The Adoption of NCLEX-RN in Canada: A Failure of Leadership at the Intersection of Nursing Regulation, Education and Practice.

This commentary presents perspectives of two senior nursing professors who have extensive faculty and leadership experience in both Canada and the United States. To understand more about how the adoption of the National Council Licensure Examination-Registered Nurses (NCLEX-RN) examination in Canada came to be, the authors conducted conversations with 29 Canadian nurse educators and nursing education and practice leaders. Based on these conversations as well as a review of published materials on the topic, the authors conclude that regulatory leaders failed to involve key leaders and stakeholders from nursing education and practice in this decision, and the resulting negative consequences have been borne primarily by the education and practice sectors. The authors argue that the NCLEX-RN adoption has introduced a misalignment into what had been a well-aligned model of education, regulation and practice in Canada and invite readers to consider the following discussion points. First, the NCLEX-RN has been designed to operate within a healthcare system that should not, by any reasonable argument, be replicated elsewhere; therefore, what are the contextual factors that led to the Canadian adoption of the NCLEX-RN? Second, American regulators stipulate that the examination must fit associate degree graduate competencies and that the additional knowledge and competencies gained at the baccalaureate level are irrelevant for licensure purposes; however, is this a fit for Canadian nursing licensure that requires the baccalaureate degree as an entry for practice? In conclusion, as American higher education in nursing now begins to move toward a competency-based model, further changes will have to be implemented to shape and frame the future of nursing education in the United States, and by extension, the future development of the NCLEX-RN within Canada's distinct historical, social, political and institutional context.