ONTARIO'S RULES BAFFLE NURSE
U.S.-educated Ottawa nurse encounters barriers to working in Canada despite shortages
Ottawa's Rachael Geiger is licensed to work as a nurse in Illinois and Massachusetts after passing the same exam as her Ontario counterparts. But as COVID-19 rages and her skills are in high demand, she isn't allowed to practise here.
Before she accepted a swimming scholarship to attend Boston's Northeastern University, Ottawa's Rachael Geiger made sure it had the kind of nursing program she wanted. The school's baccalaureate nursing program offered a fifth year of co-operative placement after four years of study — something Geiger thought would leave her well prepared for a career as a nurse when she returned home after university.
But it hasn't worked out that way.
Two and a half years after graduating summa cum laude from Northeastern, the 25-year-old is unable to work as a registered nurse in Ontario.
Geiger said she was initially surprised, especially since she wrote the same licensing exam in Massachusetts as is written in Ontario, the NCLEX-RN exam. She is licensed to practise in Massachusetts and Illinois.
“I never thought it would be such a challenge.”
She and her family are frustrated at how difficult it has been for her to get registered to be able to practise in Ontario. That frustration is heightened by the fact that nurses have seldom been in such high demand in Canada and around the world as the COVID -19 pandemic strains health systems and shortages loom. Local hospitals are among those trying to recruit nurses. The Canadian Nurses Association has been warning that Canada will experience extreme shortages in coming years.
“It is frustrating to sit and see all the news about nursing shortages and not be able to help," said Geiger.
Doris Grinspun, chief executive officer of the Registered Nurses Association of Ontario, the professional association that represents registered nurses, nurse practitioners and nursing students in the province, said she was “more than surprised” to hear of the difficulty Geiger has had.
But Grinspun, who initially studied nursing in Israel and then the U.S. before becoming one of the country's nursing leaders, said the system of allowing foreign trained nurses to work in Ontario is unnecessarily slow and complicated and leads many valuable nurses to simply give up or find another career. Grinspun herself challenged the system when she first came to work in Ontario.
After graduating, Geiger and her mother Sarah, a retired nurse, went to the College of Nurses of Ontario to find out what steps were required for her to work in Ontario. Both said the person they spoke with made it clear that it would not be easy.
“She was told she had made a ridiculous decision and she would be lucky if she ever practised in Ontario,” said Sarah.
Geiger was told to begin applying through the National Nursing Assessment Service, a not-for-profit organization that assesses foreign-educated nurses who are applying to become RNs or RPNs in Ontario by verifying their credentials and comparing them to Canadian standards. The assessment must be done before applying to the College of Nurses of Ontario.
That process took more than a year and ultimately determined that Geiger's education was not the equivalent of an Ontario baccalaureate program, a finding that both Geiger and her mother question. Among gaps identified in the 19-page assessment of her qualifications was that there was no evidence she “advocates for clear and consistent roles in the health-care team.”
Geiger said that and other gaps identified in the assessment would be difficult to demonstrate in the documents the university submitted on her behalf and don't reflect her education, co-op experience in Boston or professional experience.
She said the process that required someone at the university to submit up to 50 pages of detailed description about the curriculum and courses she took was cumbersome and lacked transparency. She did not see what was submitted.
Geiger said the people she spoke with at Northeastern were unfamiliar with the process and surprised by it. On her behalf, the school submitted about 20 pages of information.
Among information needed in the assessment was what time of day courses were taken, said Sarah Geiger.
Among other gaps the assessment identified was that she didn't receive enough ethics training in her curriculum. Geiger's mother, Sarah, noted that her other daughter studied nursing in Ontario around the same time and took no specific courses on ethics, while Geiger took three. She also said the co-op year is not available in Ontario so could not be compared.
“There seems to be no rhyme nor reason.”
Geiger said she was shocked by the findings and more by the fact that there is “no clear path forward.”
Among her options are: redoing her degree, taking part in one of the occasional provincial competency assessments available or taking some courses, but she said she has been given little confidence about what would make a difference.
While waiting, Geiger worked for a while at Farm Boy in Ottawa before taking part in a postgraduate program at Chicago's Northwestern Memorial Hospital where she gained a range of experience, including working with COVID -19 patients.
She has now started a Master's degree in public health at the University of British Columbia.
Some of her classmates are working part-time as nurses while studying.
“I think that added another layer of frustration,” she said. “I do feel I have a comparable education and could be working in a hospital and helping people.”
A spokeswoman for the College of Nurses of Ontario said around 2,000 internationally educated nurses register with it every year.
“Nurses education outside of Canada who want to work in Ontario must show they have the knowledge, skill and judgment need to provide safe care to the people of Ontario,” said spokeswoman Angela Smith.
To do so, she said, nurses must first apply with the National Nursing Assessment Service, which verifies the applicant's education based on information provided by the nursing school.
Sarah Geiger, who spent a career as a nurse, said she has compared both of her daughters' curricula — one of whom studied nursing in Ontario and Rachael who went to the U.S.
“They are identical, except Rachael had more clinical experience than my other daughter. I really believe that candidates who have graduated from an accredited program in the U.S. should be able to practise in Canada. They write the same licensing exam,” she said.
“I hear every day that there are not going to be enough nurses and there is going to be competition from all countries to get nurses. We don't seem to be placing ourselves in a very good position.”
Grinspun said she has personally helped a number of frustrated nurses who have been unable to go “through the hoops” required to get licensed in Ontario.
“There needs to be a process, but it is extremely long, to the point that we are losing resources. It should change. We are losing good nurses. They are leaving the country,” said Grinspun.
I hear every day that there are not going to be enough nurses and there is going to be competition from all countries to get nurses. We don't seem to be placing ourselves in a very good position.