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Ask Tito Mike by Michael Scott  

Provinces move to address the nursing shortage

by Michael Scott

There is no question that Canada is desperately seeking internationally trained nurses (ITN) to work in Canada. All provinces are facing a severe shortage of registered nurses and they are working to remove obstacles for nurses trained abroad.

The College of Registered Nurses of Manitoba announced in November 2022 that they would accept applications from those who do not have landed status in the country. This opened opportunities for nurses currently inside the country on temporary immigration status, visitors, students, and overseas foreign workers to start the process of obtaining the necessary license to work as a registered nurse inside the province. The provinces are currently offering cash incentives up to $10,000 to induce non-practicing registered nurses back to the workplace.

British Columbia recently announced that it is removing some of the barriers for internationally trained nurses to register with the province. BC is no longer requiring application fees and providing new financial support to nurses returning to practice after an absence. The province will now cover application costs and assessment fees, which can cost more than $3,500 as well as up to $4,000 per applicant to cover assessments and travel costs for returning nurses.

“Supporting nurses is key to our work to making health care accessible to all British Columbians. Still, the demand for nurses is outpacing the supply,” said Premier David Eby. “There are talented and skilled nurses with the right experience who want to practice in BC and support high-quality care, but they are kept on the sidelines by an expensive and complicated registration process. Whether a nurse was trained in or out of the province, we are ready to welcome those who are ready to care for British Columbians.”

The incentives in British Columbia have been in place for several years. The BC government announced $12 million in bursaries for IENs back in April 2022. Since the funding was introduced 5,000 people have expressed an interest in nursing in British Columbia and 2,000 applicants are working towards the completion of the registration and assessment process. More than 90 per cent of nursing applications received by the BC College of Nurses and Midwifes came following the cash incentives.

Ontario is another province working to hire and retain IENs. Last fall, Ontario made similar strides toward smoothing the path for IENs. In October, the Ontario Ministry of Health, the College of Nurses of Ontario, and the College of Physicians and Surgeons of Ontario implemented several changes, such as: allowing internationally educated nurses to register in a temporary class and begin working sooner while they work towards full registration; making it easier for non-practicing nurses by being more flexible in allowing time for reinstatement; and introducing an independent practice registration class for physicians from other provinces and territories, making it easier to work up to 90 days in Ontario.

Like BC, Ontario is temporarily covering the cost of fees for examinations, applications, and registration fees for the College of Nurses of Ontario, which can go as high as $1,500. Finally, Ontario has invested $764 million to provide Ontario nurses with up to $5,000 as a retention bonus.

The changes introduced by the provinces are significant but only go part way to addressing the occupational shortage for registered nurses. It is estimated that by 2028 the country will require a total of 191,100 new nurses, but current graduation rates, retention efforts and even immigration changes will only provide 154,600.

Federal immigration and the provincial nominee programs can also change their restrictions on registered nurses. The Registered Nurse (s) NOC 31301 on the recently introduced NOC 2021 can be included on the occupational demand list for the provinces, with a provision for those who pass the National Council Licensure Examination  (NCLEX). They can be given temporary work status such as the designation of “Graduate Nurses,” while they complete the registration and other requirements required for registration by the College of Registered Nurses of the province in question.

It is necessary for the immigration and health authorities to get together on this issue. Some of the barriers, such as the requirement for permanent status, never made sense and can be dispensed with. The immigration status of the applicant was never an appropriate determinant to declare which foreign trained nurse was able to work in Canada. The NCLEX test passer is an appropriate determinant and should be expanded as part of the recruitment of the foreign trained nurses.

It is time to address the immigration barriers themselves rather than encourage ITNs to come on work permits as live-in caregivers with approved LMIAs or foreign students pursuing a short-term course in a related field such as x-ray technician. The option to go around the immigration barriers is tempting and often the only viable route. The solutions are available but the commitment to change is something that must first occur. The licensing bodies and the provinces are all changing and federal immigration must adapt with them if the nursing shortage is to be addressed.

Michael Scott is a Regulated Canadian Immigration Consultant (RCIC, R525678) who has 30 years of experience with Immigration Canada and the Manitoba Provincial Nominee Program. He currently works as a licensed consultant with Immigration Connexion International Ltd. Contact him at 204-691-1166 or 204-227-0292. E-mail: