Internationally educated nurses are already here – let’s get them working
By Carlo Mikhail L. Magno
October 17, 2022
Editor’s note: In last week’s article, Carlo Mikhail L. Magno described what it’s been like to be an internationally educated nurse (IEN) working in Canada over the past 10 years. Canadian Nurse followed up with him to gain more insight into how IENs could be part of the solution to Canada’s nursing shortage, a problem that has been decades in the making — and made worse by the pandemic.
From your experience, do you think increased recruitment of IENs would be an effective strategy for addressing Canada’s nursing shortage? If so, how do we recruit ethically?
I firmly believe IENs are a good strategy to address the shortage. But what many people might not know is that there are already a lot of migrant or permanent resident IENs in Canada, trying to get jobs in the health-care system. I strongly believe that Canada should not need to actively recruit people from overseas. The nursing shortage is happening globally due to the pandemic, and we should be mindful not to make the problem worse.
We know that some health-care facilities are offering incentives for retired nurses to go back to the workforce, and some organizations are even willing to pay extra for travel nurses. That means these employers should also be able to funnel some resources into helping IENs become the next generation of the nursing workforce, which would help sustain the profession for much longer. IENs can be both a good short-term solution and a long-term answer, but only if our governments and regulatory bodies choose to do so. An increase in hiring IENs can complement other solutions such as increasing the number of college and university nursing admissions.
The College of Nurses of Ontario reached record-high IEN registrations in 2022. It is an improvement we need to recognize. It is a step in the right direction. We must, however, also remember that it should not end there.
Is Canada using its IEN pool efficiently in light of the nursing shortage?
It’s important to remember that employing IENs doesn’t simply have to mean giving them a job as a staff nurse. Employers should give IENSs the opportunity to improve, diversify and specialize. After all, a nurse can perform different functions. Granting IENs registration and employment should also mean lifting barriers and giving them a chance to be researchers, educators, or leaders, among other roles.
We should consider questions such as the following. Are there enough opportunities for IENs to become clinical researchers? If so, are these opportunities easily visible or accessible? If an IEN has a research proposal, are there avenues to seek funding and professional guidance? Can an IEN easily establish professional networking and affiliate with academic institutions to pursue roles as a researcher?
IENs could make excellent educators. I believe academic institutions should offer more mentorship programs for IENs. Wouldn’t it be nice to have senior IENs provide guidance to newer IENs in an academic setting?
There are as many possibilities as there are functions of a nurse. It all boils down to whether Canada, as a whole, is willing to recognize such possibilities. It would be fantastic if readers of this article can spread awareness on the untapped potential of IENs. In the end, doing so helps support the idea that nurses in general (not just IENs) are an integral part of health care in many ways. And ultimately, it helps patients and the public.
A potential problem for IENs is there are certain courses or academic obstacles that are difficult to overcome. These obstacles can exist even after IENs pass all the requirements, including writing their exams to prove their competency to practise.
In my case, I was a registered practical nurse in Ontario for almost a decade, but there were a lot of specialized continuing education opportunities that I couldn’t take because they were looking for a diploma from Canadian institutions. My only option was to complete a refresher course, which most IENs are obligated to take before they get their licence. I had not taken the course because it was waived for me; I was told to simply write the Canadian Practical Nurse Registration Examination (CPNRE). At the time, it was an advantage to gain my RPN licence quickly; but later, it turned out to be a roadblock for my continuing education. It was frustrating and counter-productive. Maybe my situation was rare, or maybe it no longer happens — for the sake of other IENs, I sure hope so.
Scenarios like mine can stunt the potential of IENs. I wanted to broaden my knowledge and improve my skillset so I could grow as a nurse and offer better client care, but I was effectively barred from doing so. In my mind, being an IEN became somewhat equivalent to being a second-class nurse. Despite proving I could work on par with Canadian graduates, I was still unable to branch out and specialize as easily as they could. This created a vicious cycle where I could not try new job opportunities, because a prerequisite was taking courses that were not accessible.
If you could change one aspect of current policy to make the onboarding process of IENs smoother, what would it be?
A broad strokes answer would be to improve the application process, but this is easier said than done.
Streamlining the application process needs to become a priority.
There should be closer ties among governments, regulatory bodies, hospitals, and academic institutions to help streamline the process for IENs.
A good example would be the Toronto Sunnybrook hospital’s IEN career pathway. Another example is the College of Nurses of Ontario’s recently introduced Supervised Practice Experience Partnership program, which allows applicants to complete a supervised practice experience to demonstrate current nursing knowledge, skill and judgment and language proficiency skills. These programs are extremely helpful and can be expanded to have more slots. They would be useful as templates for other hospitals and provinces.
Streamlining the application process needs to become a priority. Health care is a universal right and until we have enough nurses to support the needs of the public, patient safety will be at risk.
Canada has a lot of IENs, just sitting and waiting for the results of their evaluation. For example, in Ontario as of January this year, it was reported that there were roughly 15,000 RNs waiting for their application to be processed. Understandably, regulators need to verify both an IEN’s education and their ability to practise safely. The problem is that the system is too slow. There is a maximum allowable time from when an IEN last worked or studied and when they’re eligible to apply for their licence and, unfortunately, the lengthy waiting times often means this time has elapsed. When this happens, it basically resets some of the steps the IEN has already fulfilled. If regulatory boards had more evaluators, then perhaps these applicants, whose processing wait times pushed them out of “recency,” might have been registered sooner.
Many applicants are even willing to go back to school and start refresher or bridging courses. However, they usually can’t apply until they get the evaluation from their regulatory board.
Financial difficulty is another major factor. There are a lot of fees involved in the application process. In addition to the hefty application fee, which covers the assessment of the IEN’s qualifications, there are also other expenses associated with taking competency exams and language proficiency exams, as well as costs for asking educational institutions to send important documents to regulators. For some applicants, they are forced to go back home and volunteer to renew their safe practice requirements as they wait for the evaluation. This means spending thousands of dollars for plane tickets and spending weeks in an unpaid job. If there are more opportunities like Ontario’s partnership program, this could benefit many IENs.
The Ontario government has recently announced that it will pay for exam, application and registration fees for IENs and retired nurses, saving them up to $1,500. I encourage other provincial and territorial governments to consider such initiatives as well, as they would be a great help to many IENs.
We have a pool of capable nurses ready to work. It’s just a matter of whether Canada wants to use such a rich, diversified resource. As an old saying goes, “If there’s a will, there’s a way.” IENs are already doing everything they can to prove themselves capable and to meet requirements. The onus is now on Canadians to realize that potential and give the IENs more opportunities.
Read Carlo Mikhail L. Magno’s second part of this Q&A article next week and his original article, Rising to the challenge: an IEN’s journey and perspective during the COVID pandemic.
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.