• Robert Lovell

Nursing Students Surprised by $515 in Exam Fees Close to Final Semester

“I just assumed that any exams we would have to take would be included in tuition.” – Mikayla Ayre, Nursing Student




An apparent miscommunication with faculty surprised nursing students with unexpected costs close to the end of their program. The costs were associated with a HESI (Health Education Systems Incorporated) Exam Prep Package designed to prepare nursing students for writing the NCLEX, the national licensure exam for registered nurses.


In response, the Nursing Society sent a letter of concern to the faculty in an attempt to “reach an agreement between Term 7 students and the faculty regarding the HESI exam package.”


In March, Caper Times spoke with Mikayla Ayre, Secretary of the Nursing Society about student concerns that went into writing the letter.


CT: “What can you tell me about the letter you wrote on behalf of nursing students to the nursing department?”


MA: “I had a few students come up to me and they expressed their concerns about the HESI’s. Primarily the cost, which was virtually unknown until it was being confirmed with us—us being the Term 7 Students. Many people came to me saying, can we do something about this?”


Ayre also explained that the total number of exams concerned the students; she tells us that Willena Nemeth, Director of the Nursing Program, first proposed a total of eight exams that would be covered over the final two terms, in addition to regular coursework.


“There was a little bit of a disconnect between the students and the staff. The students were unhappy, but weren’t sure how to voice it, and the staff were also a little bit uninformed about what the students wanted. We were trying to find the happiest medium that we could with the letter.”


CT: “What has been the response so far?”


MA: “I then got a response from Willena saying that she would like to speak to all of the term 7 students, and then that she would address the cost issue. So one of the main issues we were having with the cost was that it was virtually unknown and then was going to be charged to the [student financial] accounts and was going to accrue interest next month, and when the charge [was] applied, students couldn’t register for the next term without paying for this cost.

“It was a high cost; it was around $515. Which isn’t something everyone has in their pocket. So one of the things we asked in the letter was if we could possibly remove some of the exams and therefore possibly decrease the cost or if we could at least have the cost deferred to term 8. Then the students could register [for courses].”



Nearly half the Term 7 cohort responded in Facebook chat that they knew nothing of the cost till it was being confirmed via email this term.


CT: “To your knowledge, was there any mention of this cost before this term?”


MA: “Before this term, as a term 7 student, not to my knowledge. As a nursing Society representative, it’s not something I would have known either … I don’t think it was explicitly stated that we would have to pay for the HESI exams … I just assumed that any exams we would have to take would be included in tuition. Or included in that package and that somewhere in between it would have been paid for.”


“I understand having an extra cost since it is from an outside source; it’s not the professors’ writing the exam. However, I feel like it should have been … a little more informed than just telling us the month before that we would have to pay for this cost.”


Ayre also points out that when the students were informed of the cost, they were told it was related to exams written in Terms 3, 4, 5, and 6 as well as those still to be written in Terms 7 & 8. In actual fact, the students had only written one HESI examination at that time, in Term  5.


“Essentially that’s where it all started. “Hey, we haven’t wrote those exams, so what are we paying for?” and then the proposal was, we’ll catch up on these exams, and then we dealt with the rest through the letter.”

(Elsevier)

At the end of March, the Caper Times spoke with Willena Nemeth, Director of the Nursing Program, about the ongoing issue.


In explaining what is included in the exam package for nursing students, Nemeth tells us that “we have collectively [StFX, Dalhousie, & CBU] put together a package of 3 short quizzez, 2 exit exams, and one other exam which is called a CAT (computerized adaptive testing), which is exactly what the NCLEX exam is; it’s adaptive to the candidate answering each question.”


Nemeth further explained that there is strong evidence suggesting the predictive value of these preparatory exams in relation to NCLEX success.

CT: “So do you feel this best prepares students for the NCLEX?”


WN: “We felt and still feel that it is a very good learning package for students to progress through starting with the shorter ones into the exit and then the CAT and we’ve seen that in NCLEX RN results of our graduates in the province. We’ve maintained our national average, and we’ve been above the national average with each year reporting since 2015 of our graduates being successful in the NCLEX not only on the first write, but on subsequent writes.”


CBU uses high NCLEX pass rates as a selling point for the Nursing Program.

CT: “You received a letter of concerns from the students. What actions have been taken since then, and what actions are you planning to take?”


Nemeth replied that she did speak with students during one of their classes, and began to seek more definitive answers to address their concerns.

“When we looked at the cost further, we realized when the Elsevier representative was here on campus. I reviewed it with her and we realised there was a double charge for one of the prep components of that package so the price did decrease [from $690 to $515] but then it became still an issue of the timing of the payment.

“In collaboration with our finance Department that has been moved to the spring-summer semester, which is the last semester for our senior students to have that opportunity, to have that additional length of time to pay for the package.


Costs have been deferred to May 6th, allowing students to register for term 8 courses—a prerequisite for receiving Nova Scotia Student Loans.


“The timing of the package exams is different than what we had planned. So initially it was planned at the end of semester 4 to have a customized exam for the clinical integration course. They did have an exam but not one that was from this company. Semester 5 the students did, and Semester 6 was another miss that they didn’t have the planned customized exam, and Semester 7 was planned for an exit exam which is going to happen next week, and then semester 8 will be the second exit exam and the CAT exam so those are on schedule.

“In lieu of the customized exam for semester 4 and semester 6, I asked the representative from the company [Elsevier] if we could have additional practice exams.”


Some students opted to write these three practice exams this week as part of their regular exam schedule, while others will complete them in Term 8. They will not be counted toward any course mark, and instead be used as practice to guide future studies.


CT: “What do you think could be done could have been done better in this case or for future students? I heard from students they felt surprised by this fee. they didn’t see this coming for this term.”


WN: “I did speak with the now semester 7 students twice. Not everyone is present, I’m thinking, at the opportunities that I did have to speak with the students.

“But everyone was given EAQ (Elsevier adaptive quizzing) codes, and I was in the room at the time when I passed them out and gave it to the students, and I explained the package at that time.


“I did the same thing and semester 7, again not everyone was there I realise but I took the opportunity to revisit that again and took questions when there was a guest speaker from the Canadian Nurses Protective Society…

“So, the students were aware. They were aware by the fact that they had their own codes that I provided, and that it was an additional package from an outside company.”


CT: “Were they aware there would be a cost associated with it?


WN: “Yes, I did relay the cost would be associated with it.

“And I must say, the cost was high, but it was decreased when we realised the double charging and that cost is consistent; maybe $15 more than it has been since we started this in 2015.”


CT: “So what do you think could be done better?”


WN: “We give so much information very quickly, but formally we have to write it down and send it as a memo, send it through an email, and have that face to face discussion, put it in syllabi—maybe not per se the cost but the plan for the use of these HESI Exam Prep products.”


CT: “I’ve heard from some students they wish they had a list of costs at the start of the program, like estimated costs such as book packages and HESI fees and uniform pack is there any plan to have that?”

Nemeth pointed out that while there are certain additional costs associated with the program that are managed well, such as the uniform package, there are others that students may not be well-informed on.


“To the student body’s point, [by] laying [the costs] out, students who carry student loans or have scholarships can plan the cost as they go because they’re not all upfront costs, but there is substantial costs upfront for your learning in Semester 3.”


In February, before the charges were enacted, Sheryl Trimm, Manager of Student Financial Accounts gave an email statement in response to a query about the policies surrounding Student Accounts:


“From what I was able to obtain, the only fees we add to a student account are those listed in the academic calendar as revised annually in the spring. From time to time we get requests from profs who wish to put a course fee into effect, but we have resisted this in the past.”


Placing a charge on student accounts other than at the time of course registry seems to be a new precedent, and something people on student loan should be wary of. You cannot register for next term’s classes without paying current fees, and you can’t register for student loan if you are not registered for classes.

Trimm gave another email statement this week explaining her department’s involvement “was to coordinate the initiative to facilitate the package that enables students to prepare for their non-CBU exams. This is a cost that the students would have had to incur individually, but by offering this value-added service, the Nursing Department was able to purchase the packages as a combined unit and pass the discount on to the students. Because this was done to benefit the students, the charges were placed on the student accounts as requested by the nursing department.”


[Full Disclosure: Daniel (current Editor of Caper Times), and Robert (Staff Reporter) are Term 7 Nursing Students and were also affected by this cost. Every effort was made to curb bias and report this story in a manner fair to all parties involved.]

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