Sidelined and underutilized: Red tape, finances discouraging thousands of internationally trained nurses already here

Ontario needs to hire 24,000 nurses to meet the national average; a significant way forward to meet this number is the commensurate use of Internationally Educated Nurses (IENs) already in the province. Action must be taken to reach these nurses where they are and remove the obstacles preventing registration.

Policies such as the Supervised Practice Experience Partnership (SPEP) program that provides opportunities to meet nursing registration requirements through supervised practice, financial supports for exams and registration fees and regulatory modernization have allowed progress, with more than 5,000 IENs becoming fully registered/licenced in 2022. The relatively new SPEP program is a targeted initiative that seeks to assist IENs in meeting language or recency of practice requirements.

Despite these reforms, we remain thousands of nurses away from the desired and needed level, raising questions as to how the shortfall will be met. These questions are difficult to answer accurately given the fragmentation and gaps in data about internationally trained nurses already in Canada.

Counting on Care: A Survey of Internationally Educated Nurses Not Working as Nurses in Ontario, a World Education Services (WES) report, surveyed 758 IENs in Ontario to measure the underutilization of IENs and to point to their potential to fill the nursing shortage.

The WES survey indicates that 50 per cent of IENs in Ontario have yet to start the registration process, 38 per cent are already in the process but not yet registered/licenced, and a further six per cent have no intention of resuming nursing practice in Ontario.

“Financial constraints” was noted as the No. 1 barrier for all IENs. This, plus a lack of clarity in the registration process and immigration status formed the main concerns of those who had not yet started registration but intended to (the aforementioned 50 per cent). As one IEN from Hong Kong explained: “A significant problem appeared after I had applied to a clinic and secured an interview. I discovered that my work permit from IRCC (Immigration, Refugees and Citizenship Canada) imposed a condition that prevented me from working in the health-care field, despite having a background in nursing. I had to decline the interview and proceed to amend my permit conditions, which took about four months.”

The IEN continued: “I think that Canada must streamline the evaluation process. I understand the importance of a comprehensive evaluation to ensure the quality of nursing, but I think it is important to reach a balance between maintaining standards and minimizing the evaluation time so that we can contribute our skills and expertise in a new environment sooner.”

According to the College of Nurses of Ontario (CNO), as many as 7,534 IENs are currently in the process but not yet registered, a category that comprised 38 per cent of the WES survey respondents. Many in this group have yet to take the necessary exams; others noted equivalency in educational requirements and recency of practice as major factors. Recently, the CNO has proposed changes to reform the educational equivalency requirements. These proposals would recognize Bachelor level nursing education, approved in an international jurisdiction, as meeting Ontario’s educational requirement for registration.

A further six per cent of respondents said they had no intention of applying because of what they deemed to be an unclear, long and expensive process. Anas Abidrabbu, an IEN from Jordan, said, “If I had the choice to return to nursing, I would not work as a regular duty registered nurse. Maybe I would go into a more administrative or technical role based on my experience in health informatics, risk management and quality assurance. But I don’t want to repeat the process to qualify. The process is lengthy, and I don’t think it’s worth it, to be honest. Especially when I compare the income that I would make in nursing compared to another career.”

Correcting inefficiencies in the process and addressing financial concerns could incentivize this category of IENs to return to their professions.

Further attention is needed to analyze the obstacles currently delaying the process of registration and influencing the decision to not practice. If not, these nurses will continue to be underutilized within the health-care sector (79 per cent of those employed in our survey reported working in non-nursing allied health roles) or outside of the health-care sector (21 per cent), with only 30 per cent reporting that their job uses all or a lot of their nursing expertise in either category.

The WES offers three recommendations to help put IENs already in Ontario back to work as nurses rather than focusing on recruiting from abroad:

  • Support health-sector employers in identifying the IENs already working for them in non-nursing roles and assess the supports they need to re-enter their careers.
  • Provide financial support to stimulate an increase in licensure applicants, particularly among the 50 per cent of IENs who have intentions to apply and increase funding toward programs aimed at addressing common barriers, such as providing supervised practice opportunities.
  • Reduce the complexity and provide navigation supports from immigration to registration/licensure to incentivize the six per cent of nurses who currently have no intention to apply.

World Education Services is a non-profit social enterprise that supports the educational, economic and social inclusion of immigrants, refugees and international students.



Research Report Authors:

Caroline Ewen Manager of Policy & Advocacy; Strategy, Policy & Research, WES

Marlena Flick Research Manager; Strategy, Policy & Research, WES

Joan Atlin Director; Strategy, Policy & Research, WES


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Makini McGuire-Brown


Dr. Makini McGuire-Brown is an internationally trained physician and Manager of Policy & Advocacy at WES. She is a PhD Candidate in Administration with a focus on health and accounting at the Schulich School of Business, York University.

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