Pass or Fail?

I am engaged in a painful struggle over some of the nursing students where I teach. Two of them did not accumulate enough points on their 3 exams + final to pass my course. Seems straight forward, doesn't it? If you test for level 4 instructor and there are only level 3 conditions, you cannot pass. Often seems unfair to some. The person clearly has the skills and teaching techniques but cannot find a venue in which to test. But I digress.

Looking closely at these two students, I find that both would have passed but for one low exam grade. Both, in fact, passed the final (which is a small percentage of their grade). Do I pass them? How do I decide? It isn't as if I can have them send me a video of themselves performing in level 4 conditions. Can they do the rescues? Do they have the skills to go on and pass pathophysiology and to be competent nurses?

What if I am wrong and level 4 conditions are just too much for them? What if I pass them and they invest more of their money in school only to flunk out at the next step? Do I fail them and close the door on a career (although they can choose to retake the class) or risk setting them up for failure? And here's the big catch:
my decision will also play a part in the care/safety of some future patients/paddlers I will never meet.

It's not easy being me.

Paddle safe...
DS