There is clearly a variety of perspectives and expectations among the participants in our study regarding the integration process for IENs. To allow for this variance, one respondent suggested that a system be set up to test the knowledge and experience level of IENs, and create several levels of re-training – shorter for those who are close to being ready-to-practice, and longer for those who are not – instead of accepting or rejecting applicants based on credentials or test scores. The respondent suggested that everyone's goal should be to work together to get IENs working in Canada, not simply to test their knowledge and set up barriers.

It's for the person who trains here needs to be more open, you know, because the person who is coming probably has a little bit of knowledge that it's going to be a struggle. But people over here they don't have it. They think 'Oh, go back from where you came.' That is not the answer. So what I feel is it's not immigrant nurses who need to be taught. When they immigrate they are already prepared but they're going to face a lot of challenges. But the people from here need to know that when the immigrant nurses come they're going to ask a lot of questions so they have to be ready for the challenge. [Québec IEN #2, in progress].

Some respondents went as far as saying that the equivalency process felt like a weeding out process – rather than a process to recognize, upgrade and finally use the abilities and competencies of IENs.

Bien dans ce sens que la formation c'est comme un championnat, oui, la formation c'est comme un championnat, je prends un peu l'image où est le championnat du soccer, on commence par le huitième des finales, il y a des équipes qui tombent, qu'on élimine et puis bon on va en quart de finale, il y a des équipes qui tombent, ensuite en demi-finale et puis bon la finale c'est lui qui est champion quoi...Voilà parce que moi je me dis que si on a plusieurs véritablement agents de santé, il vaut mieux former correctement ceux qui sont dévoués, ceux qui veulent vraiment faire ce travail. Il vaut mieux les former correctement pour que, vous savez la formation il faut mettre l'accent sur la formation pour que les gens puissent sortir pour qu'il y ait assez d'agents de santé, parce que tant qu'on se basera sur le côté sélectif vraiment il en manquera toujours.

[So, in this way, training is like a championship, yes, training is like a championship; I'm using a bit the image of a soccer championship, you start by the Round of 16, there are teams that lose, that are eliminated, and so you move on to the quarter finals. There's teams that lose, then you move to Semi-Finals, and then the Finals, and... where the champion wins. So there, because I tell myself that if we have many real healthcare professionals, it would be better to correctly train those who are committed, those who really want to do this type of work. It's better to train them correctly so that, you know training, you have to put the emphasis on training, so that people can make it out of school so that there are enough health professionals, because as long as the system is based on the selective aspect, honestly, there will be a shortage of healthcare professionals.][Québec, IEN #4, in progress]

In terms of cultural competence, it is clear that immigrant nurses often have difficulty adapting their practice to the Canadian approach. The flip side of the coin is that nurses with experience in their home countries understand what patients from that same country of origin who are living in Canada, are looking for and expect. IENs knowledge and experience in terms of cultural competence can be put to use rather than be discarded. Some respondents went as far as to suggest that there be an exchange program whereby nurses from Canada go to the countries where most IENs come from to see what type of nursing practice and conditions IENs who come to Canada have experienced.