Internationally Educated Applicants - Clinical Competence Assessment

In order to practice as a registered nurse in Canada, the nurse must be registered with the regulatory body in the province in which they work.

One of the requirements for registration is that the nurse must show evidence of competence to practice. Competence to practice refers to the integration and application of the knowledge, skills, judgement and attitude required to carry out the role and work of a registered nurse.

If an applicant is unable to provide documentation or evidence that he or she has been educated at, or attained experience at, the level required for registered nurse practice in Manitoba, a clinical competence assessment (CCA) will be required.

The Registered Nurse Regulation sec. 4.2 states that:
An applicant who has received nursing education outside of Manitoba that does not fully meet the criteria set out in subclause (1)(a)(ii), or who cannot produce evidence of or information relating to his or her nursing education satisfactory to the board, may nevertheless be permitted to register if he or she

1. has undergone an assessment of his or her prior learning as may be required by the board;
2. if required, has successfully completed a course of instruction set by the board; and
3. has satisfied all other requirements for registration.

When a clinical competence assessment is required, it is considered mandatory and not subject to appeal.

For internationally educated nurses (IENs), there are many challenges associated with entry to practice in a new country. Provincial regulatory bodies have documented that the IEN often has difficulty transitioning to practice in Canada. Low pass rates on the Canadian Registered Nurse Exam also reflect the often significant differences in how nursing is practiced in an IEN’s home country when compared to Canada.

The College’s objective is to ensure that the nurses we register have the knowledge and skills necessary to provide safe, competent, and ethical care to Manitobans. The CCA is one method of ensuring the delivery of quality care, and can help provide the applicant with the tools to succeed in practice in Manitoba.

If, after review of the documentation you provided with your application, the College is not able to determine that your competence to practice is equivalent to the competencies required for all RNs in Manitoba, you will be asked to complete a CCA. The assessment will provide you an opportunity to demonstrate that you meet entry-level competencies in Manitoba.

You must be referred by the College. Once you receive a letter of referral, you should call the telephone number provided to schedule your appointment.

It is completed over a 3 to 5 day period.

Assessments are conducted at the Assessment Centre for Nursing at the Health Sciences Centre in Winnipeg, Manitoba (Canada).

At this time, there is no charge. However, there are other costs you will be required to cover such as travel, food, and accommodation.

You should contact the Canadian Embassy, High Commission, or Consulate in your country of residence regarding the application process. The College is not directly involved with visa applications, but can supply a Letter of Invitation stating that you require a CCA.

You may be asked to complete assessments in any or all of the following areas:

• General Nursing
• Maternal Newborn Nursing
• Child Health Nursing
• Mental Health Nursing

The assessment is comprised of:

• Written Diagnostic Exam
• Clinical Judgement Scenarios Assessment
• Triple Jump Scenarios
• Objective Structured Clinical Examination (OSCE)
• Self Assessment

• general and/or specialty nursing knowledge
• pharmacology and medication administration
• pathophysiology
• knowledge of the Canadian healthcare system and current nursing practices
• basic and advanced clinical skills as well as use of current technology in nursing practice
• health history and health assessment knowledge and skills
• clinical judgement and critical thinking skills with evidence based practice
• therapeutic communication practices
• cultural competencies

Written Diagnostic Exam
The written diagnostic exam includes both multiple choice and short answer questions that test general nursing knowledge.

Clinical Judgement Scenarios
This is an interview style assessment that evaluates your ability to make sound clinical judgements in situations that are complex and have no “simple” answers. These situations will assess the ability of the candidate to think deliberately and critically through a nursing situation, apply essential and relevant knowledge, consider possibilities and options and take reasoned, reflective, and insightful decisions and actions. View an example here.

Triple Jump Assessment
During this interview, problem solving and critical thinking skills are tested. The candidate is presented with a brief client situation, asked to generate a problem list, identify and collect relevant data, revise the problem list, develop an intervention/management plan, and then self evaluate. View an example here.

Objective Structured Clinical Examination (OSCE)
This assessment is conducted in a lab setting, where a candidate will role-play a nurse in response to client/family health situations and demonstrate his or her abilities to apply knowledge by holistically caring for this client/family. The exercise assesses nurse-client relationships, critical thinking and clinical judgement, health assessment and nursing skills, pharmacology and pathophysiology, and decision making in rapidly changing situations.

Self-Assessment
This provides an opportunity for the candidate to describe how they have met the professional standards during nursing practice in their country of origin.

• Go to www.mtroyal.ca, Internationally Educated Nurses Assessment Centre for details and practice situations;
• Go to www.crnm.mb.ca to review the documents entitled Entry Level Competencies for Registered Nurses and Standards of Practice for Registered Nurses;
• Refer to the Canadian Nurses Association website to review the CNA Code of Ethics document;
• Review nursing textbooks, published in the last five years, that cover the knowledge and procedures of medical/surgical nursing practice;
• If referred for a focused or specialty assessment, review a current textbook on maternal-newborn health, child health, and/or mental health nursing;
• To familiarize yourself with Canadian health care equipment and supplies that you could be exposed to in your OSCE assessments, refer to the Nursing Picture Dictionary Tutorial

Approximately four weeks following the assessment you will be informed of the outcome which will include one of the following:

1. Competencies are met. For an internationally educated nurse, this means that eligibility to write the CRNE is granted. For a former Canadian Registered Nurse, this means that he/ she is eligible to apply for registration on the practicing register of registered nurses.
2. Gaps in skills and knowledge are found. An internationally educated nurse must complete a prescribed course of study prior to eligibility being granted for CRNE. A former Canadian Registered Nurse would not be eligible to apply for registration on the practicing register until a prescribed course of study has been completed.
3. Gaps in skills and knowledge are too significant to be addressed by a course of study, and applicants will be advised of other options should they wish to pursue eligibility to write the CRNE or apply for registration on the practicing register.