Why is this nurse working at a Toronto insurance firm? Ontario’s battle to get foreign-trained nurses into the field

2024/04/16 Leave a comment

Useful analysis and report:

…The report by World Education Services (WES) Canada, a non-profit organization that assesses foreign credentials, surveyed 758 internationally educated nurses not currently working as nurses in Ontario, and found that half had not begun the province’s registration process to practise, even if they wanted to. 

The respondents cited financial barriers as the top factor affecting their ability to become registered. (Registration costs, exams and testing fees can total $3,000 at the low end.) The need to show evidence of recent nursing practice, a lack of clarity around the registration process and the time it takes to get registered also played a role.

The report also 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. 

“No one can tell us how many internationally educated nurses are actually out there who could potentially be working,” said Joan Atlin, strategy, policy and research director at WES Canada. “There’s still a significantly underutilized population of nurses in the province who are still falling outside of the supports.”

The pandemic has forced health officials to confront the underutilization of skills brought by immigrants meant to fill labour needs, said Atlin, who has been engaged in foreign credential issues for two decades.

The province is well aware of the issues in the report and has worked with the College of Nurses of Ontario, which regulates the profession, to help internationally educated nurses become registered. 

In 2022, the Health Ministry introduced changes, including covering the cost of exams and registration with the college, and made it easier to meet language proficiency requirements. 

Just last month, the province made permanent a program that places these nurses under an employer’s supervision to gain work experience. The college says that as of the end of March 2024, it had matched 4,230 applicants with employers, enabling 3,324 nurses to register. 

“It has created that opportunity for health-care employers to hire those who have already applied for licensure and allow nurses to meet the practice and language proficiency requirement, by actually working and having their employer attest to their ability to work in English,” said Atlin.

In total, the college says as of April 1, it had registered more than 7,500 international applicants, with 5,215 new internationally educated nurses registered in 2022 alone. …

Source: Why is this nurse working at a Toronto insurance firm? Ontario’s battle to get foreign-trained nurses into the field

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Quebec: Stress et colère pour des infirmières recrutées à l’étranger

2024/03/28 Leave a comment

A noter:

Difficultés d’intégration, stress et anxiété, échecs. Un an et demi après l’arrivée des premières cohortes, le programme québécois visant à recruter 1000 infirmières et infirmiers à l’international connaît des ratés, selon ce qu’a constaté Le Devoir.

Alors qu’environ 300 de ses étudiants ont passé l’examen de l’Ordre des infirmières et infirmiers mardi — les résultats seront connus d’ici quelques mois —, 737 sont toujours en formation ou sur le point de la commencer et une cinquantaine ont échoué ou abandonné en cours de route, selon les données du ministère de l’Immigration, de la Francisation et de l’Intégration (MIFI).

Démarré à l’automne 2022, le programme, au coût de 65 millions, n’a pas eu pour seul effet d’amener de la main-d’oeuvre partout dans la province : il a également généré beaucoup de stress et de déception chez ces futurs soignants de notre réseau, dont plusieurs disent avoir été « trompés » par le Québec.

« Ce n’est pas du tout ce à quoi je m’attendais. Il y a eu beaucoup de non-dits », a déploré Katia, une infirmière africaine toujours dans le programme qui veut taire son identité pour ne pas nuire à ses chances. « Ça n’a pas été facile du tout. »

Il y a environ un an, cette mère de famille est arrivée dans une région québécoise seule avec quatre enfants, dont un bébé de quelques mois. L’organisme d’aide local lui avait trouvé un appartement, mais il lui a fallu le meubler, inscrire ses enfants à l’école et trouver une garderie pour son nourrisson. Tout ça dans les 10 jours avant que ne commence le cours. « C’est un programme intense. Tu dois étudier, tu dois t’occuper des enfants… Il y a beaucoup de paramètres à prendre en compte », raconte-t-elle.

Une intervenante, qui garde l’anonymat pour ne pas nuire à son organisme d’aide aux immigrants, lequel est financé par le MIFI, a dit au Devoir avoir participé à un atelier avec des étudiants qui étaient « au bord des larmes » et « très en colère ». « Ce que j’ai vu, c’était de la réelle détresse psychologique. Pas un simple choc culturel », a-t-elle confié.

La marche est trop haute, croit-elle. « Les étudiants pensaient qu’ils viendraient faire une mise à niveau. Mais ils se retrouvent à faire une technique de trois ans en à peine un an. Ils se sentent incompétents, trompés. »

Problèmes d’argent… et de logement

Chapeauté par le MIFI, en collaboration avec les ministères de la Santé et de l’Enseignement supérieur, le programme des infirmières diplômées hors Canada paye notamment pour les équivalences, le coût de la formation allant de 9 à 12 mois, et fournit une allocation de 500 $ par semaine aux participants recrutés en Afrique francophone. « Ce n’est pas assez. Avec les 500 $, tu payes ton loyer et c’est tout », a dit Katia.

Nourriture, vêtements d’hiver, transports, garderie… Ces dépenses mettent une pression supplémentaire sur le portefeuille. Certains étudiants ont même eu recours aux banques alimentaires.

« Dans notre deuxième cohorte, à Amos, Ville-Marie et La Sarre, ils les ont tous utilisées », a confirmé Manon Richard, conseillère pédagogique au cégep de l’Abitibi-Témiscamingue.

Les participants ont été accompagnés, avant et pendant leur séjour, par des agents d’accueil et d’intégration et des organismes partenaires locaux de sorte qu’ils soient sensibilisés aux défis du programme, a indiqué le ministère. Des comités régionaux ont également été mis sur pied.

« Même si on les informe du coût de la vie, ça n’empêche pas que c’est un choc énorme quand ils arrivent », a soutenu Mme Richard.

Comme ils sont autorisés à le faire un maximum de 20 h par semaine, la quasi-totalité des étudiants — 860 sur 1000, selon le ministère — ont travaillé soir et week-ends comme préposés aux bénéficiaires pour joindre les deux bouts.

Selon Mme Richard, le premier défi, c’est la rareté et le coût exorbitant des logements. « Les familles arrivent nombreuses. Ce n’est pas facile de trouver un appartement pour des familles de quatre, cinq, six enfants. »

Mame Moussa Sy, directeur général de la Maison internationale de la Rive-Sud, ajoute que les propriétaires ne veulent pas louer leurs logements à des personnes qui n’ont pas d’historique de crédit. « Certains ont dit qu’ils ne voulaient pas louer à des personnes d’Afrique noire », a ajouté l’homme, dont l’organisme a accompagné près de 40 candidats l’automne dernier.

« Une chose colossale »

Arrivée au Québec seule avec ses cinq enfants, Emelda Tabot a fait partie de la première cohorte du cégep de Valleyfield, qui a commencé en janvier 2023. « C’était une chose colossale. S’adapter au climat, à tous les changements qu’on vivait. C’était disons… un challenge », a expliqué la Camerounaise, en entrevue au Devoir.

Si son installation s’est « très bien passée », c’est pendant sa formation qu’elle a vécu les plus grands défis.

D’abord, comme elle est plus à l’aise en anglais, étudier en français lui a donné du fil à retordre. L’autre défi de taille : devoir apprendre en cinquième vitesse un tas de nouvelles choses qui n’ont rien à voir avec les maladies tropicales traitées dans son hôpital rural. « On n’a pas ça, chez nous, des lits [mécaniques] qui se lèvent lorsqu’on appuie sur un bouton. »

Malgré sa grande motivation, elle dit avoir vécu des moments de découragement. « C’était stressant. Je me sentais parfois abandonnée, mais ma coordonnatrice me disait : “Ne lâche pas, on est là” », raconte Mme Tabot, qui a fini par obtenir une bourse pour sa persévérance.

Le Devoir a obtenu un document colligeant toutes les difficultés rencontrées et les solutions préconisées par les cégeps qui ont accueilli les premières cohortes. Les problèmes sont nombreux : difficulté d’organisation, surcharge de travail, problème de gestion du stress, difficulté avec la technologie, retards.

Les cégeps ont répondu par une panoplie de mesures. Ils ont notamment donné plus de temps pour les examens, offert des ateliers sur la gestion du stress ou encore embauché plus d’enseignants. Cela ne semble pas suffisant. « Même s’ils ont de l’expérience dans leur pays, les étudiants sont très surpris. C’est un cours excessivement exigeant pour eux », explique Philippe Beauchemin, agent de mobilisation à Haute-Gaspésie me voici !.

Il cite en exemple un étudiant installé dans sa région qui peine à tout concilier. « Quand il revient de sa journée d’étude au cégep, il donne un coup de main à sa conjointe pour les enfants et il se réveille la nuit pour étudier. Cet homme-là, il ne dort jamais. »

La peur de l’échec

Katia a quant à elle dit être stressée par la possibilité d’échouer et d’être exclue du programme. C’est déjà arrivé à trois de ses camarades de classe. « Personnellement, je n’avais pas compris que c’était éliminatoire en cours de route, a-t-elle confié. Si tu as un échec, tu perds vraiment tout. Avoir su, j’aurais sécurisé mes arrières. J’avais une carrière chez moi, un certain statut. »

Étant soumis aux règles du visa d’études, les participants doivent quitter le pays s’ils échouent à la formation ou l’abandonnent. À moins qu’ils obtiennent un contrat de travail auprès d’un CISSS ou d’un CIUSSS pour se faire embaucher comme préposé aux bénéficiaires et qu’ils fassent « ensuite les démarches nécessaires dans le cadre du Programme des travailleurs étrangers temporaires », a indiqué le ministère de l’Immigration. Cela nécessite parfois une attente de plusieurs mois sans revenu.

Pour Philippe Beauchemin, le programme devrait revoir les perspectives d’échec. « Il faut enlever aux étudiants cette pression-là, dit-il. Comme ils sont en précarité financière, ça les amène à travailler plus et ça fait qu’ils étudient moins. Il y a quelque chose qui ne marche pas. »

Source: Stress et colère pour des infirmières recrutées à l’étranger

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B.C. plans to streamline licensing for internationally trained nurses

2023/01/11 Leave a comment

Of note:

British Columbia has announced new supports to help hire and train more nurses and midwives in order to take pressure off the strained health-care system.

Premier David Eby said the new measures will support Canadian-trained nurses who want to get back into the workforce, as well as internationally trained nurses looking to practise in B.C.

“There are highly skilled and experienced nurses who want to get to work in our system now but are facing barriers preventing them from delivering services that British Columbians need,” Eby said during a news conference at Langara College in Vancouver on Monday.

Source: B.C. plans to streamline licensing for internationally trained nurses

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Canada’s push to ‘poach’ nurses from abroad fuels fears of shortages in developing countries

2022/11/21 Leave a comment

Indeed. Good practical comments and suggestions by Arthur Sweetman:

As Canada and other wealthy countries scramble to hire nurses from overseas, there are growing concerns that the exodus of health-care workers from developing countries will push their stretched medical systems closer to a crisis point.

The federal government and provinces are spending millions of dollars trying to entice foreign-trained nurses to Canada — with overseas hiring campaigns, priority immigration pathways and monetary grants to individual nurses.

But Canada has strong competition from Europe, the U.S. and other countries that are also mounting aggressive recruitment campaigns touting high wages and immigration opportunities: health workers can get cheap U.K. visas, while the Australian state of Victoria offers “relocation packages” for foreign nurses, equivalent to as much as $11,670 Cdn.

We’ve seen a significant uptick in international recruitment of nurses from the beginning of this year, overwhelmingly driven by probably six or seven high-income countries,” said Howard Catton, chief executive officer of the International Council of Nurses (ICN), naming Canada as one of those countries.

“[They’re] in a rush to get a quick fix to their own nursing shortage, because they haven’t invested enough in educating their own nurses, and because the nurses that they have, in many cases, are exhausted and burnt out.”

Countries worry they’ll lose specialist nurses

Early in the pandemic, a joint report from the ICN and World Health Organization (WHO) warned of rich countries raiding developing countries’ nursing workforces to make up for their own failure to train and retain the health-care staff they need.

At the time, the Americas had about 83 nurses per 10,000 people, while in Africa, there were fewer than nine nurses per 10,000 people, according to the report.

Two and a half years and one global pandemic later, Catton says the situation has only worsened for lower-income countries struggling to hold onto their health-care workers as wealthy countries ramp up recruitment drives.

These countries are very concerned they’ll lose experienced nurses with specialist skills — like intensive care nurses or specialist cancer nurses, he told CBC News in an interview from Geneva.

“You might only lose one or two specialist nurses, but that can mean that the service no longer exists.”

Canada’s push to hire from overseas

In Canada, internationally educated health workers make up about nine per cent of nurses and 26 per cent of physicians. Over the past year, provinces have rolled out a hodge-podge of incentives meant to recruit more, including targeted immigration streams.

Newfoundland and Labrador has set up a recruitment desk in India, Saskatchewan will hold a health-care job fair in the Philippines later this month, and British Columbia, New Brunswick, Quebec and Manitoba all offer thousands of dollars to cover licensing for international nurses and other costs, which can include childcare, transportation and living expenses.

Those kinds of incentives are hard for nurses in developing countries to turn down.

“If we are pushing out more of our [nursing] professionals, then very soon … we will not have enough of them to take care of ourselves,” says Perpetual Ofori-Ampofo, president of the Ghana Registered Nurses and Midwives Association.

Ghana has about 44,000 nurses to care for its population of 31 million — a number just above Africa’s average. And low pay means “some live hand to mouth,” she said.

“It is much, much better for them to travel and work abroad than to stay here,” Ofori-Ampofo said, noting those workers may be better off in Canada, where they receive regular paycheques and the opportunity for overtime.

Bilateral deals a more ethical approach

However, Ofori-Ampofo wants to see wealthy countries like Canada take a more ethical approach to overseas recruitment.

Instead of targeting individual nurses through recruitment agencies that may not serve their interests, she says governments should make bilateral deals with countries the nurses are from — an approach WHO also endorses.

Ghana recently began deploying nurses to Barbados under a bilateral agreement that has seen about 240 nurses sent to the island for two-year terms.

Such deals make it safer for nurses to leave their home countries, knowing their salaries and other conditions of employment are clearly spelled out before they arrive, she said.

Both Ofori-Ampofo and Catton say wealthier countries also should do more to give back to countries where they’re recruiting.

“I hear a lot of [recruiting] countries who say ‘Look, we want to share knowledge, and there’ll be opportunities for people to learn and to share as a result of migration,’ and that’s true, but I’d like us to be more ambitious, more specific in terms of what we’re going to do,” Catton said.

He suggested, for example, that countries like Canada could give money to build nursing schools or help pay to educate the nursing workforce in developing countries.

Canada’s federal government does not have any bilateral agreements with other countries for the international recruitment of health workers, as provinces and territories were responsible for that work, said Health Canada.

The agency noted the federal government funds education programs for health workers in developing countries, including a pediatric nursing program in Ghana led by Toronto’s SickKids hospital.

A complete waste’

Experts see another major flaw with Canada’s international recruitment: thousands of the foreign health-care workers who come here don’t end up working in their profession — potentially as much as 47 per cent.

Some migrate only to discover their qualifications and language skills don’t meet Canada’s requirements, while for others, lengthy and expensive licensing and registration processes can delay their ability to work in their field — sometimes for years.

“We poach people, but we do it very badly,” said Professor Arthur Sweetman, the Ontario Research Chair in Health Human Resources at McMaster University in Hamilton.

Sweetman says private recruitment agencies are part of the problem because they bring workers to Canada without ensuring they have the right skills to be able to work in their medical fields.

It’s the worst of both worlds: we don’t benefit, the source country doesn’t benefit. Nobody benefits. It’s a complete waste.”

This year’s federal government budget included funding to help thousands of internationally-educated health workers have their foreign credentials recognized and find jobs in their medical fields each year.

Room for better co-ordination

While the federal government and some provinces have announced new measures to help internationally-trained nurses get licensed and registered faster, Sweetman says different levels of government should also co-ordinate their recruitment efforts.

“One of the problems is that the [immigration] selection is done by the federal government, and employment in the health-care sector is almost always done by provincial governments.”

In a statement, Health Canada says it welcomes “open dialogue” with different levels of government, health-care workers and others on ways to address health worker shortages and ensure ethical international recruitment

The agency said it encouraged efforts aligned with WHO’s code of practice on international recruitment, which urges countries not to actively recruit from a “red list” of the world’s most short-staffed countries, which includes Ghana.

However, the U.K. alone has hired thousands of workers from red-listed countries in recent years.

A WHO spokesperson told CBC News an expert advisory group is currently reviewing if anything more can be done to safeguard developing countries from unethical recruitment efforts, with more details set to be announced before the end of January.

Source: Canada’s push to ‘poach’ nurses from abroad fuels fears of shortages in developing countries

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

2022/02/15 Leave a comment

On a more positive note, progress on pathways for 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.”

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

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Rich Countries Lure Health Workers From Low-Income Nations to Fight Shortages

2022/01/25 Leave a comment

The costs to source countries:

There are few nurses in the Zambian capital with the skills and experience of Alex Mulumba, who works in the operating room at a critical care hospital. But he has recently learned, through a barrage of social media posts and LinkedIn solicitations, that many faraway places are eager for his expertise, too — and will pay him far more than the $415 per month (including an $8 health risk bonus) he earns now.

Mr. Mulumba, 31, is considering those options, particularly Canada, where friends of his have immigrated and quickly found work. “You have to build something with your life,” he said.

Canada is among numerous wealthy nations, including the United States and United Kingdom, that are aggressively recruitingmedical workers from the developing world to replenish a health care work force drastically depleted by the Covid-19 pandemic. The urgency and strong pull from high-income nations — including countries like Germany and Finland, which had not previously recruited health workers from abroad — has upended migration patterns and raised new questions about the ethics of recruitment from countries with weak health systems during a pandemic.

“We have absolutely seen an increase in international migration,” said Howard Catton, the chief executive of the International Council of Nurses. But, he added, “The high, high risk is that you are recruiting nurses from countries that can least afford to lose their nurses.”

About 1,000 nurses are arriving in the United States each month from African nations, the Philippines and the Caribbean, said Sinead Carbery, president of O’Grady Peyton International, an international recruiting firm. While the United States has long drawn nurses from abroad, she said demand from American health care facilities is the highest she’s seen in three decades. There are an estimated 10,000 foreign nurses with U.S. job offers on waiting lists for interviews at American embassies around the world for the required visas.

Since the middle of 2020, the number of international nurses registering to practice in the United Kingdom has swelled, “pointing toward this year being the highest in the last 30 years in terms of numbers,” said James Buchan, a senior fellow with the Health Foundation, a British charity, who advises the World Health Organization and national governments on health worker mobility.

“There are 15 nurses in my unit and half have an application in process to work abroad,” said Mike Noveda, a senior neonatal nurse in the Philippines who has been temporarily reassigned to run Covid wards in a major hospital in Manila. “In six months, they will have left.”

As the pandemic enters its third year and infections from the Omicron variant surge around the world, the shortage of health workers is a growing concern just about everywhere. As many as 180,000 have died of Covid, according to the W.H.O. Others have burned out or quit in frustration over factors such as a lack of personal protective equipment. About 20 percent in the United States have left their jobs during the pandemic. The W.H.O. has recorded strikes and other labor action by health workers in more than 80 countries in the past year — the amount that would normally be seen in a decade. In both developing countries and wealthy ones, the depletion of the health work force has come at a cost to patient care.

European and North American countries have created dedicated immigration fast-tracks for health care workers, and have expedited processes to recognize foreign qualifications.

The British government introduced a “health and care visa”program in 2020, which targets and fast tracks foreign health care workers to fill staffing vacancies. The program includes benefits such as reduced visa costs and quicker processing.

Canada has eased language requirements for residency and has expedited the process of recognizing the qualifications of foreign-trained nurses. Japan is offering a pathway to residency for temporary aged-care workers. Germany is allowing foreign-trained doctors to move directly into assistant physician positions.

In 2010, the member states of the W.H.O. adopted a Global Code of Practice on the International Recruitment of Health Personnel, driven in part by an exodus of nurses and doctors from nations in sub-Saharan Africa ravaged by AIDS. African governments expressed frustration that their universities were producing doctors and nurses educated with public funds who were being lured away to the United States and Britain as soon as they were fully trained, for salaries their home countries could never hope to match.

The code recognizes the right of individuals to migrate but calls for wealthy nations to recruit through bilateral agreements, with the involvement of the health ministry in the country of origin.

In exchange for an organized recruitment of health workers, the destination country should supply support for health care initiatives designated by the source country. Destination countries are also supposed to offer “learn and return” in which health workers with new skills return home after a period of time.

But Mr. Catton, of the international nurses organization, said that was not the current pattern. “For nurses who are recruited, there is no intention for them to go back, often quite the opposite: They want to establish themselves in another country and bring their families to join them,” he said.

Zambia has an excess of nurses, on paper — thousands of graduates of nursing schools are unemployed, although a new government has pledged to hire 11,200 health workers this year. But it is veteran nurses such as Lillian Mwape, the director of nursing at the hospital where Mr. Mulumba works, who are most sought by recruiters.

“People are leaving constantly,” said Ms. Mwape, whose inbox is flooded with emails from recruiters letting her know how quickly she can get a visa to the United States.

The net effect, she said, “is that we are handicapped.”

“It is the most-skilled nurses that we lose and you can’t replace them,” Ms. Mwape said. “Now in the I.C.U. we might have four or five trained critical-care nurses, where we should have 20. The rest are general nurses, and they can’t handle the burden of Covid.”

Dr. Brian Sampa, a general practitioner in Lusaka, recently began the language testing that is the first step to emigrate to the United Kingdom. He is the head of a doctor’s union and vividly aware of how valuable physicians are in Zambia. There are fewer than 2,000 doctors working in the public sector — on which the vast majority of people are reliant — and 5,000 doctors in the entire country, he said. That works out to one doctor per 12,000 people; the W.H.O. recommends a minimum of one per 1,000.

Twenty Zambian doctors have died of Covid. In Dr. Sampa’s last job, he was the sole doctor in a district with 80,000 people, and he often spent close to 24 hours at a time in the operating theater doing emergency surgeries, he said.

The pandemic has left him dispirited about Zambia’s health system. He described days treating critically ill Covid patients when he searched a whole hospital to find only a single C-clamp needed to run oxygenation equipment. He earns slightly less than $1000 a month.

“Obviously, there are more pros to leaving than staying,” Dr. Sampa said. “So for those of us who are staying, it is just because there are things holding us, but not because we are comfortable where we are.”

The migration of health care workers — often from low-income nations to high-income ones — was growing well before the pandemic; it had increased 60 percent in the decade to 2016, said Dr. Giorgio Cometto, an expert on health work force issues who works with the W.H.O.

The Philippines and India have deliberately overproduced nurses for years with the intention of sending them abroad to earn and send remittances; nurses from these two countries make up almost the entire work force of some Persian Gulf States. But now the Philippines is reporting shortages domestically. Mr. Noveda, the nurse in Manila, said his colleagues, exhausted by pandemic demands that have required frequent 24-hour shifts, were applying to leave in record numbers.

Yet movement across borders has been more complicated during the pandemic, and immigration processes have slowed significantly, leaving many workers, and prospective employers, in limbo.

While some countries are sincere about bilateral agreements, that isn’t the only level at which recruitment happens. “What we hear time and time again is that recruitment agencies pitch up in-country and talk directly to the nurses offering very attractive packages,” Mr. Catton said.

The United Kingdom has a “red list” of countries with fragile health systems from which it won’t recruit for its National Health Service. But some health workers get around that by entering Britain first with a placement through an agency that staffs private nursing homes, for example. Then, once they are established in Britain, they move over to the N.H.S., which pays better.

Michael Clemens, an expert on international migration from developing countries at the Center for Global Development in Washington, said the growing alarm about outflows of health workers from developing countries risks ignoring the rights of individuals.

“Offering someone a life-changing career opportunity for themselves, something that can make a huge difference to their kids, is not an ethical crime,” he said. “It is an action with complex consequences.”

The United Kingdom went into the pandemic with one in 10 nurse jobs vacant. Mr. Catton said it some countries are making overseas recruitment a core part of their staffing strategies, and not just using it as a pandemic stopgap. If that’s the plan, he said, then recruiting countries must more assiduously monitor the impact on the source country and calculate the cost being borne by the country that trains those nurses.

Alex Mulumba, the Zambian operating room nurse, says that if he goes to Canada, he won’t stay permanently, just five or six years to save up some money. He won’t bring his family with him, because he wants to keep his ties to home.

“This is my country, and I have to try to do something about it,” he said.

Source: Rich Countries Lure Health Workers From Low-Income Nations to Fight Shortages

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Canada has a big-time nursing shortage. So why can’t these two fully certified nurses get the OK to practise?

2021/10/27 Leave a comment

Of note, along with the backlog numbers for the various programs:

A former intensive-care nurse in the Philippines, Katrina Deauna has watched from the sidelines as Ontario — and all of Canada — struggles with chronic nursing shortages laid bare by the pandemic.

While the foreign caregiver enjoys looking after the 18-month-old baby girl and six-year-old son of her Canadian employer, she says, she would rather use her front-line nursing skills and experience to help those fighting for their lives against COVID-19.

Deauna has met all the licensing requirements of the Ontario College of Nursing. All she is missing is the authorization to work — either through a letter that confirms she’s eligible for permanent residence or a bridging open work permit.

“We are ready to practise in our profession. We are just waiting for our papers,” says the 28-year-old, who worked in the intensive-care unit of the Manila Doctors Hospital, one of the top hospitals in the Philippines, for three years until September 2019, when she was hired as a nanny in Toronto.

“They’re talking about the shortages of nurses in Ontario and Canada. And here we are. The only thing that’s keeping us from our practice is a piece of immigration paper.”

According to Ontario’s regulatory body of nurses, there are currently at least 41 applicants who meet all of its registration requirements but are waiting for the immigration authorization to work in Canada. It’s not sure what the numbers are for other provinces.

Statistics Canada reported that in the first three months of this year, the health-care and social-assistance sector had the largest year-over-year increase in job vacancies compared to other sectors, rising by 27,700 to 98,700 vacancies — an increase of 39 per cent. The positions with the largest vacancy increase were registered nurses and registered psychiatric nurses. Half of those positions had been vacant for 90 days or more, according to Statistics Canada.

Ontario has, so far, been hardest hit. With a ratio of 725 registered nurses per 100,000 people, it ranks as the lowest province in Canada and well below the national average of 811 nurses per 100,000 people, according to 2019 data from the Canadian Institute for Health Information.

Hospitals across the province currently have a vacancy rate of 18 to 22 per cent for nurses, the Ontario Nurses’ Association says.

“Some smaller hospitals closed their emergency departments after four o’clock because they don’t have enough staff,” says Vicki McKenna, head of the association, adding that some operating rooms are running at limited capacity for the same reason..

While complaints from internationally trained nurses have traditionally had to do with the lengthy registration and licensing process with regulators, McKenna said it’s deplorable that those who have met the licensing requirement are being held back due to an immigration backlog.

“We need these nurses, and we can’t afford to have them languish on that list, and we can’t afford to lose them to other provinces. The nursing shortages aren’t in Ontario alone. It’s across this country and it’s an international issue,” she said.

“The U.S. is recruiting hard. Our nurses are leaving, in some cases, to what is seen to be greener pastures there, and we can’t afford to sit and watch. We have to do something.”

Reduced processing capacity due to lockdowns here and abroad, as well as travel restrictions worldwide, have wreaked havoc in the immigration system during the pandemic.

As of July 31, more than 561,700 people were in the queue for permanent residence and 748,381 had a pending temporary residence application as students, workers or visitors, while the backlog for citizenship stood at 376,458 people.

Traditionally, many internationally educated nurses from the Philippines, the Caribbean and Africa arrive and work as foreign caregivers while trying to register and restart their licensing process in Canada once they’re here.

The permanent residence backlogs for foreign caregivers began long before the onset of the pandemic in early 2020. In April, Immigration Minister Marco Mendicino announced a move to prioritize the permanent residence applications of 6,000 caregivers by Dec. 31.

The immigration department said it had processed the applications for a total of 3,253 people under the initiative up to Oct. 17, but it’s not known how many of those were caregivers because the number included their family members. Officials were unable to say how much the caregiver backlogs have been reduced since the announcement.

“Immigration, Refugees and Citizenship Canada has prioritized applications from workers in essential occupations in agriculture and health care, where labour is most needed to protect the health of Canadians and ensure a sufficient food supply,” said department spokesperson Rémi Larivière.

“Applicants who intended to work in agriculture or health care but who applied for an open work permit and didn’t have a valid job offer in advance would not be triaged for priority processing.”

Deauna said she was thrilled with the government announcement, but feels those with pending nursing licences should be fast-tracked if Canadian officials are serious about addressing the shortages of nurses in the country in the wake of the pandemic.

She applied for permanent residence and the bridging open work permit in August 2020 but only received an acknowledgment of receipt this past June. Her caregiver work permit has expired since June.

The Ontario licensing process requires of applicants practical nursing experience within the three years before a certificate of registration is issued.

Deauna fears she may have to go back to the Philippines to get back to practice and restart the licensing process if her immigration and nursing certificate don’t come through before June.

“I can’t afford more delay in my permanent residence or open work permit,” she noted.

Leslie Apurada arrived in 2018 under the home support worker program to look after an elderly man with dementia in Montreal and initiated her licensing process with the Ontario College of Nurses a year later.

The former Filipino registered nurse with a psychogeriatric background underwent Canada’s national nursing assessment, registered for prep courses and sat for — and passed — a couple of required nursing exams, all while working full time to look after her client.

Even though her employer was supportive and tried to spare her from overtime work while she was studying for exams and attending courses, Apurada said she was mentally and physically exhausted jumping through all the hoops to get past the final qualifying test in June. She’s since been waiting for her immigration authorization to work.

“During the height of the pandemic … Canada’s prime minister said we’re all in this together. But we, caregivers, feel we’re always pushed to the sideline. No one really answers to us why the backlog for the caregiver programs has been so extensive,” said the 31-year-old, who is now enrolled in an online course about nephrology at Humber College.

“It’s disheartening to see how strained the Canadian health system is while all along we are here. We’ve passed all the exams and we could’ve helped.”

Karla Ducusin, another former RN from the Philippines, came to Canada in late 2018 by way of Israel to look after an elderly couple with medical needs in Markham. She’s responsible for preparing them meals, administering their medications, escorting them to doctor’s appointments and helping with household chores.

The permanent residence application that she filed last October costs $1,050 and each time she extends her caregiver work permit, it’s another $155.

Given she’s now in Canada on the so-called implied status — in transition with a pending permanent residence application in the system, Ducusin said she has lost her OHIP, which requires a temporary foreign worker to have a valid work permit to be eligible. Her caregiver work permit expired last November.

“I want to be able to help my family more financially. My father is sick and my two younger brothers are not working. I could make a lot more money and pay more taxes as a nurse than as a caregiver,” said the 32-year-old, whose file will be closed by the College of Nurses of Ontario if there’s no update for two years.

“This is putting a heavy toll on our mental health. You wake up every day and there’s still no movement in your immigration application. It’s just so frustrating.”

Source: Canada has a big-time nursing shortage. So why can’t these two fully certified nurses get the OK to practise?

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Helping immigrant nurses a ‘win-win’ for Canada: Study

2015/11/02 Leave a comment

An example where more effective foreign credential recognition and related bridging programs can help:

As baby boomers age, Canada faces a looming health-care crunch that will be exacerbated by a projected shortage of tens of thousands of nurses.

That makes it more important than ever for Canada to help foreign-trained nurses qualify to practice here, according to a Conference Board of Canada study.

Each dollar invested by Ottawa and provincial governments in helping registered nurses acquire Canadian licences generates $9 in future income tax revenue — a nine-fold return, according to the study — not to mention their contributions to the care of the country’s rapidly aging population.

With seniors outnumbering children for the first time ever, according to new Statistics Canada figures, and a projected shortage of 60,000 nurses by 2022, investing in bridging programs makes immense sense, experts say.

“This is a win-win for Canada and the internationally educated nurses (IEN),” said Michael Bloom, the conference board’s vice-president in charge of industry and business strategy. “The concept of investing in career bridging programs is good and sound. It yields returns.”

According to the study, more than half of immigrants with health professional backgrounds have trouble getting their foreign credentials recognized in Canada, compared to just 40 per cent in other regulated professions.

In 2011, only 54 per cent of foreign-born and educated nurses had a job that matched their education in Ontario, with unemployment rates among foreign-trained registered nurses at 6 per cent and 8.3 per cent among registered practical nurses.

Source: Helping immigrant nurses a ‘win-win’ for Canada: Study | Toronto Star

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Immigrant nurses face new hurdles with Ontario’s licensing changes

2014/11/13 Leave a comment

Another example of foreign credential recognition challenges. Given that the certification  is test scenario-based, expect that the main challenge is not technical but contextual and related to how one interacts with patients and colleagues.

But the lack of appropriate training and feedback should be addressed:

The report, released this summer, found that “some internationally educated applicants do not receive adequate explanation about their shortcomings on the OSCE.” And since there are no appeals or repeat tests allowed, “it leaves applicants with no option but to proceed to bridging education if they wish to continue with their RN application,” the report says.

“It is unclear why, regardless of the number of gaps identified in the OSCE, applicants who want to proceed with their RN application must take an entire bridging program. There is no sound justification for the ‘one size fits all’ approach.”

The college said it brought in the OSCE test for foreign RN applicants because it is an objective tool to evaluate competencies.“

It is not an ‘exam’ in the usual sense of the world. It is a holistic assessment of the applicant’s knowledge and experience. . . . They come out of it with a better understanding of which missing competencies they need to address,” said Clarke.

“It’s like getting a second opinion about how well an applicant’s education and experience match the competencies required of a nurse in Ontario.”

Immigrant nurses face new hurdles with Ontario’s licensing changes | Toronto Star.

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