Internationally trained nurse shares her journey at London Health Sciences Center


In just two weeks, Ann Shaji will have completed her final requirement to receive her license to practice nursing in Ontario.

It is the culmination of years of paperwork, coursework, language proficiency testing, and hundreds of hours of actual hands-on work for the internationally educated nurse (IEN).

Travel is also one that the next cohort of IENs will have an easier time with, thanks to recent changes to the licensing process introduced amid the COVID-19 pandemic.

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Shaji’s final step is to complete 400 hours of practical work, which she did at the London Health Sciences Center in Cardiac Care at University Hospital.

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“I was really nervous because all I have is like my internship experience from my home nursing program. But it was such a beautiful transition, I would say, because everyone was so welcoming,” she told Global News on Wednesday.

I feel really lucky to start in a hospital setting because that’s where you see a variety of things and see a lot to learn.

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The 29-year-old graduated in India in 2015 and moved to Canada the same year on a student permit, taking courses in clinical nursing and recreation therapy at Confederation College in Thunder Bay.

She initially focused on getting her permanent residency, which she did in 2020, but she technically started filing some paperwork for her nursing license process as early as 2017.

The final step was to gain hands-on experience, which she gained through LHSC’s recent participation in the CARE Center for Internationally Educated Nurses. Shaji heard about the program from friends, then found information about it on the College of Nurses of Ontario website just a few months ago.

This is actually the first time that the LHSC has been involved in the process of getting their internationally educated nurses licensed, although the hospital network has hired several over the years after their licensure.

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Ann Shaji, left, and Sarah Smith, right, seen on February 2, 2022.

provided by London Health Sciences Center

Sarah Smith, head of clinical educators and trainee nurses, said Shaji was part of a 13-person group that started on December 6. Interns are hired on contract and paired with a “buddy” to guide and oversee their practice.

“I’m so excited to work with this group because they’re just looking forward to working. They’re excited about the profession, they want to jump in and help out, they’re excited to learn,” Smith said.

“They have been sitting idle, many of them, during the pandemic, waiting for regulatory support and to verify all those credentials and get to work. Their enthusiasm, their passion for helping people is evident.

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IENs represent a growing share of Ontario’s nursing workforce.

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By province, internationally educated nurses registered and licensed to practice in Ontario made up 12.2 per cent of the province’s nursing workforce in 2020, up from 10.3 per cent in 2010.

Smith said the program has already proven successful enough that another cohort of seven internationally trained nurses will soon start in the hospital network to acquire the recently reduced minimum of 140 hours of practice.

The licensing process

As hospitals face staffing shortages due to the COVID-19 pandemic, the government has recently facilitated changes to bring more IENs into hospitals. Global News has contacted the Department of Health but has not received a comment at the time of publication.

Smith said the changes include reducing the minimum number of practice hours required by the CNO to 140, as mentioned, as well as the ability to complete proof of practice and language proficiency simultaneously.

Although the changes will not benefit Shaji, she believes they will be helpful for new nurses arriving and she hopes they will not be temporary.

She also pointed out that the roughly two-and-a-half years she spent focusing on getting her license could be considered fast paced.

“When I applied, I was a recent graduate, so I had no gaps in my skills. But then for the nurses who have a ton of experience, they have a lot of skill gaps because their training goes back 10 or 15 years,” she explained.

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“If they find gaps, they have to go back to university. The thing is, the moment they get that skill, their safe practice (requirement) expires.

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Many IENs also complete this process while working part-time (Shaji herself worked as a recreation therapy worker) and raising children.

For many of his friends who already had permanent residency and had 10 to 15 years of nursing experience, Shaji said it took them five or six years to get their license.

It is also expensive, although permanent residents have access to scholarships.

“As an international student, (I’m at) $35,000+ for my education in Canada. And then we do our paperwork with the NNAS (National Nursing Assessment System based in the United States), which equates to a fee of over US$900. And again, after and NNAS, it goes to the NOC.

“If things can be easier now, it could have been easier before.”

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Smith is excited about the changes and believes there are many opportunities for IENs in Ontario in the future.

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“It’s exciting to see how the system can work to break down barriers for internationally educated nurses,” Smith said.

“I hope this will be part of how we operate in the future. I’m excited to build the program and provide more support over time.

Meanwhile, Shaji plans to stay at LHSC. She recently interviewed for a position on the same floor where she did an internship.

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