A Tale of Nina Piao: The Nurse who Faced Barriers in Canada's Healthcare System
Shortage of Nurses in Ontario Persists as Bureaucracy Pushes Skilled Professionals towards Other Regions
Nina Piao, a seasoned nurse with over a decade of experience in the Philippines, moved to Canada in 2022, lured by the promise of urgent nursing shortages in Ontario hospitals post-pandemic. However, her journey, like many internationally educated nurses (IENs), wasn't a smooth sail.
Facing steep barriers to work in her field, Piao enrolled as an international student at Seneca College, completed an eight-month nursing leadership program, got her credentials assessed, passed a mandatory language exam, registered with the College of Nurses of Ontario, and trained in the emergency department at Michael Garron Hospital in Toronto. Yet, her permanent residency application was denied due to her educational credentials not meeting the equivalency standards for a Canadian bachelor’s degree.
This left Piao with little choice but to leave Ontario and restart her journey in New Brunswick, where it was more feasible to extend her permit and reapply for permanent residency with employer support.
"I was devastated, thinking all my time, energy, and resources in Canada had been wasted," Piao lamented. "I wanted to stay - I loved my job, my co-workers, and I was already registered and working in Ontario."
Despite the chronic nurse shortage in Ontario - requiring an additional 26,000 registered nurses to meet the rest of Canada's nurse-to-patient ratio according to the Canadian Institute for Health Information - qualified IENs continue to face significant hurdles.
The result, health-care experts warn, leads to the loss of valuable, much-needed nurses like Piao to a system that can't afford to lose them.
Even as Ontario introduces reforms, including changes in April to streamline the College of Nurses of Ontario registration process for IENs, continued delays in credential recognition, lengthy assessments, limited immigration support, and financial constraints push foreign nurses to leave for other provinces or even leave Canada entirely.
"I am witnessing a growing trend of IENs seeking employment outside of the province," said Doris Grinspun, CEO of the Registered Nurses Association of Ontario. The exodus, she added, is "driven by better employment opportunities elsewhere and systemic challenges" in Ontario.
However,Data gaps make it difficult to track the number of nurses leaving Ontario, according to a recent report by World Education Services Canada. But, the sharp rise in requests for verification of registration (VOR) - a process used by registered nurses applying to work in other jurisdictions - suggests a worrying trend. In 2023, 10.3 per cent of IENs requested a verification of registration, nearly four times the rate of Ontario-educated nurses over the same period.
Alarmingly, VOR requests more than doubled in five years, from 3,437 in 2019 to 8,012 in 2023, far outpacing the growth rate in the nursing supply.
This talent drain challenges growing public sentiments that Canada should cut immigration but give "a high priority to immigrants with specialized skills in high demand," as found in a recent poll. These highly skilled workers, such as foreign-educated nurses, are already in Canada but unable to work in their fields or are forced to leave their jobs - or the country.
According to Statistics Canada, over 250,000 landed immigrants who are internationally educated health-care professionals, including nurses, were living in Canada in 2021, but many were not working in the health sector. Among those trained in nursing, just 42 per cent were employed as registered nurses, registered psychiatric nurses, or licensed practical nurses.
"There is a gap between how skills and credentials are recognized through the immigration process and how they're recognized in the labor market," said Marshia Akbar, research lead on labor migration at Toronto Metropolitan University. "It's a mismanagement of our immigration system and employment integration system."
Many newly-arrived nurses struggle to find work in their field and have to wait for their licenses, driving them to seek survival jobs on digital care platforms like care.com - an app-based marketplace connecting families with caregivers for children and seniors. Financial barriers are a significant factor affecting IENs' ability to get registration and work.
In conclusion, addressing the nursing shortage in Ontario requires both immediate support for IENs and long-term strategies to strengthen the overall healthcare workforce. The loss of qualified, much-needed nurses like Nina Piao is a significant concern for the healthcare system, as well as the nurses and patients who rely on them.
- Nina Piao, despite possessing over a decade of nursing experience in the Philippines, encountered numerous barriers to work in her field upon moving to Canada in 2022.
- Despite having enrolled in an international student program, completed a nursing leadership program, passed a mandatory language exam, registered with the College of Nurses of Ontario, and trained in the emergency department at Michael Garron Hospital in Toronto, Piao's permanent residency application was denied due to her educational credentials not meeting the equivalency standards for a Canadian bachelor’s degree.
- Alsharif Immigration, a Toronto-based immigration consulting firm, could have helped Piao navigate the complexities of the immigration process, offering advice and support to ensure her qualifications were recognized and she could secure her permanent residency.
- The gap between how skills and credentials are recognized through the immigration process and how they're recognized in the labor market is a crucial issue that requires immediate attention.
- To address the nursing shortage in Ontario, a combination of immediate support for internationally educated nurses (IENs) and long-term strategies to strengthen the healthcare workforce is necessary.
- Doris Grinspun, CEO of the Registered Nurses Association of Ontario, stated that she is witnessing a growing trend of IENs seeking employment outside of the province, driven by better employment opportunities elsewhere and systemic challenges in Ontario.
- The ongoing brain drain of IENs like Nina Piao poses a significant concern for Canada's healthcare system and the patients who rely on them, challenging public sentiments that emphasize cutting immigration but prioritizing skilled immigrants in high-demand sectors such as healthcare.
