NNAS- Canadian citizens with US education/licensure

Pediatric Critical Care Columnist · Sep 12, 2016

If there are any other Canadian RNs out there who went to school in the US and have been licensed in the US, I would like to hear your NNAS experiences. Have you received a "non-comparable" report? If so, have you been able to obtain provincial licensure in spite of being labeled "non-comparable?'"

Are you currently living/working in Canada as a RN? How long did it take for you to receive your advisory report? What was your total cost (admin/mailing fees/cost to have licenses verified, etc)?

Are you aware that this process of assessment has only been in place less than a year? I would guess (and I could be way out in left field here) that there aren't all that many Canadian citizens who were educated as nurses outside of Canada who are now trying to come back to Canada. It would seem sensible to me that if someone who is a Canadian citizen who plans to practice in Canada would be educated in Canada, and cut out all that assessment stuff altogether. Nursing education is determined by the jurisdiction in which it's provided and is tailored to the practice environment found there. Nursing practice in Canada is not exactly the same as nursing in the US, even though we share a common language, the longest undefended border in the world and similar cultural influences.

Nursing leaders in Canada needs to know how their "streamlined" process is actually impacting Canadian nurses who are trying to practice in our home country. NNAS states on their website that the organization "strives for transparency, timeliness and harmonization across its member jurisdictions while applying rigorous standards for assessing qualifications"- however these "standards" are not disclosed to applicants.

This organization receives funding from the provinces and the federal government, and yet there is zero transparency for applicants regarding the assessment process. Applicants blindly throw their money (in US dollars) at this agency before having access to the required forms, and even then have NO idea what the criteria is. How objective can this be?

The criteria for entry to practice are readily available on any of the Colleges' websites under the heading of "competencies for entry to practice". There are also usually sections on their websites that cover standards and guidelines for nursing practice. Those are the competencies and criteria against which internationally-educated nurses are assessed. Remember that regulatory bodies are not simply paper pushers that provide an annual permit to practice; they have a legal obligation to the province to protect the public and that obligation means they must maintain certain standards - standards that are actually legislated. And that costs money. Should the people who are already registered with the College pay twice for your assessment - once with their taxes and then again with their registration fees?

Furthermore, both US and Canadian nurses are credentialed with the NCLEX now, so shouldn't there be a pathway for RNs who have passed the NCLEX in the US?
This process MUST be improved and I would like to start by compiling the experiences of other nurses to take to leaders in nursing in Canada.
Thank you in advance for your time!

The Colleges have already gotten a significant black eye over the NCLEX and the misinformation that was circulated about it before it became the standard. Passing the exam is only part of the process of becoming registered. When you registered for the first time in the state where you were educated, they already knew what standards your education met, because they were the ones who determined and approved them in the first place so when you graduated they knew your education was approved. The only way the Colleges have of determining if you meet THEIR standards is to assess you. A year ago, you would not only have had to undergo an assessment but also write the CRNE in order to be registered in Canada. The move to the NCLEX has removed THAT step. You aren't the first person to complain about the process and you won't be the last. Have you thought about what someone from the US but educated in Canada has to do to become registered in the US? How much trouble and money does that require? I'd say the number of people going down that path would be minuscule, since a nursing education in the US is shorter and generally cheaper than it is here and there are a LOT more schools of nursing there. When faced with pressure from the province who legislates nursing practice versus those who feel unjustly required to prove themselves, I can tell you which side the Colleges will take.

dishes, BSN, RN · Sep 13, 2016

I think NNAS should be required to be transparent and publish annual statistical reports on their website, at minimum the reports should indicate;

the number of applicants in each category practical nurses, registered nurses or psychiatric nurses

the number of applicants by jurisdiction where they obtained their initial education

the advisory report results including the number of comparable, number of somewhat comparable, number of not comparable by jurisdiction where initially educated

NNAS had a request for proposals for an auditing firm to provide external audit services for NNAS for 2016/17, I hope the audit report results will be made public on NNAS's website, similar to the fair registration practice reports that are available on CNO's website.

nicu_gal · Sep 13, 2016

I introduced this topic because I have seen similar posts on other threads (i.e. Canadians who attended nursing programs in the US). And the way things are going down there, I'm probably not the only Canadian that wants to run back home!

Yes, I am aware that NNAS is a relatively new organization, but this process has now been been in place for two years (effective August 2014). At this time, the organization should have initial data and results of at least the most basic level of comparable/non-comparable advisory reports by country. As an institution that receives government funding, this information should be accessible to applicants and international nursing programs, if not the public.

I am becoming increasingly aware of the standards and practices for Canadian/US nursing licensure, as I am considering this topic for a master's thesis. Professional standards and credentialing is an area that I have always been interested in, and my recent return to Canada and experience with NNAS has sharpened the interest. Take the state of California for example: A RN licensed in Canada by NCLEX is in fact eligible for licensure by endorsement and follows the same process a RN from any other state does. Isn't there a potential for a pathway for experienced RNs who are 1) English/French speaking, 2) Baccalaureate prepared, 3) Licensed by NCLEX? I understand that there is financial incentive in all of this as well and I am not balking as the fee itself- although it is somewhat irksome that the NNAS office is in Philadelphia and the fee is listed as $650 without specifying that that is USD not CAD. I am an advocate for professionalism and credentialing and understand the associated costs, as I pay a variety of annual fees for professional certification and memberships. But I really believe that there is opportunity for process improvement here, and that increased transparency from NNAS would in fact improve the timeliness and efficiency of the process from start to finish. I am interested in learning more about jurisprudence exams, as I hear they are gaining some momentum in the US now (and catching up with a lot of Canada). For an experienced nurse, I think this type of professional assessment that is directly related to the jurisdiction in which one plans to practice is extremely relevant. Having worked in more than one state, I continue to be fascinated by the variability among standards of practice between states (also possibly related to some states supporting nursing unions and others rallying against them?). Thank you for drawing my attention to the Colleges' scope of practice for nursing, as I have been reading up this morning!

On another note, I'm quite surprised you perceive nursing education in the US to be shorter/less expensive than in Canada? I did complete an accelerated 2nd degree nursing program in the US- but I know there are many accelerated nursing programs across Canada as well. I started my first degree at UWO and my tuition was a heck of a lot more affordable there than it was in the US. I sold my condo in the US to move back and was finally able to pay off my student loans after almost ten years!

Thank you for your comments, as you have given me a lot more to think about and read! I have a lot of time on my hands right now to read, as NNAS is presently splitting hairs over the envelope that my Nursing Employment Forms were sent in and requiring my already overloaded former nurse manager to send the forms again....Meanwhile in Canada, I'm just waiting to get back to the work that I love...

dishes, BSN, RN · Sep 13, 2016

@nicu_gal, a couple of your points that aren't quite correct;

NNAS was not created for financial incentive, it's a not for profit organization, NNAS hired a third party vendor to conduct the assessments, the third party vendor was vetted through RFPs as is required by any not for profit, partially government funded organization. The third party vendor would have been selected based on their ability to provide the service for the best price.

According to NNAS website, their head office is at 215 Spadina Avenue Toronto Ontario. The IEN assessment process is carried out by the third party-vendor in Philadelphia.

If you are going to compare standards and practices of Canadian and US nursing licensure, your first step is to understand the Canadian entry to practice competencies. In Canada, the competencies do the following; direct regulatory body expectations of nursing competence, direct nursing education program content, and guide development of minimal competency measurements related to the practice environment. Does the US have a set of national competencies that do these three things? The US has competencies that assess knowledge on a national licensing exam, but they do not contain all of the competencies that the Canadian entry to practice contain.

nicu_gal · Sep 13, 2016

I apologize for using the word "incentive", as I did not mean to imply that anyone is profiting through this process; rather, I was trying say that I appreciate that there are costs associated with professional practice and credentialing. Yes, NNAS identifies their HQ in Toronto, but all IENs communicate solely with their Philadelphia office (See Contact Us page). I am a dual citizen and found this to be odd, so I can only imagine what an applicant from outside North America thinks when they are forwarding all of their documents for a Canadian nursing license to PO Box in Philly. It's just an aside, but you have to admit it wouldn't be what you would expect right?

With regard to the question of whether or not the US has a set of national competencies, I'm assuming that was a rhetorical question? The American Nurses Association has been around for more than a century and promotes professional nursing in all areas from education to legislation, similar to CNA. Each state has a board of nursing to oversee licensure, just as the provinces have the colleges. The biggest difference I have seen is in the jurisprudence exams- and I think those should be required for licensure. I've spent a lot of the day reading about scope of practice in multiple states and provinces. They are more similar than dissimilar.

Thanks for your comments. I've never been active on chat boards or list serves before, and maybe I just need to get back to work- clearly I have too much time on my hands if I'm finding health policy so interesting! I miss my NICU babies!

dishes, BSN, RN · Sep 14, 2016

ANA's role and CNA's role is to establish a code of ethics and promote the profession of nursing, their role is different from a national regulatory organization such as Canadian council of registered nurse regulators. One of CCRNR's roles is to harmonize the assessment of IENs.

nicu_gal · Sep 14, 2016

I'm really not sure what your point is? Ok..Canada has CCRNR, established 2011. USA has NCBSN, established 1978. They are both comprised of the boards/colleges of nursing. The regulation of nursing practice remains on the state/province/territory level. To me this just seems to reiterate all the mirrored practices and policies in Canada/US nursing and make a stronger case for reciprocity in licensure.

dishes, BSN, RN · Sep 14, 2016

The term 'streamlining' on NNAS website, is referring to the improvement of the process that existed prior to NNAS. Before NNAS, IENs were assessed for the clinical and theory hours by a third party education assessment company first and the entry to practice competencies were assessed by the provincial regulatory body second. The results of the two step method were variable from province to province and the process lengthy. NNAS was created to combine these two assessments into one and a tool was developed based on the criteria that representatives from each of the regulatory bodies agreed to. The tool was best able to be implemented by a company based in the US, that is why the assessment company is in the US.

I think you are focusing too much on the similarities, I suggest you compare and contrast the US and Canadian entry to practice education, not just compare the similarities, as it is not just the domain of jurisprudence that is different.

Kissunshine, BSN, MSN, RN, APN, NP · Sep 16, 2016

This is why I live/work in US but decided do to my NP online through at Canadian school, I knew it would be very difficult to get licensed in Canada with a US education and I want to keep the option open of going back home one day. Even having done my BSN in Canada and license in Quebec as a nurse, it is a long process to get licensed in another province in Canada (6 months and counting!).

It's funny because with a Canadian education/license, it's not nearly as difficult to get licensed in the US.

dishes, BSN, RN · Sep 17, 2016

Prior to NNAS piloting in 2014, a US BSN education was often considered comparable to a Canadian BSN education, but since the NNAS assessment tool seems to be better at capturing the differences in education, it is resulting in fewer US BSNs being considered comparable to Canadian BSNs. I think anyone with a US nursing education who is currently undergoing the IEN licensing process is realizing that it would have been simpler for licensing purposes to obtain a Canadian nursing education. Unfortunately, they had no way of knowing the impact NNAS would have prior to going to school, because it didn't exist until after they completed their education.

Most US educated Canadians had their reasons for obtaining a US education, the two most common reasons that I have heard are; they received an international scholarship to study in the US or they relocated with their Canadian spouses who were working in the US.

It's easier for a Canadian educated RN to become licensed in the US because entry to practice requirements are an ASN education not BSN education.

RN_Pro · Dec 18, 2016

At this time, the organization should have initial data and results of at least the most basic level of comparable/non-comparable advisory reports by country. As an institution that receives government funding, this information should be accessible to applicants and international nursing programs, if not the public...
I am becoming increasingly aware of the standards and practices for Canadian/US nursing licensure, as I am considering this topic for a master's thesis...
Isn't there a potential for a pathway for experienced RNs who are 1) English/French speaking, 2) Baccalaureate prepared, 3) Licensed by NCLEX?...
it is somewhat irksome that the NNAS office is in Philadelphia and the fee is listed as $650 without specifying that that is USD not CAD...
On another note, I'm quite surprised you perceive nursing education in the US to be shorter/less expensive than in Canada? I did complete an accelerated 2nd degree nursing program in the US- but I know there are many accelerated nursing programs across Canada as well...

I agree with you nicu_gal, these stats should be available to the public. If there is nothing to hide, why not? My guess is that these stats are not provided because they would reveal that NNAS assesses all IENs as RN "non-comparable" (with a few lucky cases where RN's have been "somewhat comparable"). As well, there are very few who have become registered since the implementation of NNAS and thus the "streamlined process" that they patted themselves on the back about at the first annual NNAS Conference in Toronto this year, would be shown to be not so streamlined at all. But increased transparency in having the stats available would allow IENs to better understand their chances prior to uprooting their life and/or applying-- allow them all possible information available to better inform their decision-making. I don't see any defensible reason for not making stats public. And since public dollars were used for start-up of NNAS, that is reason as well.

Please do strongly consider this as a master's thesis topic! I think you are on to something, and from your posts, are smarter beyond opportunities provided in online forums, not to say that these forums aren't important because they most certainly are and especially in situations like this where those experiencing similar things can come together.

It would make sense for there to be a separate pathway for NCLEX passers who speak English/French, and have a 4 year nursing degree. Of course they still need to be checked out before earning a license, but I do think it would be reasonable that those who have passed NCLEX in the US not be

dealt with in the same way as non-NCLEX passers who received their education in India as an example. Just because there aren't that many of us in comparison doesn't mean we should be left unconsidered in the process.

Yes I also found it odd that I was sending my information to Philly, especially considering licensing bodies in Canada (and many other agencies such as Public Health etc) have, in most cases, quite strict policies against storing their data in the USA. But by contracting an arms-length agency to do the assessment, this provides a way around this. I am sure you are also aware that those conducting the NNAS assessment of comparability with Canadian nursing education are American and they are not nurses.

I'm not sure where the idea that US BSN's are shorter came from but from reading the forums there seem to be some people who repeatedly suggest that a US 4 year nursing degree is somehow deficient in comparison to a CDN 4 year nursing degree. You are correct that accelerated programs exist all across Canada. In many of them, the student is taking college courses for half of the program, not university courses. My US BSN was 4 years of university, very rigorous and when I compare my knowledge, skills and judgement to my peers in Canada, I am more than content and feel more than prepared with my US BSN. US ASN is different from CDN BScN but US BSN is not that different.

Again I really encourage this as a Master's thesis. If only I knew about this when I completed my own thesis. There is a lot going on here and IENs would benefit from the deeper dive into the process. There is never any harm in questioning a process and seeking ways it can be improved. It's using critical thinking skills, skills we are taught to use in nursing!