program. Only 44% of them said yes, they would, because of the integrity of our program, because they can study in French and are proud of being bilingual, and because they can work in both languages. On the other hand, 28% of them said no, since there was no preparatory material in French for the NCLEX-RN exam and because they felt they really had no choice but to write the exam in English. The remaining 28% were undecided.

If this trend continues, there will be a major impact on the number of francophone graduates and on the health services offered in French to francophone minorities. This also runs counter to the work of the Consortium national de formation en santé, which seeks to increase the number of francophone professionals who can offer services in French.

11:55 a.m.

Liberal

The Chair Liberal Denis Paradis

Thank you very much, Ms. Larocque.

Since we are running slightly late, the first round will be a five-minute round. I am going to be strict about respecting the allotted time so that as many people as possible get a chance to speak. The five-minute rounds will include both questions and answers.

Mr. Généreux, you may begin.

11:55 a.m.

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Thank you, Mr. Chair.

I want to thank the witnesses.

I will be brief.

First of all, what does the acronym AIIC stand for?

11:55 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

It is the Association des infirmières et infirmiers du Canada.

11:55 a.m.

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Fine.

There are no representatives from AIIC here today. There may be some in the second half of the meeting. If so, we will ask them why it is so difficult to obtain a proper translation of this online exam. Allow me to paraphrase the prime minister: it's 2017, after all. You say that you wanted to go from a written examen to an online exam. If that is indeed the reason why this exam was adopted — and I hope that the AIIC representatives will be able to confirm it — I can't believe that this is that complicated in 2017.

What I am hearing today is beyond me. I can't get over it. I don't want to use qualifiers to describe my thoughts. One wonders if it isn't done on purpose in order to avoid having to provide services to francophones in their language throughout Canada, especially health care. This is beyond me, truly.

I would have 50,000 questions to ask you, but I will limit myself to this one.

When we were preparing for this meeting, we noticed that some people did not seem to see a problem concerning the success rate on the exam. Does the failure rate have to be 100% for people to understand that there is a problem?

How is it possible that this can't be done in Canada?

Noon

Director, School of Nursing, Université de Moncton

Pierre Godbout

Aside from the francophone nurses of Quebec, only 4% of nurses elsewhere in Canada are francophones. That is part of the answer. We aren't considered numerous enough to justify the creation of commercial material. The market is not big enough.

Noon

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

We know that health is a matter of provincial jurisdiction, like education. Mr. Godbout, I understand from your answer that the provinces cannot get together to pay for the training.

What do you think, Ms. Durocher-Hendriks?

Noon

Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton

Suzie Durocher-Hendriks

Yes, that is precisely it. The many problems related to that exam, including the French, were mentioned as early as 2012.

Noon

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

You say that there were multiple problems. What type of problems do you mean?

Noon

Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton

Suzie Durocher-Hendriks

The quality of the French mainly, but there are other problems. For instance, the content is inappropriate and inadequate, and the exam does not reflect Canadian practice.

Noon

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

You say that the exam has not evolved.

Noon

Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton

Suzie Durocher-Hendriks

It is an American exam that was imposed on us.

Noon

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

However, there are exams for Quebec nurses, are there not?

Noon

Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton

Noon

Conservative

Bernard Généreux Conservative Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Can't we use the same ones in English Canada?

Noon

Assistant Professor, School of Nursing, Edmundston Campus, Université de Moncton