This initiative is opening doors for hundreds of Ontario’s internationally-educated nurses

When Champ Noval came to Canada from the Philippines in 2012 he thought that the country that gave him permanent resident status because he was a nurse would enable him to continue in his profession.

Instead, he found himself cleaning toilets and waging a five-year battle — which he eventually won — to get licensed as a registered nurse with the College of Nurses of Ontario.

“I thought it was going to be faster, easier,” said Noval about getting licensed by the college, “and I just have to complete a couple of requirements, just like what other countries are doing. But it was completely different.”

Now, hospitals like Sunnybrook, where Noval works, are offering paid clinical placements to internationally-educated nurses that could give hundreds of foreign-trained nurses the credentials they need to get licensed.

The placements are part of the Supervised Practice Experience Partnership, a partnership between the College of Nurses of Ontario, Public Health and approved partners like Sunnybrook.

As of Jan. 28, more than 800 applicants, and 57 employers, were approved to participate in the program, according to the college. More than 30 of the applicants are willing to relocate to rural or northern hospitals, which can have trouble recruiting nurses.

Often, internationally-educated nurses, or IENs, come to Canada expecting to work in their profession but fall short of getting licensed because they don’t meet all of the standards set by the college, which was created to ensure safe nursing practice in Ontario.

The new partnership is for nurses who have met all of the college’s requirements for licensure, but are missing recent evidence of practice or language qualifications.

Part of the problem for many applicants is the length of time it can take to get assessed by the college, which can stretch to years.

In 2020, more than 14,600 IENs were pursuing licensing by the college, according to a report by the Office of the Fairness Commissioner. There were another 5,000 or so IENs who were inactive and hadn’t been in touch with the college for the past year.

The college says that in the last five years the number of internationally educated nurses that it has registered, or licensed, has increased, from 1,456 in 2017 to 3,235 last year.

While waiting to be assessed, an applicant often gets another job working in a field outside nursing and stays in it to support their families, as was the case, said Norval, with many of his friends.

Or the college takes so long to process an application that aspects of it, such as recent evidence of practice, or language competency tests, expire past the time frame set by the college.

When an IEN falls short of meeting the college’s requirements, going back to school to upgrade is not only expensive, but time-consuming.

Before this new program, school was the only way to get a clinical placement to meet the college’s requirement for recent hours of practice. And placements through schools are unpaid.

“There are a lot of nurses that I know that were excellent nurses back at home and just don’t do it anymore,” said Noval, who is a registered nurse and mentors IENs at Sunnybrook.

The hospital plans to do more than just offer the clinical placements. Sunnybrook says it is creating a career path for IENs, many of whom are already working in hospitals, hidden in plain sight in nonnursing roles such as PSWs or bed sitters, a paid role for employees who monitor patients with illnesses such as dementia.

The hospital wants to identify IENs who are employees, as well as hire more, in unregulated roles such as observers or patient support providers and help put them on a career path. For IENs who are already enrolled in an academic program or working on their language proficiency, the hospital is using funding from the Ministry of Health to offer paid placements in clinical teams in unregulated roles.

Since promoting the career pathway on its website, the hospital has had “an overwhelming response of people that are reaching out because they want guidance on how they can move along and how they can remove the barriers,” said Tracey DasGupta, Sunnybrook’s director of interprofessional practice.

“As a health-care system, knowing that we’ve got so many people that are skilled that could contribute to a system that’s in such need, our responsibility is to help people do that,” said DasGupta. “So we have to work together as a system to help know where these individuals are, provide clear direction, provide them with opportunities, but also employment opportunities because financial considerations are an important barrier.”

Many foreign-trained nurses have to navigate the system on their own.

Noval was working as a registered nurse in the Philippines, which requires a three-year diploma, before he came to Canada in 2012. He also taught and worked in research.

Once here, he registered with the College of Nurses of Ontario and was told he could write the exam to become a registered practical nurse, which requires a diploma in Ontario, and that he would have to go back to school to get a Bachelor of Science in nursing degree if he wanted to become a registered nurse.

Noval began working as a registered practical nurse and appealed the college’s decision. In the meantime, Noval started a bridging program for RPNs who want to become RNs, while working three jobs.

Just a couple of weeks before he graduated in 2017 he heard back about the appeal — the college told him he did indeed have the qualifications to become an RN and could write the exam.

At “that time, for you to get your licence, was an uphill battle with the College of Nurses of Ontario,” said Noval.

The situation was similar for Chandra Kafle, who came to Canada in 2012 from Nepal with five years of nursing education, including a three year diploma and another two years to get her Bachelor of Science in nursing. She had worked as a nurse for eight years before she came here to do her master’s degree.

Instead, the college told her she couldn’t write the NCLEX, the nursing exam for registered nurses, because she didn’t have all of the qualifications.

“Even just with a diploma, other nurses in Nepal who went to the U.S. were able to write the NCLEX exam,” said Kafle. “So I was hoping that I would be able to write (it) within a year or so. But it took so long for them to decide. It took more than three years just to say that no, your education is not enough.”

The college told her she would have to go back to school to get her degree.

“I felt deflated. I felt demotivated,” said Kafle. “But I had to keep going ... I didn’t want to go (back) until I achieved something,” she said. “I felt like I lost my identity as a nurse and I wanted to regain that identity.”

Like Noval, Kafle wrote the exam to become a registered practical nurse and eventually started working part-time at Sunnybrook. She went to York to get her Bachelor of Science in nursing degree so that she could become an RN. She says she knew a number of foreign-trained nurses who remained as PSWs because they had to support their family.

Kafle now works as an RN in Sunnybrook’s cardiac intensive care unit and is pursuing her master’s degree.

She said of her journey, “I was a full-time student, part-time employee and my daughter was three, four years old at the time. So I had a tough time.”

Nurses have always been the front lines of health care but never more critical than during the COVID-19 crisis. In this ongoing series, we explore the many issues affecting nursing.

Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: pwinsa@thestar.ca