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August 12, 2015

Anne Coghlan, RN, MScN

Executive Director & Chief Executive Officer
College of Nurses of Ontario
101 Davenport Road
Toronto, ON M5R 3P1
Dear Anne,
National Council Licensure Examination (NCLEX) - failure rates - rewrites and
temporary registration
We are requesting that the College of Nurses of Ontario (CNO) allow applicants additional
rewrites of the NCLEX and not require an applicant to complete another nursing program where
an applicant has unsuccessfully written the NCLEX. In addition, we are also requesting
amendments to allow temporary registrants to continue working under the temporary class
when they have been unsuccessful writing the NCLEX.
The CNO and several other Canadian regulators recently made the dramatic move of requiring
all new graduate and incoming nurses to Canada to take the computerized National Council
Licensure Examination (NCLEX) for entry-to-practice into the nursing profession. Prior to this,
Canadian nursing regulators used the Canadian Registered Nurse Examination (CRNE), which
consisted of a paper-and-pencil multiple choice examination. While the NCLEX has increased
harmonization of nursing examinations in Canada and the United States, there are significant
concerns regarding the consequences of failing the NCLEX in Ontario.
The NCLEX was developed by the National Council of State Boards of Nursing, Inc. (NCSBN).
It was designed to test the knowledge, skills and abilities essential for the safe and effective
practice of nursing. In the United States, the NCLEX has been used as the sole nursing
licensure examination for over thirty years and nursing schools across the county have adapted
their curriculum to prepare nursing students to pass the NCLEX.
In Canada, the public was first made aware of the NCLEX replacing the CRNE as the sole
means of testing in 2012 and the first NCLEX was administered in January of 2015. With only
three years notice, nursing schools across Canada were likely unable to change preparatory
curriculum and approaches to prepare for this significant change in exam format. Not
surprisingly, pass rates for the NCLEX are reflective of this difficulty.
Preliminary pass rates have been published for 2015, and so far the pass rates for all RN
candidates taking the NCLEX in Canada was 73.87%, while the pass rates for RN candidates
taking the NCLEX in the United States was 85.54%1. Not only are the Canadian pass rates for
the NCLEX much lower than pass rates in the U.S., they are also much lower than the pass

Anne Coghlan, August 12, 2015

Re: National Council Licensure Examination (NCLEX)

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rates for the prior Canadian exam. Specifically, the pass rates for the CRNE for Ontario
educated candidates was 84.7% and 82.8% in 2014 and 2013, respectively2.
As indicated above, not all candidates are successful in writing the NCLEX and subsequent
attempts are not uncommon.
Although Canada and the United States are now using the same nursing examination, the two
jurisdictions have very different policies regarding how many times the NCLEX may be written.
In the United States, the NCSBN is an independent organization that is charged with developing
and administering the NCLEX on behalf of its participating boards of nursing. If a candidate is
unsuccessful in writing the NCLEX, the NCSBN has a retake policy that allows candidates to
write the NCLEX eight times a year, but no more than once in any 45-day period. Although this
is the policy of NCSBN, it is noted that a candidates desired jurisdiction may impose additional
limits on the number times an NCLEX may be written. In examining the retake policy of the
boards of nursing of the 50 participating states, 39 allow candidates to write the NCLEX an
unlimited number of times or they do not provide a retake policy different than that of the
NCSBN. Of the 11 remaining states, the retake policies are outlined below:

STATE (in alphabetical order)





South Carolina

May write NCLEX eight times a year for
five years after graduation from nursing
Must take remedial course prior to writing
the NCLEX a fourth time.
Must pass the NCLEX within three years
of graduation.
After three failures, must appear before
the Board for authorization to write the
NCLEX a fourth time.
After three failures, must complete a
remedial program acceptable to the
May write the NCLEX six times within two
If an applicant fails a retake of the
NCLEX, the applicant must present a plan
of study before taking the exam again.
Able to write the NCLEX a maximum of
five times in three years and then must
complete a nursing program before
writing a sixth time.
If NCLEX not passed within one year,
must provide proof of remediation and if
not passed within three years of
graduation, must enroll in a nursing

Anne Coghlan, August 12, 2015

Re: National Council Licensure Examination (NCLEX)



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education program.
After a second failure, the Board may ask
an applicant to do some remediation
before rewriting.
After a second failure, must take an
NCLEX review course.
May write the NCLEX ten times in five
years from graduation.

As noted above, there are only two boards of nursing that would require a nursing candidate to
enroll in a nursing program following a specified number of reexaminations: South Carolina and
Montana. However, prior to requiring a candidate to enroll in a nursing program, both boards
require candidates to either perform some remediation or present a plan of study and both allow
more than three attempts.
Unfortunately for Canadian nursing graduates, the CNO and many other Canadian nursing
regulators take a more restrictive and punitive approach to rewriting the NCLEX than the
NCSBN and its participating boards of nursing. According to the CNOs website, if an applicant
fails a registration examination three times (either the NCLEX or CRNE), the Registration
Committee will review the application to determine whether there are any extenuating
circumstances, such as an unforeseen medical situation, that might give the CNO reason to
annul one or more unsuccessful attempts. If there is no reason to annul an attempt, the
applicant will be required to complete another approved or equivalent nursing program before
another attempt may be made.3
The CNO provides some clarity on this requirement by indicating, an applicant who failed the
RN registration exam three times would be required to obtain a new degree after completing an
approved or equivalent university baccalaureate degree program. Therefore, after completing a
four-year baccalaureate nursing program, if an applicant fails the NCLEX three times, he or she
will be required to apply and complete another four-year baccalaureate nursing program. This is
not consistent NCSBNs policy or the requirements of the boards of nursing in the United States
who have been administering this exam for over thirty years.
We are therefore proposing that the CNO should have a retake policy similar to that of the
NCSBN and the majority of the nursing boards in the United States that allow applicants to write
the NCLEX an unlimited number of times. If the CNO is not amenable to an unlimited number of
attempts, at the very least, the CNO should allow applicants to provide proof of remediation
following three unsuccessful attempts at the NCLEX and thereafter allow additional attempts.
This remediation could include taking an NCLEX review course or submitting a plan of study but
it should not include completing a four-year nursing program.
It is unquestionable that requiring a graduate of a recognized baccalaureate nursing program to
complete another nursing program is unfair and unjustified given the circumstances. All
applicants are graduates of baccalaureate nursing programs approved by the CNO. Applicants
have invested significant time and money into obtaining their nursing education. While entry-topractice examinations are necessary, if there are issues with passing the exam, it would be
more appropriate for applicants to take courses to assist in taking the exam rather than

Anne Coghlan, August 12, 2015

Re: National Council Licensure Examination (NCLEX)

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repeating a nursing course they just completed. Indeed, the CNO acknowledges on its website
that: we have seen that it is not unusual for students who excelled in their nursing program to
fail their first write of the exam but pass on subsequent writes4. ONA agrees with this
statement. The inability to pass the NCLEX may have nothing to do with an applicants nursing
knowledge, skill or judgment, but rather may be due to an applicants ability to take an exam.
In addition, many applicants writing the NCLEX have already secured employment in Ontario
and started their nursing career, but, where there is a failed first attempt at the NCLEX, an
applicants temporary registration is revoked by the CNO and his or her employment terminated.
This is another area that we believe requires CNO's attention.
We trust that the CNO will consider amending its policy to allow for additional rewrites of the
NCLEX and not require an applicant to complete another nursing program. We also request
amendments to allow temporary registrants to continue working under the temporary class.
ONA would welcome involvement in further discussions with the CNO regarding these issues.
We look forward to hearing from you.

Linda Haslam-Stroud, RN


Marie Kelly, ONA Chief Executive Officer/Chief Administrative Officer (CEO/CAO)

Kaiyan Fu, Provincial Chief Nursing Officer/Director
Hon. Dr. Eric Hoskins, Minister of Health and Long-Term Care