Aligning Cross-Border Nursing Practice: Development of a Legally-Defensible International Regulatory Examination for Entry-Level Registered Nurses

Woo, Ada

Purpose:

In the United States, the NCLEX-RN^®is an examination of entry-level registered nursing competence for the purpose of initial licensure. Beginning in 2015, ten Canadian provinces and territories also adopted the use of NCLEX-RN as the entry-to-practice examination. The current paper will outline the test development procedures that were implemented to ensure that the NCLEX-RN is an appropriate and legally-defensible assessment of entry-level nursing practice in the U.S. and in Canada. The authors would like to highlight the process used in transitioning the NCLEX-RN from a U.S. licensure examination to one that is appropriate and legally defensible for use in two countries as a case study for developing a cross-border licensure nursing exam.

Methods:

Large scale, international practice analysis survey methodologies will be used. See reference section for detail.

Results:

Four major aspects of the examination development process will be discussed in this paper: (1) practice analysis, (2) test content development, (3) psychometrics and (4) implications in cross-border nursing practice. The NCLEX-RN development process begins with a practice analysis that surveys entry-level incumbents on job tasks, knowledge and skills that are relevant to entry-level practice. After the initial practice analysis survey was conducted in the U.S., a large scale validation study was completed using the Canadian nursing population. In terms of test content development, Canadian subject matter experts joined forces with their U.S. colleagues in the NCLEX-RN development and review process two years prior to the examination launch in Canada. Canadian nurses took part in the item writing, review and translation validation of the NCLEX-RN.

Conclusion:

In addition, this paper will describe the psychometric analyses applied to the examination data to ascertain whether the NCLEX-RN items are fair and unbiased for both U.S. and Canadian nurse candidates. Specially, the use of differential item functioning analyses in detecting content bias will be discussed. To conclude, the authors will discuss the implications on cross-border nursing practice in the U.S. and in Canada since the common use of the NCLEX-RN in these two countries.