Internationally educated nurses face stereotypes – how can we fix this?
By Carlo Mikhail L. Magno
October 24, 2022
Editor’s note: In his October 11 article and last week’s followup Q&A 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.
What do you think the future holds for IENs coming to Canada after the pandemic?
I would like to think that Canada will be more welcoming of IENs in the future. However, a lot of that depends on what Canada is doing now to use its pool of IENs. The pandemic has magnified the gaps in our health-care system and we should use this as a catalyst to change for the better. We should lay the foundations of improving the integration of IENs into our active workforce now. Otherwise, patient-to-nurse ratios will remain unsafe. Failing to fix this problem will cause more frustration and burn out among nurses, who are already leaving the profession in droves. We have the choice to ease the burden now instead of waiting for things to get worse.
When the pandemic finally ends, there will be a lot for nurses to reflect on. Literature will change. Evidence-based practice will reflect the things we learned from COVID-19. We will look back on the things we did that worked, and we will revisit the actions that held us back. There will be plenty of research opportunities for nurses, including — hopefully — IENs. Nurse leaders and public health advocates will have to re-evaluate existing policies. There will be a lot of questions that may force us to re-examine how robust or how weak the health-care system we had was. I’m hopeful that our profession will come out stronger. I’m hopeful that more IENs will be a part of that future nursing workforce.
One of the challenges facing the Canadian nursing workforce is ensuring its ability to provide high-quality care to a culturally diverse population. What role can IENs play in the provision of culturally competent care?
IENs can offer different perspectives and alternative approaches, and share their unique experience, to help interdisciplinary teams come up with care plans that are catered to the individual client’s needs. For the same reason that nurses look at patients holistically and take all possible data into consideration, nurses should also draw on their team’s different experiences shaped by age, gender, culture, ethnicity or religion. A diversified nursing workforce has a better ability to care for a diversified population.
IENs have come to Canada knowing they would have to adapt to new natural, social and practice environments. Experience in dealing with a new culture comes automatically for an IEN. These experiences help improve their empathy.
I have worked with nurses of different backgrounds — IENs of Chinese, Indian, Korean, Filipino, Ghanaian, Nigerian, Italian, and Russian origins, as well as White Canadians whose families have lived here for generations. Everybody has some piece of knowledge to share. Everybody has some nugget of wisdom on how to engage with patients.
A concrete example can be found in our nursing team learning common Italian phrases to help redirect our dementia patients who have lost the ability to communicate in English. Our long-term care facility had a significant population with Italian heritage. A lot of our nurses and personal support workers grew accustomed to asking clients, “Come stai? Bene o male?” whenever English greetings did not elicit a response. If one were to walk our hallways, expect to hear them cueing residents with “mangiare” or “dormire” for activities of daily living, and our nurses instructing “apri la bocca” to administer oral medications, or even our physiotherapist saying “alzati” or “siediti” to initiate or end walking exercises, respectively. This facilitates the provision of care. Whenever somebody new joins our team, we make it a point to share this knowledge.
The same process applies to clients of other ethnic backgrounds. For example, our team modifies dietary recommendations to be mindful of Muslim patients practising Ramadan and Jewish clients who eat kosher. Having colleagues who were familiar with such cultural needs made the job easier for us, and it made a meaningful improvement to meet the client’s needs.
In your original article, you implied that there can be negative stereotypes attached to the IEN workforce. Is this a deterrent to recruitment? What are three things you would propose to change negative attitudes?
I wouldn’t say it’s a deterrent strictly to recruitment only. The reality is that some negative stereotypes occur in different levels and different settings. They can come from patients, colleagues and superiors.
If IENs are visibly part of the competent workforce, the public’s perspective would gradually shift.
Upon learning that a nurse graduated outside Canada, some people would casually say things like, “I hope you know what you’re doing.” It may seem harmless to some, but for IENs, this statement is loaded with bias.
I have had the unfortunate experience of hearing from my director that she received a call from a client’s family explicitly saying they did not want to talk to any of the “brown” nurses. The client demanded to speak to a White nurse instead.
Perhaps this problem has its roots in a bigger picture. Unfortunately, there are still people who think the ethnic or religious background of a professional immediately equates to lesser service, or poor competence. Such beliefs are not easy to correct.
What makes it difficult for us is our profession is geared towards providing customer service. A nurse needs to maintain composure at work. Calling out racism or other negative stereotyping can be difficult for a nurse who is already under the stress of work. On some occasions, a nurse would not risk calling out discrimination if the nurse thought it would elicit a physiological response that could endanger the patient by increasing their tension or agitation.
These things are never comfortable to discuss. There is no one-size-fits-all answer and it can’t be solved overnight. I do believe that if IENs are visibly part of the competent workforce, the public’s perspective would gradually shift.
So, the first thing I would recommend, is that we need to increase the number of IENs practising in Canada. To do this, we should speed up the integration of IENs into the nursing workforce, which is something I discussed in last week’s Q&A article.
Second, spreading awareness about offensive stereotypes would help people become more culturally sensitive. Policy-makers, nursing leaders, and employers should promote better protection for the workforce. Nurses should have a channel to safely express how negative stereotypes affect them personally and professionally.
Finally, I think IENs themselves who are successfully registered to practise should step up and exercise leadership and advocacy. They should offer assistance and mentorship to other IENs. They should get involved with discussions and help come up with solutions. And they should actively participate in associations, councils, unions, or regulatory boards.
I believe if IENs maximize their growth and potential — and if they maximize the growth and potential of their colleagues — Canada will be able to cultivate competent and brilliant nurses, regardless of where they came from.
Read Carlo Mikhail L. Magno’s first part of this Q&A article 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.