Quebec nursing licensing exam to blame for high failure rates: report

Contrary to what the Order of Nurses of Quebec (OIIQ) has been claiming since the start of the controversy surrounding massive examination failure rates, the validity of the order’s exam – not the pandemic – is at fault.

That’s the conclusion in a new report tabled Tuesday from a commissioner tasked with ensuring fairness in entry exams to Quebec’s professions.

“We have lost a lot of great potential nurses to the failure of this exam,” said Melanie Boulerice, CEO of Nomadic Nurse Agency. “Quebec has unfortunately, let’s put it this way, failed the nursing body, the nursing students who are coming out into the profession, and have not found better ways to ameliorate the exam process.”

In addition to refuting the Order’s main argument, André Gariépy calls on the OIIQ to “get to work” to “correct the flaws in its examination.” It also seriously questions the relevance of using the American examination as desired by the OIIQ.

BACKGROUND: Reform needed for Quebec licensing exam, nurse says

In the third report of his investigation into the circumstances leading to an abnormally high failure rate in the September 2022 and March 2023 exams, Commissioner Gariépy reiterates the explanation lies in “the flaws and weaknesses of the exam,” including “its validity, its reliability and the establishment of its passing mark.”

After seriously considering the OIIQ’s argument that the pandemic could have deprived candidates of valuable hours of laboratory training and adequate internship support, Gariépy concluded these are “impressions” arising from an “apparent and intuitive logic.”

Based on surveys and interviews conducted with nursing students and educational establishments, as well as a review of scientific literature on the impacts of the pandemic on the training of health professionals around the world, Gariépy affirms that it is not “a generalizable, sufficient and conclusive explanation.”

More precisely, the commissioner once again criticizes the order for having itself created “a statistical aberration” by modifying the passing score after observing the results of the September 2022 exam. This manipulation of the pass mark would have caused some 500 candidates to fail.

The order considered it prudent to apply a “measurement error” factor because it doubted the validity of the results. An “unjustified addition” in the eyes of the commissioner.

The commissioner also deplored the lack of enthusiasm of the order to improve its current examination while, more than six months after the submission of its first findings, fundamental documents essential to the proper functioning of an examination “remain absent, incomplete or obsolete, without any real commitment to correct the situation.

“We have seen a repeat of history, which is when I graduated and when I went through my exam process. And if anybody knows me, knows my story. I did my exam three times and it was a challenging moment. And I am so happy that I’m here, but there was a chance that I wasn’t going to be a nurse. There was a high chance that I wasn’t going to be a nurse because of that exam,” said Boulerice.

One nursing student CityNews spoke to says she is grieving her dream of becoming a nurse after failing the OIIQ exam four times.
She will never know if she was one of the 500 who should’ve passed the exam in September of 2022.

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Gariépy opposed the solution put forward by the order to adopt the American exam as other Canadian provinces have done. In Gariépy’s opinion, this is not a valid solution in the short term and he describes the timetable of deployment in 2024 as “unrealistic.”

As reported by The Canadian Press last month, the Office of Professions would be very reluctant to the idea of using a foreign tool to assess the skills of future Quebec nurses. The report tabled Tuesday appears to reinforce this position.

In a press release released shortly after the unveiling of the report, the Office of Professions announced it was imposing a form of supervision on the OIIQ by deploying “support measures to ensure that the Order of Nurses of Quebec will rigorously follow the recommendations made.”

—This report by La Presse Canadienne was translated by CityNews