https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/07/13/titres-de-competences-a-la-contribution
IENs bring essential skills, cultural diversity, and commitment to Canadian health care
By Ancy Cletus Leena
July 13, 2026
istockphoto.com/Fly View Productions
Many IENs face significant physical, emotional, and systemic challenges as they adjust to living in a new country and culture.
I am an internationally educated nurse (IEN) who arrived in Canada in 2016 with a master’s degree and years of clinical experience from India. It took years of assessments and exams before I could practise as a registered nurse in my new home. During that time, I worked first as a care aide and later as a licensed practical nurse (LPN), gradually fulfilling the requirements for licensure as an RN.
Courtesy of Ancy Cletus Leena
“IENs bring essential skills, cultural diversity, and commitment to Canadian health care. Yet, their journeys involve many challenges — signs of a system still evolving to embrace global talent,” Ancy Cletus Leena says.
Canada’s projected shortage of nurses has led to supportive initiatives (Scheffler & Arnold, 2018). Yet, the pathway to licensure remains lengthy and complex. Many IENs face significant physical, emotional, and systemic challenges as they adjust to living in a new country and culture. I experienced these firsthand, balancing work, study, and family responsibilities while navigating unfamiliar academic systems and licensure procedures.
Licensing and credential recognition
Despite holding credentials from their home countries, IENs are not eligible to practise immediately upon arrival in Canada. Many take on non-nursing jobs, delaying career growth (Crea-Arsenio, Baumann, & Blythe, 2023). Likewise, some choose not to pursue licensure.
The application process and credential evaluation vary across jurisdictions; in my case, it began with an assessment through the National Nursing Assessment Service (NNAS), which took a year. I was advised to take the Nursing Community Assessment Service exam, then completed a bridging program that qualified me to take the NCLEX-RN.
The bridging program boosted my confidence and prepared me for Canadian practice; however, such programs are expensive and time-intensive, often exceeding a year. Between 2016 and 2020, only 38% of IENs in Ontario obtained registration, compared to 90% of domestically educated nurses (Crea-Arsenio et al., 2023). While there are likely many factors that contribute to this discrepancy, financial strain and systemic complexity play a significant role.
Professional growth and recognition
Despite holding a master’s degree and clinical experience from another country, I initially had few opportunities to use my skills after immigrating to Canada. While waiting for eligibility, I worked at a fast-food restaurant. It took nearly five years to become a registered nurse and in that time, many peers left Canada or changed careers. These experiences reflect systemic barriers that delay career progress, erode confidence, and contribute to attrition (World Education Services, 2022; Canadian Federation of Nurses Unions & World Education Services, 2025).
Communication and life stressors
As an IEN, adapting to Canadian communication styles was one of my biggest challenges. Though I studied nursing in English, it was my second language. Fluency alone wasn’t enough, and I had to learn medical terminology, abbreviations, and unspoken workplace cues. At first, I hesitated to speak during rounds, but I gradually gained confidence. Navigating a different health-care system and working in a second language strengthened my communication skills and helped me connect more effectively with diverse patients.
These professional challenges were closely tied to emotional and immigration-related stress. Like my Canadian-born peers, I juggled full-time work and study while supporting myself financially; but unlike them, I had to meet visa requirements and maintain a minimum bank balance. There was little time for rest, and with limited support networks, I missed my family. Yet, I persisted, knowing the path was meaningful. As Salami, Meherali, and Salami (2020) note, when IENs receive targeted communication and emotional support, they can thrive and contribute meaningfully to Canadian health care.
National support systems for IENs
Across Canada, initiatives like the Canadian Association of Schools of Nursing’s Nurse Residency Program and the College of Nurses of Ontario’s Supervised Practice Experience Partnership program support IEN integration through providing hands-on experience to help with clinical readiness (Health Canada, 2024). Many employers now offer mentorship and culturally safe onboarding.
As a travel RN in B.C. and Alberta, I’ve seen firsthand how supportive mentors help IENs build confidence and adapt to Canadian practice. Simple acts — like explaining documentation or fostering inclusion — make a lasting impact and demonstrate a commitment to welcoming and retaining internationally trained nurses.
Pathways forward: supporting the success of IENs
While the challenges faced by IENs are complex, they also present an opportunity for meaningful system transformation. Based on my personal experience and those of my peers, several strategies could improve the pathway to professional integration and help retain this valuable segment of the nursing workforce.
- Streamline credentialing and assessment timelines: Coordinated national efforts to reduce delays in NNAS and regulatory body assessments can minimize attrition and accelerate workforce entry.
- Expand access to bridging and supervised practice programs: Increasing the availability of low-cost or employer-sponsored bridging programs, especially outside major urban centres, can reduce financial burden and geographic barriers.
- Provide targeted academic and exam preparation support: Offering free or subsidized NCLEX prep courses, writing workshops, and orientation to multiple-choice-style testing would better prepare IENs for Canadian academic and licensing standards.
- Offer financial and immigration flexibility: Policies that allow part-time study permits, affordable tuition, and spousal work permits can ease the dual stress of education and economic survival.
- Foster inclusive work environments: Unit-based mentorship, culturally safe onboarding, and dedicated IEN support coordinators can enhance confidence, connection and retention.
- Support mental health and peer networks: Funding for peer-led support groups, newcomer nurse community programs, and access to culturally competent counselling could help IENs navigate emotional stress.
Conclusion
IENs bring essential skills, cultural diversity, and commitment to Canadian health care. Yet, their journeys involve many challenges — signs of a system still evolving to embrace global talent. Having walked this path, I know resilience is not just personal but shaped by support and shared determination. Our multilingual and global perspectives enrich patient care. Investing in IENs means strengthening the health-care system through ensuring diversity, resilience, and global expertise.
References
Canadian Federation of Nurses Unions & World Education Services. (2025, February). Bolstering pathways to practice: Empowering internationally educated nurses in Canada. https://knowledge.wes.org/rs/317-CTM-316/images/wes-canada-report-pathways-to-practice-empowering-educated-nurses-in-canada.pdf
Crea-Arsenio, M., Baumann, A., & Blythe, J. (2023). The changing profile of the internationally educated nurse workforce: Post-pandemic implications for health human resource planning. Healthcare Management Forum, 36(6), 388–392. https://doi.org/10.1177/08404704231198026
Health Canada. (2024, March 14). Supporting internationally educated nurses joining the Canadian health workforce. [Press release]. https://www.canada.ca/en/health-canada/news/2024/03/supporting-internationally-educated-nurses-joining-the-canadian-health-workforce.html
Salami, B., Meherali, S., & Salami, A. (2020). The health of temporary foreign workers in Canada: A scoping review. Canadian Journal of Public Health, 111(4), 645–656. https://doi.org/10.17269/cjph.106.5182
Scheffler, R. M., & Arnold, D. R. (2018). Projecting shortages and surpluses of doctors and nurses in the OECD: What looms ahead. Health Economics Policy and Law, 14(2), 274–290. https://doi.org/10.1017/S174413311700055X
World Education Services. (2022, March). Addressing the underutilization of internationally educated health professionals in Canada: What the data does and doesn’t tell us. https://knowledge.wes.org/rs/317-CTM-316/images/canada-report-addressing-the-underutilization-of-iehps-in-canada.pdf
Ancy Cletus Leena, RN, works in the neuroscience unit at Victoria General Hospital in Victoria, B.C., and is an MN student at Thompson Rivers University in Kamloops, B.C.
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