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Is English Language Background an Indicator of Success in the English Tests

Required for Nursing Registration in Australia?

Article · January 2016

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International Journal of Arts & Sciences,
CD-ROM. ISSN: 1944-6934 :: 07(05):539–570 (2014)

IS ENGLISH LANGUAGE BACKGROUND AN INDICATOR OF

SUCCESS IN THE ENGLISH TESTS REQUIRED FOR NURSING
REGISTRATION IN AUSTRALIA?

Tiffany Lynch

University of Adelaide, Australia

For health professionals, English language proficiency has increasingly been identified as important to
public safety by Australian regulatory authorities. The purpose of English language testing is to
evaluate the effectiveness of communicating in a nursing setting. The Nursing and Midwifery Board of
Australia (NMBA) (2010) outlines the current assessment requirements for nurses from non-English
speaking backgrounds (NESB) are to attain either an overall band score of 7 in each of the four
components (Reading, Writing, Listening, Speaking) of the International English Language Testing
System (IELTS) (give reference) or a band score of A or B in each of the same four components of the
Occupational English Test (OET) (give reference). Either the OET or IELTS must be re-sat in full until
the applicant achieves at least the minimum score for all sections in one sitting.
The appropriateness of the administration of the current testing process for the purpose of fitness
for nursing registration in Australia has not been examined. Additionally, the adoption of the required
scores for these tests as English language skills registration standards by the NMBA appears arbitrary.
Many nurse registering authorities have demonstrated concerns regarding English language testing with
the academic nature of these tests being identified as a barrier to registration for these nurses in
Australia (O'Connor 2008; Walters 2008; Deegan and Simkin 2010). Kingma (2001 p.212) states that
‘language was reported to be a significant barrier to nurse migration’ in the international recruitment of
nurses to fill nursing shortages in the UK, USA and Australia (Kingma 2001). The National Council of
State Boards of Nursing (NCSBN) in the United States sought to develop a nursing specific IELTS
standard that would be legally defensible (O'Neill et al. 2007). A passing standard is a reflection of the
values of those professionals who participate in establishing what they determine as an appropriate
score, and these sets of values can be quite diverse so “ultimately, the passing standard established by a
policy-making body is a judgment-based decision” (O’Neill et al. 2007 p.5). To demonstrate this point,
O’Neill et al. (2007 p.19) collated the various passing standards in other English speaking countries and
identified that Australia and New Zealand have adopted a higher IELTS passing standard for NESB
nurse registration than other English speaking countries. Differences in such policies become more
significant as the flow of nurses between countries increases. The Centre for Canadian Language
Benchmarks (CCLB 2004) conducted a multi-phase project, Benchmarking the Nursing Profession
across Canada which investigated how the language proficiency of nurses is measured for registration
and then designed a nursing specific test, the Canadian English Language Benchmark Assessment for
Nurses (CELBAN). The CELBAN is similar in its conception to the OET except with the advantage
that it is entirely nursing specific whereas the OET is only nursing specific in speaking and writing
modules, with the reading and listening modules applying to all the medical professions. Qualitative
539
540 Is English Language Background an Indicator of ...

studies have found some nurses with strong English language backgrounds who have been unable to get
the scores required in the OET or IELTS for registration in Australia (Walters 2008; Hawthorne 2001).
The current study aims to investigate the appropriateness of the administration of the current English
language testing process for the purpose of determining fitness for nursing registration in Australia.
The main objective of this study is to further understand the issue of the relatively unexplored area of
English language testing requirements for registration of migrant nurses and whether there are any
predictors for success, such as English language background, in achieving the scores required.
This research project aimed to answer the following questions about non-English speaking
background (NESB) nurses attempting to meet the English language requirements of the Nursing and
Midwifery Board of Australia (NMBA) for nursing registration in Australia:
Is there an association between demographic characteristics and test success? What is the
relationship between English language background and test success? What is the relationship between
education and work experience of participants and test success? How did successful candidates perceive
their experiences with the English tests?

Keywords: Registered nurse, Foreign nurse, Migrant, Licensed nurse, Nursing board.

Search Strategies and Methods

A bibliographical database search was undertaken (Health Source: Nursing, PubMed, Cumulative Index
of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC),
Linguistics & Language Behavior Abstracts (LLBA), Scopus and Ebsco) along with national and
international nursing websites. Search terms included migrant nurse, international nurse, migration,
experience, cultural safety, globalization, nurse migration, nurse recruitment, Australia, nurse registration
and research. The search was limited to texts published in English and peer-reviewed research-
based articles.
While a significant volume of literature was located, there were no primary studies done on the
validity of the the Occupational English Test (OET) or International English Language Testing System
(IELTS) as tools for assessment of English language for registration as a nurse in Australia. The key
terms that arose were migration, education, assessment, English language, nursing skills, competence,
fairness, cultural safety and reflection on practice. Literature considered to best reflect these main themes,
and of most relevance to Australia, was selected for this review, with preference given to research reports
and official nursing publications. Some anecdotal evidence is included in support of this proposal due to
the lack of published literature on this issue. This highlights the need for more research into English
language testing of NESB registered nurses.

Introduction

Much research has been conducted on the problems relating to the current international nursing
shortages (Hawthorne 2001; Buchan 2006; Choy 2010). This has included the need for Health Services to
manage their nursing shortages by recruiting qualified nurses from other countries (Buchan 2006). The
past few decades has seen a large increase in the levels of skilled immigration to Australia from
non-English speaking background (NESB) countries and many of these come from within the nursing
profession (Preston 2009).The role of nursing and midwifery registering authorities is to protect public
safety by establishing policies for the regulation of the profession. Therefore the purpose of
English language testing is to evaluate the effectiveness of communicating in a nursing setting
with patient safety as the main objective. However, research suggests a potential mismatch
between linguistic criteria assessed by language professionals and clinical communication deemed
relevant by health professionals (O'Hagan et al. 2011; Jacoby & McNamara 1999). Kingma (2001
 Tiffany Lynch et al. 541

p.212) states that ‘language was reported to be a significant barrier to nurse migration’ in the
international recruitment of nurses to fill nursing shortages in the USA, UK, and Australia (Kingma
2001). Many international nurse registering authorities have demonstrated concerns regarding English
language testing, indicating this is a universal problem (Hawthorne 2001; Kolawole 2009; Walker 2009).

Literature Review

Globalisation and Trends in International Nurse Migration

Globalisation of the economy, advances in information technology and transport are all factors that have
led to the increase in the international movement of skilled workers, including nurses. The past few
decades has also seen a large increase in the levels of skilled immigration to Australia from NESB
countries and many of these come from within the health profession (Preston 2009). Much research has
been conducted on the problems relating to the current international nursing shortages (Hawthorne 2001;
Buchan 2006; Choy 2010). This has included the need for Health Services to manage their nursing
shortages by recruiting qualified nurses from other countries (Buchan 2006). There are ethical issues
associated with the recruitment of nurses from developing countries when it depletes a resource that is
desperately needed in marginal healthcare systems of less affluent nations. However some source
countries have special government departments set up for exporting skilled labour, including nursing,
such as the Philippines, with their Labour Export Policy, ‘The Migrant Workers and Overseas Filipinos
Act of 1995’. This policy is administered by the Philippine Overseas Employment Administration which
is within the Department of Labor and Employment (APMM 2009). In Asia, the Philippines has
consistently topped the list of major exporters of human labour since 1996. It is followed by Thailand,
Indonesia, Sri Lanka and Nepal (APMM 2009). The training for export model provides source countries
with alternative markets for workers who cannot find domestic employment, and opportunities to gain
revenue from migrant worker remittances. For individual nurses who have invested personally in their
training and registration, the aspirations to work abroad for higher wages are completely understandable.
However, it can be frustrating to move from one environment where your skills and experience are
valued, to one where they appear to count for little (Hawthorne 2001).

Projected Shortage of Nurses in Australia

In the future, the Australian healthcare sector is expected to experience an unprecedented nursing
workforce crisis. The Australian Health Workforce Institute projections for Australia are a projected
shortfall of approximately 64,500 registered nurses by 2025. The supply of registered nurses exceeds
demand early in the projection period until approximately 2014, after which demand exceeds supply
(Hawthorne 2011). One of the reasons that the supply of registered nurses appears to exceed the demand
is the assumption that graduate nurses will remain in the profession, but this is often not the case. The
number of nurses leaving the workforce impacts the supply of nurses and the three primary outflows of
nurses are through migration overseas, retirement and looking for work outside of nursing (NHWT 2009).
At the same time the growth in demand for health services is expected to increase especially in the
aged care sector but also across acute care sectors (AHWAC 2004). The demand for nurses is expected to
increase due to a larger proportion of elderly people and medical advances that will increase the need for
nurses. The proportion of the population of 70 years and over is expected to increase from 8.3 percent in
1996 to 12.1 percent of the total population by the year 2021. While the proportion of people aged 85
years and over is estimated to rise from 1.6 percent of the population in 2006 to 3.3 percent of the
population in 2036 (AHWAC 2004). This is significant because older persons are much more likely to
need nursing care. The National Health Workforce Taskforce (NHWT 2009) reported that historical
trends indicate that the Australian nursing workforce is ageing and working longer hours and that
these trends are unsustainable for a prolonged period of time into the future. The ageing of the
542 Is English Language Background an Indicator of ...

nursing workforce will have a continuing effect on the ability of the nursing workforce supply to
replace itself at least to 2020 (AHWC 2004). Strategies to recruit more people to the profession
such as better pay, flexible careers, safe staffing and working environments that are stimulating and
empowering need to be supported. There is also a valid argument for the increased use of overseas
trained nurses in Australian hospitals in order to fully alleviate the shortage and to adequately ensure
patient safety through improving staff numbers. From 2004-05 to 2008-09 there were 14,950
registered nurses visa-sponsored to Australia, in addition to registered mental health nurses and
midwives. This is an increase from 2001-06 when 6,680 registered nurses migrated to Australia and
by 2006 twenty-four percent of all nurses in Australia were overseas-born (Hawthorne 2011).

Value of Multicultural Nurses

For nurses in Australia, balancing the benefits with perceived challenges of having international
colleagues with diverse cultural, linguistic and professional backgrounds can be confusing and
threatening. However, there is much to be gained from nurses with a variety of experience, skills, and a
passion to work here. Most migrants are resourceful and resilient, and with the right support can
contribute to increasing Australia’s social and economic capital. With approximately 22.5% of the older
population from culturally and linguistically diverse (CALD) backgrounds (Aged & Community
Care Services Australia 2006), there is a reliance on bilingual health care workers who are able
to communicate more effectively with these patients (Cioffi 2003). The value of nurses who are
able to communicate in a language other than English is prominent in the literature (Blackford
et al. 2000; Donnelly 2000; Gorman 1995).
Although the ability of NESB nurses to communicate in other languages can be valuable, it is
obviously of paramount importance for patient safety that they be able to communicate sufficiently well
in English that patient safety is not compromised, as well as having appropriate training in the profession.
The increasing number of migrants in Australia’s nursing workforce presents many challenges along with
obvious benefits. Managed effectively with patient safety and the rights of all qualified registered nurses
foremost in stakeholders’ minds, it has the potential to alleviate nursing shortages as well as to meet the
needs of our changing multicultural population

Assessment of English Language Proficiency for Nursing in Australia

The growing proportions of registered nurses coming from non-English speaking countries has
highlighted the importance of effective and informed English language testing policies. English language
proficiency is a regulatory criterion for registration with the Nursing and Midwifery Board of
Australia (NMBA 2010), and is essential for safe care and effective communication. After an initial
assessment of professional qualifications and verification of documentation, English testing via the
Occupational English Test (OET) or International English Language Testing System (IELTS)
represents the next step in the process of registration for overseas qualified nurses wishing to practise
in Australia.

International English Language Testing System (IELTS)

The International English Language Testing System (IELTS) was originally developed to assess
the language ability of candidates who intend to study where English is used as the primary
language of communication. IELTS is now jointly owned by the British Council, IDP (International
Development Programme) Australia and Cambridge English for Speakers of Other Languages (ESOL)
Examinations (IELTS 2010). The test consists of four modules (reading, writing, listening and speaking)
and degree of proficiency in each skill is rated using ‘band scores’ that range from 0 to 9. These band
 Tiffany Lynch et al. 543

scores are scaled by transforming the raw score mark separately on each module. Scores for the
four skills are also combined to produce an overall band score ranging from 0 to 9. The separate and
combined band scores are used as a benchmark for anyone who wishes to pursue education or to migrate
and work in an English speaking country. Statistics clearly show significant growth in the number of
organisations, universities, professional bodies and governments that have adopted IELTS results as a
mandatory requirement for admission into professions, such as nursing, and skilled migration, as well as
for university studies (IELTS 2010). There are two different versions (Academic and General Training) of
the IELTS that specifically apply to the Reading and Writing modules. The Academic version is typically
taken by candidates who are interested in pursuing higher education paths and due to the level of higher
education required for nurses this version was selected as being suited to the assessment of English
language competency for nursing registration candidates. However, Birrell et al. (2006 p.109) reported
that “IELTS scores are somewhat unstable: a student having a 40% chance of securing a different result
on re-testing, based on a .77 published reliability rate for speaking and writing”.

Occupational English Test (OET)

The other prescribed English test, the OET was designed to test candidates' speaking, listening, reading
and writing skills in linguistic contexts simulating the professional context. Therefore the OET is
recognised as a language test for overseas qualified health professionals offered as an alternative to
IELTS. The OET Centre states that ‘the OET measures the language competency of health professionals
who are seeking registration and the ability to practice in an English-speaking context’, (OET Centre
2010). However, at the 2009 OET Forum, issues of concern identified were a ‘potential mismatch
between linguistic criteria used by language professionals and those which are deemed relevant by health
professionals with experience of clinical communication’ and that ‘passing standards may not reflect
values of professional stakeholders, and these values may differ across different branches of the
professions’ (OET Centre 2010). The OET centre also claims that this test is ‘designed to ensure that
language competency is assessed in a relevant professional context’ (OET Centre 2010), however the
reading and listening tests are the same for nurses as for the all of the other health professions such as
medicine, dentistry, veterinary science, optometry, and pharmacy. This means that nurses will have to
demonstrate a high level of academic comprehension of articles and lectures with language and topics
specific to these other health professions as well as their own. The writing and speaking tests are the only
ones specific to each health profession.
As a majority of health authorities accept both tests, the question of equivalence has arisen. Results
of an OET-IELTS benchmarking report identified there is a marked discrepancy in the way individuals
are categorized on each measure, with some passing the OET and failing the IELTS and others doing the
converse (Elder 2007). There is a considerable financial burden on individuals who may not have the
resources to continue sitting the test. Currently to sit the OET costs $521 in Australia and $775 at one of
their offshore testing venues. Now that the registration requirements for NESB nurses in Australia has
changed, candidates will have to pay to sit all four modules each time as an A or B in less than four
modules will not be retained (OET Centre 2010). The IELTS costs $317 to sit and once again, if the
passing standard for registration is not met, candidates have to sit all four modules again. There is
considerable difficulty in accessing data around the number of individuals passing the tests and the
number of times individuals re-sit the tests and eventually pass at the required level for registration. On
passing the tests, candidates are then expected to demonstrate field-specific professional competence
according to guidelines set down and administered by the NMBA. The purpose of English language
testing is to evaluate the effectiveness of communicating in a nursing setting. However, research has
raised the question of the appropriateness of the IELTS and OET as tools for assessment of English
language for registration as a nurse in Australia. There is an obvious limitation on the use of a relatively
general proficiency test like IELTS to make decisions on the English language ability of candidates with
544 Is English Language Background an Indicator of ...

respect to nursing communication. In contrast, assessing candidates in a specific-purpose test like the
OET can make more targeted decisions about whether someone has achieved the threshold level of
performance represented by the score required for nursing registration. But achieving the English
language proficiency standard for registration through IELTS or the OET provides only very
limited evidence about whether a candidate is able to communicate effectively in health care
contexts. As previously stated, there is a possible mismatch between linguistic criteria assessed by
linguists and those which are deemed relevant for clinical communication and that passing standards may
not meet the needs of professional stakeholders.

Assessment of English Language Proficiency of Internationally Qualified Nurses in Britain, USA

and Canada

Many nurse registering authorities have demonstrated concerns regarding English language testing. Due
to the European Union agreement, formal assessment of English of NESB nurses from European Union
member countries is not required in Britain. The British Nursing and Midwifery Council (NMC) entrusts
employers with deciding on their own criteria in determining whether an EU nurse’s level of English is
sufficient for effective nursing practice in their institution (Dean 2010). In contrast, the NMC nurses from
outside the EU, including Australia, have to sit IELTS prior to registration. A Royal College of Nursing
(RCN) survey of its members found that nurses do want either employers or the NMC to test
language skills, but the NMC does not have the power to do this. The NMC said most EU country nurse
regulators want the authority to test nurses. In evidence submitted to the European Commission last year
on behalf of 26 regulators, the NMC said failure to allow regulators to test language skills 'puts
patients at risk' (Dean 2010).
Each USA state has a nursing board and each has its own set of regulations for overseas-
trained nurses. To work in the USA as an RN, you have to be licensed by the relevant state board of
nursing and the license is only valid for that particular state. To become a licensed nurse in the USA,
most states’ certification program consists of three steps: a Credentials Review; a one-day
Qualifying Exam of Nursing Knowledge that measures the applicant’s knowledge and competencies
needed to perform safely and effectively; and an English language proficiency exam such as IELTS
(Yu 2011). Applicants who received their nursing education in Australia, Canada (except Quebec),
Ireland, New Zealand, Trinidad & Tobago or the United Kingdom, and their text books and instruction
were in English, do not need to take a language test (Yu 2011).
The Centre for Canadian Language Benchmarks conducted a multi-phase project, ‘Benchmarking
the Nursing Profession Across Canada’ which investigated how language proficiency of nurses is
measured for registration and then designed a nursing specific test called the Canadian English Language
Benchmark Assessment for Nurses (CELBAN) (CCLB 2004). The CELBAN is similar in its conception
to the OET except with the advantage that it is entirely nursing specific. Recommendations made as
a result of research conducted in Canada by Blythe and Baumann (2009), highlight the need for
international standards for basic nursing and midwifery education as well as English language
testing. This is in order to address patient safety and quality of care issues resulting from migration as
well as to enable an easier transition for nursing registration in other countries.
The recruitment and migration of overseas-trained nurses is simultaneously occurring in the
US, Canada, the UK, New Zealand and the Middle East reflecting growing OECD demand, in addition to
the participation of women in skilled migration (Hawthorne 2011). The globilisation of the nursing
workforce presents many challenges along with obvious benefits. Managed effectively with patient safety
and rights of all qualified registered nurses forefront in stakeholder’s minds, it has the potential to
solve nursing shortages as well as meet the needs of our changing multicultural population.
English language proficiency is an important issue for patient safety and the testing process needs to be
reviewed with this primary objective in mind.
 Tiffany Lynch et al. 545

Methods

Introduction

For health professionals, English language proficiency has increasingly been identified as important to
public safety by Australian regulatory authorities. The purpose of English language testing is to evaluate
the effectiveness of communicating in a nursing setting. The Nursing and Midwifery Board of Australia
(NMBA) (2010) outlines the current assessment requirements for nurses from non-English speaking
backgrounds (NESB) are to attain either an overall band score of 7 in each of the four components
(Reading, Writing, Listening, Speaking) of the International English Language Testing System (IELTS)
or a band score of A or B in each of the same four components of the Occupational English Test (OET).
Either the OET or IELTS must be re-sat in full until the applicant achieves at least the minimum score for
all sections in one sitting.
The appropriateness of the administration of the current testing process for the purpose of fitness for
nursing registration in Australia has not been examined. Additionally, the adoption of the required scores
for these tests as English language skills registration standards by the NMBA appears arbitrary. Many
nurse registering authorities have demonstrated concerns regarding English language testing with the
academic nature of these tests being identified as a barrier to registration for these nurses in Australia
(O'Connor 2008; Walters 2008; Deegan and Simkin 2010). Kingma (2001 p.212) states that ‘language
was reported to be a significant barrier to nurse migration’ in the international recruitment of nurses to fill
nursing shortages in the UK, USA and Australia (Kingma 2001). The National Council of State Boards of
Nursing (NCSBN) in the United States sought to develop a nursing specific IELTS standard that would be
legally defensible (O'Neill et al. 2007). A passing standard is a reflection of the values of those
professionals who participate in establishing what they determine as an appropriate score, and these sets
of values can be quite diverse so “ultimately, the passing standard established by a policy-making body is
a judgment-based decision” (O’Neill et al. 2007 p.5). To demonstrate this point, O’Neill et al. (2007 p.19)
collated the various passing standards in other English speaking countries and identified that Australia
and New Zealand have adopted a higher IELTS passing standard for NESB nurse registration than other
English speaking countries. Differences in such policies become more significant as the flow of nurses
between countries increases. The Centre for Canadian Language Benchmarks (CCLB 2004) conducted a
multi-phase project, Benchmarking the Nursing Profession across Canada which investigated how the
language proficiency of nurses is measured for registration and then designed a nursing specific test, the
Canadian English Language Benchmark Assessment for Nurses (CELBAN). The CELBAN is similar in
its conception to the OET except with the advantage that it is entirely nursing specific whereas the OET is
only nursing specific in speaking and writing modules, with the reading and listening modules applying to
all the medical professions.
There are no quantitative studies published on the validity of the IELTS and OET as tools for
assessment of English language for registration as a nurse in Australia. Qualitative studies have found
some nurses with strong English language backgrounds who have been unable to get the scores required
in the OET or IELTS for registration in Australia (Walters 2008; Hawthorne 2001). The current study
aims to investigate the appropriateness of the administration of the current English language testing
process for the purpose of determining fitness for nursing registration in Australia. The main objective of
this study is to further understand the issue of the relatively unexplored area of English language testing
requirements for registration of migrant nurses and whether there are any predictors for success, such as
English language background, in achieving the scores required.
This research project aimed to answer the following questions about non-English speaking
background (NESB) nurses attempting to meet the English language requirements of the Nursing and
Midwifery Board of Australia (NMBA) for nursing registration in Australia:
Is there an association between demographic characteristics and test success? What is the
relationship between English language background and test success? What is the relationship between
education and work experience of participants and test success? How did successful candidates perceive
546 Is English Language Background an Indicator of ...

their experiences with the English tests? What are the perceptions of those NESB nurses who met the
requirements in terms of how these tests represent workplace communication?

Population

The target population was overseas qualified registered nurses from non-English speaking backgrounds
(NESB) who were required to pass the prescribed English tests for registration in Australia. This
included both nurses who were unable to qualify for registration in Australia and those who had
successfully registered.

Inclusion criteria

Participants had to hold a nursing qualification compliant with registration in a country other than
Australia; that is to say they had to be an overseas trained and qualified registered nurse. They also had to
be from a non-English speaking background as determined by the Nurse and Midwifery Board of
Australia (NMBA) and therefore required to meet the English language test requirements for registration
in Australia.

Exclusion criteria

Enrolled nurses were excluded. Registered nurses who were Australian trained and qualified were
excluded, as were those who qualified for a waiver of the English language test requirements at the time
of their registration. In 2010, for example, this latter category included those registered nurses who had
been taught and assessed in English in their tertiary entry to practice nursing and/or midwifery education
in Australia, Canada, New Zealand, Republic of Ireland, South Africa, United Kingdom, or United States
of America (NMBA 2010).

Recruitment Strategies

Data collection began 3rd May 2011 and ended 18th June 2012. A questionnaire was widely disseminated
through internet blogs, social networking sites, and email, as well as letters to professional organisations
asking for them to forward details of the study to their members. Fliers were also handed out at IELTS
and OET testing centres during 2011 and posted on notice boards throughout the three main universities
in Adelaide, South Australia that offer both Nursing and English as a Second Language (ESL) courses.
These announcements provided the access information for the questionnaire, which was posted on Survey
Monkey. An additional round of recruitment using electronic methods was to contact respondents who
had provided their email addresses and ask them to pass on details of the survey link to any colleagues or
friends they had who were in the same situation of having to sit the English tests for registration in
Australia.

Questionnaire: Design, Form and Format

A questionnaire was developed with the aim of collecting data on the demographics, education, work
experience, English language competency, and OET and IELTS results of NESB nurses in Australia. The
questionnaire was anonymous.
A panel of experts comprised of representatives of NESB nurses, academics who had conducted
research in this area and experts on questionnaire design were consulted to ensure face and content
validity. Items included questions on demographics (year of birth, country of origin, first language and
other languages, proficiency levels for these languages, and nursing qualifications and registrations, as
well as the countries and languages in which these qualifications or registrations were earned). Items
 Tiffany Lynch et al. 547

canvassed the English language experience of participants, seeking data on the language in which
secondary education (approximately aged 12-17yrs) had been taught and assessed as well as whether
participants held English language certificates. Data on the time spent in Australia was gathered.
Respondents who indicated they had spent time in Australia were presented with further questions on
their work experience in both nursing and other fields. These data were also important in gaining
understanding of the extent and type of experience of the target population in the Australian context and
whether these factors were correlated with the chance of success in the testing process.
Information about the OET and IELTS experiences of participants was sought, including number of
times the tests had been taken and scores. Those who had taken the tests were asked to rate, on a Likert
scale, their agreement with the statement “This test accurately assessed my ability to communicate in the
Australian nursing workplace”, as well as indicating how satisfied they had been with the English
language testing process for Australian nursing registration. An open-ended question was provided for
respondents to comment further on their individual experience with the English language testing process.
The question explicitly stated that both positive and negative feedback was welcomed.
The final question, for all respondents, invited them to participate in a follow up qualitative interview
study. Participation was voluntary.

Ethical Considerations

The University of Adelaide Human Research Ethics Committee granted approval for the study.

Data Analysis

The Statistical Package for Social Sciences (SPSS) was used to analyse quantitative data.

Results

There were 242 respondents with 129 being assessed as meeting the specifications of the inclusion
criteria. These were: overseas qualified registered nurses from NESB backgrounds who were required to
pass the prescribed English tests for registration in Australia and had already sat either test. There were 48
respondents who were identified in their answers as not being required to pass the tests as they were
eligible for a waiver, and a further 24 as having not achieved their initial registered nurse qualification
overseas. These respondents were excluded from the analysis of results but of the remaining 170
respondents, 41 met all the criteria except they had sat neither test and so these survey responses also had
to be removed from the results analysis. Thus there were 129 respondents who were eligible to be
included in the study.

Demographic Characteristics and English Test Success

Age

The mean age of the 129 respondents was 34.5 (SD± 8.60). There was no relationship between age and
passing either the IELTS or the OET (p=.512).
Table 1 shows the means and standard deviations of age by English test results at first sitting. Results
from the Kolmogorov-Smirnov test (p = .957) and the Mann Whitney U test (p=.531) indicated that the
distributions of age for participants who took the tests did not significantly deviate from a normal
distribution (p > .05). Independent sample t-tests were used to examine the age difference for participants
who passed or failed the tests. Results indicated there was no significant difference in age between
participants who passed and failed, with p = .512.
548 Is English Language Background an Indicator of ...

Table 1. Means and standard deviations of age by English test results (combined OET and IELTS exam scores)

English Test Success at First Sitting Age

Yes Mean 35.35
Std. Deviation 8.785
No Mean 34.18
Std. Deviation 8.506

Tables 2 and 3 show results of Independent sample t-tests used to examine the age difference
between participants who passed and those who failed the individual tests. For OET, results indicated that
there was a significant difference in age between participants who passed and those who failed, p = .030.
Participants who passed OET were significantly older than participants who did not. For IELTS, there
was no significant difference in age between participants who passed and those who failed, p = .112.

Table 2. Means and standard deviations of age by OET results

OET English Test Success at First Sitting Age

Yes Mean 41.08
(N=12)
Std. Deviation 8.68
No Mean 34.00
(N=13) Std. Deviation 6.58

Table 3. Means and standard deviations of age by OET and IELTS results

IELTS English Test Success at First Sitting Age

Yes Mean 35.71
(N=41) Std. Deviation 8.82
No Mean 33.12
(N=74) Std. Deviation 8.00

Gender

The majority of respondents were women (n=103; 80%) with only 26 men (20%). There was no
association between gender and pass rates (p= .476).
Table 4 shows the frequency of participants who passed and failed either English test at first sitting
by gender. The Chi-squared test was used to examine the difference in passing rate between gender for
participants. Results indicated there was no significant difference in passing rate between males and
females (p=.476).

Table 4. Gender and English Test Success at First Sitting

What is your gender?

English Test Success at First Sitting
female male Total
Yes Count 27 4 31
 Tiffany Lynch et al. 549

No Count 75 17 92

Total Count 102 21 123

The Chi-squared test was then used to examine the difference in passing rate between genders for
participants who took IELTS. Results indicated that there was no significant difference in the passing
rates of males and females, p = .274. Fisher’s exact test was used for OET due to the small cell numbers,
and results also indicated there was no significant difference in the passing rates of males and females for
OET, p = .220.

Country of Origin

Is there a relationship between country of origin and English test success?

Country of Origin of the Respondents

The respondents originated from fifty different countries. Of these, forty-three countries had less than five
respondents and so these have been represented on Figure 1 under the category “Other”. As can be seen
on Figure 1, the most common country of origin was India with 41 (31.8%) respondents. The next most
common country of origin was the Philippines with 27 (20.9%), followed by China with 12 (9.3%)
respondents.

Figure 1.

Table 5 shows the frequency of participants who passed and failed the first sitting of one of the
English tests by country of origin. The group marked “Other” includes countries with fewer than 5
respondents. The Chi-squared test was used to examine the difference in passing rate by country of origin
of participants, and results indicated there was a significant difference, F (4) = 11.428, p = .022. It
2

appears from these results that nurses who indicated South Africa as their country of origin have more
success in passing the test. However, due to the small cell size in this group (<5 in 30% of cells) this
result does not appear valid. There is no significant difference among respondents from China, India, and
the Philippines in test success at first sitting.
550 Is English Language Background an Indicator of ...

Table 5. English Test Success at First Sitting and Country of Origin

Country of Origin
English Test Success at First Sitting
Other China India Philippines South Africa Total
Yes Count 9 3 8 6 5 31
% within Country of Origin 22.5% 25.0% 20.5% 23.1% 83.3% 25.2%
No Count 31 9 31 20 1 92
% within Country of Origin 77.5% 75.0% 79.5% 76.9% 16.7% 74.8%
Count 40 12 39 26 6 123
Total
% within Country of Origin 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Table 6 shows the frequency of participants who passed and failed the first sitting of IELTS by
country of origin, and Table 7 shows these results for OET. The Chi-squared test could not be used to
examine the difference in passing rate by country of origin of participants because more than 20% of cells
had fewer than 5 cases.

Table 6. IELTS First Time Success and Country of Origin

Country of Origin
IELTS First Time Success South
Afr
Other China India Philippines ica Total
Yes Count 6 1 5 5 4 21
% within Country of Origin 17.1% 8.3% 13.5% 20.0% 66.7% 18.3%
No Count 29 11 32 20 2 94
% within Country of Origin 82.9% 91.7% 86.5% 80.0% 33.3% 81.7%
Total Count 35 12 37 25 6 115
% within Country of Origin 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Table 7.OET Test Success at First Sitting and Country of Origin

Country of Origin
OET First Time Success South
Other China India Philippines Africa Total
Yes Count 4 2 3 1 1 11
% within Country of 40.0% 66.7% 30.0% 100.0% 100.0% 44.0%
Origin
No Count 6 1 7 0 0 14
% within Country of 60.0% 33.3% 70.0% .0% .0% 56.0%
Origin
Total Count 10 3 10 1 1 25
% within Country of 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Origin
 Tiffany Lynch et al. 551

The countries of origin were then divided into two groups to explore whether there was a significant
difference in the rate of passing OET or IELTS at first sitting between countries of origin in which
English was one of the official languages and those in which it was not. These categories were determined
from a list compiled by the One World Nations Online Organisation, which is used for a reference across
many international authorities. These results are displayed in Table 8. The Chi-squared test was used to
examine the difference in passing rate across countries of origin of participants. No significant difference
was evident from the results (p = .548). When the data were split into separate categories for the
individual tests, there was still no significant difference: OET, p = .495 and IELTS, p = .321.

Table 8. English Test Success at First Sitting and English as an official or primary language for country of origin

Country Official Language

English Test Success at First Sitting English is an official or English is not an official
primary language or primary language Total
Yes Count 23 8 31
% within Country Official 26.7% 21.6% 25.2%
Language
No Count 63 29 92
% within Country Official 73.3% 78.4% 74.8%
Language
Total Count 86 37 123
% within Country Official 100.0% 100.0% 100.0%
Language

There was no significant association between pass rate and country of origin even when comparing
countries where English is one of their National Languages and those where it is not. In regards to the
variable of English language background, it would be reasonable to anticipate that those nurses with more
exposure to English in their work or education backgrounds would be more likely to gain the scores
required in the English tests for nursing registration in Australia however this was not the case. These
results could indicate the possibility that the English testing policy needs reviewing to ensure we are
achieving the objectives of the testing policy.

Is There a Relationship between First Language Background and English Test Success for Nursing
Registration in Australia?

Thirty-three different first languages were specified by the 129 respondents and sixteen were unspecified,
by being selected as “Other” without any accompanying text to indicate the language in the corresponding
free-text box. Of the specified languages, those which had less than five respondents have been
represented on Figure 2 under the category “Other” along with the unspecified languages. The most
common first language of the subjects is Filipino/Tagalog with 23 (17.8%). The next most common was
Malayalam with 16 (12.4%) followed by English with 13 respondents (10.1%). Eastern Punjabi and
Mandarin Chinese both were represented by 11 respondents (8.5%). There are several main languages
spoken in India and these are just the most represented languages amongst the respondents for these
countries which is why the national language of the Philippines is represented with a higher number than
the national language of India even though more respondents came from India.
552 Is English Language Background an Indicator of ...

Figure 2.

Respondents reported a number of different first languages. Those reported by fewer than five
respondents were included in the category “Other”. Table 9 displays the results of success in first test
sitting and first language. The Chi-squared test could not be used to examine the difference in passing rate
between countries of origin of participants because more than 43% of cells had fewer than 5 cases.

Table 9. English Test Success at First Sitting and First Language

First Language
English Test Success
at First Sitting Chinese, Panjabi,
Other Mandarin English Hindi Malayalam Eastern Filipino/Tagalog Total
Yes Count 10 3 7 0 6 1 4 31
% within 20.8% 27.3% 63.6% .0% 37.5% 10.0% 18.2% 25.2%
First
Language
No Count 38 8 4 5 10 9 18 92
% within 79.2% 72.7% 36.4% 100.0% 62.5% 90.0% 81.8% 74.8%
First
Language
Total Count 48 11 11 5 16 10 22 123
% within 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
First
Language
 Tiffany Lynch et al. 553

The first languages of participants were then divided into those which are cognate with English
(Indo-European) and those which are non-cognate with English. The Chi-squared test was used to
examine the difference in passing rate between participants whose first language was cognate with
English and those whose first language was not cognate with English. No significant difference between
these categories was evident (p = .435) for English test success. The frequencies are displayed in Table
10. When the data were split into separate categories for the individual tests there was also no significant
difference in passing rate between cognate or non-cognate first languages for OET, p = .678 and IELTS,
p = .342.

Table 10. English Test Success at First Sitting and Language Groups

Language Groups
English Test Success at First Sitting Indo-European Other
(cognate with English) (non-cognate with English) Total
Yes Count 20 11 31
% within Language Groups 27.8% 21.6% 25.2%
No Count 52 40 92
% within Language Groups 72.2% 78.4% 74.8%
Total Count 72 51 123
% within Language Groups 100.0% 100.0% 100.0%

Can communicate in any other language(s) apart from English and their First Language.
Table 11 shows the frequencies of respondents who could communicate in another language as well
as English and their first language. The Chi-squared test was used to examine the difference in passing
rate between respondents who could communicate in another language and those who could not. Results
indicated no significant difference (p = .271) for English test success.

Table 11. English Test Success first sitting and ability to communicate in another language apart from
English and their first language

Can you communicate in any other languages apart from

English Test Success at First Sitting English and your first language?
Yes No Total
Yes Count 21 10 31
% within other languages 28.8% 20.0% 25.2%

No Count 52 40 92
% within other languages 71.2% 80.0% 74.8%

Total Count 73 50 123

% within other languages 100.0% 100.0% 100.0%
554 Is English Language Background an Indicator of ...

Language Taught and Assessed in Secondary School

Respondents indicated [number] different languages taught and assessed in secondary school. Those
languages which were indicated by fewer than than five respondents were included in the category
“Other”. Table 12 displays the results by success in first test sitting and language taught and assessed in
secondary school. The Chi-squared test could not be used to examine the difference in passing rate across
countries of origin of participants because 40% of cells had fewer than 5 cases.

Table 12.

Language of Secondary Schooling

English Test Success at First Sitting Chinese, Panjabi,
Other English Mandarin Eastern Filipino/Tagalog Total
Yes Count 10 17 2 0 2 31
% within Language of 29.4% 25.8% 22.2% .0% 25.0% 25.2%
Secondary Schooling
No Count 24 49 7 6 6 92
% within Language of 70.6% 74.2% 77.8% 100.0% 75.0% 74.8%
Secondary Schooling
Total Count 34 66 9 6 8 123
% within Language of 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Secondary Schooling

English Certificates

Table 13 shows the frequencies of respondents who had or did not have English certificates by English
test success. The Chi-squared test was used to examine the difference in passing rate for those who had a
certificate in English. Results indicated no significant difference (p = .880) for English test success.

Table 13. English certificates by English test success

English language certificates

English Test Success at First Sitting
Yes No Total
Yes Count 7 24 31
% within English language certificates 24.1% 25.5% 25.2%
No Count 22 70 92
% within English language 75.9% 74.5% 74.8%
Total Count 29 94 123
% within English language certificates 100.0% 100.0% 100.0%

There was no significant association between pass rate and first language background even when
comparing countries where English is one of their National Languages and those where it is not. In
regards to the variable of English language background, it would be reasonable to anticipate that those
nurses with more exposure to English in their work or education backgrounds would be more likely to
gain the scores required in the English tests for nursing registration in Australia however this was not the
 Tiffany Lynch et al. 555

case. These results could indicate the possibility that the English testing policy needs reviewing to ensure
we are achieving the objectives of the testing policy.

Is There a Relationship between English Language Education and English Test Success for Nursing
Registration in Australia?

Language Taught and Assessed in Secondary School

Respondents indicated [number] different languages taught and assessed in secondary school. Those
languages which were indicated by fewer than than five respondents were included in the category
“Other”. Table 14 displays the results by success in first test sitting and language taught and assessed in
secondary school. The Chi-squared test could not be used to examine the difference in passing rate across
countries of origin of participants because 40% of cells had fewer than 5 cases. As can be seen in Table 1,
74.2% of participants whose language of secondary education was all delivered in English were
unsuccessful in gaining the scores required in the English tests for nursing registration in Australia and
just 25.8% were successful. This is not what would be expected as it would be anticipated that those
nurses who were educated in a high school where the language of instruction was English would be more
likely to be successful in the English tests.

Table 14.

Language of Secondary Schooling

English Test Success at First Sitting Chinese, Panjabi,
Other English Mandarin Eastern Filipino/Tagalog Total
Yes Count 10 17 2 0 2 31
% within Language of 29.4% 25.8% 22.2% .0% 25.0% 25.2%
Secondary Schooling
No Count 24 49 7 6 6 92
% within Language of 70.6% 74.2% 77.8% 100.0% 75.0% 74.8%
Secondary Schooling
Total Count 34 66 9 6 8 123
% within Language of 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Secondary Schooling

English Certificates

Table 15 shows the frequencies of respondents who had or did not have English certificates by English
test success. As can be seen in Table 15, 75.9% of the nurses who had English certificates were
unsuccessful at gaining the scores required in the English tests for nursing registration in Australia. The
Chi-squared test was used to examine the difference in passing rate for those who had a certificate in
English. Results indicated no significant difference (p = .880) for English test success however, the
figures are still worth noting as it would be expected that those who have English certificates would have
more success within their variable than 24.1%.
556 Is English Language Background an Indicator of ...

Table 15.

English language certificates

English Test Success at First Sitting
Yes No Total
Yes Count 7 24 31
% within English language certificates 24.1% 25.5% 25.2%
No Count 22 70 92
% within English language 75.9% 74.5% 74.8%
Total Count 29 94 123
% within English language certificates 100.0% 100.0% 100.0%

There was no significant association between pass rate and first language background even when
comparing countries where English is the language of instruction in all subjects at high school and those
where it is not. In regards to the variable of English language educational background, it would be
reasonable to anticipate that those nurses with more exposure to English in their work or education
backgrounds would be more likely to gain the scores required in the English tests for nursing registration
in Australia however this was not the case. These results could indicate the possibility that the English
testing policy needs reviewing to ensure we are achieving the objectives of the testing policy.

Is There a Relationship between Nursing Qualifications and English test Success for Nursing
Registration in Australia?

Registered Nursing Qualifications

Initial Qualification

As demonstrated in Figure 4, the majority (n=70; 54.3%) of the 129 respondents received their initial
registration through a Registered Nurse Bachelor Degree. Forty-eight (37.2%) had a Registered Nurse
Diploma and just four (3.1%) a Registered Nurse Certificate. The remaining seven respondents (5.4%)
did not specify, responding with “other”.

Figure 4.
 Tiffany Lynch et al. 557

The countries from which the subjects gained their initial registered nurse qualification were
represented as follows in Figure 5. India was the most common with 41 subjects (31.8%), followed by the
Philippines with 27 respondents (20.9%), and China with 12 (9.3%). There were seven (5.4%) from South
Africa and five (3.9%) from both South Korea and Fiji.

Figure 5.

The language the majority of these courses were delivered and assessed in was English with 88
(68.2%) of the subjects, followed by Mandarin Chinese with 11 (8.5%). There were five (3.9%) whose
course was taught and assessed in Korean. This information is represented in Figure 6 below.
558 Is English Language Background an Indicator of ...

Figure 6.

As can be seen in Figure 7 below, 50 (38.9%) of these initial registered nursing qualifications had
been received in the past six years, between the years 2006-2011.

Figure 7.
 Tiffany Lynch et al. 559

Second Nursing Qualification

Of the 129 subjects, 42 (32.6%) had a second nursing qualification to qualify for registration with 20
(47.6%) of those being a Registered Nurse Bachelor. Six people (14.3%) had a Registered Nurse Diploma
and nine (21.4%) had a Registered Nurse certificate as their second nursing qualification.

Figure 8.

Of the 42 respondents with a second nursing qualification, 41 indicated the country in which they
received their second nursing qualification and 23 (56.1%) of these achieved it in Australia and six
(14.3%) in India. This is demonstrated below in Figure 9.

Figure 9.
560 Is English Language Background an Indicator of ...

Forty respondents listed the language in which these second nursing qualifications were delivered
and assessed in, and of these, most subjects (n=38; 95%) indicated it was in English as can be seen on
Figure 10.

Figure 10.

As can be seen in Figure 11, most of these second nursing qualifications were achieved in the past
five years with 26 respondents (66.7%), followed by ten (25.6%) between 2001-2005, two (5.1%) in
2000, and one (2.6%) in 1995.

Figure 11.

Postgraduate Nursing Qualifications

Of the 129 respondents, 43 (33.3%) indicated they had postgraduate nursing qualifications. A Masters
degree was the most common post-graduate degree with twelve (27.9%), followed by ten (23.3%) with a
Post-registration Bachelor of Nursing degree and eight (18.6%) a Graduate Diploma.
 Tiffany Lynch et al. 561

Figure 12.

Nine (20.9%) of these post-registration qualifications were received in the Philippines, followed
equally by India and Australia with seven (16.3%). Next was South Africa with five respondents (11.6%).

Figure 13.

As can be seen in Figure 14, the majority of these post-graduate nursing qualifications were
delivered and assessed in English with 33 (76.7%) out of these 43 respondents.
562 Is English Language Background an Indicator of ...

Figure 14.

As can be seen in Figure 15, half of the postgraduate nursing qualifications (n=21) were received in
the past five years, between 2007 - 2011.

Figure 15.

Registered Nurse Qualifications

Table 16 shows the frequencies of respondents who had a Registered Nurse Bachelor degree or a
Registered Nurse Diploma or Certificate by English test success at first sitting. The Chi-squared test was
used to examine the difference in passing rate between nurses with these two levels of qualification.
Results indicated no significant difference (p = .235) for English test success.
 Tiffany Lynch et al. 563

Table 16.

Nursing Qualification
English Test Success at First Sitting Registered Nurse
Registered Nurse Bachelor Diploma or Certificate Total
Yes Count 19 10 29
% within Nursing 29.2% 19.6% 25.0%
Qualification
No Count 46 41 87
% within Nursing 70.8% 80.4% 75.0%
Qualification
Total Count 65 51 116
% within Nursing 100.0% 100.0% 100.0%
Qualification

Postgraduate Nursing Qualifications

Table 17 shows the frequencies of respondents who had postgraduate qualifications by English test
success. The Chi-squared test was used to examine the difference in passing rate for those who did and
did not have a postgraduate qualification. Results indicated no significant difference (p = .856) for
English test success.

Table 17.

Do you have any post-registration nursing

English Test Success at First Sitting qualifications?
Yes No Total
Yes Count 11 20 31
% within post-registration 26.2% 24.7% 25.2%
nursing qualifications
No Count 31 61 92
% within post-registration 73.8% 75.3% 74.8%
nursing qualifications
Total Count 42 81 123
% within post-registration 100.0% 100.0% 100.0%
nursing qualifications

There was no significant association between pass rate and registered nursing qualifications and
education even when comparing countries where English is the language of instruction in their nursing
studies and those where it is not. In regards to the those nurses who successfully studies their nursing
degree in English, it would be reasonable to anticipate that those nurses with more exposure to English in
their tertiary education backgrounds would be more likely to gain the scores required in the English tests
for nursing registration in Australia however this was not the case. These results could indicate the
possibility that the English testing policy needs reviewing to ensure we are achieving the objectives of the
testing policy.
564 Is English Language Background an Indicator of ...

Is There a Relationship between Nursing Work Experience and English Test Success for Nursing
Registration in Australia?

Nursing Registration and Work Experience in other Countries, Including Country of Origin

Of the 129 respondents, 80 (62.0%) had been registered in another country other than Australia. However
just 72 (55.8%) had actually worked as a registered nurse in another country.

Nursing Registration Outside Australia

Of the 80 subjects who had been registered in another country, most indicated this was India with 21
(26.3%). This was followed by the Philippines with fourteen (17.5%), China with seven (8.8%), and the
UK with six (7.5%) respondents.

Figure 16.

As can be seen in Figure 17, thirty-three (41.4%) of these registrations were in the 2006-2010 period.

Figure 17.
 Tiffany Lynch et al. 565

Work Experience outside Australia

As mentioned above, of the 129 respondents 72 (55.8%) had worked as a registered nurse in another
country. Of these, 36 (50.0%) indicated they had worked in two or more other countries.
Of the seventy-one subjects who gave the details of this work experience, the position of “Registered
Nurse- direct patient care” was the most common with sixty-two (87.3%), followed by “Nurse
Educator/Researcher” with just six (8.5%) subjects.

Figure 18.

The nursing area most common was Medical with twenty-three (32.4%) subjects, followed by fifteen
(21.1%) for Critical Care and Emergency and nine (12.7%) in Surgical.

Figure 19.
566 Is English Language Background an Indicator of ...

As can be seen in Figure 20, India was the most commonly represented country with nineteen
(26.8%) subjects, followed by ten (14.1%) in the Philippines and six (8.5%) in China.

Figure 20.

English was the language used in the workplace for thirty-three (46.5%) of these subjects, followed
by six (8.5%) using Mandarin Chinese and five (7.0%) using Arabic in the workplace.

Figure 21.
 Tiffany Lynch et al. 567

Nursing Registration and Work Experience in Other Countries, Including Country of Origin
Related to English Test Success

Nursing Registration

Table 20 shows the frequencies of respondents who had been registered in another country by English test
success. The Chi-squared test was used to examine the difference in passing rate and having a previous
registration. Results indicated no significant difference (p = .100) for English test success.

Table 20.

Have you been registered as a

English Test Success at First Sitting nurse in any other countries?
Yes No Total
Yes Count 23 8 31
% within registered as a nurse in any other 30.3% 17.0% 25.2%
countries
No Count 53 39 92
% within registered as a nurse in any other 69.7% 83.0% 74.8%
countries
Total Count 76 47 123
% within registered as a nurse in any other 100.0% 100.0% 100.0%
countries

Nursing Work Experience Outside of Australia

Table 21 shows the frequencies of respondents who had worked as a registered nurse in another country
by English test success. The Chi-squared test was used to examine the difference in passing rate for those
who had and did not have previous nursing work experience. Results indicated no significant difference
(p = .378) for English test success.

Table 21.

Have you worked as a registered

English Test Success at First Sitting nurse in any other countries?
Yes No Total
Yes Count 19 12 31
% within worked as a registered nurse in any other 28.4% 21.4% 25.2%
countries
No Count 48 44 92
% within worked as a registered nurse in any other 71.6% 78.6% 74.8%
countries
Total Count 67 56 123
% within worked as a registered nurse in any other 100.0% 100.0% 100.0%
countries
568 Is English Language Background an Indicator of ...

It was then analysed whether the number of years spent working as a registered nurse had any
relationship with English test results at first sitting. Results from Kolmogorov-Smirnov (p = .256)
indicated that the distributions of years nursing for participants who took the tests did not significantly
deviate from a normal distribution (p > .05). However, inspection of the histograms indicated that the
distribution was not normal, and so Mann-Whitney U Test Independent sample tests were used to
examine the difference in years spent nursing for participants who passed or failed the tests. Results
indicated there was no significant difference in years spent nursing between participants who passed and
failed with p = .336.
There was no significant association between success in the English tests and registered nursing
work experience even when comparing countries where English is the language of the workplace or
country in their nursing work experience and those where it is not. In regards to the those nurses who had
previously worked in an English speaking medical environment, it would be reasonable to anticipate that
those nurses with more exposure to English in their nursing backgrounds would be more likely to gain the
scores required in the English tests for nursing registration in Australia however this was not the case.
These results could indicate the possibility that the English testing policy needs reviewing to ensure we
are achieving the objectives of the testing policy.

Acknowledgement

The author thanks Judy Magarey and Rick Wiechula for their valuable supervision during the writing of
this research.

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