BACKGROUND: This paper describes a study that explores the experiences of internationally educated nurses (IENs) in their efforts to gain entry to practice as Registered Nurses (RNs) in the province of Ontario, Canada. AIM: The aim was to uncover, in part, the issues related to professional nursing credentialling. METHODS: This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IEN students volunteered for this study representing the Philippines, Mainland China, Korea, Ukraine and India. FINDINGS: The findings were that the IENs progress through a three-phase journey in their quest for licensure in Ontario. These phases include: (1) hope - wanting the Canadian dream of becoming an RN in Ontario; (2) disillusionment - discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment - living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications. CONCLUSIONS: Professional regulatory nursing bodies and nursing educators, as well as practising nurses, must be aware of the potentially confusing and unpleasant processes IENs go through as they qualify for the privilege of practising nursing in Ontario.
With the phenomenal rise in displaced persons and refugees, ICN has been encouraging its member associations to join up with international and local agencies to answer their health and social needs, with particular emphasis on assisting nurse refugees with their problems both as refugees and as nurses. An example of how one member responded to the call is outlined below.
A curricular innovation was designed to provide internationally educated nurses with access to nursing licensure and employment. Through a program that includes professionally relevant English language support, mentorship, academic upgrading, workplace experiences, and clinical skills support, a mechanism has been created for internationally educated nurses to earn a bachelor of science in nursing degree and overcome barriers to practicing their profession.
In this survey study, graduates of the University of Western Ontario program for foreign-trained dentists from 1999 to 2009 were asked for their perceptions of their knowledge and skill in fourteen clinical topic areas before they were admitted to the program and after graduation. Their ratings were made on a ten-point visual analog scale divided into three aptitude domains: competent, proficient, and master/expert. Definitions of each domain were provided. The majority of the respondents felt that their knowledge level improved at least one aptitude level in only four of the fourteen (29 percent) topic areas but that their skill level had increased at least one aptitude level in nine (64 percent) topic areas. Of note, clinical topics with content reflective of North American dental practice such as oral medicine and treatment planning, ethics, regulated dentistry, record keeping, and informed consent were the topic areas in which most respondents reported an improvement in both their knowledge and skill. It is suggested that programs evaluating or providing gap training for internationally trained dentists consider mandatory inclusion of these topics.
Nurses with diverse educational and cultural backgrounds are likely to adapt differently to new workforces. The aim of this study was to provide a profile of nurses educated in different countries who are employed in a major settlement jurisdiction.
Despite difficulties in measuring its magnitude, it is evident that nurse migration has increased as a result of globalization. Major destinations for internationally educated nurses (IENs) include the USA, Canada, the UK, Australia and the Gulf States. Chief donor countries include the Philippines, India and other South Asian countries. Half of all IENs registered in Canada work in the province of Ontario.
Published literature and secondary data were used to profile cohorts of nurses educated in different countries who are employed in the Ontario workforce.
Statistics available on IENs in Ontario reveal a largely urban settlement pattern. There are major differences among IEN cohorts in terms of age, gender, work status, and type and place of employment.
Although IENs resident in Ontario could not be quantified, a relatively detailed description of IENs in the workforce was possible. Comparison of nurse cohorts indicated that generalizations about IENs should be made with caution. Changes in regulatory conditions have a significant effect on IEN employment. Difficulties associated with international educational and regulatory differences illustrate the need to create global nursing standards. Further investigation of differences in workforce profiles should provide insights leading to improved utilization of IENs.
Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA.
Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information.
This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA.
These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally.
Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses.
This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible.
Many internationally educated nurses (IENs) find it difficult to reinstate themselves in their profession after migration. This article explores factors contributing to the success and failure of IENs to reestablish professional careers. The article discusses a study involving 39 IENs in 5 focus groups and 10 interviews. In all, 29 interviews are held with other stakeholders. IENs encounter obstacles at each stage of the migration process. New strategies are required to assist IENs to reenter the workforce. Given the consistent predictions of an extreme nurse shortage, it is important that the brain waste of immigrant nurses be minimized.
To analyse critically the waste in human capital of Ontario's internationally educated nurses resulting from unemployment or underemployment.
Globalization of the nursing workforce is resulting in more and more internationally educated nurses migrating to Canada every year. In Ontario, internationally educated nurses represent 11% of the total nursing workforce but many are unable to become registered in Ontario. According to the College of Nurses of Ontario (CNO), 40% of internationally educated nurse applicants never complete the application process and thus never become Registered Nurses in Ontario. Systemic barriers that prevent registration in Ontario can result from any of the seven requirements for completing the application process. The inability of internationally educated nurses to become registered is significant, considering the national and global nursing shortage. In addition, the inability to become registered results in tremendous waste of human capital, especially in developing countries that have invested financially in educating nurses. Although several programmes have been implemented in Ontario for internationally educated nurses, barriers exist in the design and administration of these programmes, and these are described.
An opinion piece of international interest and a human interest piece.
Internationally educated nurses face significant barriers, which prevent their integration into the Ontario healthcare system. Several policy and management strategies are outlined that could be implemented to ease their integration into the Ontario healthcare system.