This is a long overdue post on the process I went through to become a Registered Nurse in Canada, specifically Ontario; and since I have a rare 2 days off in a row, here goes nothing.
A fair word of warning: Don’t.
Alright!
I’ll only be sharing my application experience (and some personal sentiments) as an Internationally Educated Nurse (IEN) to the province of Ontario, Canada, with a permanent resident status. Each province of Canada has their own regulatory boards or colleges of nursing that oversee the profession, and they can be similar and different in ways but just like in the US, you have to choose which state you want to be registered to. So, if you are intending to go to a different province, on a different residence status, with Canadian nursing education, the steps would not be the same.
The first step is to make sure you really want to do this to create an application with the National Nursing Assessment Service/NNAS (all provinces, except Quebec). They’re a US based organization (in partnership with CGFNS) tasked to assess all nursing experience and education credentials for IENs, and basically generate a report stating whether the applicant is comparable to a Canadian Registered Nurse (RN) or Licensed/Registered Practical Nurse (LPN/RPN). Why they’re based in the US, I have no idea. At this point, you need to decide if you are applying to be an RN, RPN, or both, and to which province. You have to be absolutely decided because the fees are separate for each, and they’re not cheap; which is why I only started this step once I got my PR application approved, while working in Saudi Arabia.
I applied for both RN and RPN to Ontario (because I’ve heard that the process for RPNs is faster and just so that I have backup in case the RN route takes longer). The NNAS process may take some time, depending on the assessor, how fast your previous/current nursing institutions and employers are able to send the required hard copies to the US, and if the documents are satisfactory enough. When I say satisfactory, it’s if your nursing syllabus or course description is similar or at par to Canadian nursing standards.
I started my application in June 2016 and it took 6 months for NNAS to release an advisory report mainly because they did not find my BSN syllabus to be satisfactory, and kept asking for supplementary documentation. Unfortunately, despite being a proud graduate of one of the best nursing schools in the Philippines, my college could not provide a more detailed course syllabus. My MSN syllabus was not much help either.
My advisory report: RN-Not Comparable. RPN-Somewhat Comparable.
Please excuse the following rant, but it’s frustrating and annoying to be told that despite having a bachelor’s and master’s degree, and 7 years of specialized nursing experience in 2 of the biggest hospitals in the Philippines and Saudi Arabia, that you are not comparable to a Canadian RN.
So that was step 1. I’m so tired now LOL.
Ok moving on.
Now that you have your advisory report (regardless of the result), you’ll need to forward them to your specific province’s board of nursing, in my case, the College of Nurses of Ontario (CNO), where they’ll assess AGAIN all your credentials and inform you of the next steps to be registered as an RN or RPN. Why you had to go through NNAS, which didn’t exist a few years ago, and pay again for another round of assessments, is something I don’t have answers for.
I finished my contract in Saudi Arabia and landed in Canada on Jan 2017, the same time CNO received my application. While waiting for their decision, I took an English proficiency exam (IELTS or CELBAN) and a jurisprudence test which are both required for RNs and RPNs in Ontario.
For my RPN application, they required me to take the Canadian Practical Nurse Registration Examination (CPNRE) which I was able to book in June 2017. During my time, year 2017, CNO was NOT paperless, no I’m not kidding, so, every step was communicated through regular mail, including my exam result. Even if I took the exam through a Pearson Vue computer, it took more than a month for my result, which I thankfully passed. After verifying that I have satisfied all other requirements, including evidence of safe practice (meaning you have to have practiced nursing in the last 3 years), a police criminal record check, and most importantly, $$$$, I finally got my RPN license in Aug 2017, and found work in a hospital in Feb 2018. The competition is tough in Ontario for RPNs, but I was still fortunate that I was hired as an orthopedic nurse despite having no ortho nor Canadian nursing experience.
My RN application is a different story and timeline. CNO firstly asked for additional job descriptions from my previous employers, both conveniently located in the Philippines and Saudi Arabia (more sarcasm to follow). I was able to confirm they received the documents in Feb 2017, and AFTER 7 SHORT MONTHS, Sep 2017, they decided I needed to take further examinations to again, assess if I’m good enough to be a Canadian nurse or if I need to go back to nursing school. The name of the giant hurdle: IENCAP (OSCE+MCQ).
I can’t believe the movie I started in my background is done and I’m not done typing here LOL. I copied the following from the internet:
*The Internationally Educated Nurses Competency Assessment Program (IENCAP) is a standardized examination that tests the knowledge, skill and judgement of internationally educated nurses (IENs) seeking nursing registration in Ontario. The program was created by Touchstone Institute in collaboration with the College of Nurses of Ontario (CNO).
The assessment consists of two parts, which take place on the same day over five-and-a-half to six hours. No external contact is permitted during the exam.
MCQ examination – up to 97 questions (2.5 hours of writing time)
Objective structured clinical examination (OSCE) – 12 stations (13 minutes each)
The IENCAP may include clinical content from the following areas:
Ambulatory care, Community/public health, Complex continuing care, Emergency care, Geriatrics, Intensive/critical care, Medical, Mental health, Obstetrics, Palliative care, Pediatric and adolescent health, Rehabilitation, Surgical*
So let me try to summarize the OSCE. There are instructions outside the 12 rooms on what you’ll need to do. It can be ANYTHING from the nursing realm in ANY of the above content areas. There are real life people acting out as patients in each room, assessors inside the room watching your every move, and ready to ask you questions after your interaction with the patient. After the longest 13 minutes of your life, you go outside, take a deep breath and get ready for the next. Only 11 more. With no bathroom breaks in between. It’s safe to say this is the hardest exam I’ve done in my life, having graduated from nursing school back in 2008 and only focusing in dialysis nursing for my entire career.
Oh and there’s a multiple choice exam after. Or before, depending on your schedule.
I forgot to mention that you can only take the IENCAP once. If unsuccessful, CNO will require additional courses to take to fulfill the competency gaps. You could be back in school for 1-2 years or more.
Recap: Docs submitted in Feb 2017, IENCAP decision Sep 2017, and I booked the exam for Nov 2017. I could have booked it for later but when I checked the schedule there was only 1 slot left for Nov and I got pressured to take it without much thought. The day before the exam, I was a call away from cancelling because of the stress and pressure. But a good friend told me, you’re not going to study anyway even if you cancel and re-book. Real talk LOL. With 2 hours of sleep, I went to face the beast.
With God’s mercy and grace, on Feb 2018, I received the letter that I passed the IENCAP. And no, it doesn’t end there. I need to pass one more exam, the NCLEX-RN, to finally get registered. Canada switched to NCLEX a few years ago and fortunately, the number of takes are unlimited. I booked the exam for April 2018, got scared and re-booked for May 2018, and after 6 hours and 265 questions, I went home drained, scarred and expected the worst.
Trivia break! If you have passed NCLEX from the US and you apply in Canada, do you get to bypass everything? No. Every IEN, US graduates included, go through the same thing. You won’t need to take it again, but it’s only the last step in the whole process.
Back to regular programming.
I passed.
I was in disbelief, and my heart jumping with joy. I actually made it to the end.
I got officially listed as an RN in June 2018, got a job offer in 2 weeks, and started work in July 2018 in a leading research hospital in North America.
*****
Up to this date, I’m still in awe, disbelief, and grateful on how things progressed, with hard work, prayers and faith. Canada has one of the toughest route to become a nurse for IENs, without a doubt.
Final thoughts. Don’t come unprepared. Plan for it. Do your research. Be strong. Don’t give up without even trying. If there’s a much easier process to be a nurse in another country, do it. It’s unbelievably tough mentally, emotionally and financially, leaving our professional statuses in our home countries and then coming here and surviving with an alternate career to make ends meet until you get that license.
Is it worth it in the end?
Yes.
Written Echoes 