Nursing exam that failed hundreds is unreliable and lacks validity, report finds

An investigation by Quebec's commissioner of professions has concluded that there were major problems with the licensing exam for nurses last September that saw over half of nursing students fail. 

In the latest report released on Wednesday, André Gariépy, who oversees access to professional orders in Quebec, found issues with the validity and reliability of the exam. 

"The reliability level of the questions in the exam is pretty minimal, and for a high-stakes exam like this one, it should be much higher," he said 

The report also concluded that the passing grade had been raised without justification.

Gariépy said if the order had maintained the previous mark, more than 500 nursing students who failed would have passed.

"The justification for adding that markup [is] simply not there, not sufficient," he said, adding that a recalculation could allow the nursing students who "technically failed" the exam to obtain their licences.  

"With the recalculation, if they succeeded, then issue the permit and that's it. Let's have them work in the health system. We need them," he said. 

The report calls for immediate modifications to the exam and an investigation into the training of nursing students. 

The province's nurses order, known by its French acronym the OIIQ, said in a news release that it would take "a few days" to analyze the findings before offering a response.

Just 45.4 per cent of nursing students passed the September 2022 licensing exam, compared to a pass rate of between 63 and 96 per cent in previous sittings, according to an earlier report by the commissioner's office. For those who took the test for the first time, the failure rate was 48.6 per cent — the highest rate recorded in four years. 

In January, Gariépy said either the exam was "flawed" or the nursing students had not been adequately prepared by their program to pass it.

He recommended the OIIQ postpone the next exam — scheduled for March — but the order went ahead with it anyway.

The OIIQ said it is fully aware that the nursing students who took the March exam may raise questions about their test results following the commissioner's report. 

Reactions from the National Assembly

Political reactions came quickly from the National Assembly in Quebec City, where work is underway to pass Bill 15 into law — a bill which aims to overhaul the health-care system to make it more efficient.

"We can't afford to deprive ourselves of 500 nurses," said Health Minister Christian Dubé.

Joël Arseneau, health critic for the Parti Québécois, described the commissioner's findings as "appalling … in the midst of an unprecedented nurse shortage."

15% pass rate for foreign-trained nurses

According to OIIQ data, the success rate for foreign-trained nurses was a mere 15 per cent, a situation which Gariépy describes as worrisome.

OIIQ data also shows the number of permits issued annually has fluctuated between 3,000 and 4,200 over the past decade. 

Despite efforts to recruit foreign-trained nurses, last year only about 22 per cent of permits were issued to graduates from outside Quebec, mainly from France.

As part of a $65-million program launched by the Quebec government in February 2022, about 1,000 students recruited from Africa are expected to obtain their Quebec nursing licences within the next two years.