Charting a Path

STILL WAITING Internationally educated nurse Sukhpreet Kahler says her ongoing struggle to be registered in BC has taken all of her courage and energy.

Sukhpreet Kahler has wanted to be a nurse for as long as she can remember. "I lived in an extended family and I always wanted to help old people or whoever was sick in my family," she says. "I was always the one to step in to help, even when I was a little child."

Staying true to her calling, Kahler studied nursing in her native India after leaving high school, and graduated from a four-year BScN program in 2012. She married soon after and, along with her new husband, applied for landed immigrant status in Canada and arrived in 2014.

Kahler was ready to begin her career upon arrival. She understood that she would need to be registered in order to work, but admits she had no idea how difficult and costly the journey to becoming an RN in BC would be compared to India. "Over there we don't need to do any board exams to get our license," she explains. "We just have to apply for it on the basis of our education and then we submit our papers and they send us our registration papers."

Kahler, who lives in Surrey, had few professional connections upon arrival. She began by visiting local private nursing colleges to get some information. "They all discouraged me and said, 'your degree has no value in Canada' – that was really frustrating," she recalls. "All of them advised me to take their full-time LPN program. I was almost ready to do it just so I could have Canadian credentials."

Fortunately, Kahler made contact through Facebook with a friend in Toronto who had come from India as an international student and was now registered as an RN in Ontario. She advised Kahler against taking out a loan to pay the $25,000 tuition fee to become an LPN, and suggested that she instead find work as a care aide while applying to the National Nursing Assessment Service (NNAS) in order to have her Indian credentials recognized.

Kahler took the advice. "Your nursing school sends all of the documentation requested in a sealed envelope and NNAS matches all of your competencies to a Canadian standard in order to see what you meet or if there are gaps. It then makes an advisory report and sends that to the College of Registered Nurses of BC," she says.

Unfortunately, because she is a non-native English language speaker, NNAS advised Kahler that it would not process her application until she passed the International English Language Testing System (IELTS) test.

Kahler found the IELTS test to be an unexpected hurdle. "It was really hard. I took the exam five times at cost of $300 each, and was scoring well on everything but the writing component," she says. "A score of seven is needed to pass and I was scoring 6.5."

Several personal tutors and 10 two-hour classes later, Kahler passed IELTS on her sixth attempt in December 2016. She says the process felt arbitrary and unfair, given that all of her nursing education was in English, and reckons that even a Canadian-educated university graduate, with the exception of an English major, would fail the IETS exam on their first try. "It's a really high standard – they want top university level English."

With her IELTS requirements complete, the NNAS processed Kahler's application and sent its advisory report to CRNBC in January 2017. She then paid CRNBC $500 to process her application, but was told by the regulator that she would need to take a competency exam to demonstrate her skills.

They referred her to the Nursing Community Assessment Service (NCAS) conducted through Langara College. The service uses a series of computer, simulation-lab and oral tests to determine if applicants can demonstrate the skills and competencies required for practice. With this step complete, CRNBC then advised Kahler in November 2017 that she would need to take a one-year bridging program called GNIE (Graduate Nurse Internationally Educated) – but starting in January 2019, as all of the spaces in the September 2018 term had been filled.

Kwantlen Polytechnic University (KPU) is the only school in BC that offers a GNIE program for internationally educated nurses (IENs) like Kahler who have not yet begun practising in their home countries. Upon applying for GNIE, Kahler learned that KPU had begun a new, prerequisite program called "Nurse Ready" that is three weeks long (nine classes) and costs $1,700. But before she faced this new hurdle, Kahler was informed that all of the spaces in the Nurse Ready program are full until July 2018, meaning that she would not be able to complete the course before the August application deadline for her January 2019 GNIE program. To make matters worse, KPU warned her that her IELTS credential was going to expire in December 2018, and if she did not enter GNIE by January 2019 she would need to re-sit the exam.

"I can't see any chance of getting into the January 2019 GNIE program. I could get into Nurse Ready program in August 2018, maybe," says Kahler. "But then it would be too late."

With the clock ticking, the young nurse has taken it upon herself to be as resourceful as possible. "I have applied to Memorial University in Newfoundland for its bridging program and I am meeting all of their requirements so far, but have not gotten a final decision," she reports. "I will know in August for the September 2018 start date."

Kahler says Memorial University is the only bridging program that provides distance education, although she will be required to move to Newfoundland for about two or three months to complete her practical hours.

Despite the delays and frustration she has faced, Kahler isn't wasting any time getting ready to practice in BC. She is now preparing to take her NCLEX exam for the US, explaining that she will then not need to re-take the NCLEX in Canada once she finishes her bridging program. And CRNBC will then register her in BC.

"I've had feelings of desperation and mood swings," confesses Kahler, when asked how she has coped through the experience. She says that without the support of her partner she would not have succeeded  this far, and suspects there are many other IENs like her who have given up. "Now they are nowhere – they are working as labourers."

A COMMITMENT TO SUPPORT

On the evening of May 30, BCNU organized a dinner welcoming Kahler and some 50 other IENs from around Metro Vancouver. Elected union leaders and staff members were on hand to facilitate a discussion and hear first-hand about the experiences and challenges IENs face.

Participants talked about their frustration, stress, and anxiety. They noted the language barriers they face, the limited spaces in bridging programs, difficulties in getting work permits and the high cost of assessment and registration. Recently-employed IENs also shared their experiences with racism, bullying, violence and discrimination in the workplace, as well as the undervaluing of IEN experience and education.

The nurses participated in group exercises that allowed BCNU to gather important information on the supports that are lacking and the changes that IENs want to see, so that the union has a better understanding of the assistance these nurses need and the role the organization can play on their professional journey.

BCNU director of professional practice Heather Straight was on hand to listen and learn from the group.

She acknowledged IENs' frustration. "When you look at the skills that are around this room, the diversity, the different ways of knowing and the richness that you add to our health-care system – it's truly unbelievable," she remarked. "So we will definitely commit to helping you."

Straight also talked about the resource challenges within the health-care system as a whole that impact IENs. "Employers can't find enough preceptors to host the students from our own local schools, so you are in competition just for those placements," she explained.

"It's a complex issue that's about more than just creating more seats," she said. "Conversations need to occur with a lot of partners and a lot of stakeholders in order address the issue."

BCNU Provincial Treasurer Sharon Sponton is chair of our union's IEN working group. She says BCNU's renewed commitment to IENs is based on the organization's core values of social justice, solidarity and collectivity, and on the recognition that IENs are ready and willing to fill the vacant lines and short-staffed units that exist around the province.

"We recognize that IENs' concerns are our concerns, and together we will be able to make some much needed changes to the way IENs are treated," she says.

Sponton notes that BCNU is one organization in a complex system that includes other stakeholders, like the government and regulatory colleges, which have a prominent role in the experiences and challenges facing IENs.

"But BCNU will continue to raise concerns about the lengthy and often unfair processes that IENs have to navigate in order to purse their professional dreams."

Meanwhile, thousands of IENs like Kahler continue their struggle to practise in BC. "Stay strong because you will suffer more than you think," is her advice to other IENs. "I was ready for this but it took all my courage and energy," she says. "You need to stay focused and practise for everything. Do a lot of research – as much as you can, and find a job in the health-care system while you are waiting." •

UPDATE (July - August 2018)