The Clinical Competence Assessment (CCA)

Before we delve into the CCA, it is important you understand and recognize that nursing programs are developed to prepare you for your scope of practice within the country you obtain your certificate of practice. In other words, nursing programs are specifically designed to educate nurses to practice within the health  system that relates to that country. Therefore, the education needed to practice in Canada may be different than your prior learning and experience.  

To be able to practice as an RN in Manitoba, you will be walking into a health system, that as of today, you have no registered nursing experience in. It is important that as an RN entering this system, you are equipped with the skills, knowledge, and judgement to meet patient needs and to function in today’s realities. It is our role to help prepare you so that you are successful to practice as an RN in Manitoba. To do that, we both must ensure that the skills, knowledge, and judgement you possess meet the entry-level competencies that are necessary to be able to manage the scope of practice that you will be expected to fulfill. 

We both have the same goal. We need Manitobans to have access to and receive safe, quality, and competent care, and we want to ensure you are equipped to deliver quality care to the public. Which leads us into speaking about the primary function of the CCA. The CCA is a tool that assesses competence.  

You will hear this word a lot in our conversations about the CCA. It is even in the title – Clinical Competence Assessment. But how do we define it? 

We define competence as the integration of knowledge, skills, judgment, and personal characteristics that enable you to practice safely and ethically. It is not just about having the ability to perform skills or techniques. While that might be the part of RN practice that is most visible, practising as an RN involves more complexities than that.  

In your practice you must be able to understand difficult situations that you will encounter and have the capacity to be able to make decisions based on skilled expertise. You must be able to practice autonomously while contributing to a multi-disciplinary patient care team. You must be able to independently assess a situation, understand underlying contributing factors, intervene appropriately, be able to predict the outcome of an intervention, and also be prepared to respond with alternate interventions in the event of a lack of response or an untoward response. Overall, competence encompasses the ability to assess, plan, implement, evaluate, and communicate care. The public is dependent on you and the College to know and trust the care they are receiving is safe, ethical, and competent. 

This is why the CCA is such an important integral tool. It will identify your current ability to demonstrate the required Entry-Level Competencies (ELCs) and where there might be gaps. Once the assessment is completed, we can guide you into your next steps for obtaining your certificate of practice.   

Why does the CCA measure ELCs? ELCs are the benchmark of the CCA because the ELCs are foundational in nature. ELCs are not about being able to demonstrate an experienced practice or even an expert practice, rather they are the minimum competencies that communicate what can be expected of you in your entry-level practice. All applicants who practise as an RN in Manitoba must be able to meet the ELCs to practice safely, competently, compassionately, and ethically.

We understand that undergoing an assessment or measure of ability can make applicants feel unsure or anxious but the CCA is not a test that you pass or fail, as the purpose is to help identify what you will need to do next. The CCA is a diagnostic, competency-based assessment. What this means is, it is used to provide feedback on different performance measures and identifies any potential gaps in your ability to meet the ELCs . If there are gaps, it also helps the College determine the appropriate remedial education or next steps in your path to obtain your certificate of practice. You need to fill the gaps in order to be eligible  to practice as an RN in Manitoba.  

Why is this important? To practise as an RN, you will be expected to possess not only technical skills but possess the self-awareness and capacity to be able to make sound decisions once placed into the health system. The CCA ensures you have the skills, expertise, judgement needed at an entry-level capacity. It is needed to set you up for success.  

The components of the CCA 

The CCA is your opportunity to demonstrate your knowledge in a variety of different ways. The components that make-up the CCA are: 

• A self-assessment 
• A written diagnostic examination 
• A clinical judgement scenarios assessment 
• A chart review with development of a nursing care plan 
• An objective structured clinical examination 

Remember we mentioned that the CCA is diagnostic. It takes into consideration the competence that has been acquired throughout your individual practice, with your educational preparation as the foundation. It is a tool that will empower you with an objective analysis of your current level of skill, knowledge, and judgement against the ELCs. 

You can prepare for the CCA! As mentioned, the CCA looks at entry-level competencies; it does not look at expert levels of nursing practice. So, even if you have practised in a highly specialized area, your knowledge and practice is being compared to entry-level competencies. To prepare for the CCA, you will need to understand what is being assessed.

To prepare, we highly recommend you review and understand the: 

• Entry-Level Competencies (ELCs) for the Practice of Registered Nurses (2019)– paying particular attention to the identified critical competencies. 
• Scope of practice for RNs 
• Practice Direction: Practice Expectations for RNs 
• Code of Ethics for Registered Nurses 

For a more structured approach, you can also enroll in courses that are designed to help you refresh your knowledge and gain a better understanding of nursing in Manitoba. For example, the University of Manitoba offers courses in its Nursing Professional Development Series.

There may be other education providers that offer courses that will help meet your specific needs. However, we strongly encourage you to conduct thorough research to ensure you select a reputable education provider. The College does not approve or endorse any ‘CCA Prep’ courses, even though some providers may market their courses as such.

The CCA covers all of the areas of practice where RNs work in the health system including: ambulatory care, community health, emergency care, geriatrics, mental health, obstetrics, palliative care, pediatrics, and adolescent health, and medical and surgical areas.  

It is offered at the Assessment Centre in the College of Nursing at the University of Manitoba, Fort Garry Campus in Winnipeg, Manitoba (Canada) and is completed over a total of four days.

Once you complete the CCA, a report detailing a met or not met for each competency assessed will be provided to the College by the University of Manitoba. Within six weeks following the assessment, we will provide you with a copy of the CCA report and inform you of the outcome of the review of your complete application. You will also be invited to meet with a registration team member to discuss your report and the College’s decision. 

One of the following outcomes can be expected: 

1. You have demonstrated that you sufficiently possess the ELCs. In this outcome no remedial action is required as any identified gaps are not foundational to RN practice and can be safely acquired once engaged in practice. At this point, you can move on to either a) write the NCLEX-RN exam, or b) apply to RN registration (if the NCLEX-RN exam requirement has already been met). or,
2. There have been gaps identified that show that some critical ELCs are lacking in your knowledge, and remedial action is required. The remedial action could be in the form of full or partial Nurse Re-Entry Program (NREP). or,
3. There have been gaps identified that cannot be remediated by NREP. The NREP does not have the capacity to address the ELCs that you do not possess. As these ELCs are foundational for entry-level RN practice, completion of an approved nursing education program is therefore, required.

We’re here to help

Whatever the outcome, we are here to continue to guide you along the way to achieve registration. We are working together to ensure Manitobans are receiving care from RNs who have met the requirements for registration to be safe, competent practitioners.

How to interpret the results

Several variables affect CCA outcomes, including:

• how long and how recently they have practiced as a nurse,
• the nature of their nursing practice,
• the amount of time that has elapsed since they received their nursing education,
• the extent to which they prepared for the CCA, and
• whether their initial education provided them with competencies similar to those required of RNs in Manitoba.

Other things such as English language proficiency and individual circumstances can also affect outcomes.  The College does not assess applicants for factors such as currency of practice, recency of education, or English language proficiency before authorizing them to undergo a CCA. This means that some applicants without such factors will attempt the CCA and may not perform well. Given the number of potential influences, the College cannot state what variables most clearly account for CCA outcomes.

It is important that each applicant carefully evaluate their options and consider their level of confidence in their nursing skills and knowledge before selecting a pathway. They should also reflect on the recency and comparability of their practice to RN entry-level competencies and plan their CCA preparation accordingly, rather than making assumptions based on the above-noted statistics or the outcomes of other applicants.

Breakdown of results

The following results reflect the outcomes among Internationally Educated Nurse (IEN) applicants to the College. However, the CCA is also a tool that may be used to assess applicants who were previously registered and are seeking to reinstate.

Based on a recent analysis of 153 CCAs conducted among IENs between 2018-April 2024, the following outcomes were observed:

• Referral for remedial education: 67.3%
• Referral for 4-year basic nursing education: 30.1%
• No remedial education required: 2.6%

It is worth noting that of the CCA cannot currently assess suitability for other nursing professions in Manitoba/Canada, such as licensed practical nursing, nor is it currently used as a tool to recognize prior learning for advance entry to a basic nursing education program. However, the College is continuing to work with its partners to investigate these and other avenues.

Common course requirements

Among applicants referred for courses in the Nurse Re-Entry Program at Red River College Polytechnic, the top three most common courses required by the College were:

• NRSG-1012 Registered Nurse Practice: 91.4%
• NRSG-2004 Holistic Health Assessment & Skills: 84.3%
• PRAC-3017 Nursing Practicum: 80%

All three of these courses speak to the impact of cultural and organizational expectations for the practice of registered nursing in Manitoba/Canada.