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Rising to the challenge: an IEN’s journey and perspective during the COVID pandemic

A nurse’s inspirational story of frustration and opportunity

By Carlo Mikhail L. Magno
October 11, 2022
Courtesy of Carlo Mikhail L. Magno
Carlo Mikhail L. Magno moved to Toronto from the Philippines in 2012. At the time, he was told that he did not meet the competency requirements to practise as a registered nurse. “I was crushed but also determined to practise as a nurse in some capacity in Canada.” He’s now planning to pursue his RN credential again.
Editor’s note: In a two-part Q&A article starting next week, Carlo Mikhail L. Magno will examine how IENs could be part of the solution to Canada’s nursing shortage.

COVID has undoubtedly changed a lot of things — from the seemingly mundane ways we buy our meals and groceries, to the way we travel and gather. More importantly, for nurses, it has swept across the globe with unprecedented challenges.

I am an internationally educated nurse (IEN) from the Philippines who graduated in 2012. I write this article in the hopes that I can, first, inspire my fellow IENs, and second, describe my professional journey in a way that all nurses can appreciate. I hope this latest chapter in my nursing career will be fruitful, not only for my personal development, but also for the health and safety of my future clients, and the well-being of my fellow nurses.

Next week: Q&A (part 1): how IENs could be part of the solution to Canada’s nursing shortage

COVID-19 amplified challenges, helped create opportunities

Nurses already faced safety risks even before the pandemic. We are often exposed to body fluids, diseases, or a violent outburst from a client with a psychiatric problem.

COVID has not only magnified those factors in the past two years, but also brought new problems — senior and experienced nurses exiting the field, leaving novice nurses needing more support and guidance, both of which added frustration to increased caseloads.

We also saw risk from unexpected quarters, such as protests and harassment from “anti-vaxxers” who swarmed hospitals and other health-care settings. It has not been easy, and we are still far from seeing a significant ease of these burdens.

Still, as nurses, we had to find a way to go on. Among many other roles, nurses are leaders, innovators, and educators.

It was during the height of the COVID pandemic that I was given the opportunity to become all three in an expanded capacity.

‘Not on par with Canadian standards’

I moved to Toronto from the Philippines in 2012, and I was unlucky enough to have applied at a time when the College of Nurses of Ontario (CNO) had changed part of their application and assessment process multiple times since I first submitted my documents.

I was told I have not met the competency requirements to practise as a registered nurse (RN). I was crushed but also determined to practise as a nurse in some capacity in Canada.

I applied to become a registered practical nurse (RPN). This application was also denied but after an appeal, I was allowed to take the CPNRE. I passed the exam and later completed other requirements.

By 2014, I could finally practise as an RPN in Ontario. There were not many opportunities for me, and it was difficult to enter practice settings like hospitals.

Despite that, I was determined to become the best nurse I could be. I knew I had to start somewhere, so despite the less-than-competitive pay, I gladly took on a job working as a nurse in a family physician’s office. Here, I picked up everything I could so that I could build my experience in Canada.

After a little over a year, I was given the opportunity to work in a long-term care facility. I kept both jobs so that I could diversify my skill set.

Working in both a doctor’s office and a nursing home allowed me to become familiar with handling acute cases of different demographics, as well as chronic cases with a focus on geriatric patients. Despite this, I experienced a frequent pang of wistfulness every time I heard of new international graduates having fewer hurdles in acquiring their RN status in Canada.

Being told I was “not on par with Canadian standards” echoed in my mind every time I had to teach or coach a newly hired nurse who was not even aware of basic assessment procedures, nor able to identify some factors that might cause vital signs to exceed normal limits.

I kept applying to hospitals over the next few years, hopeful that my varied experience would finally show employers what I could offer. My applications continued to be declined or ignored.

Personal, familial, and financial issues have prevented me from pursuing my career further. With seniority being one of the factors in advancing my career, this eventually pushed me out of the nursing home in 2018. However, I was able to secure a job in a family clinic, where I continued to expand my skills and knowledge.

I advocated for patient screening before it became a routine step during the pandemic.

For a time, I was set on accepting that I would never progress beyond being a practical nurse, and that I might very well remain in a doctor’s office until I retired.

Pandemic changes everything

The year 2020 saw COVID uprooting the foundations of society’s sense of normalcy. I had to take charge and convince the physicians and clinic manager I worked with to take the situation seriously.

Adhering to best practices, I advocated for patient screening before it became a routine step during the pandemic. I helped spearhead infrastructural modifications, putting up signage and installing barriers, and I reduced the number of seats in the waiting room to allow for social distancing.

I educated our receptionists and patients on infection control, and I encouraged them to regularly wash their hands and clean their workspaces. Where other clinics completely shut down, I pushed our physicians to consider doing phone assessments whenever possible.

I remember donning gloves, gown, mask, hairnet, and goggles as I stood at the entrance of our clinic. I sometimes had to endure insults and mockery, but I had to be assertive while still aiding patients whenever I could. I took it on myself to stay updated, and to implement new best practices where possible.

All this went on for a few months until early August, when a simple question had me reeling. The nursing home where I used to work asked me if I was interested in returning as a nurse manager. I sat down, dazed and overwhelmed.

Up until that point, I believed that it was close to a miracle for RPNs who had studied abroad to be offered such a role. Although I had heard of, and met, some RPNs who had leadership positions, they usually graduated in Canada and/or had decades of experience under their belt.

I do not intend to speak on behalf of all other IENs. After all, we have had different paths, different backgrounds, and different situations. Based on my personal journey, however, all the years of disappointment and frustration of being told I was not good enough had railroaded me into such thinking.

I was anxious and scared of course, since at that point news of nursing homes facing critical staffing issues and uncontrolled outbreaks had already flooded the media. Access to mass testing was still months away, and the possibility of a vaccine was still uncertain. However, I knew deep inside that my answer to this new opportunity was always going to be a resounding “YES.”

The chance to use my knowledge, skills, and experience as a nurse to help long-term care residents and staff was something I knew I could and should do. I don’t think I knew it at the time, but being proactive in the clinic and learning to become more patient with frustrated and shouting clients were excellent preparation for the new journey I would embark on. At long last, I had before me a major milestone — an opportunity to grow as a nurse.

Leading by example

Although this would be a temporary contract, taking on the role of a nurse manager has been both a very humbling and very enriching experience.

Teaching has always been my passion, and it was something that I saw as an opportunity, rather than a burden, to help develop novice nurses — to bring out the best in them so that they could provide better care for clients.

It was also an important time to support student nurses and new graduates. Because of pandemic restrictions, many of them did not have a chance to work in an actual clinical setting until their last semester. Through no fault of their own, they had limited chances to practise and perform bedside care. This situation also increased frustration among their seniors and preceptors, who were already struggling with increased workload.

Now I was in a position to help bridge the gap between current nurses and the next generation, and I was not going to let it go to waste. I also had the chance to be one of the first nurses in the country, and the first from our facility, to be vaccinated. Lead by example, as they say.

Much like the clinic, the nursing home had to innovate in complying with new guidelines such as figuring out the process for screenings, testing, and visitations while working with existing infrastructure.

Overall, my role was difficult, but it was one that enabled me to grow. Gradually, I became more confident in my capabilities. After words of encouragement from my superiors, staff, and clients, I have decided it is time for me to try again to become an RN.

My contract ended in May 2022 and, due to personal reasons, I moved to New Brunswick. I now carry with me the newly found inspiration that I can do more, and that I should do more.

The fight against COVID is not yet over. Now more than ever, at a time when many in the profession are close to giving up, I must rise to the challenge.

Carlo Mikhail L. Magno, RPN, LPN, is an internationally educated nurse from the Philippines and worked in primary care and long-term care in Toronto from 2014-2022.