US IENs in Ontario, Canada

[abbyg13]

Hi, fellow nurses!

I need some help. I have been a RN/BScN for the past 2 years in a 28 bed ICU where I have received neuro, surgical and medical critical care experience. I am also in the process of obtaining my FNP. I met my Fiance in the States and the plan had always been to move to Ontario once he graduated from his medical residency (he is from the Toronto area). The process for him to convert his medical education/residency was fairly straightforward and transparent; I believe it took him a total of 4 months in all. I have been in the process, however, for over a year and there is no transparency or timeline provided. I am a Permanent Resident in Canada (that only took 5 months!) and have been going back and forth for work and school since July 2016. Needless to say I am frustrated and want to know if the end is anywhere in sight! Since I live in a city that borders Ontario, I know many Canadian nurses and professors and EVERYONE talks about how our education is more than comparable if not better.

For those of you not familiar with the process, here's a breakdown:

1. Obtain an advisory report from the National Nursing Assessment Service (NNAS). This is the 3rd party that "verifies" the internationally educated nurse's (IENs) credentials. It costs $650 USD. You must provide them documentation of your education (coming directly from your University/College), your current license (coming directly from the State where you received licensure), a letter of employment (coming directly from your place of work), and 2 different forms of notarized identification.

2. Call everyday to confirm progress, understanding that there is no wait time. I applied in early April 2016 and received by Advisory Report in December 2016.

3. Receive your report and cry a little (haha, not really). I say this because the process in which they assess is VERY subjective and if your school's curriculum does not use the correct terminology your education may be deemed as "Non-Comparable." The other categories are "Somewhat comparable" and "Comparable."

4. Apply to your regulatory body (in my case it was the College of Nurses of Ontario-CNO). The prices vary but are reasonable in comparison to the price of NNAS. I have heard people wait SIX months to hear back from them but luckily I received a letter from them after 3 weeks.

5. Provide additional information to the regulatory body if required. I say "if" but in my experience every IEN has had to provide something additional to them. It makes me question the purpose of NNAS. In my case I had to have a letterhead, sealed letter from my ICU manager outlining all that my job entails. They told me this was necessary because NNAS's report said my education was "Somewhat comparable." They already received a letter from my employer through NNAS but needed a more detailed description, I guess.

6. Successfully pass the Jurisprudence Exam (more $$$), which is the equivalent to nursing ethics in the US. This was open book, took about 3 hours, and was 150 questions.

7. Sit back and listen to the wonderful soundtrack that the CNO provides its listeners... I think I hum this in my sleep because hold times can be up to 1 hour. And, when you finally get through, the person on the other line is a customer service representative who basically tells you there is no timeline for your application and its still in the review process. THAT.IS. ALL.THEY. SAY. Like a broken record. I still call as much as possible, hoping they get annoyed with hearing my voice and put my case to the front of the line. Oh, and if you go to their headquarters (DT Toronto), they don't allow you to talk to anyone who knows what is going on, either.

So, it's April 2017 now, my 1 year anniversary of patiently (and sometimes not-so-patiently) waiting. I am trying to be optimistic but remain discouraged every time I have to cross the border, or stay in a rented apartment for over a week before returning to Canada so I can work and complete my clinical hours for school. I am so thankful for living close enough to do this, though! I can't imagine what it must be like for other IENs living overseas and beyond.

I read that by 2022 there will be a shortage of 66,000 nurses in Ontario. Why are they giving us such a hard time? Especially since their students are leaving Ontario to work and attend school in the US. I find the lack of transparency highly unprofessional and am hoping to take it further, whether or not I am ever granted a licence. The system needs to be changed and the public made aware of how they are treating their public servants.

Please provide any stories, advice and experiences you may have! :)

[dishes, BSN, RN]

Unfortunately, your experience with NNAS and CNO sounds all to familiar. You can use the search tool in the top right hand corner to find find several threads by US educated nurses who have had experiences similar to yours, some of the thread titles are;

NNAS Experience

U.S. educated RN coming to Ontario

US Nurse NNAS

NNAS-Canadian citizens with US education/licensure

[RN_Pro]

@abbyg13 I empathize with you 100%. I too am going through the same, except, my 4 year BSN was deemed "non-comparable" by NNAS and I had to do the $400 IENCAP. (I say $400 but can you really put a price on stress?) It took forever to get a spot in the exam.

If I can offer any solace to you, I'd say that my best guess (based on what has been happening with others recently) is that they will (eventually, whenever they update you) say that you have met your education requirement. It is an incredibly good sign that they did not ask you to complete the IENCAP when they sent you the letter six weeks after you applied to CNO. The reason I have a good feeling about this is that prior to September 2016, CNO was taking NNAS Advisory Reports to heart and those who were not "comparable" (so, pretty much everyone, including US-educated) were asked to do the IENCAP. At the September 2016 CNO Council meeting, a member brought to light the difficulties IEN's are facing with NNAS and the unreasonable Advisory Reports. They decided that they would go back and review all applicants who were found "non-comparable" by NNAS, and ask those who were "somewhat comparable" to submit further documentation regarding their nursing work experience in order to prove themselves to have the skills equivalent to that of an entry-level Canadian-educated RN. In most "somewhat comparable" cases, the documentation from your current employer is enough for it to be decided that you have met the education requirement. So essentially, sleep well tonight knowing that your "somewhat comparable" is likely to be no different from "comparable" and that it's just a question of when they actually get back to you. Of course I can't guarantee this will be the outcome but it seems like it is most likely.

As for taking this further, that's a good idea. The more that do, the better. On top of sending CNO a formal letter outlining the issues (I'd wait until after you have your license), I would recommend sending one to the Office of the Fairness Commissioner. @dishes has also suggested in the past that MPP's be engaged in understanding what is happening with this process. Especially, I'd say, MPP's in border regions who have plenty of constituents who may be affected by how this plays out.

May I ask which school you received your nursing education?

For the record, I did cry when I received my Advisory Report What a nightmare.

[dishes, BSN, RN]

I agree that you should remain hopeful about becoming registered in Ontario, as according to the Fair Registration Practice Report 2016, CNO received 123 new applications from USA educated nurses and 78 US educated nurses became fully registered members in Ontario, between Jan 1- Dec 31, 2016.

[dishes, BSN, RN]

Hi, fellow nurses!

5. Provide additional information to the regulatory body if required. I say "if" but in my experience every IEN has had to provide something additional to them. It makes me question the purpose of NNAS. In my case I had to have a letterhead, sealed letter from my ICU manager outlining all that my job entails. They told me this was necessary because NNAS's report said my education was "Somewhat comparable." They already received a letter from my employer through NNAS but needed a more detailed description, I guess.

:)

CNO is comparing the detailed job description to the competency gaps on your NNAS advisory report. Did you ask your manager to give you an additional copy of your detailed job description? If so, have you compared your competency gaps from your NNAS advisory report to your job description to see if there is proof that you are able to meet the competency gaps through your work experience?

[dishes, BSN, RN]

@abbyg13 CNO is assessing your work experience to determine whetherthe entry to practice competencies can be identified, are they also assessing any additional nursing education you have obtained?

[abbyg13]

Thanks, @dishes! You seem to have a lot of experience in this topic. Today I went to the CNO office in Toronto with additional information written from the head of my FNP nursing department (same school I went to for undergrad), and asked to speak with my administrator or their secretary. The receptionist was very polite and called up to my administrator but she refused to come down to speak with me. I left the info for my file but the visit was not beneficial at all. So, I am considering getting a lawyer involved to provide additional push on the college to review my application. Thoughts?

[abbyg13]

@RN_Pro: í ½í¸³ wow! Your experience sounds very stressful and in sorry you had to go through all of that!! Thanks for providing all the helpful info and o really do hope that once they review my education it will be deemed acceptable. I went to D'Youville College... how about you? And some of the sections were "somewhat comparable" but overall it was "non-comparable." I updated my original post to clarify that. I'm thinking of getting a lawyer involved to maybe speed up the process. Thoughts?

[dishes, BSN, RN]

@abbyg13, my advice is to try to be patient and hope for the best. A lawyer won't be able to help you push through your application faster, the CNO processes applicants' information in the order that they receive it and your's will be one of many applications that they are reviewing. RN_Pro pointed out that last September the CNO started reviewing a large number of applicants whose NNAS advisory reports were deemed not comparable and somewhat comparable.

Just some food for thought, phoning the customer service reps frequently and asking the same questions about your application isn't going to improve the speed or the results of your assessment. It's possible that they are tracking your calls and writing a note in your file each time you phone, the note may say something along the lines of 'explained to applicant that the assessment is still in the review process'.

[RN_Pro]

@abbyg13

Okay so if the overall Advisory Report was non-comparable, please disregard my previous response. I was basing that response on a "somewhat comparable" advisory report.

Unfortunately, I think you are a long way out from licensing. When CNO responds they are likely to send you the registration info, or "invitation" to do the IENCAP. Then you will have to sign up for a date to do the exam and that can take months, depending on when they release dates and open them up for applicants to register etc. Now that CNO is permitting those with nursing education but no nursing experience to also opt to do the IENCAP, I expect the number of people registering for IENCAP will increase at least slightly.

I agree with @dishes that hiring a lawyer isn't likely to change anything for you. There are a lot of problems with this process, especially for US-educated nurses, but no laws are being broken. It won't speed up the process because CNO has farmed out the assessments so are absolved of any responsibility over them. Also, their role is protection of the public, not allegiance to or advocacy for RN applicants. I'd say your grievances would be better forwarded to Office of the Fairness Commissioner as there are definitely issues with transparency, timeliness, etc. But a lawyer wouldn't really be applicable. CNO has their own big-time lawyers.

Probably not the info you want to hear but I feel like there isn't any reason to be anything other than honest or straightforward with each other on here!

[dishes, BSN, RN]

It's possible that CNO will accept the letters of work experience and additional education as proof that she meets the entry-to-practice competency gaps.

[RN_Pro]

I suppose anything is possible but they didn't do that for me. That would be incredibly unfair to be quite honest.

So far I don't think there has been anyone with "non-comparable" that has had that happen, only "somewhat comparable". But, not every US-educated IEN is on the forums so of course my measurement isn't population-level. When I last talked to CNO that was the case anyway. They said the percentage comparable obtained when someone is deemed "non-comparable" is much too low to consider letting them through without the IENCAP.