Posted in Health & Medicine, Own Story

The Plight of Internationally Educated Nurses in Canada

For most internationally educated nurses (IENs), Canada & United States are the top destinations for a nursing career in North America. With the high demand of health care and very favourable wages, it’s undeniably “too appealing”. Equipped with various skill sets and experiences, internationally educated nurses migrate to Canada as the country’s warmth and multicultural workforce invites each aspiring nurse to pursue their career and live the Canadian dream.

In 2013, according to Canada’s Regulated Nurses: A Look at Internationally Educated Nurses in Ontario and Canada publication, the top countries of internationally educated nurses in Ontario were from the US, UK, Poland, India, China and the Philippines. There was a significant decrease of  the growth in the supply of IENs in Ontario from 2009 to 2013. Additionally, in 2013 about 64.6% of internationally educated registered nurses (RNs) were employed at a hospital compared to Canadian educated nurses which was 63.4%. Moreover, internationally educated registered practical nurses (RPNs) who were employed at a hospital was 25.1% as opposed to Canadian educated nurses which was 43.5%.

Now, let’s go back to the part where there was a decline of IENs growth in Canada. The reason being was the assessment process became more expensive, lengthy and biased. The launch of the National Nursing Assessment Service (NNAS) added a fair amount of difficulty to IENs who were willing to reciprocate their international licenses to a Canadian nursing license and integrate into the workforce.  In fact, the proficiencies of these professionals are wasted instead of getting utilized as a work force asset in Canada. For those who are unfamiliar, NNAS is an assessment body that evaluates the equivalency of IENs’ education with that of the Canadian nursing degree. In short, they will tell you if your education is up to par or not. With a fee of $650 for the main application, IENs have to pay this amount upfront and fulfill the documentations needed for the assessment of their international nursing degree. Let me tell you, that’s just the beginning of never-ending fees. Along with this application comes a huge number of requirements such as English test, licensure verification and transcripts certification. UNDERSTANDABLE. They have to protect the public and that’s just fair.

What doesn’t sink in to me is for the price that the applicants have to pay, they’re not getting their money’s worth. What’s worse is the lengthy wait times. The application process came to a point when IENs have to wait 2-5 years of completion. RIDICULOUS! And after years of waiting, unfortunately, a few received an offensive evaluation such as, YOUR EDUCATION IS NON COMPARABLE OR SOMEWHAT COMPARABLE TO THAT OF THE CANADIAN EDUCATION, enough to crush one’s spirit trampled the years of professional experiences in highly acute areas and disregarded their almost perfect English test. By the time they receive their result, they have been stagnant for years from their practice waiting for a process that’s cocktailed with ineffectual arbitration.

I have met various IENs who have worked in ICUs and highly acute areas overseas who received a non-comparable result. Some of them have master’s degrees, numerous years of experiences and specialized skill sets. Surprising, isn’t it? The inconsistencies with the process to obtain a Canadian nursing license have to be terminated. I’m not complaining but it’s certainly a case of unfairness in plain sight and one has to speak up. I understand that the gaps for knowledge can be corrected by refresher programs  and they’re setting the bars high however, when does this systemic unfairness stop? Systemic unfairness or systemic racism? Internationally educated nurses are discriminated because English is not  their first language despite the fact that they have passed the NCLEX, met the requirements, have worked in highly acute areas and PASSED AN ENGLISH EXAM. What are we missing here?

I bumped into an open letter by the where it tackled some few interesting points. It says that regardless where we came from, we are all Canadian nurses and opening up about racism in nursing and healthcare must be addressed.  Systemic racism education is omitted in the nursing curriculum and workplaces. I agree. While cultural sensitivity is greatly emphasized, systemic racism among  health care staff and fellow nurses are not discussed. It is a touchy subject that most people fail to address and even refuse to acknowledge. It exists and it is real. So, how can we tell that each application from an IENs is not viewed by an adjudicator without discrimination and prejudice? There is no valid proof to this claim but there should be a better system of transparency and open communication between the applicant  and assessment bodies. Be more accessible, perhaps? After all, they’re not paying for cheap fees.

Additionally, I also understand that each province have standards of their own. I’m not saying to make it easier, MAKE IT FAIR. One does not realize that these IENs have a life to live. The emotional turmoil and stress of waiting for result is too much to fathom. This is unacceptable on all levels. Stop wasting their time. Stop making the application processes a money grab. Shorten the wait times. Establish a pathway so each case can be dealt with appropriately. Develop an effective system where applicants and nursing bodies can benefit from each other. We are in need of more nurses!

The questionable processes, amounts and timelines are the problems we have to solve as it strains the applicants financially and emotionally. To add, I don’t think anybody has questioned this because of possible repercussions. And I doubt change will happen soon because of extreme red tapes. It’s a life altering process for the applicant’s end and some lose their hope and confidence on what this country has to offer.

And as the pandemic continues to hit, the shortage of nurses is obvious. The health care system is overwhelmed with patient overflow and short staffing issues. This is the time to expedite applications. On the contrary, I still think that the standards have to be maintained to protect the public at all cost. After all, we’re all in this together. Or, are we really?


Filipino-Canadian. Lives in Ottawa, Ontario. Full time frontliner, part-time scribbler.

4 thoughts on “The Plight of Internationally Educated Nurses in Canada

  1. I am a Registered Nurse back home in Philippines and currently living here in New Brunswick,Canada for over two years now and still pursuing my Nursing profession here but it tooked me a long process in order for me to win what I’m aiming for. Spent lots of $ to get through this process. I’ve got my NNAS done and their assessment was lots of competency gaps. After getting my assessment, I applied as RN to CNO which is my regulatory board coz the English exam was waived as compared to the other regulatory board. Also, I was advised to do the exam in Toronto under touchstone or to do the bridging class to meet my competency gaps. Apparently, COVID-19 hits us and everything slowed down. I was waiting for available schedule from Touchstone for couple of months or even closed to a year now to get my exam done but all schools are closed and can’t get it done. Whilst everything slowed down i realized to add LPN assessment to NNAS and told them I am willing to pay for the additional over 200$ fee for the assessment since they have all my files with them but not willing to pay the 650$ to start a new assessment since we are encountering this pandemic but they’ve told me that I have to start another new application which cost 650USD$ again. It’s just difficult to be a nurse here in Canada and dont know what to do coz there are lots of hindrances in order for everthing to be in placed which is to be a Registered Nurse. Tons of IEN’s in Canada are stucked and can’t do their profession because of the process.. Some switched their pathways or even their jobs and didn’t continue pursuing it. I just hope that they can addressed the shortages of Nurses but we can’t join the workforce due to the hindrances. Colleagues are shouting and cying for help but what can we do, we are nothing. Why can’t we just be like United States process? For as long as IEN’s can passed the NCLEX exam they are recognized as Registered Nurse and can join the workforce and addressed the shortages. 🤦‍♀️🤷‍♀️

  2. Good post. In Britain, there’s a serious shortage of nurses, the National Health Service is dependent on nurses who’ve trained in other countries, and Britain’s making it as difficult as possible for them to stay. It’s insane.

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