Some Quebec nursing students getting licensed out of province to bypass controversial exam

Several nursing students in Quebec are going to what some might consider extreme lengths to avoid taking the province's licensing exam — one that has failed hundreds in the past year and was found to be flawed last fall. 

In a workaround getting more popular as word spreads, some nursing candidates in Quebec are registering to practise in other provinces in order to take the exam offered to all other nursing students in Canada. 

It's a route Mélanie Bélair Domenech took when she found out she failed Quebec's exam by one percentage point last September. 

"I was very stressed to not be a nurse after all the studying I did, all the time I put [in]," she said, adding there was "a lot of ambiguity" in the exam's questions. 

This spring, just over half the nursing students (53.3 per cent) who took Quebec's exam for the first time passed, a success rate similar to that of last fall (51.4 per cent), when the exam came under intense scrutiny for the high failure rate.

Many nursing students have told CBC the exam, offered by the Ordre des infirmières et infirmiers du Québec (OIIQ), did not reflect what they studied in school. 

A recent investigation by Quebec's commissioner of professions also concluded there were major problems with the exam last September, noting issues with its validity and reliability. 

Faced with the prospect of failing the OIIQ exam for a second time, Bélair Domenech opted to use a loophole that allowed her to take — and pass — a different test: the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam, which is used in the United States and everywhere else in Canada to obtain a licence to practise.

She said the NCLEX-RN exam, which she was able to take in Montreal through a private testing company, was very straightforward. 

Bélair Domenech, who is now a nurse clinician at Montreal's McGill University Health Centre (MUHC), says it makes her wonder what's going on in Quebec. 

"It makes me very sad for the [people] that maybe could have passed this OIIQ exam and be a nurse today. It should not be like this."

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How does it work?

Hundreds of Quebec nursing candidates are joining a private Facebook group called Étude NCLEX Québec/Canada to help each other out with the procedure in hopes of skirting Quebec's exam. 

Is this loophole legal? Yes. Simple? Not quite.

The first step involves registering to become a nurse with a province that approves and recognizes your educational background.

CBC spoke with nursing students who had registered with British Columbia and Nova Scotia.

Next, comes receiving authorization to take the NCLEX-RN exam from that province's nursing regulatory body, passing and then paying for your licence in that province. 

Now that you're a licensed nurse, it's time to work toward getting that licence recognized in Quebec. 

According to the OIIQ, even if you hold a permit in another Canadian province or territory, you must apply for one specifically to practise in Quebec.

This involves paying a fee to scan and transfer your documents, paying to get certified in two training courses on the OIIQ website and then, once approved, paying for your new licence to practise.

In all, the fees during this process leading to, obtaining and maintaining your practice permit in Quebec will run you upward of $1,000.

For Esther Ha, the price was worth it. 

"I just wanted to practise so bad," said the registered nurse working at the MUHC's Glen site. 

She failed the OIIQ exam twice this past year, each attempt costing $638.11. She too says the ambiguity of the questions tripped her up. 

"The questions were, for example, 'what would you do?' and not, 'what is the priority intervention?'" she said.

I just wanted to practise so bad- Esther Ha, Montreal nurse who got licensed in Nova Scotia

That's when she remembered the NCLEX-RN exam was an option. She applied to be a nurse in Nova Scotia, passed the exam in July, and began working in Montreal soon after. 

"I just went with it and I'm thankful that there was this alternative," she said, adding the national exam covered many more topics and was clearer with its questions. 

 "There's definitely a flaw [in Quebec] and some things have to be changed." 

NCLEX-RN exam for Quebec nurses delayed

In the wake of the damning May report by Quebec's commissioner of professions, André Gariépy, the OIIQ said it would be adopting the NCLEX-RN starting in the spring of 2024. 

However, in a statement to CBC Wednesday, the office of Treasury Board President Sonia LeBel confirmed the new exam won't be in place by then. 

"Replacing the current exam with the NCLEX requires serious analysis to ensure that the exam applies to the Quebec context," said spokesperson Marylène Le Houillier.

"This is not a short-term solution for 2024."

Houillier says, as Gariépy noted in his report, the work required to correct the current exam is unavoidable, even if another exam like the NCLEX-RN is adopted. 

"For us, the important thing remains to integrate all qualified nurses into the network so that the population benefits from the best possible services," she said. 

Meanwhile, for the second session in a row, hundreds of nursing candidates are choosing not to take Quebec's licensing exam next week.

Of the 4,094 candidates invited to take it on Sept.18, a total of 949 have opted to sit it out. This abstention rate of 23 per cent represents a slight increase from last spring.

The OIIQ has offered two exemptions so far to aspiring nurses following the commissioner's report and in wait of the new exam.