English-Language Proficiency
Policy Change
Executive Summary
On January 1, 2020, the College of Registered Nurses of Manitoba (the College) will be instituting a
requirement that graduates from nursing education programs undergo language testing to
demonstrate English language proficiency. The purpose of this requirement is to establish that
graduates who apply for registered nurse (RN) registration have the minimum level of Englishlanguage competency to be capable of engaging in registered nursing (RN) practice in a safe and
competent manner.
Language proficiency is the foundation of effective communication, and is the aspect of
communication that can be measured objectively. As well, English is the language most commonly
spoken and understood by our population and the language that the health system operates in.
Therefore, a high degree of English-language proficiency is essential to providing safe registered
nursing care, to establish therapeutic relationships with clients, and to collaborate effectively as part
of the health care team, which are competencies required of RNs at entry-level.
Over the past several years, the College has received data from a variety of sources, which are detailed
in the background paper, which forced us to question an assumption that informed our previous
policy: successful completion of a Manitoba nursing education program could serve as an effective
proxy measure for English-language proficiency. As a result, the College will be implementing the
requirement that unless an applicant has practised as a registered nurse in the past two years and
was required to meet an English language proficiency requirement where they obtained registration,
the applicant will be required to undergo English-language proficiency testing.
The College has met with students and faculty in the nursing programs to advise them of the change.
Since the results from language tests are valid for two years from the date the test was taken, students
are being encouraged to take their tests while in the third year of their programs.

 English Language Proficiency in Canadian Applicants
for Registration with the College of Registered Nurses of Manitoba
Background
In The Regulated Health Professions Act (RHPA), the overriding mandate of any regulator is to serve and
protect the public interest. For the College of Registered Nurses of Manitoba, the public interest
includes access to safe, competent and ethical registered nursing care. Safe, competent and ethical
care cannot be provided without the ability to communicate with the client, members of the client’s
family and other healthcare providers.
The work of the College in protecting the public interest falls into three broad categories:
1. Setting the standards for registration;
2. Supporting registered nurses in achieving the standards; and
3. Taking action when the standards are not met.
Communication is a vital element in nursing in all areas of activity and in all its interventions such as
prevention, treatment, therapy, rehabilitation, education and health promotion (1). Effective
communication promotes collaboration and interdisciplinary teamwork, helps ensure that ethical and
legal responsibilities and professional practice standards are met, and contributes to positive patient
outcomes (2). Ineffective communication may lead to poor patient outcomes and increases in adverse
incidents (3).
“Communication competence” is the appropriate use of language and strategies to enhance
communication or repair breakdowns in communication in a specific context and culture (4). Therefore,
language proficiency is the foundation of effective communication and is the aspect of communication
that can be measured objectively. There are four elements of language proficiency: listening, speaking,
reading, and writing. These four elements include the capabilities that allow an individual to
comprehend and produce spoken language for proper and effective interpersonal communication (5).
A high degree of English language proficiency is extremely important for providing safe registered
nursing care. The ability to engage in relational practice and to establish therapeutic relationships with
clients are competencies required of registered nurses at the entry-level. Therefore, demonstrated
English language proficiency is one element of fitness to engage in registered nursing practice. This is
also why English language proficiency is identified in the College of Registered Nurses of Manitoba
Council General Regulations as a requirement of all applicants for registration as a registered nurse in
Manitoba.
The current policy on language proficiency includes three ways an applicant can demonstrate meeting
the English language proficiency requirement in Manitoba:

1

 1. Current or previous registration as a registered nurse in Canada with evidence of safe practice
within the past two years working as a registered nurse in another jurisdiction in Canada where
evidence of English language proficiency was required for registration eligibility;
2. Successful completion of an approved nursing education program in Canada within the past two
years and where the education was provided in English or there was an English language
requirement for admission to the program;
3. Completion of an approved English language proficiency test with minimum required scores
achieved. This requirement is in keeping with the regulators of the three nursing professions in
Canada who accept the International English Language Testing Source [IELTS] and Canadian
English Language Benchmark Assessment for Nurses [CELBAN]. The College requires the
minimum test scores for safe nursing practice as recommended by the national nursing
language fluency working group following an extensive standards setting project to harmonize
language requirements in Canada.
College policies are regularly reviewed to ensure that they remain evidence-informed and based on
established best practices. We are reviewing our current policy regarding language proficiency because
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 Issue to be Addressed
In 2011, the College began to receive information that suggested students with language proficiency
issues at the university and college level were being managed through the educational institutions’
student accessibility services offices and by way of academic accommodations (additional time for
writing tests and examinations). We began to see that some students on application for initial
registration asked for similar additional time to write the national RN-entry-to-practice-examination. As
part of the College’s assessment for eligibility for exam accommodation, individuals were asked to
provide documentation of the need for similar accommodations in the past. The College received
information that showed academic accommodations related to the following examples:
“post-traumatic stress disorder” - which the disability coordinator attributed to the individual
originating from outside of Canada and therefore not proficient in English;
“learning disorder” - related to poor performance on assessment of reading comprehension,
writing mechanics and writing composition due to the student’s level of English language skills;
and
“difficulty completing exams in allotted time due to anxiety experienced in seeing others
complete exams and due to a secondary language difficulty”
Further analysis on requests for testing accommodations show that since 2010, the College has received
requests for accommodations for at least one writing on the RN-entry examination from a total of 76
individual applicants. Sixty-seven (89%) of these requests were from graduates of Manitoba nursing
education programs. In 16 of the applications (24%) from the Manitoba graduates seeking testing
accommodation, there was a documented language proficiency issue.

2

 Also in 2011, the College became aware of a number of applicants for registration who had completed a
Manitoba entry-level nursing education program and who, in the course of their application process,
demonstrated that they had failed English language proficiency tests or degrees of reading power tests
(a measure of literacy skills). The information that these individuals did not possess English language
proficiency at the required level only became apparent to the College when the individuals were unable
to meet the entrance requirements (a degree of reading power test for Canadian individuals or a
language proficiency test for non-Canadians) for admission to Red River College to complete a required
course of instruction. The course of instruction, a legislated requirement in the Registered Nurses
Regulation, was required following a second failure of the RN-entry examination in order to be eligible
for subsequent examination attempts. Of the 18 individuals that the College learned of, five were nonCanadian and were unable to demonstrate overall English language proficiency at the required level.
The remaining 13 were Canadian students not able to read at the Grade 10 level as determined by a
degree of reading power test. To date, four of the total 18 individuals have been able to achieve RN
registration.
As a result of the above information, the College deemed there to be enough information to question
that successful completion of a Manitoba nursing education program served as a proxy measure for
English language proficiency.
In 2012, the College brought the language proficiency issue to the leaders of Manitoba nursing
education programs (see Appendix A for a copy of the communication sent October 18, 2012). The topic
of language proficiency issues in Manitoba nursing program graduates was discussed at a meeting with
the education leaders October 25, 2012 and at all three regularly scheduled meetings throughout 2013.
The majority of the programs expressed their own concerns about the language proficiency of students
admitted to their programs. Many had indicated that they were considering introducing demonstrated
language proficiency for entrance into the programs. When asked by the College however, they were
not prepared to indicate a guarantee of any kind related to the English-language proficiency of
graduates, citing a number of factors that could result in language proficiency not necessarily
maintained at program completion.
As a result of the discussions between the College and the Manitoba nursing education programs, the
University of Manitoba, former Faculty of Nursing (they are now known as the College of Nursing)
pursued the introduction of an English language proficiency test for admission to the nursing program
(see Appendix B). The nursing faculty advised the university’s senate that the lack of proficiency in oral
English was creating significant problems for some students who are admitted to the four-year
baccalaureate program. This was even though these students had demonstrated their language
proficiency through an assessment test or qualified for a waiver of assessment tests by virtue of length
of residency or completion of high school in Canada.
Under The Registered Nurses Act, previous legislation in Manitoba, applicants were required to undergo
language testing if they identified that their first language was not English or French. In 2013, the
College began to receive information that on application, some Manitoba graduates were indicating that
their first language was English or French in order to avoid having to undergo language testing to be
eligible to write the RN-entry examination. We conducted a retrospective review of the results of
language test results we received and the number of language test attempts in Manitoba graduates
since 2009 who were required by College policy to undergo language testing. College policy during that
3

 timeframe required testing in applicants who 1. identified that their first language was not English or
French, or 2. indicated that their first language was English or French but the College had been advised
of or identified language proficiency concerns. The results of our review showed that between 2009 and
2013, the College required 12 Manitoba graduates to undergo language testing under the policy. Four
had declared that their first language was English and eight had declared a first language other than
English or French. Of the eight individuals who had indicated a first language other than English or
French, four successfully met the minimum language proficiency requirements on their first attempt and
went on to achieve RN registration. Of the remaining four, only one was successful on a subsequent
language test. Of the four individuals who had indicated that their first language was English or French,
all were unsuccessful on their first attempts on the language proficiency test. Three were successful on
subsequent testing.
It should be noted that the majority of the data included in this report was collected in 2013 as that is
when the College began to analyze the magnitude of the language proficiency issue brought to our
attention regarding Manitoba nursing program graduates. The requirement for individuals to complete a
course of instruction following a second failure on the RN-entry-to-practice examination is no longer in
place and so we no longer receive information regarding applicants unable to meet the required
language level or reading power level. When the College became governed under The Regulated Health
Professions Act, we were able to discontinue asking applicants to declare their first language and instead
more appropriately focus on English language proficiency at the time of application.
With respect to complaints received by the College, for several years “communication” has been in the
top three most frequently identified reasons, if not the most frequently identified reason, in complaints
received regarding the practice of registered nurses in Manitoba. A review of the professional conduct
matters managed by the College showed that to date there have been 7 cases where language
proficiency was identified as a factor in a registrant’s unsafe nursing practice. Four of the cases involved
Canadian graduates; two were from Manitoba.

The Solution
The College will require all applicants for registration to undergo language proficiency testing. The
purpose of the College’s English language proficiency requirement is to establish that an applicant
possesses the requisite entry-level language competency to be able to engage in registered nursing
practice in a safe and competent manner. The perceived preferential treatment of Canadian applicants,
based simply on the fact that their nursing education took place in Canada, could be deemed to be
discrimination, as well as an unfair practice. According to The Manitoba Human Rights Commission,
discrimination involves treating a person differently, to their disadvantage, where it is not reasonable to
do so on the basis of a number of factors that include ancestry, nationality or national origin, and ethnic
background or origin (6). In addition, The Fair Registration Practices in Regulated Professions Act is to
help ensure that regulated professions, and individuals applying for registration by regulated
professions, are governed by registration practices that are transparent, objective, impartial and fair.
Requiring all applicants for registration, regardless of where they received their nursing education, to
demonstrate English language proficiency by successfully completing an approved language test is fair
and will help to ensure that all registered nurses have met the language requirement for registration
and in a consistent manner.
4

 Accepted Language Tests
The College currently accepts two English language proficiency tests: Canadian English Language
Benchmark Assessment for Nurses (CELBAN) and the International English Language Testing System
(IELTS).
CELBAN has advised the College that their test has not been validated outside of an international
population and therefore, is not an appropriate test for Canadian nursing program graduates.
IELTS has advised the College that their test is currently being used in native English language speaker
assessments to measure their achievement in attaining the levels required for the purpose of taking the
test. IELTS has advised that it would be important to encourage English language speakers to prepare for
the test and they have resources to help such candidates prepare. We note that the Government of
Canada requires that individuals applying for Canadian citizenship to undergo language testing, even if
they are from an English-speaking country. IELTS is one of the English language proficiency tests
accepted by Immigration and Citizenship Canada for this purpose.

Effect on Students
The College recognizes that requiring graduates of nursing education programs to undergo language
proficiency testing places an added burden on them when they apply for eligibility to write the RN-entry
examination. We are introducing this requirement on January 1, 2020 so that there is ample time to
communicate this requirement with the education program leaders and students.
An industry standard is that language test results are deemed valid by the testing companies for two
years from the date the test was taken. Therefore, we are encouraging students to take their tests while
in the third year of their programs to avoid any delays when they complete their programs.
We also recognize that undergoing testing carries a financial implication in that language tests can cost
between $300-$400 per attempt. Again, we want to communicate this to students as early as possible
so that they may plan accordingly.

Conclusion
A high degree of proficiency in reading, writing, listening and speaking in English is extremely important
for providing safe registered nursing care. Over the past several years, the College has received a
significant amount of information that led us to question the assumption that successful completion of a
Manitoba nursing education program served as a proxy measure for English language proficiency. As a
result, the College will be implementing the requirement that unless an applicant has practiced as a
registered nurse in the past two years and was required to meet an English language proficiency
requirement where they obtained registration, an applicant must undergo English language testing. This
requirement will be in place for applicants for initial registration effective January 1, 2020.
5

 References:
1. Fakhr-Movahedi A, Salsali M, Negarandeh R, Rahnavard Z. Exploring contextual factors of the
nurse-patient relationship: A qualitative study. Koomesh. 2011;13(1):23–34.
2. Apker, J., Propp, K.M., Zabava Ford, W., & Hofmeister, N. (2006). Collaboration, credibility,
compassion and coordination. Professional nurse communication skill sets in healthcare team
interactions. (Journal of Professional Nursing, 22(3), 180-189
3. Jakubec, S. L. & Astle, B. J. (2014). Communication (Chapter 17). In Canadian Fundamentals of
Nursing (5th Ed,), Potter, P. A. & Perry, A. G. (eds).
4. Office of the Manitoba Fairness Commissioner (2013). Document: Intercultural Communication.
Received at an OMFC presentation.
5. Morehouse, K. (2017). What are the four language skills? Online access:
https://www.linguacore.com/blog/the-four-skills/
6. The Manitoba Human Rights Commission (2009) Document: Fact Sheet: Discrimination is
prohibited by The Human Rights Code. Available on-line:
http://manitobahumanrights.ca/v1/education-resources/resources/fact-sheet-pages/fact-sheetdiscrimination.html

6

 - Appendix A -
If? COLLEGE OF REGISTERED
??wfl R4 NURSES OF MANITOBA
MEMORANDUM

Date: October 18, 2012
To: Education Leaders

From: Suzanne Wowchuk, Director, Regulatory Services

We wanted to let you know that the College of Registered Nurses of Manitoba is moving forward with a
policy change that may require all applicants to demonstrate English or French language proficiency by
way of one of achieving the minimum scores on an accepted language test in order to be eligible for
registration. A high degree of proficiency in reading, writing, listening and speaking is extremely
important for providing safe registered nursing care. Currently, only applicants who self-declare a first
language other than English or French are required to provide acceptable language test results from one
of the language tests CRNM accepts. The change to require testing of all applicants is as a result of the
numerous and increasing issues related to the current approach where applicants are being put in a
position to self?assess and self-decla re their first language which poses a significant risk to the public.
The current approach also adversely affects students who find out as a result of their poor performance
on one of their limited number of writings of the Canadian Registered Nurse Examination (CRNE), that
they have language issues.

At this time, CRNM has 3 approved language tests (CELBAN and IELTS to test English, and TEF to test
French), and in keeping with the policies of the test providers, test results are valid for 2 years from the
date of the test. In considering the approach to implementing a change to the language testing policy so
that all applicants are subject to a language test and being mindful ofthe impact that this will have on
nursing students in particular, one method that we have looked at is encouraging nursing students to
complete one of the approved language proficiency tests while they are in their 3rd or 4th year of their
program (since results are considered valid for 2 years from the date the test was taken). This would
help to avoid a situation where students will be trying to fit in a language test after they have completed
their programs but before applying to write the CRNE, as such an approach would result in a delay in
writing an exam that students might have otherwise been eligible to write. We are interested in your
thoughts on the implementation of such an approach and this topic has been added to the agenda for
discussion at the next scheduled Education Leaders meeting October 25, 2012.

We are aware that some Manitoba nursing education programs are considering instituting language
proficiency testing as an entrance requirement to the nursing program and CRNM is interested in
whether your program is one of them. We may be able to work together in this regard as there is the
potential for policy to be developed by CRNM to address the situation where a student who has
completed a language proficiency test for entrance to the Manitoba nursing education program AND
who successfully completes the program in an appropriate time frame could be deemed to have met
language proficiency requirement. We are hoping for your assistance in the development of
such policy and again, would like to discuss this when we meet.

If you would be able to give the implementation ofthe policy changes outlined above some thought, we
could discuss all of the considerations when we meet. Please do not hesitate to contact me if you have
any questions. We look forward to meeting you next week.

3/12/2019

Nursing facuity wants English test - Winnipeg Free Press

Nursing faculty wants English test Appendlx 
or SENATE DELAYS DECISION UNTIL 2014

By: Nick Martin
Posted: 07/21/2012 1:00 AM

 

The University of Manitoba's faculty of nursing could require new students to pass an

English language oral proficiency test as early as September 2014.

The nursing faculty reported 13 per cent of applicants from a pool of more than 600

would?be students a year do not have English as a first language. Of those who make

the cut, 23 per cent do not have English as a first language.

 

Sharon Alward

 

?Lack of proficiency in oral English is creating Significant
problems for some students who are admitted to the
four-year baccalaureate nursing program, even though
these students have demonstrated their language
proficiency through an assessment or qualified for
a waiver of assessment tests by virtue of length of
residency or completion of high school in Canada,? the
nursing faculty told the university?s senate.

Not only is a lack of oral English proficiency a classroom
problem, it can be dangerous in the workplace, warned
the faculty.

The ability to communicate effectively in the clinical
setting is a critical element of the student's ability to

provide safe, ethical and competent care, the senate was told.

1/3

3/12/2019 Nursing faculty wants English test Winnipeg Free Press
The nursing faculty had wanted new proficiency standards in place by the start of the
2013 school year, but the senate bounced the proposal back for further study, delaying
implementation until at least September 2014.

University officials said the faculty of nursing would not be making anyone available for

an interview.

Nursing is studying the senate discussion and reconsidering details of its proposal, said
john Danakas, director of of marketing and communications.

The of Faculty Association also declined to comment.

"This isn't an issue which the membership in nursing have raised with us, and so we
don't have sufficient information regarding a position, and don't have any comment on
it at the present time," said UMFA president Prof. Sharon Alward.

of Students' Union president Brian Arte said UMSU accepted nursing's position in
principle, but not in the details.

"It is really important, especially during the practicum and patient interaction, that they
be able to comprehend the most common language spoken in Manitoba and in the
health?care system," Arte said. "It can be life-threatening."

UMSU questioned part of the proposal that would have required prospective students
to pay for an oral language test if English wasn't their first language, even if their oral
English skills were otherwise perfectly acceptable, she said.

"There was some concern this would be discriminating against students who indicated
English was their second or third language," said Arte.

Arte said a student should be able to declare proficiency and not be automatically tested
just because of the language spoken in their home when they were born.

The first language a student learns is not relevant if that student is proficient in English,
said the UMSU president.

Neither the nursing faculty nor the of would say what, if anything, had caused the
faculty to come forward.

2/3

3/12/2019 Nursing faculty wants English test Winnipeg Free Press

Officials could not say if any other program has a requirement similar to the faculty of
nursing's proposal.

nick.martin@freepress.mb.ca

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