International nurses told 'leave the N.W.T. then come back'
Sarah, not her real name, moved to Yellowknife to pursue a career in nursing in 2021. She is what Canada terms an “internationally educated nurse,” or IEN, meaning she received her training in another country – in this case, India.
Internationally educated nurses wishing to resume their work in Canada have to follow each province or territory’s process to become a fully licensed registered nurse.
In the N.W.T., Sarah says, the process has felt almost impossible – at a time when the territory is finding it hard to recruit nurses and spending millions of dollars a year on agency nurses to fill gaps.
The College and Association of Nurses of the Northwest Territories and Nunavut, known as CANNN and previously named RNANTNU, is the two territories' regulatory body for nurses.
According to CANNN’s policy, internationally educated nurses who want to work in those territories must gain practice hours – the hours needed to acquire or maintain a registered nurse’s licence – in another Canadian jurisdiction, for a minimum of 1,125 hours, prior to being able to register in the North..
Sarah already has registered nurses’ licences from two provinces, Ottawa and Alberta, and 4,000 practicum hours of training from India. To her, the requirement that she head south for another 1,125 hours before she can work in the N.W.T. feels unnecessary and unusual. In her experience, southern provinces often try to make it easier for nurses like her to gain a licence rather than sending them elsewhere.
Unlike other jurisdictions, Sarah said, the territory has neither a bridging program for IENs nor any means to acquire supervised hours locally.
When Sarah approached CANNN to inquire about alternatives besides temporarily leaving the territory, she was told there were none. She said she even asked to work without pay under an experienced nurse in Yellowknife until she gained the required hours, but was told no.
"You can't say, 'Leave the territory and come back after eight months.' Why will I come back after eight months? Why will I come back from Alberta if I work there to get my hours and get the same pay as here?” Sarah said.
“Living in the N.W.T. is expensive – the rent, the groceries. There are no reasons to come back."
Sarah says she knows of at least one other nurse in a similar position who flew to Ottawa and stayed there. Meanwhile, Sarah can’t help but notice “open until filled” positions racking up on the GNWT’s website. “But I can’t apply because I don’t have a licence here,” she said.
“They need the nurses here. There’s a chronic shortage of nurses.”
Scott Robertson, a registered nurse and healthcare consultant in Yellowknife, says Sarah is not the first person to find this exasperating.
"Previously, I have spoken to nurses who have gone through this process, had to go to Alberta first and go through all the steps there before they can apply to work in the Northwest Territories," Robertson said.
"It can be a very complicated, frustrating and inconsistent process."
Trista Haugland, a spokesperson for health minister Lesa Semmler, told Cabin Radio Semmler “is eager to streamline the registration process for internationally educated nurses” in the N.W.T., but the minister isn’t the one in charge.
CANNN manages registration, Haugland said, adding that CANNN “may lack capacity due to complexities of the process,” which may explain why nurses end up being sent elsewhere.
Although the Nursing Profession Act does not speak specifically to internationally educated nurses, the N.W.T.'s health authority says the legislation gives CANNN "broad bylaw-making powers" to set out how registration for international nurses should be handled.
A health authority spokesperson said CANNN decides which education programs are accepted, what kind of English proficiency is needed, and what other requirements may be necessary “to protect the public and the profession.”
Denise Bowen, executive director of the College and Association of Nurses of the Northwest Territories and Nunavut, declined to comment.
In an email seen by Cabin Radio from November last year, CANNN's former executive director Colleen Bytheway told one prospective nurse: "While I cannot promise anything at this point, I know the board is currently giving serious thought to waiving the 1,125 hours required of IEN RNs to practise here."
"If they do that, we still do not have the capacity here to review IENs' requirements. This means you would still have to go through that process elsewhere, but once you were licensed in another jurisdiction, it may be just a matter of registering here and paying your fee," Bytheway's email continued.
Sarah recently cleared the NCLEX-RN, which she described as a "really, really difficult" assessment exam for nurses. To prepare for the test, she took a year away from full-time work. She said her partner supported her financially during that time.
"We have flown to Edmonton twice to write that exam, because we don't have a centre here," said her partner, who also asked for anonymity to discuss Sarah’s sensitive employment situation.
"All in all, she has spent resources like money, time, and working hard to get the licensing done, and now she cannot work. So it’s about almost three years of trying to navigate the system to see where she can get her licence.
"There should be something for internationally educated nurses. Any other provinces have reduced the requirements to get nurses on board so they can fill the gaps to provide the best services to Canadians. But here, that hasn't been the case for years."
Change has been taking place elsewhere in Canada.
For example, Alberta's regulatory body for nurses made changes last year to its application process for internationally educated nurses. The College of Registered Nurses of Alberta (CRNA) says that decision stemmed from "recognizing that the system had too many barriers."
"We made changes to the process in order to provide applicants with a fair and predictable application process, regardless of their origins," a CRNA spokesperson told Cabin Radio.
Subsequently, the body says, it noticed a 10.6 per cent year-on-year increase in permit renewals in the 2023-24 year. CRNA said changes to the application process did not alter its 10 requirements of all applicants who seek a practice permit.
"Now, they have greater flexibility in how they can provide evidence of meeting some of them," CRNA noted of those requirements, adding that the goal was to make it easier for IENs "to be recognized for their skills and experience in an equitable manner."
Creating a facility for IENs to gain practise hours while living in the North would mean investing in specialized senior nurses who are skilled to assess IENs' competency, Robertson said.
For large jurisdictions like Alberta, he said, that works. In the territory, however, he feels investing in a full-time position to make those assessments may not be a viable option.
"In larger jurisdictions, where we have 100 applicants every year, we can have full-time people doing that job. If we have four or five or even 10 a year here, that might be enough to keep somebody employed," he said.
"Also, because the North is small, if we hire someone to do it and they leave for another job, you can't hire another person to do that job off the street the next day. It's very challenging to do that sort of specialized work when you don't have backup to do it."
Robertson said experienced nurses within hospitals are often asked to act as mentors for newer staff, which can act as another drain on resources if not managed properly.
"Often, a nurse is asked to do that for free, or that's expected to be part of the job. It's a lot of work to do that,” he said.
"We need to make sure they have the right supports in place so that we're also supporting the nurses that are here, allowing new nurses to become successful without burning out the nurses that we always ask, over and over again, 'Hey, can you orient this new person? Help train this new person?'"
Ultimately, Robertson said, the N.W.T. needs to work on keeping its experienced nurses as much as it needs to recruit new ones.
"Fundamentally, we need to ask: Why are nurses not coming from around Canada to come and work here? Why aren't they coming to live here? It's expensive. The wages are not as competitive as they used to be," he said of recruitment and retention challenges the territory faces.
"Anyone that's looking for a job will go where it's best for them. From a morale standpoint, we need to make sure that we're investing in keeping nurses that we have here. Experienced nurses are so, so, so valuable to us.”
Aastha Sethi, Local Journalism Initiative Reporter, Cabin Radio
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