Angel Wang, a recent graduate from Ryerson’s school of nursing, spent most of last spring at home studying.
As she prepared for the National Council Licensure Exam, it wasn’t her grades that were on the line — it was her future career as a nurse.
In January, the American-based NCLEX replaced the former Canadian Registered Nurse Examination as the standard licensing exam. Wang would be part of the first group of students to be tested.
“It was the most stressful thing I’ve ever done,” she said. “In the first month, I studied four hours a day. For the second month, it was six to eight hours. By the time it got closer to my test date, I literally woke up, studied, then went to sleep.”
With huge relief, Wang passed the NCLEX on her first attempt. A lot of other students weren’t so lucky.
Jonathan Garcia, another recent graduate and the former president of Ryerson’s Nursing Course Union, took the NCLEX for the first time in early August. He used the allotted six hours to write the test, but couldn’t finish, and failed.
“When I got my results, I took two days off for myself and then went right back into study mode,” he said.
Garcia succeeded in passing the test in October, again after six hours of writing. But his experience is indicative of a larger trend that has left some experts concerned about the number of students who failed.
Results from the first two rounds of testing, released in September, showed that just under one-third of students in Ontario did not pass the test, an increase of about 20 per cent from last year, according to the Council of Ontario Universities.
“With students not doing well, it might give people the impression that we are graduating substandard students, when that couldn’t be further from the truth,” said Dr. Don Rose, director of Ryerson’s Daphne Cockwell School of Nursing.
Rose said that nursing school leaders do not support the NCLEX. He said that its American roots are problematic and that the exam only tests a part of the students’ knowledge base by testing them at a six-month practice level. A part of what students have learned does not get tested, he said.
Despite the increase in failure rates, the Canadian Council of Registered Nurse Regulators, which is responsible for imposing and overseeing the NCLEX, has defended it on multiple occasions.
The group has stressed that the data reviewed so far represents only the first six months of the year and that only a small number of students were tested in certain jurisdictions.
In a press release, the council said the NCLEX is geared to all nurses and is neither an American or Canadian exam. But many disagree and say that its American roots have influenced its content.
“It is a fallacy to believe that something has no culture. Every test has a culture,” said Dr. Kirsten Woodend, president of the Canadian Associations of Schools of Nursing. “You can’t say that an exam primarily developed in the US has no American culture or content.”
Woodend has gone through the Pearson Exam Cram practice questions, designed to help students prepare for the NCLEX. She found that the prep material uses American drug names and transitions between metric and imperial units of measure.
It’s unclear why the questions have been designed this way.
“We have smart students, so it’s easy to teach them this. You just wonder why we even have to teach it to them,” she said.
According to Rose, Ryerson is in conversation with other schools in Canada to help prepare students in the best way possible.
He says that Ryerson was one of the few nursing schools to pay for Health Education Systems Incorporated testing, which includes mock NCLEX exams that provide individual reports based on students’ results.
While the goal of the mock exams was to assist students, Wang said that they did little to help her or her peers. In addition to their usual classes, students were asked to do the tests while also doing 40 hours of mandatory consolidation a week.
She also said that the test predicted students’ outcomes incorrectly, even though it promises around a 98.5 per cent accuracy rate in determining how well a student will do.
“I failed the practice test and passed the NCLEX,” she said. “Some of my friends, on the other hand, were told that they were going to pass and then ended up failing.”
In the end, the university found that students didn’t follow through with these supports. As a result, the faculty took a different approach and altered the nursing curriculum, making it an assignment for students to create a study plan for the NCLEX.
Betty Qi, a Ryerson nursing graduate who passed the NCLEX in July, brought up another concern for students: its hefty price tag.
The two preparation courses she took, Kaplan and Nurse Logic, cost her a total of $625, and her textbook was about $100. Including the $360 NCLEX application fee, Qi spent more than $1,000 preparing for the exam.
“It’s just annoying that I had to spend that much on this exam,” she said.
The experience was even more expensive for Wang, who spent almost $2,000.
“The biggest loss was that I wasn’t able to work for that period, in addition to the many fees I had to pay,” Wang said. “I think everyone can relate that they spent all their money on writing this test, and if you don’t pass you have to rewrite it.”
Qi also said that preparing for the NCLEX was difficult because her group was the first cohort to write the test.
“These days, students in first year start preparing for the NCLEX. We were prepped to do the Canadian exam in first year and it changed in third year. People from previous years couldn’t give us any advice, my friends and I had to go about it ourselves,” she said.
Nevertheless, the fact that students can now start preparing early has done little to relieve the stress for some future NCLEX writers. This year’s early results have left many students anxious, especially third-year nursing students who will be writing the exam next year.
“I’m worried for my future career,” Nicole Abejuro, a third-year nursing student, said. “I heard it was going to be more difficult than the CRNE, and knowing that there was a significant drop in success makes me anxious for how well I’ll do.”
Nursing school experts will need to work hard to mitigate these concerns. In the meantime, Rose remains optimistic about the next set of results, which should be released sometime in the coming weeks.
“The initial data that was released in September was preliminary,” he said. “A larger proportion of students have written the exam since then and the results might give a bit of a different picture.”