Waiting Game

READY TO SCRUB IN Natalie Nelson can't wait to care for patients again. But the US nurse has found herself in "a black hole of paperwork and bureaucracy."

Between the unrelenting pressures of COVID-19, the ongoing opioid crisis, the lack of available seats in nursing schools and the rapidly aging health-care workforce, it's becoming ever clearer that we'll need "all hands on deck" if we hope to address Canada's worsening nursing shortage.

But a big part of the solution is in our midst. Today there are scores of internationally educated nurses (IENs) who could and should be working, but who are prevented from doing so.

Natalie Nelson is one of those nurses. The US-educated RN lives across the street from Vancouver General Hospital. She is qualified, skilled, and ready to begin a career in Canada, but she's been sidelined by licensing and regulatory red tape.

An experienced critical care nurse, Nelson received her nursing degree in Utah, where she worked before moving to Oregon and later to Alaska. She lived there for over two years prior to arriving in Vancouver so her partner could attend graduate school at UBC.

Nelson understood that getting a nursing licence in Canada could be time-consuming and frustrating, so she began the application process prior to moving to Vancouver. "It's an elaborate process to navigate," she says.

Any nurse who wishes to work in Canada must first apply to the National Nursing Assessment Services (NNAS), the organization that assesses international qualifications to ensure they meet Canadian standards. NNAS also helps determine if an IEN requires further education or training before they can be licensed. 

Nelson began collecting details of her education, training and work experience to support her application and submitted the required paperwork to NNAS in February 2021. The organization's website states applicants that can expect to wait up to 12 weeks to move from the "ready to review" phase to the phase when a licence is ready to process.

Nelson says she waited while the 12-week mark came and went without any communication from NNAS. She then contacted NNAS in mid-August 2022 to request a status update as she and her partner were due to arrive in Vancouver at the end of that month.

The move from rural Alaska to downtown Vancouver is not inexpensive, and the couple first had to make ends meet on a small university stipend. Thankfully, Nelson quickly managed to find a serving job at a well-known Vancouver restaurant. It was there that she first met Sara Mattu, council member for BCNU's Vancouver Richmond region.

"When I first met Natalie and she told me she was a critical care nurse who had worked in ICUs in the US, I was surprised and disappointed that she was unable to be registered in BC." Mattu remembers. "Of course, I am familiar with challenges nurses coming from other countries face, but I never imagined US-educated nurses were also going through the same struggles."

Nelson says she didn't realize how many nurses were in the same situation until she started doing research and discovered just how many IENs are unable to work in Canada due to the strict application process. "I learned that less than half of the IENs in Canada are working as nurses due to issues with application processes, and that it can take as many as three years and as much as $20,000 for IENs — including Canadians who studied abroad — to clear all the hurdles," she says.

Mattu took Nelson's case to heart. "Her story made me feel disappointed and angry at the system for creating unnecessary barriers," she says. "We are in midst of the worst nursing crisis in history, yet here we have nurses working in restaurants instead of helping in health care."

After Mattu's offer to assist, BCNU advocated on Nelson's behalf, and was able to help her secure a temporary licence to work until June 2022. "But the catch is that I can't apply to nursing units because those are not temporary positions, and managers are not looking to hire someone only until June," Nelson sighs. "I feel a lot of guilt, being able to see the hospital from home and not being allowed to work, to help."

She concedes that it's been a challenge supporting herself and her partner with her restaurant earnings and admits that if her situation does not resolve soon, she may have to return to the US and work there.

"It's been over a year since my first submission to NNAS with multiple contacts and information exchanged," Nelson reports. "I know that I'm qualified and ready, but yet I'm stuck in a black hole of paperwork and bureaucracy."

Are there solutions? Nelson says the current application system is paper-based, archaic, and she believes it should be streamlined. "I don't understand why there isn't an online system to coordinate this," she says. "Yes, there's a lot of information that needs to be assessed but I feel an online system could present applicants with a more informed reality on steps and timing."

Nelson's future is still uncertain, but her optimism shines through, and she remains steadfast in her desire to nurse in Canada. "I have to say that the BC Nurses' Union advocacy in my case has been so helpful and amazing," she remarks. "I've belonged to unions in a couple of previous positions, but BCNU has been extraordinary, especially as I'm not even a member yet!" •

UPDATE (Spring 2022)