The regulatory body for Manitoba nurses has found local nursing students are sometimes graduating from local schools without adequate English skills — but a plan to introduce mandatory language testing before writing their final registration exams is being put on hold.

Some nursing students say the $320 test is too expensive, and some post-secondary institutions fear it will affect recruitment and create uncertainty for students investing in nursing programs.

The College of Registered Nurses of Manitoba announced earlier this year that as of Jan. 1, 2020, every prospective nurse would have to pass an academic English test before taking a registration exam.

This came after years of study revealed multiple examples that called into question whether nurses were graduating from Manitoba programs with full proficiency in English, according to the college, the regulatory body for about 14,000 registered nurses and nurse practitioners in the province.

It found seven cases where language proficiency was identified as a factor in unsafe nursing practices.

"We have reason to believe that completion of a nursing education program in Canada is not a valid measure of English language proficiency at the level required for safe registered nursing practice," the college wrote in an executive summary released earlier this year.

Test paused after pushback

The test the college wanted to mandate was the International English Language Testing System, a standardized international proficiency test that would have assessed prospective nurses' abilities in English-language listening, reading, writing and speaking.

However, the regulatory body told CBC News in an interview that its plans for the requirement on hold after several nurses came forward with concerns.

"We heard from a lot of individuals … and we learned of a lot of unintended consequences of things that were perhaps not at first contemplated," said Katherine Stansfield, the registrar for the College of Registered Nurses of Manitoba.

Those consequences included the $320 cost to write the test, lack of academic support for those who may not meet the requirements, and concerns raised by post-secondary institutions, she said.

Students who have already taken the test will be reimbursed by the College of Registered Nurses, as will students who were penalized for not cancelling the test in time, Stansfield said.

None of the money from the cost of the test goes to the College of Registered Nurses. It is privately administered.

1st in Canada

The policy would have been a first in Canada. While it is typical for a regulatory nursing body to require proof of English proficiency, it is not typical to refuse to accept graduation from a local school as proof.

"I think Manitoba was the first to realize there might be an issue here," Stansfield said. "I know our regulators across the country are very interested in what we were finding."

She couldn't comment on why some Manitoba nursing graduates might be leaving school without an acceptable level of English proficiency.

"I can't answer it because I'm not an educator. I know that the world of health care has become incredibly complex over many years, and that's not news," she said.

A spokesperson for the University of Manitoba — which offers undergraduate, graduate and nurse practitioner programs — said the school is committed to ensuring students are prepared for entry into the nursing profession.

"UM's nursing program is offered entirely in English, and English-language proficiency is required in order to succeed in the program," wrote a university spokesperson in a prepared statement.

Communication complaints

A detailed executive summary released by the College of Registered Nurses went over various examples it has documented over the years regarding the English level of nursing graduates.

The College of Registered Nurses found:

Students with language proficiency issues were being given extra time to write university exams due to mandates from the school's accessibility services.

A number of applicants for registration who had completed Manitoba entry-level nursing education programs later failed additional English language proficiency tests.

"Communication" was the among the top three most frequently identified reasons for complaints received by the College of Registered Nurses.

Some Manitoba students requested testing accommodation for the nursing registration exam due to language proficiency issues.

The U of M nursing faculty reported that a lack of proficiency in oral English was creating significant problems for students in the four-year nursing program.

Nursing programs opposed policy

The five post-secondary institutions in Manitoba with nursing programs joined forces to oppose the new policy, arguing it could impact enrolment and create unnecessary fears for prospective students.

That opposition was led by led by L'Université de Saint-Boniface. The University of Manitoba, Red River College, Brandon University and University College of the North were the other schools involved.

Peter Dorrington, the vice-president of education and research at Université de Saint-Boniface, led the charge by post-secondary institutions to oppose the mandatory tests. (Université de Saint-Boniface)

"We told the College [of Registered Nurses] that we had serious reservations about the policy as it was being proposed — that it would create uncertainty for students," said Peter Dorrington, vice-president of academics and research at Winnipeg's Université de Saint-Boniface.

"They shouldn't find out toward the end of their program if they had the right level of English."

Dorrington is a member of the working group established by the College of Registered Nurses that will have until early summer to figure out an alternative solution to test.

One solution may be to test students at the beginning of the program rather than toward its end, Dorrington said.

Test takes time, money: students

CBC spoke to one new graduate who expressed concerns about the cost of the test — $320 on top of the more than $500 new graduates have to pay for their registration exam with the college.

"We felt it was insulting and a cash grab and will defer people from wanting to study in Manitoba because of the extra cost and stress of another intensive exam," said the student, who the CBC has agreed not to name.

The test also requires study in order to pass, even for those whose first language is English, the student said.

Manitoba Nurses Union president Darlene Jackson is worried the tests would have a negative effect on nurse recruitment. (Travis Golby/CBC)

The Manitoba Nurses Union also expressed concern the new policy would have affected recruitment.

"Manitoba has a critical nursing shortage," union president Darlene Jackson said in a prepared statement.

"This [proposed test] is problematic, as it poses additional barriers and may significantly delay the (re-)entry of qualified nurses into the workforce."

Stansfield said the working group will look at a number of alternatives to the test, but remains committed to monitoring the situation.

"Where we can assure the public is that we have not backed away from our public safety mandate," she said.

"And there are many, many ways that we monitor practice and we require nurses to demonstrate that compliance over the course of their whole career. And that hasn't changed."