New American Entry-to-Practice Exam a Failure for Canadian Nursing Students and for Canada

OTTAWA, Sept. 9, 2015 – The first results of the NCLEX-RN, the new American-based entry-to-practice exam for Canadian nurses, were released yesterday.  The results are troubling for Canadian nurses, their employers and the Canadian health care system.

Canadian nurses, long recognized internationally for the quality of their training, had lower pass rates than on the previous Canadian entry-to-practice exam. They also had lower pass rates than did their American counterparts. The pass rate for Canadians was 70.6%, more than 10 per cent below the pass rate for the last number of years. In contrast, the NCLEX-RN pass rate for Americans was 78.3%.

The NCLEX-RN is run by the National Council of State Boards of Nursing (NCSBN), the organization made up of state nursing regulatory bodies for American nurses. It was introduced in 2011 by the Canadian Council of Registered Nurse Regulators (CCRNR), without proper stakeholder consultation, to replace the previous Canadian entry-to-practice exam.

The results validate concerns among Canada’s nurses and nursing schools about the use of the NCLEX-RN as an entry-to-practice exam for Canadians. Canadian and American applicants write the same exam, despite important differences between health care systems and approaches to treatment in the two countries. French language schools, nurses and students have been especially concerned about the quality of the French language version of the test and the fact that much of the test prep materials that have been developed to support writers of the NCLEX exist only in English.

Quick Facts

  • Since January of 2015, Canadian nursing students have been required to write the American licensing examination (NCLEX-RN) in order to be registered to practice in any Canadian jurisdiction other than QuebecQuebec has its own system.
  • The CCRNR’s rationale for introducing a new test was to replace the former Canadian national pen and paper entrance-to-practice exam with a Computer Adaptive Test. However, as evidenced by the results, the impact of the change is much further reaching.
  • The pass rate for Canadians was 70.6%, more than 10 per cent below the pass rate for the last number of years.
    • Pass rates are below 70% in six out of ten jurisdictions.
    • In New Brunswick, where there is a greater proportion of francophone students, nearly half the students failed (pass rate is 54.3%).
  • The Canadian Association of Schools of Nursing, the Canadian Nurses Association, the Canadian Federation of Nurses Unions, the Aboriginal Nurses Association of Canada, the Colleges of Applied Arts and Technology, the Council of Ontario University Programs in Nursing, and the Ontario Nurses Association, among others, have expressed concerns about the extent to which the NCLEX-RN fails to reflect Canadian entry-to-practice competencies.
  • According to the NCSBN itself, Canada is the only non-American jurisdiction that uses the NCLEX to qualify its nurses to practice in their own country.
  • Nursing is the only Canadian health profession to have adopted a non-Canadian entry-to-practice exam.


“While the new entry-to-practice exam was supposed to be adapted to Canadian requirements, what has happened instead is that Canadian schools are having to do their best to prepare their students to pass an American exam that fails to address the Canadian context. The tail is wagging the dog. It is inappropriate for an American exam to be driving the focus of the curriculum in Canadian schools.”

“Canadian nurses and their patients deserve an entry-to-practice exam that reflects and reinforces the high quality of Canadian nursing.”

  • Dr. Kirsten Woodend, President, Canadian Association of Schools of Nursing,  Dean, Trent-Fleming School of Nursing, Trent University

SOURCE Canadian Association of Schools of Nursing 

For further information: Keelan Green, 613-220-2016,; Alexandra Evershed, 613-293-5700,


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