My Experiences and Recommendations for supporting IENs
by Laxmi Regmi Kaphle, RN
Canada has been welcoming immigrants for centuries, and as a result, millions of people from around the globe get to live, work, and play in a diverse, inclusive and vibrant multicultural society, where the whole world can be experienced in one place. Canada also has a long history of attracting and recruiting internationally educated nurses (IENs).
During the early 1990s-2000s when we began to see the nursing shortage in Canada, the numbers of IENs started to increase drastically. At that time, many provincial health systems and independent organizations advertised for nursing positions abroad and recruited IENs through international conferences and career fairs. To address the shortage of skilled workers, including nurses, the federal government of Canada also introduced a federal skilled worker programme (FSW), which has been attracting more IENs to Canada. While the exact number of IENs that have attempted to achieve registration in Canada is unknown, according to a study done in 2007, “IENs represent 7-8% of the nursing workforce, ranging from 1.9% in Newfoundland to 15% in British Columbia”, with numbers to be expected to increase each year. 
I was born, raised and educated to be a registered nurse in Nepal. I moved to Canada almost a decade ago with the hopes of investing my skills and abilities in exchange for a better and more successful life. From an immigrant’s perspective, moving to another country for a secure career and a better life is both a blessing and a challenge at the same time. For the majority of immigrants, the first few years of life after immigration are extremely challenging and require a tremendous amount of support and direction, especially in the areas of socialization, financial stability and being able to enter the profession they were trained in from their country.
For myself, this experience was no different. The process to achieve registration as a registered nurse in Canada was a long and challenging three and a half years, adding to the stress of my family’s transition to Canada. Despite feeling alone I quickly learned that I was not the only IEN facing these challenges. In fact, the majority of IENs spend, on average, three years acquiring the necessary requirements to obtain their registration in Canada. This lengthy process continues to be a major concern for IENs, and this, along with other challenges that my colleagues and I experienced suggests that greater supports are needed by all stakeholders involved in IEN integration, especially in the areas of communication, financial support, workplace integration and mental health supports.
During my integration into Canada and its health care system, communication was my biggest challenge. I suffered psychological and emotional breakdowns that not only degraded my confidence, but also my self-esteem and self-image. The emotional and psychological impact of stress, fear of the unknown and being judged by colleagues and patients was particularly difficult during this transition. It was not that English was a difficult language to learn, but rather learning the language within the context of Canadian culture, and being able to communicate just like any other Canadian was very difficult. While I have come a long way, at times I continue to face discrimination because of my accent.
The financial burden was also particularly stressful. The inability to obtain entry level work to earn any kind of income, despite rigorous efforts (due to not having any other work experience other than nursing), while paying for private English lessons, and various expenses for registration was daunting. Even after entering into the Canadian nursing workforce, IENs still lack the support they need for a smooth transition. The unfamiliar workplace settings, culture, different roles, responsibilities and scope of practice compared to the IEN’s country of origin are some of the areas where IENs require greater support.
While the Canadian Nurses Association (CNA) predicts a shortage of almost 60,000 nurses by 2022, we also see many IENs with rich and extensive nursing experience giving up their hopes of becoming nurses in Canada due to the hardship of the lengthy registration process, as well as the lack of support and resources once in practice. Why is this happening? What can we do to prevent this? How can I make a difference and advocate for change? If I have taken anything away from my ARNBC internship, it’s to “be brave enough to start a conversation that matters.” With this in mind, I would encourage nursing organizations to take further measures in supporting and retaining the valuable IENs that have so much to contribute to nursing, the healthcare system, and patients.
Re-evaluate the current registration process and requirements, provide resource and supports to those who are in process of registering and integrating into the workplace, and support our networking, communication skills, and mental health and well-being. As IENs, we bring our unique perspectives, knowledge and experiences to nursing and healthcare, but we can’t do it alone. To this day, I continue to appreciate the quality of life that Canada has offered me throughout the years, and I will never take this opportunity for granted. Being a registered nurse in this country is a blessing, and I know that nursing organizations and nurse leaders have the ability to continue working towards improving the quality of life of IENs. So let’s come together and continue to support each other, because when we thrive, our communities, colleagues and patients thrive.
Tregunno, D., Campbell, H., Allen, D., de Sousa, D., (2007). Internationally Educated Nurses (IEN) knowledge translation Project report. College of Nurses of Ontario. Retrieved from https://www.cno.org/globalassets/docs/policy/ienexternalsummaryjan2308.pdf
ABOUT LAXMI REGMI KAPHLE (Rosha), RN
Roshna is a proud Internationally Educated Nurse from Nepal and current Post-RN student at the University of Victoria completing her community practicum placement at ARNBC. Roshna graduated from her nursing program in 2006 where she worked for a year in a labour and gynecology unit in Nepal. After arriving in Canada in 2007, Roshna began the process of registration and completed the Graduate Nurse Internationally educated re- entry (GNIE) program from Kwantlen in 2011. Since 2012 she has worked as an RN at Langley Memorial Hospital in Acute Medicine and currently works on a Medical/Oncology Unit at Surrey Memorial Hospital. Roshna is particularly passionate about nursing in the field of global health and aspires to continue her education to work and advocate for health care internationally. Roshna will carry on her advocacy efforts for IENs in order to further the resources and supports available as they make their transition in Canada.
Very well written. I am an IEN from Nepal as well, and now working towards my NP licence. I share the same experience as yours being IEN and am grateful for the quality of life Canada has offered to me and to my family. When I started my career as an RN in Canada in 2008, VCH used to have a program called IEN program, which is 3 months training program for hired IENS to successfully integrate and transition them to Canadian health care system. It was a great program. Unfortunately the program was closed soon after. I agree with you that there should be a program to transition IEN to nursing work force.
I agree, the process for IENs to become licensed in BC lacks vision, common sense, and humanity. It's time for "new blood" in the organizations who perpetuate this. Credit needs to be given to IENs for their rich experience, education, and work ethic.