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REx-PN: Frequently Asked Questions
Background and purpose
What is the REx-PN™?
The Regulatory Exam – Practical Nurse (REx-PN™) is an entry-to-practice exam for those applying to become a Registered Practical Nurse (RPN) in Ontario or Licensed Practical Nurse (LPN) in British Columbia. When implemented on January 4, 2022, it will test for the knowledge, skills and judgment nurses need at the beginning of their careers to practice safely.
Why do we have a registration exam?
Registration exams such as the REx-PN contribute to patient safety. As provincial regulators of the nursing profession, CNO and BCCNM are accountable for ensuring that only those who demonstrate the ability to apply nursing knowledge and provide safe care at the beginning of their careers are able to practice. The registration exam helps to do this.
When will the REx-PN be implemented?
The new exam will be implemented on January 4, 2022. We established this timing with nursing education programs in Ontario and British Columbia to give educators time to include the revised entry-to-practice competencies in their curriculum and support students in preparing for the REx-PN.
Why is Ontario changing to the REx-PN?
As Ontario’s nursing regulator, CNO is accountable for ensuring that it grants registration only to those who demonstrate the nursing knowledge to provide safe care. We regularly review processes for assessing this knowledge to determine the most accessible, fair and efficient approaches.
The REx-PN will meet our requirements for being a valid, reliable and secure exam. It will also meet the needs of writers by giving them year-round access to the exam and faster results.
How do the Canadian entry-to-practice competencies relate to the items that will be on the exam?
The REx-PN is based on data collected from an analysis of RPN/LPN practice conducted in early 2019, a process that will be repeated every five years. In addition, revised national entry-to-practice competencies were mapped to the practice analysis to ensure the competencies essential for safe nursing practice are included on the exam.
Prior to writing the REx-PN, Practical Nursing students will have completed an educational program designed to teach them the knowledge, skills and judgment to prepare them to enter the nursing profession. Nursing candidates’ academic preparation provides a starting point for them to practice in a variety of settings. In complement, the REx-PN will assess whether Practical Nursing candidates possess the minimal entry-level competence to provide safe and effective care.
What will the REx-PN test?
The exam will focus on testing entry-level competencies that are essential to providing safe care at the beginning of an RPN career. The REx-PN will not test all competencies that are taught during a Practical Nurse program, which was also the case for past exams.
Is the content of the REx-PN being reviewed by Canadian nurses?
Yes. Nurses in Ontario and British Columbia are reviewing the content of the REx-PN. They continue to review and develop the exam to ensure it meets our needs as regulators and the needs of the public for safe nursing care.
How are the exam questions being translated into French?
To meet the needs of French-speaking Canadian REx-PN candidates, the exam will be offered in French. A third party will translate questions following best practice and recommended standards. A panel, made up of French PN academics who are familiar with nurse practice settings, developed a lexicon that is informing third party translation. The third party translates questions following the lexicon, best practice and recommended standards.
Following this translation, a Canadian Translation Panel made up of French-speaking Canadian nurses will review each translated question for accuracy and contextual equivalency.
This method, referred to as a mixed-method, process-oriented approach, is supported in the literature as a preferred method for ensuring construct equivalence in health care measurement instruments.
Will the exam be tested before it is implemented?
Practical Nursing programs in Ontario and British Columbia are pretested the exam items on student volunteers who are preparing to graduate in 2020 and 2021. The results are being used to determine the difficulty level for each question, which is a critical feature of a CAT exam (computerized adaptive testing). In addition, questions are being flagged if they need to be revised and retested or possibly removed from the bank of questions. Once the new exam has been implemented in 2022, all new questions that are developed will be pretested on the REx-PN.
How is it safe for the public if an applicant has unlimited writes on an exam?
Regardless of the number of writes, the only way a writer will be successful on the REx-PN is if they are able to show they have the knowledge, skill and judgment to practice safely as an entry-level Practical Nurse. Each person who writes the exam will have a different set of questions. There is no risk of memorizing content because the software system behind the REx-PN knows when someone is rewriting the exam and generates a new set of questions for them each time.
Rather than a traditional multiple-choice exam, the REx-PN will be a Computerized Adaptive Test (CAT-exam), where the exam writer must sustain a pre-determined level of difficulty to show their ability. Whether they pass the exam on their first try or any subsequent try, they won’t be passing by chance or because they memorized test content. They will pass because they have the ability, which helps to keep the public safe.
I'm applying for registration in Ontario. Will I be able to write the CPNRE and the REx
The CPNRE will remain the registration exam for practical nurses in Ontario until the end of 2021. On Tuesday, Jan. 4, 2022, the REx-PN will become the registration exam for Ontario Practical Nurses, and the CPNRE will no longer be an option for Ontario applicants.
If you pass the CPNRE by the end of 2021, it will count as you meeting the regulatory exam requirement, even if you have not completed the other requirements of your registration by that time.
Visit https://www.ncsbn.org/13764.htm for additional FAQs.
If I apply for registration in Ontario, will I have to write the REx-PN exam in Ontario?
No. You will be able to write the REx-PN at any Pearson VUE test centre that offers the exam. However, there will be an additional fee if you write the exam outside of Canada or the U.S.
Will my Ontario nursing education prepare me for the content covered on the REx-PN?
Yes, the REx-PN tests competencies that nurses need at the beginning of their nursing careers to practice safely in Ontario as covered in your nursing program’s curriculum.
Will there be REx-PN study resources to help me prepare?
Yes, resources have been or are being developed, including:
- Test plan, in English and French
- Computerized Adaptive Test (CAT) educational video and presentations, in English and French
- Frequently Asked Questions (FAQs), in English and French
- A practice exam, in English and French.
- REx-PN Tutorial, in English and French (expected November 2021)
- REx-PN Candidate Bulletin, in English and French (expected November 2021)
Should I take an REx-PN prep course?
You may find prep courses helpful in preparing to write the exam, but the choice of what will help you prepare is yours. Your nursing education and the resources provided on this page should be enough to prepare you to write the REx-PN. Third-party vendors may develop and offer REx-PN preparation courses, but it is important to be know that they do not have access to the REx-PN question bank. CNO is aware of some prep courses being developed in English but CNO cannot attest to their success in helping someone to prepare to write the REx-PN. To date, we have not been made aware of any preparation courses being produced in French, although we continue to make inquiries..
What is the REx-PN Test Plan, and how can I use it to prepare?
The REx-PN Test Plan (EN; FR) provides an excellent guide as you prepare to write the exam. It’s a concise summary of the content areas and scope of what will be tested on the exam, and also includes: definitions for each Client Needs category; nursing activity statements; sample REx-PN questions; and, information on the format of the exam and how it will be scored.
Will I have to memorize normal lab values?
The lab values an exam writer is expected to know are located on page 36 of the REx-PN Test Plan (EN; FR), and include the lab values for ABGs (pH, PO2, PCO2, SaO2, HCO3), BUN, cholesterol (total), creatinine, glucose, glycosylated hemoglobin (HgbA1C), hematocrit, hemoglobin, INR, platelets, potassium, PT, PTT & APTT, sodium, and WBC. All other values will be provided.
Writing and results
How many times will I be able to write the REx-PN?
Applicants will have no limit on the number of times they can write the exam in order to pass. Because the REx-PN will be a computerized adaptive test (CAT exam), it allows for no limit on the number of times a writer can attempt it. The system knows if a writer is retaking the exam and supplies them with a set of questions different from those the writer had in previous attempts. Regardless of the number of attempts, the only way a person will successfully pass the REx-PN is if they are able to show they have the knowledge, skill and judgment to practice safely as an entry-level RPN.
How often will the REx-Pn be available to write?
The REx-PN will be available to write at any time in permanent and temporary centres of the exam provider, Pearson Vue. REx-PN writers will have to wait a minimum of 60 days between attempts, which equates to a maximum of six attempts per year.
How much time will an exam writer have to answer each question?
While there will be a time limit of 4 hours to complete the overall exam, no time limit will be set per question. On similar exams, candidates generally take 60 – 90 seconds per question. Writers should not feel the need to rush. For more information on the time limit, please see the section “Examination Length” in the REx-PN Test Plan for more information.
Do I have unlimited chances to write the current (CPNRE) exam as well?
No. The current regulatory exam, the Canadian Practical Nurse Registration Exam (or CPNRE for short), is limited to three writes as it is a multiple-choice exam using “classical test theory.” With classical test theory, the mark at the end of the exam can include some measurement error. For example, a person could get an answer correct by guessing. If they fail the exam and retake it later, they may see the same questions again and could have memorized the answers. The exam would then be scoring their memorization skill rather than their ability.
For a classical test theory exam, the more often a person writes the exam, the more likely they are to pass because of measurement error. This is why Council limits the number of writes on this type of exam to three times; it supports the final exam result as being a valid and reliable measure.
Where will Ontario's REx-PN test centres be located?
You will be able to use Pearson VUE’s Test Site Locator to find the test centre nearest you.
What happens if I don't pass the REx-PN the first time?
There will be no limit to the number of times you can write the REx-PN until you pass. If you are not successful, Pearson VUE will send you a Candidate’s Performance Report (CPR). This document will provide information about how you did in each section of the exam, indicating whether you performed above, near or below the passing standard. Find more information about CPRs on NCSBN’s website.
How many times will I be able to re-write the exam?
There will be no limit to the number of times you can write the REx-PN until you pass. You will be able to take the REx-PN once in any 60-day period (up to a maximum of 6 times per year). However, you will also need to meet all other requirements to become registered to practice as a nurse in Ontario.
How can i improve my chances of passing if I have to retake the REx-PN exam?
If you fail, you will receive a breakdown of your results, including content areas in which you had deficiencies on the exam. You can then use this information to determine additional learning you may need to complete to increase your ability and overall competence. For example, this could mean studying more in this area, getting additional academic help, or taking a continuing education course on a specific topic to improve your knowledge in that area.
If before the REx-PN is implemented in January 2022 I have failed the CPRNE three times, will I be able to write the REx-PN?
Yes, if you meet the exam eligibility requirements, you will be able to write the REx-PN. There is no limit to the number of times you can write the REx-PN. CNO will keep your application open so you can attempt the REx-PN exam when it is implemented in January 2022. For additional information, see Options when failing the CPNRE: Frequently Asked Questions.
Content and format
What will the REx-PN test?
The REx-PN will not test everything that is taught during a Practical Nursing program. Rather, it will test entry-level skills, knowledge and judgment — what nurses need to know to provide safe care at the beginning of their careers. The REx-PN Test Plan describes what will be tested.
Will the REx-PN include questions specifically about Canadian health care systems or legislation?
No. The REx-PN will not test knowledge of health care systems, history, cultural issues, or government policy and laws. Such items vary by province and territory in Canada. While nurses must know about the health care system they work in, including its legislation, testing for that knowledge is not the purpose of the REx-PN.
Applicants to CNO write a Jurisprudence Exam that tests for this knowledge.
What format will the REx-PN take/what is computerized adaptive testing?
The exam format will be Computerized Adaptive Testing (CAT). Using CAT, the system determines the level of difficulty of the question it presents to the writer based on how well they responded to the preceding question. For example, if a writer responded correctly to a question of medium difficulty, the next question presented will be slightly more difficult. A candidate must achieve a certain ability level on the exam to pass.
This video provides you with more information about the CAT format of the REx-PN.
How many questions will the REx-PN have?
The number of questions an exam writer will receive will range from a minimum of 90 to a maximum of 150. Of those, 30 questions are being pretested for possible inclusion on future exams and will not count in the exam writer’s score. The remaining 60 to 120 questions will count in the exam writer’s score, with the actual number of questions they receive depending on how long it takes the exam’s algorithm to determine whether the writer is consistently performing above or below passing level.
Pre-testing is required to ensure CAT exams function properly. By administering pretest items to a large sample of REx-PN writers, the degree of difficulty of each question can be determined. The writer will not be able to distinguish between an unscored pretest question and a scored question on the REx-PN, so exam writers should give each question their best effort.
Will the exam use generic and trade name medications in questions? Will there be a need-to-know list of drugs?
At this time, the REx-PN will reflect, on most occasions, the use of generic medication names only. The use of the medication generic name is more consistent, while a brand/trade medication name may vary. Some items may refer to general classifications of medications. A list of medications that are on the exam will not be provided.
Will there be a default practice setting for the questions?
No. If needed to answer the question, a relevant practice setting will be stated.