‘Everyone supported me’: How MGH is helping internationally educated nurses practice in Canada

By Amanda Di Luch

Prabhjyot Kaur grew up in Punjab, India, and had a dream of moving to Canada to work as a nurse.

Though she became a Registered Nurse (RN) in India, she says the country had limited opportunities for nurses to develop their skills and gain independence in delivering healthcare.

So in 2019, Prabhjyot made the decision to move to Canada on a student visa and study Advanced Healthcare Leadership, with the hope of becoming a nurse in Ontario.

She’s among the 25,000-plus internationally educated nurses (IENs) who have immigrated to Canada in the last 10 years. However, these health human resources go mostly untapped.

The College of Nurses of Ontario (CNO) requires IENs to complete a set of requirements before they can practice as a RN or a Registered Practical Nurse (RPN) in Ontario.

These requirements can be challenging to meet and the COVID-19 pandemic introduced even more barriers for IENs.

“At a certain point in my journey of meeting the requirements to become a nurse, I was required to go back to India to get more hours of practice. Because of COVID-19 and lockdowns, I couldn’t go back,” Prabhjyot says. “I was also a student at the time, so I was busy studying and writing exams.”

Prabhjyot recounts the moment she hit a roadblock in her pursuit of an Ontario nursing license.

With no way to practice as a nurse in Ontario, she took a job as a personal support worker (PSW) at a long-term care home.

However, a stroke of luck and good timing led her to Michael Garron Hospital (MGH) and a new program that would be her ticket to getting licensed as a nurse in Ontario.

About the Supervised Practice Experience Partnership (SPEP)

“I was browsing the job board at MGH and saw a posting for internationally educated nurse clinical extern. I applied right away,” Prabhjyot says.

“After getting that position and starting work at MGH in February of this year, I heard about SPEP.”

The Supervised Practice Experience Partnership (SPEP) is a collaborative program between the CNO, Ontario Health and CNO-approved organizations, including MGH, to allow IENs to become licensed in Ontario.

It offers IENs the opportunity to complete supervised practice hours at healthcare organizations to demonstrate current nursing knowledge, skill, judgement and language proficiency.

These hours are part of the requirements that IENs need to meet so they can practice in Ontario.

In April, MGH accepted eight nurses, including Prabhjyot, to complete their supervised hours in departments like Medicine, Cardiology, Surgery, Nursing Resource Team, Complex Continuing Care and the Stavro Emergency Department.

IENs who were matched with MGH as part of SPEP came from India, the Philippines, Nepal, Pakistan and more.

“The IENs that apply for this program are typically people who have been connecting with CNO for a long time and are on their final requirement to obtain their registration in Ontario,” says Jennifer Reguindin, Clinical Resource Leader of Nursing Practice and Education at MGH.

“Less than two weeks after completing the program at our hospital, they can expect to be licensed in Ontario. We help them get over that last hurdle in their journey to become a licensed nurse. More importantly, we share with them what Ontario’s definition of nursing is, which is different in every jurisdiction.”

Ronald Ejercito, another participant in SPEP at MGH, relocated to Toronto to take part in the program.

After immigrating to London, Ontario, from the Philippines on a student visa in 2019, he realized pursuing nursing in Canada would be harder than he expected.

“When you are an IEN, you cannot immediately work as a nurse in Canada – only as a PSW or caregiver. So I took a job as a PSW at a nursing home in London at the peak of the pandemic,” Ronald says.

“I heard about SPEP from the news and on social media and, after applying, was matched to MGH. I had to make a life-changing decision – stay in London and wait for a hospital or long-term care center to hire me under SPEP there, or quit my job as a PSW and move to Toronto to participate in the program at MGH.”

Ronald considered his long-term success as a nurse in Canada and decided to relocate to Toronto to begin the program at MGH.

Gaining hands-on experience in Canada’s healthcare system

As a participating organization in SPEP, MGH agrees to provide nurse preceptors to supervise and guide the applicants, and provide feedback and learning opportunities. The role of the nurse preceptor is pivotal to the program.

The preceptor acts as a resource, role model and clinical supervisor to the SPEP interns in training. They also demonstrate how nursing is delivered in Canada, which may differ from what SPEP participants are familiar with.

“It is about the Canadian experience. We teach our nurses and nursing students to critically think and be leaders, not just take orders. This may be a different way of thinking from other countries,” Jennifer says.

“The main difference in Canada is that nurses are more involved in patient care,” Prabhjyot says.

“In India, most assessments are done by the doctor. But in Canada, nurses do primary and secondary assessments, and then report back to the doctor.”

"I like this because the nurse has the authority to provide care independently,” she adds.

During his time in SPEP, Ronald also noticed some key differences between nursing at MGH and at hospitals in the Philippines.

“Tender love, care and passion are the same in nursing anywhere in the world. But one difference I noticed is the technology,” he says.

“Back home, we do manual charting. Here, it is computer-based and everything is integrated.”

Mikki Layton, Chief Nursing Executive at MGH, says MGH’s participation in SPEP aligns with the hospital’s commitment to supporting nurses in their professional development and ability to deliver high-quality patient care.

“SPEP is an excellent initiative to introduce these diverse and talented health professionals into our hospital and community in East Toronto, and support them in obtaining their Ontario nursing license,” she says.

“I am so proud of the work they have done so far at MGH, and I thank our existing staff for welcoming them with open arms.”

Participants welcomed with open arms at MGH

Both Prabhjyot and Ronald are grateful for the welcoming and encouraging work culture they experienced at MGH during SPEP.

“Everyone supported me. I was assigned to the Emergency Department and had a designated preceptor for the program, but everyone on the unit was giving me opportunities to learn,” says Prabjhyot.

“I really believe that I am blessed to have had this kind of support from all the emergency nurses. There is a lot of teamwork on the unit.”

Ronald echoed Prabjhyot’s sentiments.

“I was instantly accepted with open arms at MGH. The unit I worked on was like a family. My preceptor was especially helpful – she wanted me to pass this internship program with confidence,” he says.

“One thing is for sure, wherever I go, whatever I do, Michael Garron Hospital will be in my heart. I am appreciative of what they did for my career.”

Health human resources for our future

Once the graduates of SPEP receive their license from the CNO to practice in Ontario, many of them reapply to the healthcare organization they completed their supervised practice hours at.

As of August 2022, MGH has hired three nurses who were part of its first cohort of SPEP participants.

The hospital hopes to hire other graduates of the program who are successful in their application to available nursing opportunities.

As Ontario continues to navigate COVID-19 and pandemic recovery, MGH’s participation in SPEP comes at a time when health human resources are critically needed across the province.

SPEP integrates applicants into the province’s workforce, helping them to obtain the requirements needed to register as a practicing nurse. In return, Ontario gains competent, qualified nurses.

“SPEP gives IENs the opportunity to participate in the career they chose for themselves,” Jennifer says. “We are happy to be a part of that future.”