The inaugural class of Centre d’études collégiales à Chibougamau’s Cree-centric nursing program leapt towards certification earlier this month, as they posted a 100% success rate on their technical exit exam.

The program is based on a mandate from the Cree Human Resources Department (CHRD), to meet the need for nurses in Northern communities, something that caused union demonstrations in Montreal in March. The CHRD launched the program with the help of the Cree School Board, the Cree Health Board, the Ministry of Education and Emploi-Québec.

“[Cree communities] need more and more nurses who can speak Cree to patients and families, and who understand the cultural approach, too,” said Carole Tremblay, the program’s coordinator. “This program is meant to address that.”

The four-year program – extended from the common three-year nursing programs in Quebec – is designed to accommodate Cree students, many of whom have families to care for. It includes social workers who help coordinate lodging, daycare for children during class and during work placements, and offer extra help to students who require it, either for difficulties with content or with language. All 14 of the students in the first graduating class, which began in 2008, passed their technical exam, though three still need to pass the English proficiency portion of finals.

“Relieved, I felt relieved to be finished with the four years,” student Nancy Shecapio said when asked about the exam. “I’m very happy.”

“This group is now well on their way to passing the OIIQ exams in September,” said Tremblay.

The Ordre des infirmières et infirmiers du Québec (OIIQ) is the college that oversees the nursing profession in Quebec. They administer an exam each year, which prospective nurses must pass in order to be cleared to work in a hospital. The exit exams at CEC Chibougamau mimic the OIIQ format, putting its students in an ideal position for accreditation.

Both exams’ technical portions are set up as “bell-ringers”: students progress through various stations, and in each they have just 10 minutes to not only sort out the answer but, in many cases, figure what the question is, too.

“They get a paper that says, ‘You’re a nurse on this unit, here’s the patient and their charts: assess the situation and act on it’,” explained Sasha Dyck, a nurse and researcher at the Montreal General Hospital who was an exam proctor. “Answers to the original questions should lead you to some more questions, and we [the proctors] wait for them to ask the right questions and check them off.”

One of the situations simulated a discharge: the student was informed that they were sending a long-term care patient home. They were required to procure the patient’s basic information – their baseline, or ordinary, condition, what they were capable of then versus now, and what drugs they are taking, for example.

Dyck or one of his colleagues waited aside with a list of the questions that absolutely needed to be asked – many of which were borne from the answers to those initial, basic questions – so they could assess how well a student could think critically in a complex situation with real-life time constraints.

This rigorous testing process is advanced compared to other provinces, Dyck says, because it eschews the computer-based multiple-choice system with a fluid and changing simulation of a real hospital. Still, the graduates have more work to do before they can help alleviate the pressure on medical staff in northern communities.

Unlike nurses in much of Canada, graduates of this program must work for two years in a major hospital – in Chibougamau, where four of this year’s graduates will work, or at the Montreal General – before returning to their communities. The Cree Health Board argues that since northern hospitals run on skeleton staffs, the nurses must be highly trained before arriving, because they will be working alone and must not need the help often required by new entrants.

Tremblay, while not necessarily disagreeing with this sentiment, was concerned that the demand for nurses would not be filled in good time.

“I wrote a letter to the Cree Health Board saying they need at least 100 new nurses in the next few years,” she said.

With the program graduating about 15 students a year going forward, filling this quota will take longer with a two-year delay. But the program promises to pick up steam in the coming years, as its partnership with nearby CEGEP de St-Félicien creates a near-seamless transition in the path from high school through to professional certification as a nurse.

Tremblay speaks highly of graduating students, who she describe as hard-working and resilient. Dyck, too, lavished high praise on them.

“They all really know their stuff,” he said. “I would want my grandmother to be taken care of by them.”