New employer’s guide to hiring internationally educated nurses

One in 10 nurses working in Ontario today trained outside of Canada. Many foreign-trained nurses are underemployed or have turned to other jobs because of obstacles and barriers they faced while attempting to practice here.

The inability of internationally educated nurses (IENs) to successfully integrate into the workplace is a significant challenge for employers, particularly when faced with a pending shortage of nurses and an increasingly aging patient population. (The Canadian Nurses Association (CNA) projects Canada could be short almost 60,000 full-time registered nurses by 2022 if new policies are not implemented). An increased demand for a workforce that provides culturally, and linguistically, relevant quality care, makes it imperative that care is delivered by a diverse team that can address the complex needs of clients entering the Ontario care system.

For the first time, a guide has been developed for health care employers who wish to diversify their workforce. The guide answers many questions employers have when they hire internationally educated nurses.

With the click of a mouse, employers have leading practice guidelines for hiring IENs at their fingertips with the launch of a web-based guide developed by the Ontario Hospital Association (OHA) in collaboration with the Nursing Health Services Research Unit (NHSRU) at McMaster University.

Internationally Educated Nurses: An Employer’s Guide ( offers extensive resources, interviews with hospital administrators who have developed successful IEN programs and numerous case studies of Canadian institutions who are leading the way. The Saskatchewan Health Region (SHR), for example, has successfully implemented an innovative program.

An SHR team developed guidelines for ethical recruitment of IENs and worked with three recruitment agencies and the Philippine government. The region hired 200 internationally-trained nurses and staggered their arrival to provide enhanced settlement support. Nurses arrived in Saskatchewan in groups of 15 – 30 individuals over an 18-month period.

To track best practices and improve immigration supports for subsequent candidates, recruitment staff collected feedback from each group about their settlement experience. The organization educated its workers, including those in rural communities, about the new staff. The team secured housing, furniture, clothing and food for the nurses, who received help with shopping, paperwork and other aspects of settling in as well as assistance in preparing for the Canadian Registered Nurses examinations (pass rate was more than 80 per cent – exceptionally high for IENs writing their first exam). The province helped cover costs with a Ministry of Health relocation grant of $5,000 for each nurse. This SHR initiative led to its selection as one of the Best Employers for New Canadians in 2010.

Andrea Baumann, scientific director, NHSRU, led the development of the guide with Jennifer Blythe, a senior researcher in the unit.  “In order to provide quality care that is inclusive, it is important to recruit nurses that have a diverse set of clinical interventions. This includes culturally specific care as well as the ability to converse and assess in some of the multiple languages that represent the Canadian mosaic,” says Baumann.

Use of the web guide can lead to “not only effective use of human resources but a more ethnically diverse health care workforce that better reflects both the population and the government’s emphasis on accountability and quality health care for Ontarians,” she says.

The guide is a plain language internet summary that is accessible and comprehensive , targeting key areas such as workforce diversity, regulatory overviews, cultural competence, recruitment strategies, screening processes and hiring practices, bridging programs, settlement support and managers and educators responsibilities.

Where possible, web-based resources are listed, with additional resources on migration, settlement, recruitment and integration, and stories by IENs. The website is accessible globally 24 hours a day, 365 days of the year.

“As hospital employers, we are uniquely positioned to hire and support the integration of internationally educated nurses,” says Verla Fortier, senior consultant, nursing recruitment and retention, at Hamilton Health Sciences (HHS) in Hamilton, Ontario. “The OHA website gives the evidence for why this is a good idea.”

Fortier describes the website as “a welcome and useful information hub for employers and IENs.”

In a video on the website, Fortier describes the success HHS has had in integrating 60 IENs, and nurses who speak English as a second language, into the workplace through its Internationally Educated Nurse and English as a Second Language Integration Project.

In this project, approximately 30 nurses act as integrators, providing information support and advice. A number of interventions focus on learning clinical skills, cultural competence, language, interview skills and use of hospital on-line resources. The program partners with Mohawk College Bridging for Internationally Educated Nurses program, Creating Access to Regulated Employment (CARE) Centre for Internationally Educated Nurses and the Hamilton Centre for Civic Inclusion.

Baumann’s nursing research unit is conducting an on-going evaluation of the HHS program to determine the initiatives that work best and the ones that do not.

While clinical managers within HHS were initially unsure about hiring IENs, Fortier said the program has altered their perspective and they are now asking for “more IEN recruits.”

The website will continue to be developed and refined. A printable version of the guide is in the works.

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