NATIONAL CONVERSATION 2020

PARTNERS IN INTEGRATION AND EDUCATION OF INTERNATIONALLY EDUCATED NURSES

National Nursing Assessment Service

Presentation to PIE/IEN ConferenceMay 26, 2020

Gayle Waxman, Executive Director

1

Strategic Priorities

1. Improve effectiveness of nursing assessment process– Continued increase in volume (+17%) of Advisory Reports issued– Qualitative study of applicant experience– Applicant priority on efficiency of service and communication/resources

2. Strengthen organizational capacity– Enhanced staffing providing expertise and stability

3. Transform NNAS Governance– Phase 1 changes expected in Fall 2020, Phase 2 in Fall 2021

4. Strengthen stakeholder relationships– Increased communication– Commitment to working collaboratively

2

Advisory Reports Issued17/18 to 19/20

22374

8360 7123 6891

0

5000

10000

15000

20000

25000

3-Year Total 19/20 18/19 17/18

Advisory Reports3

COVID 19 Response• Extended expiry date for all applications

– June 30, 2020– Monitoring need for further extensions

• Enhancing communication – Applicant updates, FAQs.

• Placing emphasis on applications from IENS who:– Have submitted complete documentation and could be

deployed because they are living in Canada• Experiencing delays in logging of documents• Monitoring other potential impacts on IENs

4

Career Paths for Skilled Immigrants

The Training Group, Douglas College

www.douglascollege.ca/careerpaths

Career Paths for Skilled Immigrants Program

Goal: Provide customized support to help experienced, skilled immigrants gain commensurate and/or temporary aligned employment in their field in BC.

RNs, RPNs, LPNs, Health Care Assistants (HCAs), Physicians, Sonographers LIVING ANYWHERE IN BC

Introducing…. Jenie K, RN

2020-05-21 2

2004: BSc Nursing, Philippines; Company Nurse, Philippines, 6 years

2010: Staff Nurse, Med-Surg, Military Hospital, Saudi Arabia, 6 years2018:

Moved to Canada

Gained employment as Caregiver NNAS Credential Evaluation application

Attempted CELBAN assessment

Registered with Career Paths program

Career Paths Health Specialty Services

2020-05-21 3

Language Proficiency &Communication Skills

CELBAN (Canadian English Language Benchmark for Nurses) • Exam preparation course• 1 – 1 individualized tutoring• Listening Skills for CELBAN

Medical Terminology and Pronunciation

IELTS (International English Language Testing System) • Exam preparation course • 1 – 1 individualized tutoring

Nursing Specialty Workshops • Scope of Practice for HCAs, LPNs, RNs• Professional Communication for IEHPs• Exam Preparation (study skills, reading skills, test anxiety)• Simulation Lab Orientation workshops

Skills Enhancement Funding(via reimbursements)

• Regulatory body membership fees• Skills assessments• Bridging education

Career Paths Pilot: Winter 2018/2019

2020-05-21 4Career Paths for Skilled Immigrants

Credential Assessment &

Registry application

NCAS Skills assessment

Remedial Education

Direct Registration

HCA employment

27% of IENs in pilot!

BC Care Aide Registry: Scope of practice/ competency resources

BC Care Providers Association: Job Shadow at Long Term Care facility

SafeCare BC: Violence Prevention & Safe Resident Handling training

NCAS: Additional assessment dates

Langara College: Additional Sim Lab orientation tours

Ministry of Jobs, Economic Development and Competitiveness: Funding for NCAS assessment

Douglas College Continuing Education:Expedited course registration

Health Match BC: Bursaries for NCAS and remedial education

Collaboration

BC Care Aide & Community Health Worker Registration

Career Paths for Skilled ImmigrantsCLARE QUIRICO

quiricoc@douglascollege.ca778-384-6944

The Training Group, Douglas College

www.douglascollege.ca/careerpaths

Andria Phillips RN MScN CCNEYork UniversityAssistant Professor - Teaching Stream

Are they the same thing?

What is the difference?

Frames Of Reference

Promotion of diversity of thought

Awareness of own frames of reference

Recognizing and valuing what has informed prior nursing actions and experience

Critically examine similarities and differences between what is being taught and prior practices

This Photo by Unknown Author is licensed under CC BY-NC-ND

This Photo by Unknown Author is licensed under CC BY-SA-NC

Attracting Pre- and Post-arrival Internationally Educated Nurses to

employment opportunities in rural and northern communities

CARE Centre for Internationally Educated Nurses

Canadian Nurses Association

www.care4nurses.org

www.cna-aiic.ca

Pre-Arrival Supports and Services

2

• Opportunities to connect with nurse mentors through the Canadian Nurses Association

• Program of CARE Centre for Internationally Educated Nurses, funded by Immigration, Refugees and Citizenship Canada (IRCC).

• PASS serves nurses living in their countries of origin/residence planning migration to Canada.

• PASS provides information and orientation webinars, individual case management, online nursing communication courses and referrals for post-arrival assistance.

www.pass4nurses.org

PASS Mentorship• Mentors support integration of

IENs by sharing education, wisdom, life and career experiences

• Direct online interaction

• Mentors are important clinical and professional resources

• Provide IEN mentees with spoken, interactive guidance that cannot be found in textbooks

3

Questions? Follow-up questions can be directed to:

passinfo@care4nurses.org

Jeannie Hare, RN, Provincial Councillor, College and Association of Registered Nurses of Alberta (NortheastRegion):

Oneikah Richards, RN, MW, BScN, MScN, NursingCare Manager, Manning Acute/ER/LTC, AlbertaHealth Services

Meghan Wankel, MA, BA, PASS Program Coordinator, CARE Centre for IENs

4

.

Core Project Team: Pat Marten-Daniel, K. Susan A’Court, Henk Demeris, Elizabeth Hanna, Mandy Lowe, Paula Mastrilli, Tracy Paulenko, Sylvia Summers, Margaret Verkuyl

Game Design and Development: Digital Education Strategies team at the Chang School of Continuing Education at Ryerson University

Virtual Game Simulation (VGS): “High fidelity, 2D immersive simulation using videos of actors in which the user can make clinical decisions for learning in health care” (Verkuyl et al, 2019, p. 8).

Reference: Verkuyl, M., Lapum, J. L., St. Amant, O., Hughes, M., Romaniuk, D., & Mastrilli, P. (2019). Designing virtual gaming simulations. Clinical Simulation in Nursing, 32, 8-12.

. . . The story continues with eight Decision Points plus a role clarification activity. These address six competencies identified by CIHC as essential behaviours for interprofessional (IP) collaborative practice (CIHC, 2010).

Embedded additional resources for learners and educators include information about IP team roles, debriefing, IP competencies, resources for further reference and a Summary of each player’s responses and related feedback.Reference: Canadian Interprofessional Health Collaborative (CIHC). (2010). A national interprofessional competency framework. Retrieved from https://drive.google.com/file/d/1Des_mznc7Rr8stsEhHxl8XMjgiYWzRIn/view

TeamWorks! Impact

• High degree of user satisfaction: Majority of users surveyed (n=97) “agreed” or “strongly agreed” that pacing and audio/visual quality were good. They were able to navigate the game, were motivated to continue playing and felt the game was realistic.

• Significant learning took place: Pre- and post-game perceptions of knowledge and ability showed large or moderate-to-large gains across all six IP collaborative competencies.

• When asked “What do you feel you gained by participating in the game?”77% said the game helped develop knowledge and skill23% said the game increased their confidence

• What did game players like/dislike? They liked relevant practice-related content, inclusion of feedback and realism. Many requested “more” e.g., “It could have been longer with more to explore and learn. I felt the IP team meeting was short.”

• Usage: Since piloting, TeamWorks! has been used in many learning contexts with many different professionals E.G.: In addition to IEN bridging program classroom and clinical courses, UHN and UT’s Centre for IPE have used it in their IPE sessions, Ryerson and Centennial placed it on their ‘virtual hospital’ portal where, within the first two weeks of April, it was accessed by 1,728 users from Canada and USA .

Thanks for your interest! To view and use this open source resource go to: https://de.ryerson.ca/games/teamworks/

If you have questions, please email Susan A’Court, sacourt@georgebrown.ca

Providing Online Supports for Ontario Course Consortium

Internationally Educated Nurses

Bradley, P. (York University) PRESENTERBhatti, A. (Program Manager)Patrick, L. (University of Windsor) Santa Mina, E.(Ryerson University) Woodend, K. (Trent University)

1

BACKGROUNDCOMPETENCY-BRIDGING PROGRAM OF STUDY

ACTIVITY DATEEnglish Language and Culture of Nursing in Canada Course 24/09/18 – 14/12/18

Academic and Professional Writing Course 24/09/18 – 14/12/18

Ethical Practice Course 07/01/19 – 29/03/19

Knowledge-Based Practice: Competent Application of Knowledge Part 1 Course 22/04/19 – 12/07/19

Clinical Placement 1 22/07/19 -- 30/08/19

Professional Responsibility and Accountability, and Service to the Public Course 23/09/19 – 13/12/19

Self-Regulation Course 23/09/19 – 13/12/19

Knowledge-Based Practice: Specialized Body of Knowledge Course 06/01/20 – 27/03/20

Knowledge-Based Practice: Competent Application of Knowledge Part 2 Course 20/04/20 – 10/07/20

Clinical Placement 2 20/07/19 -- 28/08/20

NCLEX-RN Workshop 09/20Resume and Cover Letter Writing and Interviewing Skills Workshop 09/20

Computerized Exit Exam 09/20

ACTIVITY DATEOrientation Module 17/09/18 – 23/09/18

HESI Exam 10/18

English Language and Culture of Nursing in Canada Course 24/09/18 – 14/12/18

Academic and Professional Writing Course 24/09/18 – 14/12/18

Ethical Practice Course 07/01/19 – 29/03/19

Knowledge-Based Practice: Competent Application of Knowledge Part 1 Course 22/04/19 – 30/08/19

Clinical Placement 1 22/07/19 -- 30/08/19

Professional Responsibility and Accountability, and Service to the Public Course 23/09/19 – 13/12/19

Self-Regulation Course 23/09/19 – 13/12/19

Knowledge-Based Practice: Specialized Body of Knowledge Course 06/01/20 – 27/03/20

Knowledge-Based Practice: Competent Application of Knowledge Part 2 Course 20/04/20 – 10/07/20

Clinical Placement 2 20/07/19 -- 10/07/20

NCLEX-RN Workshop 09/20Resume and Cover Letter Writing and Interviewing Skills Workshop 09/20

HESI Exam 09/20

rncompetencies.ca

22

LEARNER-CENTERED TUTORSACCESS FLEXIBILITY SUPPORTS

Assist students to:Develop individual learning plans Improve their English language skillsBrainstorm strategies for academic successVoice their concerns

By using accessible formats:Moodle, Big Blue Button, email, phone, and texting

33

CHANGES MADE

Tutor role changed to be more focused on learning needs

Competency Learning Plan AdvisorEnglish Language Advisor

Added:In person student orientation Online learning plan module developed for team and students

Thank you

The Rural IEN RN Pilot:three years on……

The Evaluation Results

Catherine Baxter, RN PhDBrandon University

Lori Fontaine, MAManitoba Health, Seniors and Active Living

Timeline

Phase One Planning

Phase TwoBridging Education

Phase ThreeRelocation & Employment

Phase Four

Evaluation

Findings

IENs’ Experiences

• Community Integration• Choosing an unexpected path• Transition to rural Life• Settling in or moving on• Living life

• Workplace Integration• Confidence• Canadian RN practice• Attitudes of others• Rural nursing• Future plans

Managers’ Experiences

• Confidence• Cultivating confidence• Growing confidence• Additional responsibilities

• Considering culture• Supporting integration

Policy implications for the recruitment & retention of IENs

• Integration is multi-factorial including community context • Relationships are the number one driver• Ability to leverage funding• Fine-tuning and the connectivity of players• Being responsive to the specific realities at play• The fundamental role of managers• Safe practice and the preparation of workplaces

INTERNATIONALLY EDUCATED NURSES’ EXPERIENCE WITH INTERPROFESSIONAL COLLABORATION

Balakumaran Mahathevan, MScNCentennial College

Jasmine Balakumaran, MScNCentennial College

Edward Cruz, PhD University of Windsor

Natashia Deer, MNCentennial College

Jennifer Innis, PhDCentennial College

BRIEF OVERVIEW OF THIS STUDY

DEFINITION of IPC

A collaborative process in which health care providers from different

professions work together with patients, families, carers and

communities for the purpose of achieving health goals and increasing

the quality of care (WHO, 2010)

LITERATURE REVIEW

Concept is still relatively new and there has been less uptake of

interprofessional collaboration in developing countries (Herath et al., 2017; Sunguya, Hinthong, Jimba &

Yasuoka, 2014).

RESEARCH QUESTION

What is the knowledge and experience of IENs participating in a

bridging program with respect to interprofessional collaboration?

SAMPLE

All students enrolled in the Practical Nursing Program for IENs at a community college in Toronto,

Canada (N=110)

QUESTIONNAIRE

Assessment of Interprofessional Team Collaboration Scale II (AITCS-II)

INTERVIEWSOne on one interviews

exploring previous experiences with, and understanding of IPC

Total of 9 Interviews = 2 ThemesThis is one of the themes and relevant quotes

: “…back home we (have) team work…we are all joined. If I finish my work, if I see that maybe (another nurse) is struggling, shehas not completed the assignment…I’ll go volunteer (to help).”

“…the head nurse…briefs us on how the day’s going to go out. She gives us the assignment…when we get our separate assignments, we perform our nursing duties…and then the (head nurse) : “…back home we (have) team work…we are all joined. If

I finish my work, if I see that maybe (another nurse) is struggling, she has not completed the assignment…I’ll go volunteer (to help).”assesses how they (were done)”

Working Together as Nurses

What we found…

. The participant’s ratings were slightly lower for the coordination section of

the questionnaire.

The items in this section relate to the development of a team, selecting a

leader and core values within a team.

These are practices that may be more specific to an interprofessional team

made up of professionals from different professions, as opposed to

intraprofessional teams that were described in the interviews, which were

composed of nurses.

The participants intertwined interprofessional collaboration with intraprofessionalcollaboration

• May be due to the differences in health care models and practices of health care teams worldwide.

IENs may be disadvantaged in

understanding interprofessional

collaboration as it is used in the North American practice

setting as they may have minimal

experience practicing in their new setting

THANK YOU!

WE WELCOME ANY QUESTIONS, COMMENTS

What happens next? Career success of IENS

Marie-Douce Primeau, Ph. D., PMPIsabelle St-Pierre, Janosch Ortmann, et al.

What is career success?

• Two components– Objective (income/salary; promotions; status)– Subjective

• Career satisfaction• Career development* for later!All have different predictors!

Objective career successN=1951Three components evaluated: access to promotion, access to mentorship title; work position (management & academia VS direct care)

Overall mixed results: 82.6%, 55.2% and 19.0% respectively achieved mentorship status, received a promotion and obtained a position of responsibility

Predictor Mentorship status Promotion Position of responsabilityCareer_2_Year_first_job_RN * *Career_3_Wait_until_licence *Career_5_Year_Employer **Career_6_Year_Position *** ***Individual_1_Age *Individual_4_Parenting *Individual_5_VM_Black **Individual_6_Education ***Individual_7_YearImmigrate * Job_1_Work_status_Occasional *** ***Job_1_Work_status_Partial * ** ***Job_2_Nursing_profession_RN *Org_1_Work_Setting_Acute * ***Org_1_Work_Setting_HomePrivatePhysician ***Org_1_Work_Setting_Other ***Org_3_Discrimination_0_index *** *** *Org_3_Discrimination_1 ***Org_3_Discrimination_2 **Org_3_Discrimination_3 * *** *Org_3_Discrimination_4 *Org_4_Receive_Mentorship *** ***Org_5_Professional_Development *** *Subjective - Career satisfaction * ***

Subjective career success : Career satisfaction (n=1951)Overall high satisfaction with career (median 9, mean 8.2, SD 2,01)• Individual characteristics: age (+), gender F-+), parental responsibilities (C-+),

education (-), year of migration (-) and race/ethnicity (-)• Career characteristics: year of license (-), year of first job (-) and perception of

achievement of career goals (+)• Job characteristics: work status (Full-time 8,31; part-time 8,05; occasional

7,85), and type of license (RPN 8,02; RN8,35; LPN 6,87)• Organizational characteristics: work setting (LTC 7,96; Community 8,13;

Hospital 8,27), region of employment (Ontario 8,39 Prairies 8,29 VS Qc 7,99 & BC 7,99) and workplace discrimination (-)

Any questions?

Thank you!!!

)

Enhancing Success:A web-based intervention coaches

IEN work readiness, with interprofessional care education.

Bradley, P.1 , Santa Mina, E. 2 , Espin, S.2, Rose, D. 2, Castillo, R., Khaira, R.3, Marasco, G. 1, White-Williams, H. 2, &

Manafo, E. 2

1 York University, 2 Ryerson University, 3 Seneca College

5/21/2020 Partners in Integration & Education of IENS Calgary, Virtual, May 26, 2020. 1

Project Purpose

to support IEN transition to education and employment and expand the capacity of interprofessional care (IPC) education across bridging programs and health care organizations

developed and implemented a web-based interventiona case based scenarioin the IEN voice integrates IPC with work readinessembeds online coach support quizcertificate of completion

5/21/2020 Partners in Integration & Education of IENS Calgary, Virtual, May 26, 2020. 2

www.iehpconnect.caScoping reviews on 3 constructs and key informant interviewsDeveloped and implemented a web-based intervention

a case based scenarioin the IEN voice integrates IPC with work readinessembeds online coach support quizcertificate of completion

5/21/2020 Partners in Integration & Education of IENS Calgary, Virtual, May 26, 2020. 3

Website Survey OutcomesN = 119 from 2 Ontario community colleges Quantitative Survey data n = 15

Majority agree: website is relevant, accessible,culturally sensitive, engaging and valuable to learning

Qualitative narrative responses:audio perspective of an IEN ….most valuableaudio transcriptions… helpful want more videos with facial expressions and physical gesturescoaching part helps ‘clear my doubts’

5/21/2020 Partners in Integration & Education of IENS Calgary, Virtual, May 26, 2020. 4

Next steps

open access of website www.iehpconnect.ca

Add IEN education and resource links to support IENs

Future grants and applications submitted

(Santa Mina, Bradley, Rose, & Espin, 2019)

5/21/2020 Partners in Integration & Education of IENS Calgary, Virtual, May 26, 2020. 5

CARE Centre for Internationally Educated Nurses

Virtual PIE-IENs National ConversationMay 26, 2020

Supporting IEN Integration through

Observational Job Shadowing (OJS)

About CARE Centre for IENs

• Created in 2001 • Funded by Ontario Ministry of Labour, Training and Skills

Development (MLTSD) and Immigration, Refugee, and Citizenship Canada (IRCC)

• Pre Arrival Support Service Program (PASS) • Supports, Training and Access to Regulated Employment

Services program (STARS)• Provide Individualized case management support

throughout journey to licensure and employment

Observational Job Shadowing Program (OJS)

• Unique learning experience in which IENs, partnered with an “expert nurse” through a work shift to observe first-hand the nursing profession in Ontario

• Strictly observational with no direct hands-on patient care

• 3 day observation only placement (full shifts)

The aim of the OJS experience is to…

• increase the IENs understanding of the role and scope of practice of a nurse in various healthcare settings

• receive orientation to the Canadian healthcare system workplace and learn employer expectations

• acquaint the IEN with the language and culture of the Canadian workplace

• give the IENs the benefit of shadowing an expert nurse on a first hand basis

Mentorship: A Key to Successful Integration of

Internationally Educated Nurses

Ramesh Venkatesa Perumal, RN, PhD(C), CCNE, CNCC®

York University.

Background and Literature Review

• My Story ….

• IENs – Focus of research -10 yrs (Ramji et al., 2019)

• Abundance - challenges experienced

• Finding a job, and transitioning into the nursing workplace and discrimination (Ramji & Etowa, 2018)

2020-05-21PIEIEN conference 2

Successful Integration leads to

• IENs - happy, self-sufficient, and productive -essential member of a caring team.

• Members - question the status quo and facilitate the growth of a profession (Sreitzer et al., 2012)

• Integration leads to Career Advancement (CA)2020-05-21PIEIEN conference 3

Mentorship

• Helping Relationship (Pelin & Ayise, 2019)

• Structured Program- Vision (Jakubik et al., 2017)

• Needed-career advancement of IENs (Salma et al., 2015)

• Safe care (Purcell et al., 2013)

• My intended research …2020-05-21PIEIEN conference 4

References

• Jakubik, L. D., Weese, M. M., Eliades, A. B., & Huth, J. J. (2017). Mentoring in the Career Continuum Of a Nurse: Clarifying Purpose And Timing. Pediatric Nursing, 43(3), 149–152.

• Pelin, K., & Ayise, K. (2019). Assessment of Mentorship Applications in Nursing Clinical Education. International Journal of Caring Sciences, 12(2), 869–876.

• Purcell, E. P., Mitchell, C., Celestin, M. D., Evans, K. R., Mcfall, A., Troyer, L., & Sanchez, M. A. (2013). Research to Reality (R2R) Mentorship Program: Building Partnership, Capacity, and Evidence. Health Promotion Practice, 14(3), 321–327. https://doi.org/10.1177/1524839912474277

2020-05-21PIEIEN conference 5

References

• Ramji, Z., & Etowa, J. (2018). Workplace Integration: Key Considerations for Internationally Educated Nurses and Employers. Administrative Sciences, 8(1), 2. https://doi.org/10.3390/admsci8010002

• Ramji, Z., Etowa, J., & ST-Pierre, I. (2019). Unpacking “two-way” workplace integration of internationally educated nurses. Aporia, 10(2). https://doi.org/10.18192/aporia.v10i2.4121

• Salma, J., Hegadoren, K. M., & Ogilvie, L. (2015). Career advancement and educational opportunities: experiences and perceptions of internationally educated nurses. 25(3), 56–67. https://doi.org/10.12927/cjnl.2012.23055

• Sreitzer, G., Porath, C. L., & Gibson, C. B. (2012). Toward human sustainability. How to enable more thriving at work. Organizational Dynamics, 41(2), 155–162. https://doi.org/10.1016/j.orgdyn.2012.01.009

2020-05-21PIEIEN conference 6

• Thank you

2020-05-21PIEIEN conference 7

Canadian Institute for Health Information

cihi.ca @cihi_icis

Pan-Canadian lens oninternationally educated nurses

May 26, 2020

Ryanna Bowling, Program SpecialistHealth Workforce Information

2

Proportion of internationally educated nurses in Canada, 2018

9.8%

8.7%

4.7%

8.1%

14.8%

—

3.4%

7.4%

4.5%

11.2%

9.9%

2.1%

14.9%11.2%

5.2%

11.4%

5.7%

0.8%

0.1%

1.7%

3.1%

0.3%

3.8%

2.2%

6.6%

2.5%

3.7%

3.6%

1.2%

0.6%

2.4%

Y.T.

N.W.T. and Nun.

B.C.Alta.

Sask.Man.

Ont.

Que.

—

N.L.

P.E.I.

N.S.

N.B.

9.3%

4.5%

5.8%

Canada total: 8.6%

Registered nurses (RNs)

Nurse practitioners (NPs)

Registered psychiatric nurses (RPNs)

Licensed practical nurses (LPNs)7.3%

9.8%8.7%8.1%

7.9%1.6%

0.8%

12.5%

—

Notes— Data not available or suppressed due to data quality issues..

RPNs are regulated only in Manitoba, Saskatchewan, Alberta, British Columbia and Yukon.In Ontario, LPNs are referred to as registered practical nurses (RPNs). Supply information for the Northwest Territories and Nunavut is reported together.SourceHealth Workforce Database, 2020, Canadian Institute for Health Information. © Canadian Institute for Health Information, 2020

3

Pan-Canadian variability among RNs working in rural/remote settings, 2018

24.6%29.4%

23.8%19.4%

10.6%5.9%

21.2% 21.5%

10.3%6.1%

17.5%

50.3%

31.4%

21.1%

28.0%

44.5%

2.3% 1.9%

13.1%18.3%

6.4%3.1%

23.9%

62.5%

0%

10%

20%

30%

40%

50%

60%

70%

NL PEI NS NB Que Ont Sask Man. Alta BC Yuk NWT/Nun

Canadian eduated RNs Internationally educated RNsNoteDue to voluntary reporting to CIHI of employment status in Manitoba, RN employment numbers may be understated. Please use with caution.SourceHealth Workforce Database, 2020, Canadian Institute for Health Information

4

A lens on internationally educated nurses

Nursing supply, 2018

Regulated nurses with an active licence in 2018

Canadian-educated nurses (CENs)

42%

392,000

Internationally educated nurses (IENs)

36,188

48% 63%

Nursing Home/LTC

Top Place of Work for IENs

Hospital

RPNsNPs RNs

48%

LPNs

Coming soon… May 28

• Data tables

• Chartbook

• Quick Stats

• Methodology notes

• Report (July 2020) SourceHealth Workforce Database, 2020, Canadian Institute for Health Information

A Narrative Inquiry into the Transition Experiences

of Internationally Educated Nurses (IENs): A Research ProposalRobyn Stewart RN, BN, MN; Dr. Andrew Estefan; Dr. Edward Cruz; Dr. Aniela Dela Cruz

University of Calgary, Faculty of Nursing, Calgary, Alberta

Background• IENs reported experiencing four main challenges during transition into professional

RN practice in Canada: English language proficiency, understanding and adjustment to the role of registered nurse, cultural displacement and competence, and varying degrees of marginalization and discrimination (1,2,6,7,9,12,17,19)

• Immigration is a complex and challenging experience for IENs (10,13,14,15,18)• Several transition theories exist and will be used in this research (3,8,11,16)• IENs transitioning into work environments in Alberta reported feeling disillusioned

and unsupported (9)• There is a paucity of research that focuses on the strengths and coping ability of

IENs during times of transition• There is a paucity of research that focuses on the immigration and transition

experiences of IENs in Alberta

Research PuzzleHow do IENs’ experiences of transition shape their lives, identities, and integration into new and diverse contexts of life and practice in Canada?

Methodology (4,5)• Human beings share their experiences in the world through story. • People shape their daily lives and identities by stories of who they, and others are. • My research will explore through story how IENs feel, think, behave, and understand their

experiences of immigration and transition into new professional work environments. • Narrative inquiry (NI) is a qualitative methodology within the social sciences that focuses

on learning with stories and is a way of understanding experience. • Thinking with stories is an approach that situates story and inquirer within a reciprocal

relationship wherein the inquirer is invited to consider questions such as, “How are these stories acting upon or changing me?” and “How do these stories impact or effect other stories as they are being lived, told, retold, and relived?”

• It is a collaboration between researcher and participants, over time, in a place or series of places, within social or relational contexts.

Methods

SignificancePersonal • Sense of belonging and security (19)• Identity development (12)Practical • Responsibility to mentor and support new

colleagues (8)• Effective collaborative interprofessional

practice• Effective professional communication (19)Social • Negative impact on the health of IENs (17)• Patient safety (17,19) • Issues of marginalization/discrimination (7,19)

References1. Allan, H., & Larsen, J.A. (2003). “We need respect”: Experiences of internationally recruited nurses in the UK. Guildford: European Institute of Health and Medical Sciences.2. Blythe, J., Baumann, A., Re´haum, A., & McIntosh, K. (2009). Nurse migration to Canada. Pathways and pitfalls of workforce integration, Journal of Transcultural Nursing, 20(2), 202-210. doi: 10.1177/1043659608330349.3. Bridges, W. (1980). Transitions: Making sense of life’s changes. Reading, MA: Addison-Wesley.4. Clandinin, D.J. (2013). Engaging in narrative inquiry. Walnut Creek, CA: Left Coast Press. 5. Clandinin, D.J., & Connelly, F.M. (2000). Narrative Inquiry: Experience and story in qualitative research. San Francisco, CA: Jossey-Bass.6. Covell, C.L., Neiterman, E., & Bourgeault, I.L. (2016). Scoping review about the professional integration of internationally educated health professionals. Human Resources for Health, 14(38), 1-12. doi: 10.1186/s12960-016-0135-6.7. DiCicco-Bloom, B. (2004). The racial and gendered experiences of immigrant nurses from Kerala, India. Journal of Transcultural Nursing, 15(1), 26–33. 8. Duchscher, J. (2008). A process of becoming: The stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441-450. Retrieved from: http://web.a.ebscohost.com. 9. Higginbottom, G. (2011). The transitioning experiences of internationally educated nurses into a Canadian health care system: A focused ethnography. BMC Nursing, 10(14), 1-13. doi:10.1186/1472-6955-10-14.10. Jeans H., Hadley F., Green J. & Da Prat C. (2005). Navigating to become a nurse in Canada: Assessment of international nurse applicants. Canadian Nurses Association, Ottawa, ON, Canada. Available at: http://www.cna-nurses.ca/CNA/docu ments/pdf/publications/IEN_Technical_Report_e.pdf.11. Meleis, A. I., Sawyer, L.M., Im, E., Hilfinger-Messias, D.K., & Schumacher, K. (2000). Experiencing transitions: An emerging middle-range theory. Advanced Nursing Science, 23(1), 12–28. Retrieved from: ebscohost.com.libproxy.mtroyal.ca.12. Neiterman, E., & Bourgeault, I.L. (2015). Professional integration as a process of professional resocialization: Internationally educated health professionals. Canada Social Science & Medicine, 131, 74-81. doi: 10.1016/j.socscimed.2015.02.043.13. Rogler, L. (1994). International migrations: A framework for directing research. American Psychologist,49(8), 701–708. Retrieved from: ebscohost.com.libproxy.mtroyal.ca. 14. Ronquillo, C., Boschma, G., Wong, S., & Quiney, L. (2011). Beyond greener pastures: Exploring contexts surrounding Filipino nurse migration in Canada through oral history, Nursing Inquiry, 18, 262–275. doi: 10.1111/j.1440-1800.2011.00545.x.15. Salami, B., Meherali, S., & Covell, C. L. (2017). Downward occupational mobility of baccalaureate-prepared, internationally educated nurses to licensed practical nurses. International Nursing Review, 65(2), 173–181. doi:10.1111/inr.12400.16. Schlossberg, N.K. (1981). A model for analyzing human adaptation to transition. The Counseling Psychologist, 9(2), 2–18. doi: 10.1177/001100008100900202.17. Tregunno, D., Peters, S., Campbell, H., & Gordon, S. (2009). International nurse migration: U-turn for safe workplace transition. Nursing Inquiry, 16(3), 182–190. doi:10.1111/j.1440-1800.2009.00448.x.18. Walton-Roberts, M., Guo, J., Williams, K. & Hennebry, J. (2014). Immigration policy changes and entry to practice routes for internationally educated nurses (IENs). Retrieved from https://www.deslibris.ca/ID/246299.19. Xu, Y. (2007). Strangers in strange lands: A metasynthesis of lived experiences of immigrant Asian nurses working in western countries. Advances in Nursing Science, 30(3), 246–265. doi:10.1097/01.ANS.0000286623.84763.e0.

ContactRobyn StewartPhD Candidate

University of CalgaryEmail: stewarrd@ucalgary.ca

Cell: (403) 998-0386

PurposeThis research aims to• hear, inquire into, and better understand

the experiences of IENs as they transition into Canadian society and into their new role as registered nurses.

• enhance the ability of agencies to better facilitate and support IENs to transition into life and professional nursing practice in Canada.

Purposive sampling of 4-6 participants,

guided by NI methodology

Participants are IENs who completed

bridging education and are now working as Registered Nurses

in Alberta

University of Calgary Research

Ethics Board (CHREB) approval

2-3 conversation style interviews with each participant that will be recorded and

then transcribed

Data analysis is iterative and ongoing

during data collection: looking for

narrative threads

Participant validation of

texts

Field textsinterim

research texts final

research texts

Response community

Partners in Education & Integration of Internationally Educated Nurses: National Conversation, May 26, 2020Research Report:Apples to Oranges — IEN Performance on Two Language Proficiency Exams Approved for Professional Registration*

Dr. M. Gregory Tweedie, Werklund School of Education, University of CalgaryDaniel Grossutti, The CELBAN Centre, Touchstone Institute

*Research funding: Social Sciences & Humanities Research Council of Canada

Case study: the impetus for our researchAhmet (pseudonym) is a new permanent resident, and a qualified nursing professional in his home country. He has completed requirements for Canadian licensure, including scores of 7 and above on IELTS Speaking, Listening, and Reading. After 9 attempts at IELTS ($300 per attempt), Ahmet is still a half-band score short of the Writing requirement: a 250-word academic essay expressing an opinion on a topic unrelated to nursing. Ahmet is ready to contribute professionally in his new home, but feels a growing mistrust with the regulatory system in Canada, and feelings of failure and exclusion.

2

Background● Research collaboration between the University of Calgary and Touchstone Institute● Language proficiency as a barrier to success for IENs● Seeking to understand the equivalencies of the Canadian English Language

Benchmark Assessment for Nurses (CELBAN) and the International English Language Testing System (IELTS)

Methodology

● A concurrent validity study to analyse IEN results on CELBAN and IELTS

● Methodology and study recruitment

● Impact of COVID-19

● Next steps

3

Participant Details

4

a = CELBAN/ IELTS Completeb = CELBAN/ IELTS Not Completec = CELBAN Complete, IELTS Not Complete

a - 6b - 9c - 14

a - 4b - 3c - 3 a - 1

b - 1c - 4

a - 1a - 0b - 1

a - 0b - 0c - 4

a - 4b - 2c - 3

Participant Status # of Participants

CELBAN/IELTS completed 16

CELBAN/IELTS not completed 15

CELBAN completed, IELTS cancelled 29

Total 60

1

CASN Accreditationinternationally educated nurse bridging

program

May 2020Virtual Conference

Cynthia Baker, RN PhD & Joni Boyd, RN, MEd

CASN and Accreditation

• Accrediting Canadian nursing programs for 23 years• National accrediting body for entry-to-practice and

IEN education programs• Association of Accrediting Agencies of Canada co-

founder and active member• Currently completing an accreditation program for

nurse practitioner programs and piloting a practical nurse accreditation programs

2

History of CASN’s IEN Accreditation program

• Obtained funding from Health Canada and CASN board approval in May 2016

• Established an advisory committee in September 2016• Piloted with three programs (George Brown College &

John Abbott Colleges & Kwantlen Polytechnic University) in 2017

• Evaluated the program through three focus groups (accreditation coordinators, reviewers & IEN-CASN Accreditation Bureau members) and a survey of the standards. The program was adopted by the advisory Committee and CASN’s Board of Directors in 2018

• Launched the IEN program in September 2019

3

What to Expect of Accreditation

• Self assessment against standards• Reviewer report validating self assessment and

outlining strengths, vulnerabilities, and opportunities for improvement.

• A thorough review of structures, processes and outcomes

• Fosters quality improvement• Provides public recognition of accreditation status• Repetitive cycle of planning – implementing –

assessing - acting

4

Essential Components of an Accreditation Service

Accr

edita

tion

Body Governance

FrameworkDecision making bodyOperational structure

Accr

edita

tion

Prog

ram Policies,

processes, proceduresDocumentation supporting the program

Stan

dard

s Specific quality expectations that the educational programs must meet

5

Phases of Accreditation Review

6

Preparation Site Visit DecisionMaking

Standards Framework

7

Quality Dimensions

Standards

Descriptors

Key Elements

IEN Accreditation Standards

I. IEN LearnerII. Partnerships/RelationshipsIII. Teaching and LearningIV. ResourcesV. CommunicationVI. Program EvaluationVII. Program Outcomes

8

9

Thank you!

May 2020Virtual Conference

Cynthia Baker, RN PhD & Joni Boyd, RN, MEd

Thank you!