I am a USA trained RN with over 5 years of experience. I have and BSN Degree and a Master degree to work as a NP. I got married this years and move to the Ottawa area. I started the process to transfer my license over to Canada from USA last October 2015. I called the CNO and I was told to contact NNAS for educational evaluation first.
The NNAS are a USA based third party company that reviews education for the Nursing Boards in Canada. Their reviewing criteria are unknown to me even after I asked them, they stated that it is confidential and they will not disclose this information to me. They told me that it takes about 6 to 8 weeks to process paperwork that is sent to them by mail. I had to call them multiple times, they could not find my paperwork, my school had to send them the same paperwork several times before it was finally found and processed.
They requested paperwork is for verification of employment, verification of education (which includes transcript, course description or syllabus of each course), Verification of Nclex exam with a notarized paper for the Nclex to release my actual Nclex grade to them. Plus, I had to pay them $650.00 US dollars for them to start the process.
The report was completed 8 months later around the beginning of July 2016. They issued an evaluation to the board of nursing that was unfavorable to me. They deemed my education as not equivalent to that of Canada. Although they ask for specific classes to be evaluated at the end of their report, I was given a 38% equivalence rate. I asked them to explain this to me and honestly they could not explain it because to me, it's confidential. I was told this percentage is not uncommon for USA trained RN. Mind you my husband studied nursing in Canada, we studied in same books by the same publishers, and the only difference is that they had Canada in front of all their books.
The NNAS claim that they look for certain words in the syllabus to see if I meet those criteria. I explained to them the syllabus gives you a brief description of the class and the contents that you are expected to have mastered. The remain exact topic studied needs to be followed through by going to the delineated chapters of each nursing book as outlined by the syllabi in order to provide a fair assessment of the topics that was mastered. Then I was told that they do not have the time to go look in every book, it should be in the syllabi or they assume that I never learned it.
I ended up have to go the dean of my school in order to request for them to send NNAS all my nursing education courses' syllabi. Then, I called NNAS again, and they did not receive the paperwork that was FedEx to them by the school. I was very disappointed by the work of NNAS because I went a prestigious Catholic University in USA, graduated with a 3.4 GPA, received two grade based scholarships and a job offer before graduation.
I was advised by my family to call NNAS. So I did call, I asked them why they issued this report that is not fair to my level of knowledge, training, and application of nursing sciences?
Then, I realize that although they requested these listed classes.
1 - Medical surgical for adult
2- Maternal and infant
3- Care of children
4- Psychiatric
5-Geriatrics
6- Community health
7- Anatomy and Physiology
8- Pathophysiology
9- Pharmacology
They actually look for other component of the nursing program not covered under these classes such as community nursing, health assessment and lab, simulation classes and competencies, ethics, professional role, nursing research, therapeutic interventions and lab, professional nursing, medication calculation and more.
So now, August 2016, I am still waiting 10 months later for another report that the NNAS agreed to re-issue because they realized that the prior report was not appropriate before I can get to step 2 which is applying to the CNO. The CNO actually is much quicker than NNAS, and I truly believe that they would do a better job by themselves or allow USA RN to either practice based the Nclex scores or allow us to take the exam again since it is the actual measure of competency for entry of practice for both Anglo-Canadian provinces and US States.
Does anyone have any recommendation for me?
Because I am here in I cannot work because I am waiting on NNAS…
How can we go about changing this process into a both safe and seamless process?
I am saddened that Canadians think US nurses are not "competent" enough for them; but are they competent enough to be accepted in the US without any issue? I don't think it's fair at all. I am sorry they are having trouble with their visas, but at least they are not being denied a license...
@Icelocababe we are on the same page here. As a Canadian, I too am saddened that the provincial licensing bodies, or the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications that @dishes mentioned, has resulted in a process that degrades nursing degrees obtained at proper US universities which have the highest rigour and teach equivalent content, skills, knowledge, etc. I am all for strict requirements in terms of what is expected of a nurse who wishes to be licensed in a Canadian province. I value "vetting" knowledge and skills thoroughly. But what is embarrassing to me is how un-Canadian this whole process is towards IENs. How much of an industry it has turned into, how the assessment tool that is used (NNAS) is so unreliable at picking up on equivalent education and continues to be used despite regulatory bodies knowing the tool does not work, how the companies contracted to provide assessments are allowed to treat applicants the way they do, and in my case and yours, how education that is already known by the regulatory body to be equivalent turns up as "non-comparable" and we are dragged through expensive, lengthy and unnecessary processes in order to become licensed. In your case, this lengthy process will be the first year or more of your child's life.
What I meant by "immigration" was just that it is not an issue of immigrants immigrating, as has been so big in the news lately. I understand that visas are dealt with through the Citizenship and Immigration Services, including work visas, even though no immigration is happening. Actually, I cross the border every day to go to work--no immigration or even migration happening on my part. So that's all I meant.
I see what your friend is saying, in a sense, she is right. Right that there isn't really a nursing shortage in the places that people want to immigrate to (larger cities) and there are tonnes of new nurses entering the workforce as well as seasoned nurses with many years in their career to come. I can't speak about CNO recruiting practices, but I can say that the recruiting practices of some post-secondary institutions in Canada is very misleading and often utilize the power of suggestion to make prospective nursing license applicants feel like there is a far, transparent and consistent process to becoming licensed and that just isn't the case. False advertizing really. But many of the post-secondary institutions here are held up by foreign dollars/tuition, so this is why they recruit in such ways. This needs to be looked at and changes need to be made. And it's the fact that the assessment of your education wasn't a fair assessment is what your friend from Ottawa is missing. I don't think war and presuming who would protect who has anything to do with it. The assessment tool is flawed and now that that has been identified, it should be remedied. Please know though, that it's the licensing process, not Canadian people, who question whether the US educated nurses are competent. The people themselves value a diverse health workforce, from all over the globe.
Just to clarify, CNO has nothing to do with 'recruiting' nurses, their mandate is to protect the public by ensuring nurses meet the licensing requirements and recruiting nurses would be a conflict of interest.
Ontario employers who are located in cities have not actively recruited IENs since the late 1980's and early 1990's, currently the only employers that may have a need to actively recruit experienced nurses are employers in Ontario's first nations and rural communities.
There has always been surplus and shortage cycles of nursing jobs depending on political and economic factors in Canada. I can understand why the RN who lost her job to a RPN (who happens to be an IEN), is angry. Over the past decade, employers have addressed budget shortfalls by laying off RNs and replacing them with RPNs, all Ontario RNs are angry about this practice, not just the ones who were directly effected. The practice has been published in media reports and is available on the RNs union website ONA.
The licensing assessments are to help ensure that IENs can successfully manage their role in the Canadian health care system. The NNAS and competency assessments identify where gaps are so that remediation can occur before getting into a job, not after. The licensing process may seem like a barrier specifically to keep IENs out of nursing, (and that is how some IENs who take it personally see it), but the process is simply a part of the strong public accountability framework that exists in Canada.
Strong public accountability is obviously a good thing, but why does it always have to be such a disaster for the nurses trying to get licensure? Ensuring safe nurses shouldn't mandate an all encompassing hell on earth for applicants. Getting a license in Britain is similar; a quagmire of largely impotent government regulatory bodies that do little else but make applicants feel beaten with a bat by the time the process is over, with significant costs to boot (and quite possibly, not even a license to show for it once all the dust clears). Much of what is asked for and scrutinized is unnecessary, & often becomes highly subjective, while actually proving little regarding competency and safety to practice as a nurse (Letters of recommendation from my probably near senile or near dead nursing instructors from decades ago, who have no reason to remember me at this point. Really??). I have to say, it sounds like much of the Canadian evaluation amounts to a laborious word search. Regardless, it's obvious from these posts that (certainly) there are more efficient and better ways to assess competency than what these agencies are doing. However, since we are at the mercy of a government bureaucracy, we have to tap dance and jump through hoops of fire for months (to years!) on end, & meanwhile they have little in the way of real accountability and aren't really doing what they say "all this due diligence is for" anyway. It's very, very frustrating, to say the least...Off topic, but I can't help but think of the Joint Commission. Once when visiting an ICU I was working at, with all the potential issues regarding standards of care, patient safety, HIPPA, etc...they became obsessed with nursing care plans not being comprehensive or individualized enough (pt had septic shock, pneumonia, ARDS...and God forbid no one took the time to make a new problem on the care plan when he transiently went into afib one day, and quickly popped out of (please file care plans in the No Reasonable Person On Earth Cares file), then freaking out because she couldn't find out if the just opened and completely used bottle of sterile water a nurse used to mix her gtube meds with had a preservative in it or not, and then started hassling us over the high number of ventilated patients that were restrained. Are you kidding me? That's the kind of common sense, real world evaluations we have come to know and love. These nursing licensure agencies are no better, and probably worse, truth be told.
I have to say, it sounds like much of the Canadian evaluation amounts to a laborious word search. Regardless, it's obvious from these posts that (certainly) there are more efficient and better ways to assess competency than what these agencies are doing
It is very possible that NNAS uses a technology called optical character recognition. A special software that scans documents much as an assistant instructed to look for certain words and phrases would. Which means, a computer not a human is reading applicants credentials and comparing them to the entry to practice competencies. The humans may be verifying authentication of documents, but not doing word searches.
@dishes I can understand that all this is just a way to ensure public safety but really then why adopt the NCLEX? Why a Canadian new grad who passed the NCLEX is considered "better" than a n American new grad nurse who's passed the same test? I am 99.9%sure that the average Canadian new grad nurse would not be able to answer half of those questions that were asked at the OSCE portion of the IENCAP! Some of those answers come from pure experience. If Canadians are so worried about IENs being comparable to "an entry level Canadian nurse" why don't they just go ahead and identify the legitimate gaps that we may have and that I recognize (such as differences in legislature, regulations, ...etc), have a way for us to fulfill it (a class or a test) and get us licensed instead of making us go through all this??? Especially us coming from across the border? THEY KNOW that the curriculum is the same so why all this torture? Why trying to make us seem inferior? How about the state boards of nursing in every single state in the US considered Canadians as not comparable to an entry level new grad American nurse?
This is all very upsetting and hearing people give it an excuse just makes no sense to me...
The reason the regulatory bodies selected NCLEX is because NCSBN's proposal met their requirements for a computer based exam and ASI's proposal did not. The NCLEX is one way of measuring entry to practice competencies, but it is not weighed as the most important measure. The regulatory bodies have research studies as well as chart reviews that show in the past, an IEN could be licensed but not understand basic competencies in Canadian nursing. The CNO reviewed mandatory reports of nurses who were reported after being terminated, the reports and the research showed that IENs had differences in practice expectations as well as communication issues that led to termination. That is the reason the regulatory bodies want IENs education to be assessed for entry to practice competencies that are similar to Canadians.
Just to clarify, CNO has nothing to do with 'recruiting' nurses, their mandate is to protect the public... The NNAS and competency assessments identify where gaps are so that remediation can occur before getting into a job, not after. The licensing process may seem like a barrier specifically to keep IENs out of nursing, (and that is how some IENs who take it personally see it), but the process is simply a part of the strong public accountability framework that exists in Canada.
Thank you for the correction, yes, CNO doesn't recruit and that's an important distinction. The recruiting of nursing students by some post-secondary institutions in Canada that I was referring to though, I still hold that their advertizing needs to be more accurate and accountable.
I wholeheartedly agree with a strong accountability framework. I think there should be high expectations, and that they should be met, before one is able to be licensed. That isn't at all what I have the issue with. My issue with NNAS is that it is not a valid tool for assessing education and finding competency gaps. Licensing bodies know this but are resistant to making changes. I don't think this is a case of just some people who take things personally--it's not an individual issue of feelings, but a larger structural issue of how the change in the assessment process has been implemented and how the tool itself was designed and is utilized, and further, how identified problems with the tool are not being corrected. Public accountability deserves and requires valid and reliable tools in place to assess nurses. Fairness, transparency, objectivity and impartiality must be embedded.
It is very possible that NNAS uses a technology called optical character recognition...but not doing word searches.
I did contact NNAS regarding this and their answer was:
Thank you for contacting NNAS
Please be advised our reports are not "machine [COLOR=#000000]assisted" and are done manually by trained professionals.
[/COLOR][COLOR=#000000]As usual, not signed by the name of the staff member who responded. But whether a machine does it or a person does it, it's a word search.[/COLOR]
I am familiar with the key word software, lots of government agencies use it, and the military uses it. I'm sure lots of other companies do, but those are the only entities I personally know of. So, I was being a bit facetious.
I did contact NNAS regarding this and their answer was:
Thank you for contacting NNAS
Please be advised our reports are not "machine [COLOR=#000000]assisted" and are done manually by trained professionals.
[/COLOR][COLOR=#000000]As usual, not signed by the name of the staff member who responded. But whether a machine does it or a person does it, it's a word search.[/COLOR]
It doesn't make sense for NNAS to pay people to do the word search when a software program is faster, more efficient and accurate.
I am familiar with the key word software, lots of government agencies use it, and the military uses it. I'm sure lots of other companies do, but those are the only entities I personally know of. So, I was being a bit facetious.
Where I am, school faculty use Turnitin software to detect plagiarism in student's essays and large healthcare employers use keyword software to screen resumes.
Thank you for the correction, yes, CNO doesn't recruit and that's an important distinction. The recruiting of nursing students by some post-secondary institutions in Canada that I was referring to though, I still hold that their advertizing needs to be more accurate and accountable.
I wholeheartedly agree with a strong accountability framework. I think there should be high expectations, and that they should be met, before one is able to be licensed. That isn't at all what I have the issue with. My issue with NNAS is that it is not a valid tool for assessing education and finding competency gaps. Licensing bodies know this but are resistant to making changes. I don't think this is a case of just some people who take things personally--it's not an individual issue of feelings, but a larger structural issue of how the change in the assessment process has been implemented and how the tool itself was designed and is utilized, and further, how identified problems with the tool are not being corrected. Public accountability deserves and requires valid and reliable tools in place to assess nurses. Fairness, transparency, objectivity and impartiality must be embedded.
Are those post-secondary institutions recruiting international students or IENs? I know a couple of them were recruiting and misinforming IENs in the past, but I thought they stopped that practice following complaints.
I agree there are issues with the NNAS tool and the IENCAP. I think the issues will be dealt with by the regulatory bodies becoming more flexible in how they interpret results, and IENs becoming more informed about what needs to be demonstrated in their curricula and practice in order to meet the requirements.
RN_Pro
276 Posts
@Icelocababe we are on the same page here. As a Canadian, I too am saddened that the provincial licensing bodies, or the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications that @dishes mentioned, has resulted in a process that degrades nursing degrees obtained at proper US universities which have the highest rigour and teach equivalent content, skills, knowledge, etc. I am all for strict requirements in terms of what is expected of a nurse who wishes to be licensed in a Canadian province. I value "vetting" knowledge and skills thoroughly. But what is embarrassing to me is how un-Canadian this whole process is towards IENs. How much of an industry it has turned into, how the assessment tool that is used (NNAS) is so unreliable at picking up on equivalent education and continues to be used despite regulatory bodies knowing the tool does not work, how the companies contracted to provide assessments are allowed to treat applicants the way they do, and in my case and yours, how education that is already known by the regulatory body to be equivalent turns up as "non-comparable" and we are dragged through expensive, lengthy and unnecessary processes in order to become licensed. In your case, this lengthy process will be the first year or more of your child's life.
What I meant by "immigration" was just that it is not an issue of immigrants immigrating, as has been so big in the news lately. I understand that visas are dealt with through the Citizenship and Immigration Services, including work visas, even though no immigration is happening. Actually, I cross the border every day to go to work--no immigration or even migration happening on my part. So that's all I meant.
I see what your friend is saying, in a sense, she is right. Right that there isn't really a nursing shortage in the places that people want to immigrate to (larger cities) and there are tonnes of new nurses entering the workforce as well as seasoned nurses with many years in their career to come. I can't speak about CNO recruiting practices, but I can say that the recruiting practices of some post-secondary institutions in Canada is very misleading and often utilize the power of suggestion to make prospective nursing license applicants feel like there is a far, transparent and consistent process to becoming licensed and that just isn't the case. False advertizing really. But many of the post-secondary institutions here are held up by foreign dollars/tuition, so this is why they recruit in such ways. This needs to be looked at and changes need to be made. And it's the fact that the assessment of your education wasn't a fair assessment is what your friend from Ottawa is missing. I don't think war and presuming who would protect who has anything to do with it. The assessment tool is flawed and now that that has been identified, it should be remedied. Please know though, that it's the licensing process, not Canadian people, who question whether the US educated nurses are competent. The people themselves value a diverse health workforce, from all over the globe.