Despite the shortage of nurses in Ontario, steep barriers forcing qualified ones to leave for other provinces

Nina Piao moved to Canada in 2022 to help fill urgent nursing shortages after the pandemic left hospitals across the country understaffed and emergency rooms overwhelmed.

 

With over a decade of nursing experience in the Philippines, she was told her skills were in demand in Ontario hospitals, which faced some of the worst shortages.

 

Like many internationally educated nurses, the 35-year-old knew her credentials alone wouldn’t be enough to work in Canada. She enrolled as an international student at Seneca College, completing an eight-month nursing leadership program, had her credentials assessed by the National Nursing Assessment Service, passed a mandatory language exam, and registered with the College of Nurses of Ontario, eventually training and working in the emergency department at Michael Garron Hospital in Toronto.

 

But even after clearing every professional hurdle and assessment, Piao’s path to staying in Ontario hit a wall: her permanent residency application was denied due to her educational credentials not meeting the equivalency standards for a Canadian bachelor’s degree.

With her post-graduate work permit expiring, Piao had little choice but to leave Ontario and start over in New Brunswick, where it was easier to extend her permit and reapply for permanent residency with an employer’s support.

 

“I was devastated, thinking all my time, energy and resources in Canada had been wasted,” Piao said.

 

“I wanted to stay — I loved my job, my co-workers and I was already registered and working in Ontario.”

 

Despite a chronic shortage — Ontario needs 26,000 more registered nurses to catch up to the nurse-to-patient ratio of the rest of Canada, according to the Canadian Institute for Health Information — qualified internationally educated nurses (IENs) like Piao continue to face steep barriers to working in their field.

 

The result, health-care experts warn, is that qualified and much-needed nurses who are already in the province and ready to work are being lost to a system that can’t afford to lose them.

 

Even as the province 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 are pushing foreign nurses to leave for other provinces, or leave Canada.

 

While there is no official data on the number of nurses leaving Ontario, Doris Grinspun, CEO of the Registered Nurses Association of Ontario, said she is witnessing a “growing trend of IENs seeking employment outside of the province.”

 

The exodus is “driven by factors such as better employment opportunities elsewhere and systemic challenges” in Ontario, she 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, according to a recent report by World Education Services Canada.

 

But in lieu of official numbers, Grinspun said a key indicator of IENs leaving the province is the sharp rise of requests for verification of registration (VOR) — a process used by registered nurses applying to work in other jurisdictions. This includes registered practical nurses and nurse practitioners.

 

In 2023, 10.3 per cent of IENs requested a verification of registration, up from 4.5 per cent in 2019, according to the latest CNO data. That’s nearly four times the rate of Ontario-educated nurses, which rose from 1.5 per cent to 2.7 per cent over the same period.

 

Overall, 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.

 

“It’s very concerning,” Grinspun said, noting that half of new registrants to the college in the last year were IENs.

 

The 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 — said Marshia Akbar, research lead on labour migration at Toronto Metropolitan University.

 

According to Statistics Canada, more than 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.

 

But 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 labour market,” Akbar said. “It’s a mismanagement of our immigration system and employment integration system.”

 

Because many newly arrived nurses struggle to find work in their field and have to wait for their licences, many turn to 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 major factor affecting IENs’ ability to get registration and work, according to World Education Services Canada data. Registration costs, exams and testing fees can total $3,000 at the low end, on top of immigration, housing and living expenses.

 

Working for these platforms can offer quick income and entry into the labour market, but keeps professionals stuck in precarious, low-paid work, said Laura Lam, a researcher at TMU who studies migration, precarious employment and app-based platforms.

 

The result, said Lam, is an “underutilized labour market where you’re attracting qualified people who end up in jobs that don’t match their skills.”

That was the case for Mark Gravoso, a nurse from the Philippines with a decade of experience, including several years of hospital work in the United Arab Emirates.

 

He arrived in Canada as a landed immigrant in 2017, but it took four years to become registered in Ontario because his credentials weren’t recognized. Gravoso worked as a personal support worker, earning minimum wage while navigating the licensing process.

 

Gravoso, now a hospital nurse in Ontario and president of the Integrated Filipino Canadian Nurses Association, said some IENs can wait eight years to get registration in Ontario and end up working in survival jobs including as PSWs “for high-risk patients in community settings without proper risk assessments.”

 

Many IENs “feel they have no choice but to accept these roles,” he said.

 

Gravoso notes he’s seen many qualified IENs like Piao leave Ontario for other provinces or the U.S., where navigating credential recognition and immigration is easier.

 

“It’s a huge waste.”

 

According to College of Nurses of Ontario data, the top destinations linked to verification-of-registration requests in 2023 for IENs were the U.S., Alberta and B.C. — suggesting nurses are looking to leave Ontario for jurisdictions with fewer barriers, said Grinspun.

 

“These IENs are outstanding and they bring expertise and knowledge,” she said.

 

“We cannot afford to lose them — we are tremendously short and it’s the patients and nurses who are suffering.”

 

 

 

 

This article was first reported by The Star