Politics of Access: Negotiating Permissions for Qualitative Research into NCLEX-RN© Exam Preparation in British Columbia

Friday, 26 July 2019

Patricia R. Rampersaud, MSN
Department of Educational Studies, University of British Columbia, Vancouver, BC, Canada

Gaining access is a crucial endeavour in qualitative research and yet very little is written in the literature about

the politics of gaining access into higher educational settings (Burgess, 1984/2016). ‘Gatekeepers’ have the power

to permit or deny access into the organization, including its people, procedures, and situations (Burgess,

1984/2016; Leblanc & Schwartz, 2007). This poster reports on the politics of gaining access into multiple access

points of a local post secondary educational organization, including access to its classrooms, faculty, meetings, and

documents. The qualitative study was designed to examine how a school of nursing (SON) prepared for a relatively

new assessment, the NCLEX-RN© exam, and the poster illustrates how a continuous process of negotiation and

renegotiation were required throughout the research process (Burgess, 1984/2016; Leblanc & Schwartz, 2007;

McDermid, Peters, Jackson, & Daly 2014). In addition, both the researcher and organization demonstrated several

moments of being reflective, creative, and flexible as part of gaining access.

Background

As of 2015, Canadian nursing graduates, except those in Quebec and the Yukon, no longer completed a

Canadian based registration exam as part of their program requirements. Instead, they wrote the American

National Council Licensure Examination for Registered Nurses (NCLEX-RN©) exam as one component in the nursing

registration process (Canadian Nurses Association (CNA), 2011; College of Registered Nurses of British Columbia

(CRNBC), 2015). The NCLEX-RN© exam replaced a Canadian based registration exam which had been in place

from 1970-2015. Greater protection of the public was the rationale provided by the Canadian Council of Registered

Nurse Regulators (CCRNR) (CCRNR & National Council of State Boards of Nursing, 2012) and the CRNBC (2011) for

the adoption of the NCLEX-RN© exam as Canada’s new registered nursing regulation exam. The Canadian

Association of Schools of Nursing (CASN) (2012a, 2012b), and the CNA (2011), both expressed concerns with the

adoption of the NCLEX-RN© exam. One concern expressed was the amount of time and resources that would be

needed to assist nursing educators to revise their teaching practices to assist students’ success on the test (CASN,

2012a, 2012b). Additionally, in a 2014 online survey of Deans and Directors of Schools of Nursing across Canada,

CASN (2014) researchers found many nursing programs across British Columbia (BC) and across Canada began

adjusting their curriculums and purchasing new computerized teaching and testing materials to prepare both faculty

and students for the NCLEX-RN© exam.

The adoption of the NCLEX-RN© exam was a result of many factors. Global and economic restructuring

generated the need for policies that were more responsive to economic, labour, and market needs (Taylor, Rizvi,

Lingard, & Henry, 1997). Educational policies (such as the adoption of the NCLEX-RN© exam in Canada) are often

created to assist in managing change (Taylor et al., 1997); however, educators (a) are routinely left out of the

policy-making process, (b) are given little opportunity to understand or learn about particular policies,

(c) experience a displacement of their own pedagogical and curricular values, and (d) are often confused and resentful

about recent policy shifts that implicitly and explicitly ask them to change their historical practice (Ball, Maguire, &

Braun, 2012a, 2012b; Laschinger & Finegan, 2005; Taylor et al., 1997).

Purpose

Currently there is a void in the nursing and educational literatures about how SONs, nursing administrators,

and nursing educators are positioned and constructed by the adoption of the NCLEX-RN© exam. The purpose of

this qualitative study was to gain insight into how the NCLEX-RN© exam influenced Canadian SONs, nursing

administrators, and nursing educators as they prepared students for the new NCLEX-RN© exam. The significance

of this study is that its findings will contribute and extend current disciplinary knowledge, theory, and practice and

may inform future policy- and decision-making at local and national levels. Moreover, the study provides important

research on how Canadian SONs, nursing administrators, and nursing educators are positioned and constructed

through legislative and other policy-making practices. The study’s focus on how the power relations involved, with

the design and implementation of educational policies in nursing, has significant practical relevance when

participants and other stakeholders find the study’s contributions insightful and applicable to their own practice

(Tracy, 2010).

Methodology

The study consisted of two complimentary qualitative approaches, focused ethnography and critical policy

analysis. Focused ethnography is designed to examine phenomena in real time, in a natural setting, and uses

ethnographic methods (such as participant observations, interviews, and document analysis) to explore an ‘emic’

point of view pertaining to specific situations, activities, and actions under study (Ball, 1994; Cruz & Higginbottom,

2013; Knoblauch, 2005; Taylor et al., 1997; Wall, 2015). Critical policy analysis is concerned with power, politics,

and difference as well as how actors are “constituted in and by policy” (Webb & Gulson, 2015, p. 5). There are

parallels between ethnography and critical policy research in that both can be disruptive and threatening to

organizations and local participants (Ball, 1994; Tamboukou & Ball, 2003). Moreover, both qualitative approaches

reveal how power and knowledge operate within specific sites of change, conflict, and struggle (Ball, 1994;

Tamboukou & Ball, 2003). Because of this qualitative design, the processes involved in obtaining access to

organizations and its personnel were a delicate process of negotiation and renegotiation.

Methods

My research consisted of specific methods of participant observations, participant interviews, and document

analysis in a SON in BC. As the researcher in this study, I served as the primary research instrument in each

method and functioned as both an ‘insider’ and ‘outsider’ in the setting in relation to my own positionality as a

nursing educator (Dwyer & Buckle, 2009; McDermid et al., 2014; Murchinson, 2010). For instance, because I

conducted research in a SON other than the one where I work, I was an outsider to the organization that I

researched. However, I was also considered to be an insider in the profession and may have known some of the

participants (that is, nursing educators and administrators) from shared professional development events. My dual

role as both insider and outsider provided a key component to obtaining access to the organization and its

personnel.

Gaining Access

Ethics approval was obtained from the University of British Columbia’s (UBC) Behavioural Research Ethics Board

(BREB) (2016). An ethics application was concurrently submitted to the Riverside [pseudonym] organization that

housed the Bachelor of Nursing SON, and specifically to its respective institutional research ethics board (IREB).

The process of obtaining ethics approval often revolves around both institutions providing approvals once the other

institution grants permission. This process is often a very delicate and convoluted one. Importantly, I had

established a relationship with a key informant in the SON. Prior to submitting my research application to

Riverside, I had been in contact with the Board’s Chair who believed that since my study was deemed minimal risk

at UBC, the approval process at Riverside would be short.

Ethical approval from the UBC’s BREB was obtained seven days after submission. Ethical approval from

Riverside’s IREB was more complex and took a total of eight weeks. Four days after the submission of the

application, I was informed that the ethical application needed to go to a full board review by default due to the

complexity of the study and the Chair’s wish to have input from the other IREB members. The full board did not

meet for another six weeks. After the full board met, they created a list of provisos and amendments to

documents. Their concerns revolved around (a) justification for attending faculty and department meetings;

(b) the indirect identification of faculty; (c) the preservation of confidentiality and participants’ rights; and (d) the

methodology. They requested that a SON sponsor be identified as a coinvestigator in the study and suggested that

the Faculty Association was contacted to see if participation in the study would affect the participants’ risk to

employment. Finally, they requested that someone at the institution read a draft of the study’s findings and

discussion sections to ensure confidentiality of participants due to the potential for participants to be exposed to

criticism (for example, their teaching methods, pedagogical decisions, etcetera). The IREB exercised great care to

protect the faculty and institution’s welfare partly due to my description of the critical nature of the study. A

continuous process of negotiation and renegotiation with key players took place to address the provisos.

Gaining access also consisted of multiple points of entry besides the specific organization. Once ethical approval

was obtained from both research ethic boards, gaining access to classrooms, faculty, meetings, and documents

remained a challenge that required constant negotiation and renegotiation. SON faculty did not readily volunteer to

be observed in participant observations of classroom or meeting settings. Few faculty volunteered for interviews. A

schedule of the SON faculty meetings, meeting agendas, or meeting minutes were not provided as originally had

been discussed. The head of a committee responsible for the planning and assessing of the SON’s response to the

NCLEX-RN© exam did not communicate after initial contact.

A continuous process of negotiation and renegotiation, being reflective, creative, and flexible was required

throughout the process of gaining access.