Arundeep Dhadwal, an internationally-educated nurse (IEN), came to Canada in 2009 from Chandigarh, India, to make her late father’s dream come true – he wanted to see her succeed in her nursing career.
Jignesh Joshi, also an IEN, came to Canada in 2010 from Ahmedabad, India, for the good lifestyle the country promised. He saw it as a safe place with good infrastructure and well-established systems.
Both Joshi and Dhadwal also wanted to move to a country where nurses got more respect than they did in India.
“In India, nurses don’t get the kind of respect they deserve for all the work they do,” says Joshi. “I’d heard that here nurses work as part of a team with the physicians.”
Both came to Canada with big hopes and both hit the roadblock many internationally-qualified professionals face.
Joshi found getting a foot in the door, becoming a part of the system, incredibly tough.
“To get Canadian experience, you have to volunteer, maybe go back to college for some courses... my wife and I knew no one in Canada when we moved. I was the first person in my family to be here and we had to do everything ourselves, learn by making mistakes.”
Unable to find work as a nurse in Canada in spite of having four or five years of experience in ICU nursing and ER in India, Joshi picked up odd jobs as a labourer to make ends meet.
“People ask for experience, for references, how can a newcomer give these?” he asks.
Dhadwal describes the early period as very difficult. “I’d never imagined it could be so hard, it was a struggle,” she says today, looking back.
She found work through a temp agency.
When she had contacted College of Nurses in Ontario (CNO) while still in India, she’s been told it would take four to five months for her to get the letter that would allow her to sit for the certifying exams. She missed the mark by one per cent and found work as a file clerk at a doctor’s office while trying to figure out her options.
She was determined to pass that exam come what may. She also helped translate for patients who were not fluent in English and helping them gave her a sense of hope.
It was to help IENs like Joshi and Dhadwal that Zubeida Ramji co-founded the CARE Centre for Internationally Educated Nurses in 2001.
Funded by the government of Ontario, CARE provides immigrant nurses with a continuum of service to support them to be successful and has helped hundreds of internationally-trained nurses find meaningful employment in Ontario.
Having worked as a frontline nurse and in supervisory roles in three provinces, Ramji was well aware of the significant issues faced by foreign-trained professionals.
“I saw how newcomers faced barriers in education, health and employment. And of course, barriers to internationally educated nurses were core to that. There were so many stories of how they transformed their lives, putting aside years of education and lots of experience, abandoning their hopes and aspirations.
“We knew of the reality of the barriers internationally-educated nurses faced,” says Ramji. “And we knew employers were concerned about whether their staff could respond to the needs of a diverse population. Well, one obvious way to fix the disconnect was to hire a diverse staff!”
Joshi, who got his RPN (Registered Practical Nurse) licence from CNO, says he wishes he’d known about CARE when he started out.
After qualifying for immigration, Joshi wanted to get a head start by registering as a nurse in Canada. He didn’t have the name of the organization and all his searches led to CNO.
Joshi was confused. Back home, one went to a college to study, and to a council to register as a nurse. He gives this as just one example of valuable time he lost.
“They could have helped me fill out forms, given me information about exams, the qualifying process, I would have begun volunteering earlier, I would have had access to job shadowing that CARE provides for its members.”
When he did join, Joshi’s case co-ordinator helped him choose a course he required, helped him apply for a bursary and arranged job shadowing opportunities.
Dhadwal’s online searches also led her to CARE, where her case co-ordinator guided her and provided emotional support.
“She pushed me when I was ready to give up. She suggested courses at George Brown College which I did, but I continue to go back to her just to talk. I still follow the schedule she drew up for me. Nikki became a friend.”
Dhadwal formed some strong, nurturing relationships with others at CARE.
“They helped me prepare for the Registered Nurse exam. There’s an amazing nurse, Lindy Lewis. I wanted to learn from her and CARE arranged for her to come teach us. She even came to my convocation. Who does that?They knew how I was struggling, they knew how important it was for me to pass that exam.”
But helping IENs is not as simple as creating a bridge to cross the barriers to employment.
All nurses from all countries are not equally-qualified to practise in Canada.
Ramji, who serves as CARE’s executive director, says, “Nursing goes way beyond the biomedical knowledge – it’s about many other skills including an understanding of the culture of healthcare in Canada. Nursing is a regulated profession in Canada. There are processes here to be gone through. Very rigorous processes.”
In Eastern Europe, nursing is a three-year course while in Canada, it’s a four-year Baccalaureate program. In many countries, there is just the one category whereas here, there are Registered Nurses, Registered Practical Nurses and the new emerging category of Nurse Practitioners.
Ramji points out that in many countries, the role of a nurse is subservient to that of a physician. In Canada, you are expected to be a fully functioning member of a team. And in some countries, nurses may be tech savvy, but not comfortable on computers when it comes to work. Comfort level with technology is a basic requirement in Canada as video-conferencing forms a very vital link in the healthcare services in remote areas of the country.
Then there’s terminology embedded in the role and culture of health care. It’s not just the words, as Ramji points out, but the cultural context, the verbal and non-verbal behaviour. Language is learned by being immersed in a culture, a soft skill that applies to interpersonal communication in any area of work. She speaks of a study that demonstrated that over 60 per cent of a nurse’s work has to do with language.
“Nursing is totally different in two countries. The fundamentals are the same, obviously – how to give an injection and things like that – but the paperwork, policies and procedures, those are very different. Even the attitudes and personalities of nurses are different. I’ll give you an example. Back home, the concept of privacy and confidentiality is still a developing one. One routinely shares information about a patient with family members. Here, we can’t tell even the spouse without the patient’s permission.
“Back home, you’ll find very few cases where licences were suspended, it’s extremely rare. Here, not so! Here there are restrictions you work under and the pressure to meet standards.”
He signed up for courses in wound care and health assessment.
Dhadwal signed up for the workplace communications course at CARE.
“I learned there are different ways to say the same thing! Names of medications are pronounced differently. Sometimes an accent can come in the way of communication effectively. During the course, they test you even for phone conversations, where you can’t gesticulate or communicate with facial expressions. They show you how to rephrase a question without upsetting the patient or the doctor you are speaking to.”
CARE can help those nurses who have obtained a letter of assessment from the Ontario College of Nurses. Once the equivalency to locally educated nurses is determined, they are eligible to write the licensing exam.
Of course, just because one is eligible to write the exam does not necessarily mean one will pass the exam.
Nurses who may have worked for many years in neonatal care, for instance, may be specialized in that field. But while gaining that experience, they might become less current in other areas of nursing. The exam in Canada tests a nurse’s knowledge of all fields – everything from mental health to workplace health and gaps may be identified in the curriculum in the home country.
CARE helps prep clients for the exam. Academic courses may be suggested to help them understand the professional and legal framework in which nurses work in Canada. A brush-up of the knowledge base as well as communication skills, specifically communication skills within the nursing context, may be required.
Each client is assigned a case manager who works on an individual action plan based on his or her need. Care provides observational job shadowing and after passing the exam, help with job search.
Over the past few years, CARE is also doing pre-arrival work with Canadian Immigrant Integration Project (ciip), helping prepare internationally-educated nurses prepare for the challenges they may face in Canada before they leave their home countries.
It took her two years of working part-time at the clinic while working part-time as a cashier at a department store to supplement her income while she did her courses, but Dhadwal is an RN today.
She works at a nursing home where continuing care is provided to patients who are discharged from hospitals but can’t go home.
“I am in-charge of all procedures,” she says with pride. “I monitor the patients, they are my responsibility.”
Having worked three jobs, seven days a week, in the initial period, Joshi now works as a clinical supervisor of personal support workers at Red Cross Care Partners.
He was also, he shares with pride, assigned supervisor to a physician by the College of Physicians and Surgeons of Ontario (CPSO).
“No one believes me when I tell them that I supervise a doctor!” he says with a laugh. “I’m called a chaperone and every three months I send a report.”
He knows many IENs looking for work in their field and is happy to help, to share his experience.
He tells them to focus on their field of choice.
“Pick one – Operating Room, Emergency, ICU – and focus on that instead of moving randomly. Don’t try and do everything all at once. Start as a volunteer, gain practical experience. Volunteering can also lead to your getting hired. Get certification in the field. I was looking for admin work and found a good position.”
He says IENs who drive can try for home visit nurse jobs, but admits that while newcomers may be able to purchase a car, many can’t afford the insurance payments.
He also tells IENs looking for jobs to broaden their field of search.
“Everyone wants to be in the GTA! But there are limited opportunities there. Be willing to move to the periphery – I have worked in Sudbury!”
Dhadwal refers IENs to CARE.
“People want short cuts. They don’t understand the process involved. This nursing licence is a lifetime thing, you have to give it the required time to earn it.”
To-date, CARE has helped over 1400 nurses from 140 countries – the largest number being from the Philippines followed by India – find employment in Ontario.
For more info, visit www.care4 nurses.org.
New initiative supports transition to work
Every year, internationally-educated nurses bring valuable knowledge and experience to Ontario healthcare organizations. To support those who are newly registered in the province, and are looking to gain experience or a full-time position, the Ontario government has launched the Nursing Career OrIENtation (NCO) Initiative.
“Many nurses who studied abroad are eager to find a job,” says Zubeida Ramji, Executive Director, CARE Centre for Internationally Educated Nurses. “The NCO Initiative provides eligible nurses with the opportunity to apply and compete for permanent, full-time employment and supports their transition into practice in Ontario.”
Through the NCO Initiative, employers receive up to 26 weeks of funding for a temporary, full-time nursing position that is over and above their regular staffing complement. Nurses receive an extended orientation and one-on-one training to better develop their skills. Nursing opportunities are available across a variety of sectors, including: acute care, long-term care, home care, community care, primary care and public health.
“The NCO Initiative doesn’t just benefit these nurses – there are advantages for employers, too,” says Ramji. “It supports efforts to recruit and retain nurses, and helps level the playing field for all organizations, regardless of their size, including the ones in rural and northern areas.”
Eligible internationally-educated nurses include those who have never worked in a paid nursing position in Canada before, and have received their General Class Registration from the College of Nurses in Ontario (CNO) within the last six months.
Internationally educated nurses who would like to register in Ontario can learn more by visiting the CNO website at www.cno.org.
For more information about the NCO Initiative, visit www.healthforceontario.ca.
CARE members’ profile
Most members come from the Philippines, India, China and Iran.
70 % are pursuing an RPN license.
Over 73% have at least a bachelor’s degree.
10% have education at the Masters level.
74% are permanent residents and 8.5% are men.
51% have nursed for more than six years.
68% have been in Canada less than three years.
47% had employment in non-nursing jobs when they joined CARE Centre.
76% found employment in nursing within 9 months of registration.
64% gained work as RPNs.
41% found full time employment, 44% part time jobs,
15% are working on casual status.
RPN nursing wages range from $45,000-$55,000 per annum.
Where CARE Centre members are employed
14% Community nursing/public health
30% Acute care
46% Long-term care
5% Nursing agency