I am guest-writing CARE Centre for Internationally Educated Nurses’ executive director’s message, as the publication of this newsletter finds CARE Centre still dealing with the aftermath of a 30 per cent funding cut at the beginning of 2013. CARE Centre understands, perhaps more than most (given the harsh fiscal realities of many of our members’ home countries), that we live in challenging times and governments have many responsibilities to meet. We know that in balancing budgets and evaluating competing demands, our elected officials and our provincial ministries have difficult decisions to make, especially with federal priorities and transfer payments having seen significant changes in recent years. However, and this is our big however, CARE Centre’s board of directors, its staff, its many supporters (both individual and organizational) and most especially its thousands of members, do not agree that a bridge training program that was both the first of its kind and an unequalled success over 12 years, should be handicapped by such a significant reduction in funding.
As is available on our website and reported in our audited financial statements every year, CARE Centre does amazing work assisting internationally educated nurses in achieving their licence to practice in Ontario on extremely modest budgets. Extending from the nursing field, settlement services, and the professional educational field, CARE Centre gives incredible dollar-for-dollar value that ultimately increases the viability of Ontario’s healthcare sector. We all know the reality of, and have read the projected statistics for, the increasing diversity of Ontario’s population where already today IENs make up 25 percent of the GTA’s workforce and 10-15 percent in other places in the province. IENs reflect the patients and clients they serve, in hospitals and long-term care homes, in schools and the community, and in the homes of Ontarians.
Interesting information about Ontario’s population growth and change are available on the website fin.gov.on.ca/en/economy/demographics/projections/#s2. Two facts we know incontrovertibly: we will have a huge number of seniors to care for with the aging of the baby boom, and immigration to our province, the number one destination for Canadian newcomers for decades, will continue to grow, with ethnic communities equalling more traditional Canadian populations within the next few years. How should we best care for these significant demographics? With internationally-educated, globally experienced nursing professionals who have cultural and language skills they can bring to the workplace to augment and enhance the kind of healthcare excellence that is our Canadian nursing tradition. The federal department of immigration has identified nurses as one of their priority occupations for skilled newcomers, as many areas of the country are experiencing a nursing shortage, also acknowledging that when Canada’s baby boom nurses also retire, those positions will also be hard to fill.
Because IENs cannot easily resume their nursing careers when they arrive here. The College of Nurses of Ontario is an exacting regulatory body, and has recently shortened the recent practice window for IENs, instituted a jurisprudence exam, and put a deadline on completion of the application process, amongst other measures. IENs, who may be working under two-year agreements as live-in caregivers only have two years from their last day working as a nurse in their home country to pass their exams to practice in Ontario. Without the assistance of a specialized, may we say expert bridging program like CARE Centre to guide them on their registration journey, many IENs will never be able to return to their passion for nursing.
We hope you’ll write to your own MPP or cabinet ministers, some of whom are identified at the beginning of our Intake section, which welcomes our new Minister of Citizenship and Immigration, Michael Coteau. Send them a letter of support for CARE Centre, expressing how much you value our organization and our thousands of member IENs. You may want to ask for restored funding for CARE Centre, or you may just want to add your voice to all those who already recognize IENs as essential to serving the healthcare needs of Ontario families. Either way, we appreciate the expression of your commendation for CARE Centre; please cc. Executive Director Susan VanDeVelde-Coke at SVanDeVelde@care4nurses.org. Thank you so much for your support.
CARE Centre for IENs would like to welcome the Hon. Michael Coteau, MPP for Don Valley East, to the portfolio of Minister of Citizenship and Immigration (MCI). CARE Centre receives its Ontario government funding through MCI and the Government of Canada. Michael Coteau was elected to the legislature in 2011 as the MPP for Don Valley East. He was appointed Minister of Citizenship and Immigration in February, 2013. Prior to entering government, Coteau served as a school board trustee for almost eight years. As a trustee, Coteau worked to make schools more accessible to community groups that run after-school programs for children. He also served as the Vice-Chair of the Toronto District School Board and helped to bring forward nutritional changes that increased awareness around student hunger and resulted in healthy food programs. In addition, he is a champion of the integration of technology in education. Coteau is former CEO and Executive Director of a national literacy not-for-profit, Alpha Plus. He was also on the board of the Toronto Foundation for Student Success and on the board of the Toronto Land Corporation. If you would like to read about Ontario’s immigration strategy, see the pdf on the Ministry website at citizenship.gov.on.ca/english/keyinitiatives/imm_str/strategy/strategy.pdf, and to contact Minister Coteau, email firstname.lastname@example.org. Parliamentary Assistant to the Minister of Citizenship and Immigration is MPP Bas Balkissoon (Scarborough–Rouge River), who is also Chair of the Committee of the Whole House and Deputy Speaker (email@example.com).
“None of this could have happened without CARE Centre,” El-Assaad said, “They put me on the right track. Their specialized courses really helped.” Ismail, who is planning to return to school to do a master’s degree, faced tough competition and was selected from an outstanding field of member nurses who are exemplary professionals and compassionate caregivers. LHSC CEO and President Bonnie Adamson, who is herself a former nurse, spoke at the event, and Ismail received his award from last year’s winner, Loy Asheri. Ontario Health Minister Deb Matthews provided a video greeting. Also on hand for the celebration were CARE Centre Executive Director Zubeida Ramji and board member Flor Dandel, Executive Director of Kababayan Community Centre. The call for nominations for the 2013 award will go out in June.
More Support for IENs in Ontario
Announced at the start of Nursing Week May 6-12, 2013, the province is expanding the Nursing Graduate Guarantee so that new nursing graduates from other provinces and territories have the opportunity to work in Ontario. As part of the Nursing Graduate Guarantee, the province is creating the Nursing Career OrIENtation Initiative, an employment initiative to help internationally educated nurses transition to practice full-time in Ontario. “Our Nursing Graduate Guarantee has been a tremendous success in helping nurses gain a foothold into their profession with some immediate hands-on experience, said the Honourable Deb Matthews, Minister of Heath. “We are now providing the same opportunity to new nurses who were educated in other provinces and internationally to ensure Ontario has the best nursing workforce providing care to patients.”
These initiatives will provide newly registered IENs with an opportunity to gain employment and to work with experienced nurses to enhance their knowledge and skills. Supporting nurses who are entering the workforce in Ontario is part of the government’s Action Plan for Health Care. “The Nursing Career OrIENtation Initiative supports the vision of our Immigration Strategy and will benefit Ontarians in many ways, from helping internationally educated nurses achieve success and building our highly skilled workforce, while ensuring we have strong communities where the people of Ontario can thrive,” said Minister of Citizenship and Immigration, the Honourable Michael Coteau.
Since 2007, more than 14,300 nurses have participated in the Nursing Graduate Guarantee initiative, and there are 16,400 more nurses working in Ontario since 2003. “No one works more closely with patients than nurses,” said Zubeida Ramji, CARE Centre Executive Director. “These initiatives will assist nurses who are new to Ontario to launch and continue a career in nursing while ensuring that the province has a stable workforce meeting the care needs of patients.”
Changes at CARE Centre
At the end of December, 2012, CARE Centre completed a three-year funding cycle and had applied to a government request for proposals for renewed bridge training funding, and also submitted some project applications. Unfortunately, the Ministry of Citizenship and Immigration, which itself received reduced funding from the federal government, provided a phase one funding renewal with a 30 per cent reduction, resulting in some significant changes to CARE Centre. Six positions were terminated across the organization, with CARE Centre’s presence in Windsor now served by case management services out of the London office. The Hamilton office lost two positions, with service to the wide catchment are including Kitchener-Waterloo and Niagara Region being impacted. Additionally, staff cuts will affect activities out of the Peel Region office in Brampton, which also experienced reduced case management capacity. “CARE Centre has served IENs and the the nursing, healthcare and settlement communities with loyalty and ever-increasing expertise for 12 years, so the funding cuts hit especially hard,” said Executive Director Zubeida Ramji. “As we move into the next funding phase we will be calling on our membership, Ontario’s nursing leadership, major healthcare employers and all our stakeholders to express their support for CARE Centre, that we can continue to develop Ontario’s first bridge training program for internationally educated health professionals as a model that is emulated across disciplines and in other provinces.”
Zubeida Ramji Participates in Conference Board of Canada Philippine Delegation
Executive Director Zubeida Ramji took part in a late January Conference Board of Canada Leaders’ Roundtable on Immigration meeting in Manila to learn about efforts to achieve better settlement and integration outcomes for immigrants by visiting projects and exchanging insights on various strategic initiatives for migrants at the pre-departure stage, before they arrive in Canada. The Philippines is the number one source country for permanent resident applicants to Canada and provides the largest group CARE Centre member nurses. Along with Citizenship and Immigration Canada and Canadian Trade Commissioner Service participants, many senior academicians took part in the conference which included visits to the Australian SITE Skills Training campus and University of the Philippines and De La Salle University, both of which have nursing faculties. Zubeida Ramji addressed a large class of nursing graduates at University of Santo Tomas and met with various other nursing colleagues. “Our objective was to learn more about the nursing sector in the Philippines, as our largest source country for IENs – this was definitely achieved by the connections made through this Conference Board of Canada initiative.” said Ramji. “CARE Centre has already been working with the Canadian Immigrant Integration Program (CIIP) office in Manila, along with the other CIIP offices, so being able to meet with people face-to-face was very advantageous to our continued collaboration on improving successful immigration for IENs coming to Ontario.”
Objective Structured Clinical Examination (OSCE) now required for CNO registration
An important part of the CNO application process for all IENs is determining program equivalency, a non-exemptible requirement for registration. The CNO evaluates RN candidates on their educational background to determine if their previous studies have equipped them with the nursing knowledge, skill and judgment equal to that of a recent graduate of an Ontario RN nursing program. If the CNO determines that an applicant does not meet the program requirement, then they will be asked to complete an OSCE (Objective Structured Clinical Examination).There is a $200 administrative fee that will be refunded after providing proof of completion of the OSCE. Administered at the Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA) in Toronto, the OSCE gives applicants the opportunity to demonstrate their nursing knowledge and skills. The OSCE is completed over a four-hour period at CEHPEA’s offices in Toronto. After about two months, the applicant will receive their results, which will either allow them to write the registration exam, or direct them to a course of study for identified gaps, or if assessed with significant deficiencies in skills and knowledge, the college will advise them of other options. The OSCE consists of a short, written multiple-choice exam that tests general nursing knowledge, and a series of mock client examinations in a clinical setting. The blueprint for the OSCE is based on the National Competencies in the Context of Entry-Level Registered Nurse Practice. For questions about the examination itself, including upcoming testing dates and directions to the testing centre, contact CEHPEA at 416 924-8622 or email firstname.lastname@example.org. (adapted from the CNO website: cno.org/become-a-nurse/about-registration/entry-to-practice-examinations/observational-structure-clinical-examination-osce/.)
Raymonde Degbey immigrated to the United States in 2004 from her home in Cotonou, Benin, completed a Masters in Public Administration Management, then found her calling in nursing, completing an RN degree in Michigan. She moved to London, Ontario in 2009, where she joined CARE Centre and was registered in 2010, becoming Director of Care at a long-term care home in the Huntsville area. Degbey now works as an RN for Corrections Canada at the Collins Bay Institution.
What was your biggest inspiration to become a nurse?
I became a nurse because I like to help others. I was working as a manager for a big retail company but was not satisfied by my job. I wanted to make a difference in people’s lives and help people. Nursing was the ideal profession. People are grateful for what you do for them. Your work impacts their lives and you have the satisfaction of making a difference in someone’s life.
What was nursing like in your home country?
Nursing in my home country is not too different from nursing here in Canada. Patients are at the center of everything. In Canada, we have more means, more technology to use in the profession. In Canada, nurses take care of the patient totally. In my home country the family does the personal care and the nurse does the nursing/medication part.
Why did you want to pursue nursing in Canada?
Nursing in Canada is more rewarding and uses advance technology. Canada is a beautiful country and people live here freely.
What was your biggest obstacle?
My biggest obstacle was to pass the CRNE. I had to take class to prepare for it. CARE really helped in that area. I was able to take a class offered by CARE. The class helped me review my knowledge and practice the exam’s questions.
What has been your proudest nursing moment?
Passing the CRNE!
What are the duties of a prison nurse?
I take care of inmates’ health concerns in a medium security prison. I do everything: assessment, blood draw, immunization, treatment, counseling, wound care, taking care of injuries or overdose. Nurses see the inmates first and assess them. If it is an issue above our scope of practice, we call the doctors and talk to them about our findings and get guidance from them. We have medical directives that guide us in our care to the inmates. The doctors cannot be on site at all times so the nurses take care of the inmates first. If it is an emergency, we send them to a nearby hospital by ambulance.
Words of advice for IENs on their journey to registration?
Do not be discouraged by the process. It can be long and tedious. Take your time to prepare for the exam. Seek advice from other IENs and instructors and case managers. Do not hesitate to ask questions.
London prides itself on the range of opportunities it provides New Canadians as the sixth largest city in Ontario, with easy access to rural communities in Middlesex County, three Great Lakes and the United States just across the border. The city publishes a website under the name “Point, Click, Immigrate”, proclaiming it’s openness to newcomers, which comprise 22 percent of the population according to 2006 statistics. In 2008 CARE Centre began offering services in London, first on the premises of Fanshawe College, CARE’s partner educational organization, and now in office space at Access to Community Employment Services at 171 Queens Avenue in downtown London. Case Manager Anna Wilson, who also works with IENs in a large catchment area stretching to Windsor, has seen the profile of IENs grow substantially in the community.
“More IENs are moving from the Toronto and Mississauga area to London because of word of mouth advertising from London CARE Centre members,” Wilson notes. “There has been an increase in families originating from India, Colombia, the Philippines, the Middle East and Asia settling here, often because they know someone who is living in London. The web site immigration.london.ca/default.htm provides links to immigrant services, and IENs have the support of the Access Centre if they have not applied to the CNO. London Cross Cultural Learning Centre provides additional services, especially surrounding language. London Health Science Centre was the first to set up a committee to make integration more positive for IENs, both at the hospital and in the community. And McGarrell Place and other long-term care facilities and community agencies are working to help IENs transition to nursing in their field.”
CARE Centre now has over 100 members in London and area, and was proud to host a ceremony in early 2011 celebrating the first 25 members to achieve registration, attended by the Minister of Health and Long-term Care, Deb Mathews, and other prominent politicians. Valedictorian speaker Raymonde Degbey (featured in the On the Job section of this issue of the IEN Connector) stated that “the sky is the limit” after achieving her RN, and was interviewed by the local TV station (view clip here). More recently the CARE Centre Joan Lesmond IEN of the Year Award was presented to local member Ismail El Assaad at his London Health Science’s Centre’s University Hospital workplace (view clip here).
Wilson had retired as a nursing instructor when she started with CARE Centre and found a special affinity for bridge training. “I love working with our clients. It has been a mutual learning process. They bring so many gifts and abilities to nursing and are capable of contributing to and enhancing nursing care within our own health care system. They are so motivated and dedicated to nursing and are keen to do whatever it takes to get back into the profession.”
CARE Centre’s Observational Job Shadowing (OJS) is a unique learning opportunity for member IENs to be partnered with an expert nurse through two to three work shifts and observe first-hand the nursing profession in Ontario. The program aims to increase IENs’ understanding about the role and scope of practice of a nurse in a particular health care setting, and get them more acquainted with the language and culture of the Canadian workplace. “We know that some employers still have hesitations about hiring IENs because they’re unsure of their ability to communicate effectively and integrate well into the inter-disciplinary team environment,” said CARE Centre Professional Practice Lead Ruth Wojtiuk who helped redesign the program recently. “We’re also well aware that one of the biggest barriers for IENs to find jobs is a lack of Canadian experience. THE OJS program addresses both sides of that equation by exposing participating employers to the “hire-ability” of CARE Centre member nurses, and many of our employers take part year after year, and it also lets our member IENs get that all-important experience with a foot in the door of an Ontario healthcare provider.”
Case Managers in the various CARE Centre locations recruit and match members with expert nurses from the health care organizations of their choice depending on availability. “It is indeed a very unforgettable experience and I learned so much about the hospital setting here in Canada,” said member IEN Melissa Gaspar. “My expert nurse was very patient and always asking me what else do I need to do to achieve my learning goals. I learned infection control, communication with patients, documentation and much more. She even volunteered to be my reference and gave me the (web)site at Sunnybrook where I can apply for work. I’m very satisfied with my OJS experience.”
Lourdes Vicente, Case Manager and Toronto OJS lead, advised that, “Members can undertake more than one placement, and we’re striving to continuously add new healthcare provider-partners so our members can get first-hand exposure to the array of different nursing jobs that are available in the marketplace. Working in a hospital is significantly different from community nursing, or working in a long-term care facility. OJS lets our IENs refine their career focus and gives them that entrée into the working world of nursing.”
Participating IENs must pay a $25 fee for workplace insurance, have a mask fit testing, vulnerable sector police clearance, current CPR- BCLS level C for HCP, and immunization records. They must also complete an OJS learning plan and have completed a Nursing in Ontario course or equivalent. OJS is strictly observational with no direct hands-on patient care. Over two to three shifts CARE members will shadow an expert nurse in their chosen facility, although it usually takes one to three months to arrange a placement so it is advisable to submit an application with complete requirements early. “My experience with all the IENs that have job- shadowed with me has been excellent,” said Expert Nurse Paula Watkis from Sunnybrook Hospital. “It’s a medium for me to refresh my memory and skills as well. The CARE Centre member that I was partnered with was excellent too, punctual, well-mannered and has an eager mind. She has a quest for knowledge that is never ending. The CARE centre OJS program is an excellent vehicle for integrating more diversity and expertise into healthcare.”
Employment Strategies for Nurses
When IENs first join CARE Centre they receive a full menu of programs and services to help prepare them for registration exam success. Once the goal of registration is achieved, the next step on their career path is the job search, which can be done at career fairs, online, through face-to-face networking – the possibilities seem to multiply every day. The best way to take advantage of all the opportunities for career development is to conduct the job search with a systemized approach. Employment Strategies for Nurses is a new program developed by CARE Centre which is also now available for delivery by partner organizations.
“Research was done by CARE Centre to identify the unique employment requirements of internationally educated nurses in order to understand the scope of the challenges and barriers experienced by them,” said Michelle Gordon, a CARE Centre case manager who helped develop the program. “We also looked at the attitudes of health care employers regarding their hiring. The top two employment challenges were language fluency or communication perception and differences in workplace culture. The workshop addresses those hurdles by covering topics including creating a personal profile, understanding terminology used in job postings, writing the resume and cover letter, developing interviewing skills, and understanding workplace culture.”
The workshop has eight modules in total for delivery over 24 hours. To address differences in workplace culture, participants interact with real world employers who give feedback on how they present themselves at hiring opportunities. One-on-one mock interview are done with each of the participants and feedback is given at the end of each interview. There is also one module that specifically deals with both the general Canadian and the Canadian workplace culture, the role of inter-professional teams, and how to deal with conflicts on the job.
As a follow up to the Pilot Session in Hamilton, WIL Employment Connections, www.wil.ca , in partnership with the CARE Centre London, has delivered two sessions of Job Search Strategies. Each session was delivered in 8 modules over four days. Nancy Griffiths, an Employment Advisor at WIL and Facilitator for the sessions, states: “Transition is challenging and the nurses I have met are professionals in the final stages of their journey. They had successful careers prior to joining us in Canada and their most recent focus has been on preparation for exams and registration.”
When nurses are working or preparing for exams they will not necessarily be thinking about their qualifications- how to present them in a resume or cover letter and how to discuss them in an interview to show a potential employer why they are the right person for a critical role in their organization. This is where Job Search Strategies is essential and beneficial.
Job Search Strategies for Internationally Educated Nurses is a solid opportunity – essential to developing skills and confidence to broaden the focus from studying to include career-specific employment assistance. Sessions are scheduled for just after CNO exams so participants’ learning can expand to focus on career specific job search.