Why is this nurse working at an insurance firm?
Foreign-trained health-care workers struggle to get credentials recognized
Registered nurse Karim Wannous thrived in the emergency room, triaging patients, tending to critical medical and surgical cases, and performing resuscitation if needed. That was in Lebanon. Today, the new immigrant is working as a clinical case manager for an insurance company in Toronto, assessing claims, co-ordinating care for clients and arranging billing.
Although Wannous is happy to have a job related to health care, he’d rather be back on the nursing front line caring for people with dire needs.
The 32-year-old started the licencing process to work as a registered nurse in Canada six months before he arrived in June 2022, and has one final exam to complete. If he passes, it will have taken him a full two years to get back to his field.
“I love bedside work,” said Wannous, who has almost a decade of experience as an RN in his home country. “I am passionate about working directly with patients.”
Internationally educated nurses like Wannous are vital to Ontario’s health-care system, plagued in recent years by severe nursing staff shortages, thanks in part to attrition, high turnover and burnout.
Despite this desperate need, a new report finds that many internationally educated nurses who want to practise in Ontario still face an uphill battle to get their credentials recognized and obtain the experience required to become licenced.
The report by World Education Services (WES) Canada, a nonprofit organization that assesses foreign credentials, surveyed 758 internationally educated nurses not currently working as nurses in Ontario, and found that half had not begun the province’s registration process to practise, even if they wanted to.
The respondents cited financial barriers as the top factor affecting their ability to become registered. (Registration costs, exams and testing fees can total $3,000 at the low end.) The need to show evidence of recent nursing practise, a lack of clarity around the registration process and the time it takes to get registered also played a role.
The report also said data gaps make it “nearly impossible” to track how many internationally educated nurses are in Canada, how many intend to or are trying to qualify, and how many are practising.
“No one can tell us how many internationally educated nurses are actually out there who could potentially be working,” said Joan Atlin, strategy, policy and research director at WES Canada. “There’s still a significantly underutilized population of nurses in the province who are still falling outside of the supports.”
The pandemic has forced health officials to confront the underutilization of skills brought by immigrants meant to fill labour needs, said Atlin, who has been engaged in foreign credential issues for two decades.
The province is well aware of the issues in the report and has worked with the College of Nurses of Ontario, which regulates the profession, to help internationally educated nurses become registered.
In 2022, the Health Ministry introduced changes, including covering the cost of exams and registration with the college, and made it easier to meet language proficiency requirements.
Just last month, the province made permanent a program that places these nurses under an employer’s supervision to gain work experience. The college says that as of the end of March, it had matched 4,230 applicants with employers, enabling 3,324 nurses to register.
“It has created that opportunity for health-care employers to hire those who have already applied for licensure and allow nurses to meet the practice and language proficiency requirement, by actually working and having their employer attest to their ability to work in English,” said Atlin.
In total, the college says as of April 1, it had registered more than 7,500 international applicants, with 5,215 new internationally educated nurses registered in 2022 alone.
The college is now considering allowing applicants to meet requirements if they complete nursing education recognized or approved in any jurisdiction.
“These proposed changes will make an incredible difference in reducing barriers to registration for our internationally educated nurse applicants, while also contributing to increasing human health resources to support the health system,” Silvie Crawford, the college’s CEO, said in an email.
Paolo Varias, who went through the licensing regime almost a decade ago to become an RN in Ontario, was glad to see the recent changes to make the journey easier for incoming foreign nurses, but said the initiatives tend to focus on the latter stage of the registration process.
For instance, candidates must pay up front for all registration expenses and get reimbursed later. He said some earlier financial support could go a long way.
“It’s not just the registration fees. People coming here have to think about paying for their apartment, paying for their transportation, paying for their food,” said Varias, who immigrated from the Philippines in late 2014 and got his licence in September 2016. “If you only have a $100, where are you going to spend it? Your transportation to write your exam or to buy food?”
The WES report also notes one factor affecting registrations was the need to obtain permanent residency status to work.
Karla Ducosin, who trained as an RN in the Philippines, came to Canada in 2018 and worked as a caregiver to an elderly couple while chipping away at her registration with the college. By late 2021, she had completed the requirements, including her licensing exam and language proficiency test, but hit a roadblock when she couldn’t get her permanent residency.
Desperate, she and two dozen other internationally educated nurses in the same situation started a Twitter campaign to try to get Ottawa’s attention.
“I was telling them that I was already licenced and you’re telling me there is a shortage of nurses in Canada,” recalled Ducosin. “So why don’t you use me?”
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario (RNAO), saw the tweets and offered to help. Working with the federal government, Grinspun and the RNAO were able to help fast-track the permanent residency applications, and by March, Ducosin started orientation for her new job at Sunnybrook hospital’s Veterans Centre.
Grinspun said the nurses who face delays in getting work permits or residency approvals face the most challenges.
“This is the most complex group because we don’t always know about them … they’re lost in the system,” she told the Star, adding the recent changes made by the college and the province will result in “humongous progress” in the coming years.
Rather than trying to recruit more internationally educated nurses to face the same hurdles, Varias said, it makes more sense to first integrate those already here. Red tape and delays in licensing are going to discourage foreign-trained nurses from attempting the registration process, he said.
“I always emphasize with people who are underutilized or working in different capacities right now that the journey is difficult, but it’s all worth it,” said Varias. “There’s light at the end of the tunnel.”