Licensing rules keeping internationally trained nurses from working in Manitoba, critics say
Nurse licensed in Ontario, Quebec was told she needed to go back to school before she can work in Manitoba
A registered nurse currently working in Ontario says she'd love to work in Manitoba, where her family lives — but she says the strict licensing requirements of the province's nursing college have kept her from working here.
The nurse — whom CBC has agreed not to name because she fears repercussions in her job for speaking out — is among the many internationally educated nurses who want to work in Manitoba, but first have to meet requirements set out by the College of Registered Nurses of Manitoba.
"I want to stick here because … our entire family started here since the 1970s," the nurse, who immigrated to Manitoba from the Philippines in 2013, told CBC in an interview last week.
"[I have] deep roots here because … of my family."
The issue of licensing internationally educated nurses (IENs) in Manitoba came up again recently, when Health Minister Audrey Gordon said the province would rely on the nurses to help fill staffing shortages in Manitoba hospitals.
The nurse who spoke with CBC works as a registered nurse in northwestern Ontario, where she is licensed. She travels back and forth from there to Winnipeg to be with her family. She also works part-time in Winnipeg in a licensed practical nursing role — but is not licensed to work as an RN in Manitoba.
She originally trained as a registered nurse in the Philippines, and says she came to Manitoba with a well-researched plan, hoping to work here. As a backup, she got licensed to work as an RN in both Ontario and Quebec.
'How come Manitoba is different?'
Her plans to work in Manitoba were derailed in 2014, however, when she failed her clinical competence assessment.
That assessment is intended to test the entry-level competencies for registered nurses in Manitoba. It determines if an applicant can write their licensing exam, or will be required to take bridging courses to supplement gaps in knowledge or complete basic nursing education through a degree program.
But the nurse says only two people in her class passed the competence test. The others were told they'd need to take a four-year program at the University of Manitoba.
The competency test is only part of the lengthy licensing process for internationally educated nurses in Manitoba, which also includes an English language requirement and expensive paperwork.
The nurse working in Ontario is baffled by Manitoba's bureaucracy, especially since she has registered nursing licences in other provinces.
"Why do you need me to take this test?" she said. "I took the bridging [program] …in the Canadian school."
Nursing bridging programs are intended to prepare nurses from other countries to work as registered nurses in Manitoba, and bridge any gaps between the skills they have and what is needed in the industry.
The nurse from the Philippines completed her bridging program and got licensed in Quebec — a licence which is recognized in Ontario, but not Manitoba.
"What else is different from another province to this province?" the nurse said. "If Ontario can acknowledge my registered nurse licence from Quebec, how come Manitoba is different?"
'We want to maintain the standards': health minister
Opposition NDP MLA Malaya Marcelino (Notre Dame) says there are currently over 2,000 nursing vacancies in Manitoba, which nurses educated elsewhere could help fill — if it was easier for them to get licensed here.
She's been pushing the Progressive Conservative government to take action on that.
"It's been an issue at least since 2016, when the clinical competency assessment test was given over to a new provider" to administer, Marcelino said.
Since then, "the failure rates, anecdotally, are about 90 per cent," she said.
Marcelino says advocates for internationally educated nurses have suggested that the competency test needs to be recalibrated or removed, or applicants should be given more support to adequately prepare for it.
Other provinces have supports in place to assist international nurses, she says, including financial grants, and recruitment and retention strategies for nurses.
She has recently repeated her calls for the province to provide more help for nurses who want to work here.
Manitoba's health minister says the province has created a working group "to look at how we can streamline the process for internationally educated nurses to be licensed here in the province."
During an interview last week with CBC, Audrey Gordon also said she is set to meet this week with the nursing college.
She said the province might need more "wraparound services," such as mentorship programs, to support applicants, but defends the clinical competence assessment, saying it helps nurses get ready to practise.
"We want our internationally educated nurses to be welcomed in Manitoba, be welcomed in the health-care system, but to be successful in their profession," she said.
"If there are ways that we can … streamline the process to ensure that success, I am open to working with the stakeholders," Gordon said.
"But at all times we want to maintain the standards while we are streamlining the licensure process."
'Tremendous waste of human capital'
Catherine Baxter, an assistant nursing professor at Brandon University, says it's essential to integrate nurses into the workforce early.
Baxter, who has been working with internationally educated nurses for over 15 years, has studied the integration of Filipino nurses and other internationally educated nurses into the western Canadian workforce.
"Workforce integration focuses really on two separate things," she said. "First is the ability to become licensed within the regulated profession. And then second … to be successful once you're working in the workplace."
That requires supports like high-level language courses so international nurses can meet English requirements, funding support for licensing costs, and access to bridging programs, she says.
"But we have limited places available," in those types of programs, she said. "So certainly additional funding of bridging program courses would be required to increase capacity."
Seid Oumer Ahmed from the Manitoba Association of Newcomer Serving Organizations (MANSO) said his organization has also pushed for expanding bridging programs.
It has also urged other changes to nurse licensing policy, including exempting certain countries from the English language testing requirement, eliminating redundant documentation and getting rid of third-party assessments.
He said that through its provincial nominee program, Manitoba has attracted some of the best and brightest from other countries to immigrate to Manitoba, only to have them work in less-skilled jobs.
"The inability to become registered … is [a] tremendous waste of human capital," he said.
Nova Scotia offers conditional licensing
Other jurisdictions, meanwhile, have taken steps to address some of the issues raised by internationally educated nurses trying to get licensed in Manitoba.
The Nova Scotia College of Nursing, for example, says it has brought in policies to issue conditional licences and implement nursing mentorships — measures that college says speed up the licensing process in Nova Scotia.
It's also worked to streamline and reduce the documentation required from nursing applicants, and to approve more internationally educated nurses who have most of their registration requirements for conditional licences, a spokesperson for the Nova Scotia college said in an email to CBC.
"The conditional licence allows these nurses to practise while fulfilling the outstanding requirements and with some specific limitations to their licence," the spokesperson said.
The head of Manitoba's college for registered nurses says the pandemic actually opened the door to some conditional practice here, too.
At one point in the pandemic, the entry-level exam that is a requirement of registration couldn't be offered, says College of Registered Nurses of Manitoba CEO Katherine Stansfield.
"So what we were able to do was to say to some … 'You've met all the requirements for registration except the exam. And in our registration regulation, you can then practise as a graduate nurse, and that means you can enter practice,'" while still under supervision, she said.
Stansfield also defends the province's clinical competency exam.
"Clinical competence assessment is actually a cornerstone of our registration process for those individuals coming from outside of the country," she said.
"It's minimum standards of safety. And that's really important because … the public needs to know and trust that every single registered nurse has met the requirements for registration in Manitoba."
The internationally educated nurse CBC spoke with said she hopes that the Manitoba college will change its mind about the assessment, though.
She says there are others who have previously failed their competence exam, now practising nurses in other provinces, who want to come back home.
"A lot of nurses already left the province and moved to a province that would accept them. We know that we are still fighting, but we don't know until when we can still do this."
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With files from Peggy Lam