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Kim Mitchell stands in the student lounge at the College of Nursing.

Prof aims to research English literacy testing of Manitoba nurses

December 13, 2022 — 

Dr. Kim Mitchell has joined the College of Nursing with the research goal of helping nursing programs manage English literacy – a much-discussed topic in the context of the current nursing shortage.

The Winnipeg-born Mitchell holds four UM degrees: a bachelor of arts in English literature and a bachelor, master and doctorate of nursing. Having received her PhD in 2021, she joined the College of Nursing in the Rady Faculty of Health Sciences this year as an assistant professor.

For the previous 20 years, she was a nursing instructor at Red River College Polytechnic, where she developed the program’s writing course. “My plan was to teach surgical or medical courses, but I fell into teaching writing,” she says.

In about 2011, Mitchell started to research writing self-efficacy. Writing, she says, helps nurses develop critical thinking skills and nursing identity, which are applicable to caring for patients.

“I wanted to know if my course was actually helping students,” she says. “This led to a project with Dr. Diana McMillan at UM, who became my PhD advisor.”

In 2019, in response to proposed policy changes by the College of Registered Nurses of Manitoba (CRNM), Mitchell began studying English language exams for graduating nursing students.

At the time, the CRNM was proposing that graduates of nursing programs in Manitoba would have to pass an English proficiency test before moving on to a registration exam. The proposed test was the International English Language Testing Services (IELTS) exam, the most commonly used English language test for international nurses applying to the profession in Canada.

Over the past year, Mitchell has been running a study to see if another exam specific to nurses, the Canadian English Language Benchmark Assessment for Nurses (CELBAN), would be more appropriate for nursing students who speak English as a first language.

“CELBAN was designed for practising nurses, so we needed to see if it was too complex for nursing students, which it is not,” she says.

However, the CRNM ended up pausing its proposed policy change after a large outcry from students about mandatory testing and its cost. A test costs between $300 and $400 to take. If a student fails, they must pay to take the test again, on top of paying $360 for the registration exam.

After the CRNM paused the policy, Mitchell says, it offered to reimburse students who had written the exam to prepare for meeting the expected requirement. Many students sent in their results as proof of having written it.

“Anecdotally, it was observed that about 50 per cent of those who shared their results had failed the writing section of the IELTS,” the professor says.

While Mitchell acknowledges that there is an issue with literacy among Manitoba nursing graduates, she doesn’t believe these language tests are the right solution.

“We should be doing something that provides regular literacy assessments of students throughout their program,” she says.

“This is an area that is highly prone to people with disadvantages being the most likely to fail – students who are Indigenous, from a low socioeconomic status or who speak English as a second language.”

One project Mitchell is currently working on is a virtual simulation to assess literacy. Students would view a simulation on a computer or tablet and would be required to demonstrate their literacy skills in what Mitchell calls the “trouble zones” of nursing practice, such as speaking and writing using medical terminology, and reading complex medical information from charts and books.

The intent, she says, is for students to be tested on both their language skills and nursing knowledge simultaneously.

“This will assess reading, writing, speaking and listening in a way that uses real-life scenarios,” she says. “Can they translate medical jargon into something that is understandable by a non-medical person?”

Mitchell plans to launch a pilot study of the virtual simulation in January.

“In the U.S.,” she notes, “nursing programs typically use an entrance test to screen students for literacy pre-admission. But the danger of that is screening out disadvantaged students. I’m going in a different direction, seeking ways to prevent attrition of nursing students from programs due to literacy-related challenges.

“Patient safety is one issue, but students dropping out or falling out of sync from their entrance cohort is another. These issues delay or reduce the supply of nurses to the health-care system.”

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