Driving Change how three jurisdictions are responding the Canada’s healthcare challenges

At a glance: provincial regulators respond to nationwide healthcare challenges

Across Canada, there is a push by governments to improve the state of our healthcare.

It would be a futile argument to disagree that the almost three-year-old COVID-19 pandemic has changed healthcare as we know it in Canada. From overworked nurses to limited resources due to supply chain issues, and unprecedented financial pressures to a backlog of more than one million surgeries, the status quo, already in dire need of repairs, has collapsed.

Stephanie is a 46-year-old nurse from Ottawa who has worked in intensive care and other areas of her profession for 25 years. Requesting to withhold her last name for reasons of privacy, she is one of the latest nurses who has announced she’s leaving profession.

“I’m done. I just can’t do it anymore,” she expressed in an interview with The Registrar magazine. “While I appreciate the outpouring of support from the public towards healthcare workers, the reality is that we need better infrastructure, improved mental health supports, and more nurses. It feels as though the burden has been put on us to make Canada healthy again, but we just can’t do it alone.”

These sentiments are not isolated to Ontario, but reverberate across the country, and, in fact, around the world. Already at their breaking point in Canada prior to the pandemic, the collective exhaustion faced by healthcare professionals, financial challenges, and limits on resources has forced governments, organizations, regulators, and associations to find solutions.

One answer to bring reinforcements to the frontlines of the Canadian healthcare system is accelerating the licensing of foreign-trained healthcare practitioners.

Ontario

In August, Ontario’s health minister, Sylvia Jones, directed the province’s regulatory colleges for nurses and physicians to find solutions to speed up the registration process of internationally trained nurses and doctors.

In response, the College of Nurses of Ontario (CNO) updated its Temporary Registration and Reinstatement regulations, allowing for the quicker registration of nurses. “We are resolutely committed to protecting the public by registering safe and competent nurses,” said Silvie Crawford, Executive Director and CEO of the CNO in a recent announcement. “The regulation changes proposed by Council today [Sept. 29, 2022] will allow CNO to build on an already successful year, where we are breaking records for nursing registrations in Ontario.”

Some of those ongoing changes, which were originally included in an August 2022 response letter to Minister of Health, include:

• Regulation changes so that more IEN applicants can register in the Temporary Class enabling them to work in the system while they continue to meet requirements for General Class registration.

• Continuing existing strategies, such as the Supervised Practice Experience Partnership program.

• Surveying IEN applicants to understand the reasons why they delay taking their registration exam, which may lead to the identification of other actions that CNO, or our system partners, can take.

“As leaders in nursing regulation, Council is pleased that the proposed changes serve our purpose to protect the public,” Naomi Thick, CNO Council President, said.

British Columbia

To address frontline nursing shortages, the BC government outlined in an April 2022 press release their intention to make the process simpler for internationally educated nurses, or IENs.

The British Columbia Colleges of Nurses and Midwives (BCCNM), alongside the Nursing Community Assessment Service and Health Match BC, partnered with the provincial government to facilitate these support systems, which include:

• consolidating the provincially based assessment processes for IEN candidates.

• offering approximately $9 million in bursaries to help with assessment fees, which is expected to benefit approximately 1,500 IENs in the first year.

• creating new nurse navigator positions to help IENs navigate the assessment and licensing process.

The pandemic has demanded a lot of the nurses we regulate, who have been called upon to deliver care under extraordinary circumstances.

“Our government is committed to addressing the province’s demand for nurses,” current B.C. Minister of

Health Adrian Dix said in the release. “That’s why we’re launching this comprehensive suite of supports for internationally educated nurses to help them put their skills to use here in B.C.”

Of particular note were the forward-thinking initiatives set out to make the rollout of support systems easier for IENs. Health Match BC and the province are currently working together to provide IENs with bursaries, ranging from $1,500 to $16,000. These were intended to offset the costs of registration requirements to practice, such as assessment services, language testing, skill evaluation and educational upbringing.

In conjunction with this initiative, the BCCNM announced in May 2022 that it aimed to redesign its application systems into a more consolidated framework. IENs will now only be required to submit a single application and one fee, which results in reduced application costs, ensuring they gain registration sooner in their preferred designation.

“The pandemic has demanded a lot of the nurses we regulate, who have been called upon to deliver care under extraordinary circumstances,” Registrar and CEO of the BCCNM Cynthia Johansen said in the aforementioned B.C. government press release.

“It has also underscored the need for more nurses in our health-care system. We are delighted to be partnering with the Ministry of Health and NCAS to remove barriers wherever possible and bring internationally educated nurses into the system safely and efficiently.”

Nova Scotia

Nova Scotia has also actively been developing a framework to accelerate registration processes for foreign-trained healthcare workers.

Currently, an internationally trained physician must first obtain a Defined license to practise under the province’s Medical Act. It is time-sensitive, and may be issued to physicians without the qualifications for a full license, as they work towards Canadian licensing certification standards.

A new streamlined approach, announced by the College of Physicians and Surgeons of Nova Scotia in August 2022 in a press release, discussed the changes to Defined licensure, enabling faster decisions to be made for professionals to practise. After obtaining the new Defined license, the system will:

• provide a comprehensive orientation program for physicians. •

reduce the required time physicians on a Defined licence must practise under supervision.

• focus on demonstrated competency rather than certification.

The College’s streamlined strategy was informed by half a decade’s worth of data, alongside working with sponsors and supervisors who oversee the licensing pathway of physicians seeking full licensure.

Similarly, a strategy was undertaken by the Nova Scotia College of Nursing, where IENs can practise faster through reduced registration and licensing wait times.

In an August 2022 press release, the provincial government issued a onetime funding of $340,000 in June 2022 to the College. This was to assist the ongoing review of registration requirements for IENs aiming to work in the province. While the College has already taken the reins in expediting this process, the additional support will grant IENs better support systems when it comes to practising without feeling overburdened.

“NSCN is pleased to receive funding from the provincial nursing strategy to support our work to continue to evaluate and change the registration and licensure processes to reduce the time it takes for qualified internationally educated nurses to receive a nursing licence,” Sue Smith said, the Registrar and CEO of the NSCN. Some of these changes include, but are not limited to:

• adding more options for IENs to meet the English language proficiency registration requirement.

• streamlining and reducing the documentation required of IENs.

• providing conditional licences to nurses already registered, licensed and in good standing elsewhere in Canada, which allows them to enter practice while completing the remaining registration requirements.

“While we are very pleased with the changes we have made to our policies thus far, we are committed to continuing to evaluate our policies to make sure they are relevant, flexible and positively contribute to the supply of nurses, while simultaneously meeting NSCN’s legislated mandate to protect the public”, Smith said.

The efforts are intended to reverse the tide of a challenged healthcare system. With new approaches and more healthcare practitioners, the provincial governments might have found the answers.