A Canadian Perspective on the ‘NCLEX-RN World’: Pragmatism When the Stakes are High

Abstract

According to the Ontario nursing regulatory body, the American-designed high stakes nursing licensure examination, the NCLEX-RN, is a valid measure to assess the Canadian entry-to-practice competencies requisite of each new graduate registered nurse. This examination is used to “…ensure that it grants registration only to those who demonstrate the nursing knowledge to provide safe care” (para. 1). However, limited research exists that explores, examines and evaluates the impact of the NCLEX-RN in Canada since adoption from the United States of America in January 2015. Particularly, no studies existed that explored the experiences and perceptions of practicing Registered Nurses (RNs) who have written the NCLEX-RN, outside of the first-year test-takers. This thesis document describes the findings of a collective case study to better understand the NCLEX-RN, as experienced by six Canadian RNs from both acute and non-acute healthcare environments in Ontario, Canada. A within-case, document, and cross-case thematic analysis was used. The participants described their experiences with, and perceptions about, the NCLEX-RN within four main themes – influencing preparedness; examining the Canadian RN; becoming ready for safe practice; and reflecting as a practicing RN. The findings of this study support existing literature that a lack of content reflective of Canadian healthcare values exists in the NCLEX-RN. The educational impact and consequences of high stakes testing such as, curricular molding to external evaluation and concerns related to exam validity, are also highlighted. Presently, Canadian nurse educators and future test-takers must approach the NCLEX-RN pragmatically to ensure licensure of graduates with minimal disruption to the Canadian baccalaureate nursing education.