Alberta Registered Nurses Assessment Program Preparation (ARNAP Prep)

Contract # 095263929

Project Summary Report

May 2022

Program Development

The project’s objective was to develop sustainable materials to be used to familiarize

Internationally Educated Nurses (IENs) with the Alberta Registered Nurses Assessment Program (ARNAP) process through an intense review of clinical scenarios and multiple-choice questions (MCQs). The curriculum would be made accessible to other immigrant-serving associations in Alberta. Bredin Centre for Career Advancement will use the curriculum in their programming and be responsible for the updating and maintenance of the materials.

The ARNAP Preparation program focused on helping 60 IENs to navigate the ARNAP requirements and exams. The curriculum is designed for instructor-led exam preparation activities including, two MCQ examinations, 16 exam preparation modules, and the development of Objective Structured Clinical Examination (OSCE) scenarios. Participants had the opportunity to engage in mock OSCE events. The finalized curriculum was then posted online for other agencies working with IENs to use.

The management of the project included recruiting qualified staff, the process of curriculum development, engaging IENs to participate in the project, structuring the program delivery, and collecting information and feedback from IENs, instructors, and curriculum developers to ensure high-quality materials. The development of a long-term sustainability plan included incorporating the final project into ongoing services, developing a schedule for regular review and updates of the curriculum, and structuring an accessible platform for resource sharing.

Staffing

The Program Coordinator is a long-term Bredin employee who has experience in supporting IENs to meet the requirement for licensure in Alberta and Canada. Nada Ali developed and oversaw the project management including vetting the contracted instructors and curriculum developers to ensure suitability and understanding of the project.

Three Registered Nurses (RNs) Manusha Phoolbosseea, Sampsa Taipale, and Kinjal Khandival were selected to join the project. All are IENs who have achieved RN status in Alberta, and have experience in developing curriculum, lesson plans, and mock OSCE materials. Each had strengths in different components of the competency framework for registered nurses and worked together to develop highly effective learning materials and processes.

Development of Promotional Materials

A web page was developed and launched in March 2020, which included an inquiry form for prospective participants to complete. There was a huge response, not just in Alberta, but across Canada and from other countries. The inquiry form was revised to make it easier for the Program Coordinator to quickly identify and prioritize IENs in Alberta who had received their letter of acceptance from CARNA and were ready to begin the exam process.

A rack card was developed that could be shared electronically with other organizations as COVID had severely limited any in-person promotions throughout the delivery of the project.

The launch of the ARNAP Prep curriculum included providing access to our community partners and the public via the webpage. The webpage will be updated and maintained through the BredinWorks for Internationally Trained Professional program.

Alberta Registered Nurses Assessment Program (ARNAP) Preparation - bredin

Environmental Scan

The environmental scan commenced in March 2020 and resulted in a list of organizations and resources available to support the goals of the ARNAP Preparation project and the sustainability of the curriculum.

The primary resource list includes the following:

• BredinWorks for Internationally Educated Professionals (BW-IEP) program
• College of Registered Nurses of Alberta (CRNA)
• Alberta Health Services (AHS)
• Touchstone Institute
• CARE Centre for Internationally Educated Nurses

Community Connection

Ten immigrant-serving organizations and primary contacts, in addition to the BredinWorks for Internationally Educated Professionals (BW-IEP) program, had been identified as partners in the delivery of the project and benefactors of the resources developed:

• Catholic Social Services Immigration and Settlement Services (CSS)
• Edmonton Mennonite Centre for Newcomers (EMCN)
• Norquest College
• Edmonton Regional Immigrant Employment Council (ERIEC)
• Edmonton Immigrant Services Association (EISA)
• Action for Healthy Communities
• Directions for Immigrants in Trade and Professional Careers
• Calgary Regional Immigrant Employment Council (CRIEC)
• ASSIST Community Services Centre
• Servus-Bredin Microloans for Newcomer Professionals

The majority of referrals came from BW-IEP and the Touchstone Institute.

Curriculum Development

The development of the curriculum began in phase one (Months 2-6) and continued through to phase 3 (Months 3-27). The curriculum included 2 MCQ examinations, 16 Modules of study material, and OSCE Scenarios with Lesson Plans.

The three RNs fulfilled the roles of instructor and curriculum development. This established a team that worked together to evaluate and provide feedback and revisions to ensure a high-quality resource. A meeting was held with Touchstone Institute to ensure materials and processes adhered to competency and ethical standards of the examining body. Though integrating the instruction and development resulted in a better-quality resource, it did pose some challenges in the tracking of budget as curriculum development and instruction were separate budget items and the two activities are highly integrated.

Originally, the project objective was to create curriculum to be used for in person classes. The onset of COVID was the biggest challenge faced throughout the project. To ensure the project could continue despite the restrictions, the curriculum was transferred to an online format while keeping the integrity of the original goals of the project. The finished product can be used to deliver in person, virtual or a hybrid exam preparation session.

The course was launched online in March 2022 and made available for community partners to be delivered in an instructor-led class:

Alberta Registered Nurses Assessment Program (ARNAP) Preparation - bredin

Program Delivery

Program Delivery indicated that orientation sessions and exam preparation modules should begin 6 months into the project and continue through the remaining 22 months. The timeline was based on the scheduled ARNAP exams which are offered semi-annually in February and September in Alberta. However, COVID-19 resulted in the cancelation of all in-person exams, which were then rescheduled, only to be canceled again. This ongoing uncertainty impacted the recruitment goals of the project. Bredin developed a schedule to accommodate fewer registrations in the initial sessions with numbers increasing in the later sessions. Any IENs completing the session but whose exam schedule was impacted by COVID restrictions were able to attend future sessions to review any modules in which they felt they needed a refresher.

IEN Recruitment

The onset of COVID and the ensuing cancellation of exams created difficulty in recruitment. It was no longer feasible to expect to deliver 5 intakes of 12 participants within the project timeframe. The schedule was reworked to establish 7 scheduled intakes with the expectation that the later sessions would increase in numbers as exam schedules were reestablished. By February 2022, Bredin was able to recruit 62 IENs, with 58 IENs completing the training successfully.

Orientation

In preparation for each intake, bi-weekly orientation sessions began from the first intake and continued through to the last intake. Clients completed a feedback survey to determine their knowledge and understanding of the licensure process for RNs in Alberta before and after attending the orientation.

Part One - Delivery of Multiple-Choice Question Mock Exams (MCQs)

The MCQ exam consists of 97 questions to be completed within 2.5-hours. Delivering pre and post MCQ mock exams provided instructors with the basis to evaluate the effectiveness of the instruction and curriculum in increasing knowledge.

The original implementation plan was to have revisions complete and then transfer the materials to the online platform Moodle. However, due to COVID-19 restrictions and the uncertainty of when we would be able to implement classroom delivery, Moodle became an important element of the development process.

The Moodle platform provides immediate feedback to participants and individual and group results for the instructor/developers and the program staff. An unforeseen benefit when we originally began using it as it has helped to prepare the participants for Touchstone Institute’s development of a virtual MCQ exam, the first of which was scheduled on April 15, 2021.

Part Two - Session Delivery: 16 Modules of Exam Preparation

The content of each module delivered on an online platform was not altered from curriculum developed for in person delivery. The formatting processes of Moodle are the same basic format used in curriculum development. The most substantial change was using Zoom to provide the instructor led sessions online. This was implemented across Bredin’s programming and the ARNAP program was fully supported by management in establishing a Zoom business account and dedicating it to the delivery of the sessions. The instructors and the program coordinator were experienced with using Zoom for instructional purposes and in conducting individual intake and coaching sessions.

Delivery of 4 Mock OSCE

Delivery of the mock OSCE was the most daunting challenge faced. The University of Alberta’s Health Sciences Education and Research Commons (HSERC) facility was shut down, only to open and shut down again. The four in-person mock OSCEs were rescheduled and delivered in September and November 2021 and then twice in March 2022. All 58 IENs attended the mock OSCE and received verbal and written feedback from instructors and examiners. All performed well at the stations and gained experience in the actual setup of the OSCE exam, as the same facility hosts the actual exam.

Evaluation and Adaptation

Bi-monthly sessions included students completing feedback/evaluation forms, individual and group discussions, peer review of curriculum materials and conferring with the regulatory representative from CARNA and Touchstone Institute.

Feedback from Participants

Individual client and group feedback helped to ensure the curriculum and scenario development produced materials that can be used by IENs from diverse backgrounds. The curriculum was reviewed by all seven student cohorts. The participants provided feedback that was vital in ensuring the materials enabled understanding of their previous learning in the context of the Canadian competency standards and the regulatory processes in Alberta.

Participants were able to provide feedback and as some attended sessions to refresh before their exam, we could gather additional feedback to determine if the adjustments to the material had increased the effectiveness of the materials, thereby providing the testing of the materials.

Instructors

The contracted RNs engagement in peer review of each others’ contributions to the curriculum and instruction was instrumental in the continued enhancement of the curriculum. By working as a team to assess the students’ outcomes on the mock exams, they were able to pinpoint any areas of concern and revise the content and revaluate the delivery module.

Regulatory Body and Touchstone Institute Inputs

Throughout the development of the materials, we had the opportunity to consult with the College of Registered Nurses of Alberta (CRNA), which oversees the licensure process for IENs seeking RN designation, and Touchstone Institute which delivers the ARNAP exam.

• CRNA has provided valuable advice in identifying resources to be used in the development of the materials ensuring they are reflective of the competency level required for RNs. Though CARNA as the regulatory body cannot recommend the Bredin program, they do include information on our project with the resources they provide to IENs making inquiries.
• Touchstone Institute has provided advice and resources and keeps us updated on the changes the ARNAP exam is undergoing. Their updates and advice help us to continue to develop the materials with accurate and up-to-date information.

Compilation of Results

The compilation of results indicated that the IENs who competed in the ARNAP Prep course have increased awareness of labour market integration, resources, program, and activities and their ability to connect with workplaces including knowledge, skills, and opportunities.

Awareness of labour market integration, resources, program, and activities including the following:

• Bi-weekly orientation sessions delivered in preparation for each intake. Clients completed a feedback survey to determine knowledge and understanding enhancement of the licensure process for RNs in Alberta before and after attending the orientation.
• Prep and post surveys were developed by Bredin, Bredin received feedback from the survey. 80% IENs reported that they have no knowledge to some knowledge of ARNAP in relation to the licensure process. The same group reported after they attended the ARNAP prep orientation session, their knowledge had increased significantly to very good knowledge with a good understanding of the ARNAP process.
• A survey question was included to address financial concerns about licensure. Information on Windmill & Bredin/Servus Micro lending services resulted in 23 (37%) participants reported that they were likely to access the service and 33 (53%) did not need financial support because they are employed, or they are using their savings to pay for exam fees.

Ability to connect with workplaces including knowledge

Clients were provided support to begin working as RNs. In total 58 clients completed the program and 10 are now employed as RNs. Of the remaining 48, 14 have successfully met the RN requirements and are applying for positions. Due to the COVID delays in exam scheduling 24 are still in the process of writing exams to complete the regulatory process. It is expected that a total of 50 of the original 58 clients will secure employment as an RN (86%). Bredin will continue to support the IENs as they proceed towards RN status and employment as registered RNs.

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