Quebec's nursing exam to get makeover after high fail rate sparks controversy

Quebec's nursing regulatory body is revising the nursing licensing exam after more than half of applicants failed in September.

The Ordre des infirmières et infirmiers du Québec (OIIQ) announced its intentions Thursday, after an investigation by the province's professions commissioner concluded there were major problems with the exam.

The commissioner's report calls for immediate modifications to the exam and an investigation into the training of nursing students. The report also concluded the passing grade requirement had been raised without justification.

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.

The OIIQ says in a news release that it will now rely on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) as an assessment tool starting early next year.

Nearly all regulatory agencies in the United States and Canada use the NCLEX-RN, and it has been around since 1994, the OIIQ notes. It has tested over six million people, making it a proven measurement tool, it says.

But before the OIIQ can make any changes, a request to modify the exam will be submitted to the Office des professions du Québec in the coming days, as required, the OIIQ says.

Waiting until the spring of 2024 to use the new NCLEX-RN assessment tool means aspiring nurses will rely on a modified version of the current test in the fall.

OIIQ president Luc Mathieu says the nursing regulatory body intends on improving "the existing examination by implementing some of the recommendations put forward by the commissioner."

The OIIQ says the passing mark for the March 2023 exam was established with the contribution of clinical experts, as recommended by the commissioner — all supervised by an experienced psychometrician (a specialist in measuring abilities).

However,  André Gariépy, who oversees access to professional orders in Quebec, said in his report that the OIIQ should have postponed the March exam given the situation.

When Gariépy's report came out, arguing the OIIQ's test cost the province some 500 nurses, Parti Québécois health critic Joël Arseneau described the commissioner's findings as appalling in the midst of a nursing shortage.

The health minister agreed. "We can't afford to deprive ourselves of 500 nurses," said Christian Dubé.

Mathieu said in a statement Thursday that the changes announced make it clear that the OIIQ "does not hesitate to question its ways of doing things."

"However, no compromise will be made on the protection of the public," he says. "The scarcity of labour is worrisome, but it is not a reason to lower the requirements to enter the nursing profession."