Design does matter. It matters as much as where something is made – just think about the simple phrase that comes with most Apple products: “Designed in California, Assembled in China.”
Recently, 10 nursing regulatory bodies gave away a significant right to the design and quality assurance of Canadian nurses to an American nursing organization. On December 2nd 2011, ten provincial nursing regulators announced that the National Council of State Boards of Nursing (NCSBN) would begin to deliver the entry-to-practice examination for registered nurses (RNs) in Canada, as of 2015. The announcement was quite subtle and carefully crafted to minimize the perceived impact of this change.
The announcement in Canada focused on a few things: the exam will become computerized, be delivered in testing centers across the country year round (a good thing), and test results would be available much quicker than before. However, the regulators failed to mention the Canadian exam will now become the NCLEX (the American nursing entry-to-practice examination), and will no longer be the Canadian Registered Nurses’ Examination (CRNE). The corresponding announcement in the US was much clearer: NCSBN to bring the NCLEX to Canada.
Please don’t think I’m crying wolf or in anyway think something American is inherently evil, bad or wrong. I do not believe for a minute that Americans are to be feared or are in any way bad people. The issue is the distinctly different values our countries have on issues of healthcare delivery and funding.
The real reason Canadians should be aware of this change is the impact it may have on their nurses’ values and value. RNs take a Bachelor of Science of Nursing (BScN) which upon graduation makes them eligible to write the entry-to-practice exam. Our universities will still control curriculum, but they also have an obligation to students to prepare them for the entry-to-practice examination, whatever it may be. This means that the education which Canadian taxpayers subsidize, and Canadian nurses pay for, will carry the values of an American examination. This could very subtly and significantly impact nursing values. As an example, on a NCLEX question such as the one below, a Canadian nursing student would have a difficult time choosing the right answer, because our values and healthcare system are so different.
According to the NCLEX, the answer most Canadian nurses would give is wrong. While there are not always enough organs for Canadian patients, our system will provide care to any patient that requires a transplant, if it is a viable option (they would be able to survive/recover from the surgery and it would improve their quality of life). So do you want your nurses learning (and getting tested on) American values like distributive justice for patients who do have insurance to pay for a liver transplant, a problem that will never arise in Canada? Or do you want your nurses to be taught Canadian values like their responsibility to advocate and be accountable for a patients needs?
Additionally, writing the NCLEX could result in more Canadian trained nurses migrating to the US, since this examination will make them eligible to practice there. This may increase the cost to retain nurses and make it more challenging to maintain adequate hospital staffing requirements. Anyone concerned with health and human resources can attest to the growing demands on our healthcare workforce. Not only does this switch have the potential to leave Canada short of nurses as demand for health professionals and nurses increase, it may also change the way nurses are educated and the values of the profession. For more, listen to the Canadian Nurses Association’s reaction, and feel free to check out their petition.