“Before coming here, we researched. We really wanted to be nurses. [What] were the documents needed, what were the steps to be nurses?” says Ma-Ann Arellano, an internationally-educated nurse (IEN) from the Philippines.
The 33-year-old came to Montreal in 2018. She arrived with her husband, Alvin Cascara, also an IEN.
In 2014, when they were working as nurses in Dubai, a friend encouraged them to consider working in Canada.
Through an immigration agency based in the Philippines, they submitted separate applications to the Quebec Skilled Worker (QSW) program, since they weren’t married yet.
By luck, their documents were processed at more or less the same time.
While they waited, they postponed and rescheduled their wedding twice.
It took two years and nine months before their visas arrived—which was quick, they say, compared to the experiences of other applicants.
In 2017, they entered Montreal as singles, and stayed for a couple of days. Then they returned to the Philippines, got married, and wrapped up their work in Dubai.
And after a long application process and tedious paperwork, they finally started life as a married couple in Montreal in February 2018.
Still, more lay ahead before they could work as registered nurses.
Planning, patience, and dedication
Quebec’s requirements for IENs who want to register and practice as nurses differ from other provinces’ in Canada. But for IENs who do not speak French, the language requirement presents its own challenge. Nurses need to be proficient in the language in order to get a licence to practice. And with only one college offering the nursing bridging program in English, the program is competitive.
Cascara and Arellano did their best to meet every requirement.
They looked into Quebec-specific requirements for transitioning into the workforce as RNs, including paperwork, deadlines, and the kind of documents they could obtain within the timeframes they had.
“You really need to plan ahead. Which cohort do you want to join?” says Arellano, referring to the English bridging program at John Abbott College. The couple wanted specifically to be part of the cohort that started in July when the weather is similar to what they were used to in Dubai and Manila.
For a couple of months, their days started at six in the morning and ended at 10 in the evening, first with work, followed by French classes—“so we [could reach the level] they wanted us to have,” says Arellano.
“It was challenging, but recalling [it now], everything went smoothly,” says Cascara. “We managed to be part of the cohort that we wanted.”
They did their nursing integration program from July to December that year. By January 2019, as they applied for their RN license, Arellano and Cascara started working as nurses at a local hospital.
Financial resources help, too
“It’s easy to migrate to Canada as a nurse, but it is difficult to practice the profession as IENs have to undergo a lot of assessments and re-entry programs,” says Jason Tan, a licensed practical nurse (LPN) based in Victoria, B.C. “IENs need to invest a lot of money and time to be able to practice.”
These re-entry programs take about two years to complete, and language proficiency exams such as the IELTS cost around $300. Its results are valid for two years. For caregivers with nursing qualifications and experience, who are still waiting on their permanent residency application, expired test results mean they need to take the IELTS again if they wish to practice as nurses.
The 40-year-old came to Canada in November 2017 with his wife, also a nurse, and their then-three-year-old daughter.
Tan graduated with a bachelor’s degree in nursing in the Philippines and passed the local licensure exam, but chose not to practice as a nurse—until he and his wife decided to move to Canada. In 2016, they worked with an immigration consultant on their Federal Skilled Worker program application.
They paid a hefty sum for the consultant’s fee alone—roughly $12,500 he says, nearly half a million Philippine pesos—and received their permanent resident status relatively quickly.
“I guess we were just lucky that money was no object during our application.”
After they arrived, Tan enrolled in an 18-month program to be able to work as an LPN, which he continues to do.
His wife will soon start a bridging program to be able to work as an RN, and he intends to follow suit once she’s done.
A better process, and an open mind
While Tan considers his immigration journey to be smooth, he does think a better process would benefit IENs—as well as Canada.
“[Make] it easier for IENs to practice their profession by streamlining the process,” he says. “Because at the end of the day, IENs, if successful, will become the backbone of many hospitals in Canada.”
Gayle Waxman, executive director of the National Nursing Assessment Service (NNAS), says they are looking at ways to achieve this.
The NNAS is a non-profit that works with IENs, nursing regulatory bodies, and the healthcare system in Canada (excluding Quebec, Yukon, Nunavut, and the Territories). Specifically, they assist IENs with their RN application process.
“NNAS is currently looking at a number of ways to improve the effectiveness of the nursing assessment process,” says Waxman.
This includes “providing applicants with more information regarding the steps they can take to complete the process efficiently, and making sure our processes are clear and transparent.”
Cascara thinks that Quebec’s requirements are fair. He adds that while a shorter immigration process would be preferable, it’s also important for IENs to keep an open mind.
“I hear people get frustrated when they come here, not expecting this is [what] they’ll experience. Things will be different, and we have to accept it so that we will not suffer emotionally,” he says.
“If they could prepare ahead of time before coming here, it would also help. It saves them a lot of time and energy and resources.”
Arellano thinks it’s important for IENs to be prepared to adjust to local requirements.
“We can’t really change [the process],” she says. “So for us, if we choose to be here in Canada, we really have to embrace it. We need to do what they require us to do.”
“When they say, ‘stamp the paper like this,’ you just need to stamp the paper like that.”
Editor’s note: This story has been updated to correct the duration of Jason Tan’s LPN training. It was 18 months, rather than three months as initially reported. Sorry
Johna Baylon is a freelance journalist and writer based in Vancouver, B.C. She is also NCM's Local Journalism Initiative Reporter. She is drawn to stories around immigration, care work, and communities in the diaspora. Born in the Philippines, Baylon grew up in Hong Kong, where she covered food and design as a writer and editor prior to moving to Canada in 2019. Find her on Twitter @johnabaylon.