Internationally Educated Nurses

CFNU’s Position Statement about Internationally Educated Nurses

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In an attempt to address the nursing shortage crisis in Canada, which has been significantly worsened by the COVID-19 pandemic, many provincial governments are turning to internationally educated nurses (IENs), both those currently in Canada and to their international recruitment.

The CFNU believes that a focus on recruiting nurses internationally as a first priority is misplaced. Recruiting nurses internationally should be part of a comprehensive health human resource plan. All efforts to address nurse shortages within the domestic context must be a priority for all provincial and territorial governments. A multi-pronged approach to health human resources must focus on both short-term and long-term measures to enhance the retention and recruitment of nurses within Canada, which would include IENs.

The CFNU endorses the ethical recruitment strategies as outlined by the International Council of Nurses (ICN) and encourages governments and organizations, including employers, recruiters, and non-governmental organizations, to adopt the ICN principles[1], including:

• Access to full and flexible employment opportunities
• Regulation of recruitment and good faith contracting
• Comprehensive and effective nursing regulation
• Freedom of movement, freedom of association, freedom from discrimination
• Equal pay for work of equal value
• Access to grievance procedures, safe work and effective orientation/ mentoring/ supervision
• National self-sustainability to effectively match health human resources to population needs

In keeping with these principles, the CFNU would discourage the targeted recruitment of nurses from countries that are experiencing a chronic or temporary shortage of nurses. When international migration occurs, the CFNU will advocate to protect nurses’ interests and rights to ensure decent work. The CFNU also strongly supports IENs’ right to freedom of association, including the right to join a union in the pursuit of collective workplace goals arrived at through the collective bargaining process.

The CFNU recognizes that many internationally educated nurses currently in Canada are unemployed or underemployed. Internationally educated health professionals are significantly less likely to work in their field than their Canadian-born counterparts. Faced with many barriers to employment in their fields, many internationally educated nurses may experience deskilling. Getting a good data picture is difficult, but we do know that thousands of internationally educated nurses have applied to nursing regulators to work in nursing. Even as Canada desperately needs nurses on the front lines, non-practising nurses continue to be unemployed or underemployed. IENs may be working as personal support workers, as live-in caregivers, in home care, or even in non-health care jobs like retail – because the barriers to working as a nurse in Canada are onerous, expensive and time-consuming. According to World Education Services, many of these nurses will be unable to return to practise in their chosen field.

Internationally educated nurses have the right to expect appropriate clinical and cultural orientation, and supportive supervision in their workplaces. IENs have the right to fair and equal treatment on employment-related issues, including working conditions, promotion and access to career development. They must be educated about union rights and occupational hazards, including workplace violence. When nurses’ rights, benefits or safety are threatened or violated, appropriate processes must be in place to hear grievances in a timely manner.

The Canadian Federation of Nurses Unions (CFNU) and its Member Organizations are committed to representing our IENs and ensuring that they are educated about the provisions in the collective agreement, and ensuring that IENs have access to all provisions within it and are supported by the union. Nurses will be provided with a union orientation, focusing on areas such as seniority, job postings, hours of work, overtime, no discrimination/harassment, etc., to ensure that they are aware of their rights and are able to actively participate in the workplace. Nurses’ unions will actively engage with employers to ensure that IENs have conditions of employment as favourable as those of other nurses in Canada, and to encourage a workplace environment that is culturally safe, and respects diversity and multicultural perspectives. IENs will be provided contact information for union representatives, who will provide advocacy and support for workplace issues.

On an immediate basis to help address the nursing shortage, Canada and employers must act to better utilize internationally educated nurses in Canada.

Federal and provincial governments must adopt a pan-Canadian approach to addressing the underutilization of IENs systematically, and in a coordinated and coherent way, including:

• Establishing a dedicated coordinating body to address critical health workforce data gaps, including with respect to basic data on IENs currently in Canada (i.e. numbers, status in licensure process) to significantly enhance existing health workforce data infrastructure, standardize data collection and analysis across workers, sectors and jurisdictions.
• Creating a coherent system-wide approach across the country, built by all the key stakeholders that would ensure systematic, equitable and accountable labour force integration of IENs. The strategy must address the three interconnected elements of the IEN journey, and the roots of underutilization and inequity: the immigration and licensure process, as well as employment.
• Implementing existing best practices and solutions, drawing on the dozens of successful programs and models that exist across the country (and internationally) to effectively assess, orient, bridge or upgrade, where necessary, and integrate IENs into our workplaces. Scale up externship pilots and expand successful externship pilots, including in LTC, community health and home care settings.
• Taking a multi-stakeholder approach, bringing all players to the table, to identify the barriers and design solutions collaboratively, engaging governments, occupational regulatory bodies, employers, unions, health education faculties, immigrant service delivery agencies that support IENs, consulting directly with IENs themselves and the unions that represent them.
• Providing financial support to preceptors and for the cost of the registration support.
• Developing national strategies to recognize the contribution of IENs and to encourage an environment that respects diversity and multicultural perspectives.

The employer must demonstrate accountability for third parties contracted to recruit nurses, including the following:

• Appropriate accommodations
• Relocation allowances
• Demonstrated sensitivity and attention to cultural issues faced by both internationally educated nurses and their co-workers
• Facilitating contact so that internationally educated nurses are assisted in establishing a community

Ensuring that any recruitment initiatives do not create additional fees or barriers to IENs obtaining employment in Canada and joining one of its affiliate bargaining units

[1] International Council of Nurses (ICN). (2019). ICN Position Statement. International career mobility and ethical nurse recruitment. Retrieved from https://www.icn.ch/nursing-policy/position-statements