Posted on November 18, 2010 by rkhan
Authors: Jennifer Blythe & Andrea Baumann

Executive Summary:

Ontario does not educate sufficient nurses to avoid a serious shortage in the future. Therefore, it is essential that planners understand the importance of internationally educated nurses (IENs) as a supply source. This report builds on Report Number 3 in the Health Human Resource series (Baumann, Blythe, Rheaume, & McIntosh, 2006) and answers three questions: What are the characteristics of the Ontario IEN workforce? What factors are likely to influence IEN supply in the future? What are the implications of IEN migration for policy making and workforce planning?

Characteristics of the IEN Workforce

Over half of all IENs in Canada work in Ontario and comprise 10.78% of the provincial nursing workforce (College of Nurses of Ontario, 2007c.) Among nurses working in Toronto, about a quarter was educated abroad. Most internationally educated registered nurses (RNs) in Ontario come from 10 countries, with about one-third from the Philippines. The workforce profiles of IENs from these countries differ from each other and from Ontario educated nurses. Few IENs are under 30 years of age, but their age composition varies by country. Nurses from the UK are the oldest contingent and Romanian nurses are the youngest. Groups from the USSR and Yugoslavia include proportionately more men. Nurses from the Philippines, Eastern Europe and India have the highest rates of full-time work; nurses from the UK have the lowest. Most IENs work in direct practice and the majority work in hospitals. However, frequencies vary by country. For example, one-third of the nurses from China and Yugoslavia work in long-term care, proportionally more than from the other groups.

Numbers of IENs entering the workforce decreased in the 1990s, increased dramatically in 2004/5 as IENs made efforts to obtain licenses before regulations for entry to practice changed, then fell abruptly in 2006. Eastern European countries ceased to be among the top 10 IEN groups entering the workforce that year. In contrast, numbers of registered practical nurses (RPNs) entering the workforce doubled between 2005 and 2006. Rates of attrition have varied among IENs during the past decade, but overall gains have been relatively small. There were only 824 more IENs in the workforce in 2006 than in 1997.

Influences on IEN Supply

Migration usually occurs from poorer to richer nations. Global forces, push-pull factors and policy decisions all influence migration. While the worldwide nursing shortage has affected nurse migration, individual nurses have multiple motives for leaving their countries. The International Council of Nurses encourages countries to be self-sufficient but upholds the freedom of nurses to migrate. Policy decisions affect the volume of migration. The US has been assertive in attracting IENs and provides National Council Licensure Examination (NCLEX) RN testing worldwide. Canadian provinces vary in their overseas recruitment efforts.

Internationally educated nurses come from source countries with different economic characteristics. These include populous developing countries such as the Philippines and India that educate nurses for export, politically or economically unstable countries (e.g., Iran and the former USSR) and developed countries such as the UK, which acts as a conduit for nurses intending to settle in the US or Canada. Rates of migration from Africa are low, but the loss of even a few nurses negatively affects small workforces in the continent.

Implications for Policy

Without IENs, the nursing shortage in Ontario would be more severe. However, fewer IENs may enter the Ontario workforce as RNs in the future. Encouraging IENs to prepare for RPN examinations may be a useful strategy, but international competition for nurses is increasing and additional strategies (e.g., allowing nurses to take licensing examinations before migration to Canada) may be warranted.

Source: NHSRU