Thank you.
Mr. Chairman, honourable members, it's a privilege to appear before you today.
I'm here on behalf of the College and Association of Registered Nurses of Alberta, which is the regulatory body and professional organization for Alberta's 33,000 registered nurses, the largest health profession in our province. Since 1916 we've been established under legislation and responsible for setting requirements to enter the profession, as well as establishing monitoring and enforcement standards of nursing practice.
My comments are framed primarily within the context of the assessment and recognition of internationally educated nurses, or IENs, and are based on our cumulative experience and expertise gained from reviewing and processing more than 9,000 applications from IENs over the last six-plus years.
Between 2007 and early 2009, there was a very proactive recruitment of internationally educated nurses in Alberta. Our regulatory body went from receiving an average of 40 applications per month to receiving more than 450 per month during the peak period. Much of the expertise and experience we've gained, however, is common to other regulated professions and regulatory agencies in Canada.
I'd like to describe a little bit about the steps in the assessment and recognition of IENs, as well as mention a couple of current activities that my organization is involved with. I'll describe some lessons learned, and then offer some recommendations to the committee.
The intent of IEN assessment at our regulatory organization is primarily to determine if an applicant has a combination of education, experience, practice, or other qualifications that demonstrate the competence required for registration in Alberta. Application can and should start when the applicant is still offshore. A number of documents are collected. Probably the most important piece of information we look for very early in the application process is the demonstration of language proficiency, and in Alberta that's English.
Last week you heard from Dr. Pam Nordstrom from Mount Royal University about the substantially equivalent competency assessment process. If we are unable to determine on the basis of paper alone that an individual has the required qualifications and competencies for practice in Alberta, we require a SEC assessment. This uses a combination of written, oral, and clinical skills exam techniques to determine the extent to which a person has the required skills and knowledge. Very often, following an SEC assessment, we will make a determination on the need for additional bridging education. Mount Royal University has been a partner with us in this endeavour since 2005.
Following the successful completion of bridging education, a person becomes eligible for provisional registration and can write the national entry-to-practice exam toward finalization of registration. Work experience in Alberta, with the submission of a satisfactory employer reference, is also required at this point and can be completed as the person is finishing the entry-to-practice exam.
There are a number of activities currently under way in which CARNA is involved, as well as some across jurisdictions and nationally. However, I'd like to highlight two of these initiatives in a little more detail.
This year CARNA learned that we had been successful in obtaining a grant from the federal government through the internationally educated health professions initiative to make a retrospective study of the characteristics and profile of applicants to us over the past five years, and correlate this with their registration outcomes. We are just getting under way with this piece of research, and we hope to have some recommendations for policy change, particularly with a view toward shortening the process that is experienced by our applicants.
The other initiative that I'd like to draw your attention to is the national nursing assessment service project. This was initiated following recommendations arising from the 2005 report called Navigating To Become A Nurse In Canada. The national nursing assessment service project is seeking to establish a single point of contact for internationally educated nurses seeking registration anywhere in Canada. At this point in time, the assessment service is incorporating itself as an entity in Canada and has selected a vendor to provide these assessment services. A funding proposal to support the development of the next phases and to get this assessment service up and running is now before the federal government. The project is a success story considering the level of consensus and support that has been built among 23 regulatory bodies from across Canada, which are involved in the regulation of not only of registered nurses but also registered psychiatric nurses and practical nurses, or auxiliary nurses as they're known in Quebec.
With regard to the lessons learned or experiences acquired in the assessment and recognition of internationally educated nurses, over the past four years we have tracked the numbers of people who have applied to us and the length of time it has taken them to go through the registration and application process. One of the first measures showed us that it takes between 77 and 252 days for an individual to assemble a complete portfolio of documentation from which we, as a regulatory organization, can make an assessment. Following that assessment, it may take between 540 and 768 days from the time someone applies to us until they achieve registration as an RN in Alberta. There are a lot of reasons it can take that much time, and not all of these are within the control of the regulator.
The challenges experienced by individuals very often have to do with obtaining an exit or entry visa to come to the country to undergo assessment or to sit the exam. Sometimes they must enter the country with a student visa to undertake studies but are then required to have a work visa to complete the work experience that's required at the end of the registration process. Very often an individual comes from a country where the system of professional regulation is very different from what they've experienced here in Canada, and gaining an understanding of the processes involved in that system is quite a challenge. In Alberta we also experience issues getting access to both the competency assessment and bridging education.
Regulators experience challenges in sharing information about individuals. Often such sharing is limited by legislation as well, because of differences in our regulations from province to province. Time and volume also impact on our ability to receive and assess applications from internationally trained nurses.
Finally, managing expectations and communications with the wide variety of stakeholders, such as you and other interested parties in this process, is oftentimes quite a challenge for us.
Before I tell you about our recommendations, I would like to say that another very important lesson that has been learned is that a nurse is not a nurse is not a nurse. The health care systems in countries around the world vary a great deal, a fact that is sometimes particularly difficult to overcome for an individual wishing to integrate themselves into our workplace.
I'd like to recommend that the government consider clarifying in policy the difference between newcomers who enter the country under a temporary foreign worker program and those who are seeking to come in with landed status or permanent residence. In Alberta, for instance, many nurses arrive under the TFW program and clearly intend to stay permanently. Doing so becomes a challenge once they've obtained their first visa, and oftentimes they have to change their status at some point along the way.
I think that coordinated and flexible support is needed to increase access to assessment services, language training, and bridging education. Programs are also needed to address the need for workplace integration. We haven't yet experienced anything coordinated going on in this particular area in Alberta.
Finally, I'd like to say that we should not lose sight of the need to ensure quality and safety in the regulation of professionals and to support our regulatory mandate to protect the interests and well-being of the Canadian public.
Thank you very much for your attention today.