The Struggles of The world over Trained Nurses in Canada’s Residential Care Sector

The Struggles of Internationally Educated Nurses in Canada’s Residential Care Sector Lead Image: Photo of a nurse taking a moment's rest during the pandemic

After his 2009 commencement from nursing college within the Philippines, Paolo discovered paintings temporarily. He was once employed to guage the have an effect on of common well being care methods and was once quickly promoted to a control function at a neighborhood well being care corporate.

After a number of years, Paolo and his spouse, an in depth care unit nurse additionally trained within the Philippines, made up our minds to proceed their careers in Canada. They arrived in Ontario in 2014 and, mindful that they might wish to download skilled registration earlier than they might resume their careers, promptly started the registration procedure.

What they didn’t know on the time have been the numerous demanding situations that lay forward. Even supposing their years of revel in and coaching within the Philippines intended that they met all of the necessities had to paintings as nurses of their new house nation, the registration procedure was once advanced, dear, and time-consuming. Whilst they waited, the couple took on survival jobs, running in positions that didn’t make use in their schooling.

Registration demanding situations, like the ones confronted via Paolo and his spouse, proceed to stop numerous across the world trained nurses (IENs) from striking their schooling and experience to paintings in Canada nowadays. After arriving within the nation, those execs—who steadily have really extensive revel in—in finding their paths to employment barred via expensive, advanced registration necessities that may take years to navigate.

The well being disaster has considerably raised the prices of those delays. Simply because it has beaten well being care methods all over the world, the COVID-19 pandemic has battered Canada’s as properly, straining the rustic’s scientific execs to a snapping point this is more likely to live much longer than the pandemic. Well being government in Canada are sounding the alarm over a projected scarcity of nurses and different well being care execs. Given those realities, policymakers and immigration advocates wish to act temporarily to get the rustic’s many across the world skilled, however these days underutilized, nurses and different scientific execs again to paintings.

Thankfully, Paolo and his spouse arrived in Canada early sufficient to enroll in the rustic’s coronavirus reaction. In September 2016, just about two years—and hundreds of bucks—after starting their packages, the couple won their nursing registrations and have been in spite of everything ready to renew their careers. Earlier than lengthy, Paolo’s spouse permitted a role as an ICU nurse at a neighborhood health center, and Paolo discovered paintings as a registered nurse at one among Ontario’s long-term care (LTC) amenities. He was once later employed as director of nursing at a bigger, 244-bed LTC facility.

In those amenities, which most often supply care to the disabled and the aged, nurses are in top call for. The pandemic has hit the sphere specifically laborious, making the experience of Canada’s many across the world skilled nurses extra treasured than ever. However, had Paolo arrived in Ontario at the beginning of the pandemic, he won’t were ready to place his abilities to paintings. Six years earlier than he changed into its director of nursing, he had carried out to paintings on the similar LTC facility as a non-public make stronger employee (PSW), a non-regulated well being care place that most often calls for just a secondary schooling or a related university degree. He by no means were given the task. Regardless of his revel in and coaching, he didn’t have the certification required for the submit.

To deepen our working out of the obstacles that save you nursing execs from attaining their profession targets and contributing to Canada’s well being care gadget, Global Training Services and products (WES) carried out 4 focal point staff periods with IENs in Would possibly 2021. We spoke with IENs who have been both in the hunt for employment or these days running in non-nursing roles at residential or LTC amenities.1 Those amenities have no longer best been ravaged via the pandemic, for years, they have got additionally hired a disproportionate selection of global well being care execs, a lot of whom paintings in low-paying positions for which they’re overqualified.

Like Paolo, the IENs we spoke with confronted an laborious trail to skilled registration and nursing apply. They reported quite a few ambitious stumbling blocks, akin to top monetary prices and long processing instances, echoing a lot of the ones already documented within the related literature (Kolawole 2009, Blythe J, Baumann A. 2009, Higginbottom, 2011). However additionally they introduced ideas that would result in a greater trail ahead. Their tales defined the tactics by which a holistic and coordinated means may higher make stronger their go back to the nursing career whilst, on the similar time, rebuilding Canada’s well being care team of workers.

Working out Underutilization: A Have a look at the Numbers

Given the present and projected state of Canada’s well being care paintings power, policymakers and advocates around the nation will have to make integrating IENs a public well being precedence. Knowledge and media protection disclose simply how urgent the problem has transform.

A rising selection of experiences level to an forthcoming exodus of well being care staff, pushed via long-standing considerations over running prerequisites and the extended rigidity of fighting the coronavirus. Knowledge from a 2021 survey of well being care execs in Ontario discovered that 41 % of nurses sought after to go away their jobs as soon as the pandemic is over. Every other learn about, revealed via the Ontario COVID-19 Science Advisory Desk in October 2021, warned that “burnout has larger to ranges that pose a danger to keeping up a functioning healthcare team of workers.”

Prerequisites are specifically dire within the nation’s residential care amenities, which serve more or less part 1,000,000 aged and disabled Canadians. Those amenities were specifically at risk of the virus. In step with the Canadian Institute for Well being Data (CIHI), residential care amenities accounted for greater than 80 % of all reported COVID-19 deaths all over the primary wave of the pandemic. Over the similar duration, infections amongst team of workers on my own made up greater than 10 % of general instances throughout Canada.

Whilst containment measures have since helped sluggish the unfold of an infection, the virus continues to precise a disproportionately top toll at those amenities. Via March 2021, nursing and seniors’ houses nonetheless accounted for the best percentage of the rustic’s COVID-19 instances and deaths, consistent with the Public Well being Company of Canada. And with shut touch between team of workers and citizens all however unavoidable, mavens warn that the danger of renewed outbreaks in those amenities stays top.

Given their demanding situations, Canada’s residential care institutions urgently want the abilities and experience of the rustic’s IENs. In lots of instances, that want has already been translated into truth: Residential care amenities nowadays make use of a disproportionate selection of immigrants. In Ontario, 41 % of nurse aides, orderlies, and affected person provider mates—maximum of whom paintings in residential care amenities—are immigrants. That share jumps to 79 % in Toronto.

Girls—and racialized immigrant ladies specifically—are particularly overrepresented at those amenities. In nursing houses, ladies make up 86 % of the team of workers. In the house care sector, that determine rises to 89 %. Racialized ladies, even though making up just a small share of the inhabitants, account for one-third of all nurses, aides, orderlies, and affected person provider staff national. Their presence is even greater in Canada’s house well being care sector, the place they make up 38 % of all house make stronger staff.

Nonetheless, even though IENs already play an oversized function at those institutions, many stumble upon difficulties advancing of their careers. Others fight to seek out paintings in those establishments within the first position. Just about part (47 %) of across the world trained immigrants with post-secondary credentials are underutilized; this is, they’re unemployed or paintings in occupations that require not more than a highschool degree. Immigrants running as nurse aides, orderlies, and affected person provider mates—positions that require some post-secondary coaching however no longer a complete bachelor’s stage—are some distance much more likely to be overqualified than their non-immigrant colleagues. Amongst immigrants in the ones jobs, 25 % held a minimum of a bachelor’s stage, in comparison with simply 5 % of non-immigrants.

Demanding situations and Alternatives: Focal point Team Findings

Addressing the obstacles fighting those IENs from running of their desired occupations is significant no longer best to their prosperity and well-being, but additionally to the efficient functioning of Canada’s well being care gadget. Our focal point staff periods sought to spot the stumbling blocks IENs face in Ontario, Canada’s maximum populous province, and to assemble suggestions that would assist IENs during the rustic achieve their profession targets.2

Right through those periods, 4 essential topics emerged:

  1. Immigration standing affects profession development and, now and then, sharply restricts skilled construction alternatives.
  2. Lengthy processing instances prolong the go back of IENs to the nursing career and threaten to make skilled registration an “unending” procedure.
  3. The price of accredited nursing teaching programs {and professional} registration is steep, putting in a just about impassable barrier for plenty of IENs.
  4. Go back of provider (RoS) agreements, which change tuition aid for a dedication to apply nursing for an outlined duration in a selected house or office, can assist ease monetary pressures, however wish to be well-designed to be efficient.

In what follows, we discover those 4 topics in higher element.

The Faculty of Nurses of Ontario’s Registration Necessities

Lots of the demanding situations confronted via IENs relate to the method of acquiring nursing registration (or licensure). To paintings as a nurse in Canada,3 execs will have to be authorized or registered via the nursing regulatory frame of the province or territory by which they want to paintings.

In Ontario, that frame is the Faculty of Nurses of Ontario (CNO). CNO governs the province’s nursing execs: Registered Nurses (RNs), Registered Sensible Nurses (RPNs), and Nurse Practitioners (NPs).4 CNO’s obligations come with keeping up top requirements of apply and behavior during the province and surroundings necessities for access to the career.

CNO has established the next 8 registration necessities, each and every of which will have to be glad earlier than an applicant will also be registered with the school:

  1. A success final touch of an accredited nursing schooling program
  2. Demonstration of latest proof of apply
  3. A success final touch of a CNO-approved registration exam
  4. A success final touch of the RN/RPN or the NP jurisprudence exam
  5. Demonstration of English or French language skillability
  6. Evidence of labor authorization
  7. Declaration of previous offences and findings
  8. Declaration of sound well being and behavior

Immigration Standing and Profession Development

Image 1: A quote from an IEN focus group participant: “I’m waiting for PR [permanent residency] which means I am not eligible for certain programs. For example, you can’t complete your CNO [College of Nurses of Ontario] application without PR status. We can’t pursue RPN or RN because of that, so it’s a barrier. I am qualified, I have years of experience, but [permanent] residency is a huge factor to move on in the process to gain qualification.”

Focal point staff members agreed that the eligibility standards of publicly funded employment and academic methods could make it tough to fulfill CNO’s nursing registration necessities. However additionally they famous that the precise nature of the ones difficulties varies consistent with an IEN’s immigration standing.

For instance, many IENs have entered Canada underneath the federally controlled Reside-in Caregiver Program (LCP).5 Even supposing most of the positions taken up via IENs on this program didn’t require a bachelor’s stage, IENs are allowed to make use of a few of their skilled coaching and schooling whilst taking good care of Canadians at house. This system additionally opens a pathway to everlasting residency for IENs who’ve fulfilled the phrases in their contract. However till then, IENs hoping to switch employers face demanding situations. IENs running in Canada thru this system obtain an LCP paintings allow which, like common paintings lets in, restricts whom they are able to paintings for.

The principles of the LCP program will even motive delays for IENs hoping to advance their careers after their contracts finish. To fulfill CNO’s nursing schooling requirement, many IENs wish to download further instructional {qualifications} in Canada. However LCP prerequisites limit get admission to to instructional, vocational, or skilled coaching classes, forcing some IENs to attend till they have got acquired everlasting residency earlier than pursuing the extra schooling and coaching.

IENs protecting different visas or lets in face other units of demanding situations. For instance, some focal point staff members entered Canada with a learn about allow to join a college-level nursing program. Those methods steadily come with medical rotations and will assist IENs meet each CNO’s nursing schooling and up to date apply necessities. However whilst learn about lets in permit IENs to meet some registration necessities, they too include prices. Learn about allow prerequisites limit the selection of hours their holders can paintings. In addition they make their holders ineligible for government-set tuition charges. Not like tuition charges for Canadian voters and everlasting citizens, the ones for global scholars with learn about lets in aren’t regulated via the provincial authorities. Because of this, learn about allow holders pay considerably upper charges than Canadian voters and home scholars for a similar instructional program—greater than 4 instances as a lot within the 2020/21 instructional 12 months. Blended, top tuition charges and employment restrictions could make the already expensive nursing registration procedure prohibitively dear.

Eligibility necessities for sure government-funded methods and products and services too can save you IENs on sure visas or lets in from making the most of all of the alternatives to be had to advance their careers. For instance, eligibility for some publicly funded, college-level bridging methods is particular to IENs with everlasting residency, secure individual standing, or a sound learn about allow, whilst except for the ones with a short lived paintings allow.

Different publicly funded career-bridging and career-laddering methods will have other access necessities. In step with team of workers at some immigrant-serving organizations, program eligibility necessities range consistent with the supply of investment. So, whilst methods funded via Immigration, Refugees and Citizenship Canada (IRCC) most often require members to be an everlasting resident or a practice refugee, the ones funded via different authorities departments and ministries could also be open to another vary of members. For instance, no longer best can everlasting citizens and conference refugees get admission to methods funded via the Ontario Ministry of Labour, Coaching and Talents Building, however so can also refugee claimants and naturalized voters.

This jumble of visa regulations and eligibility necessities is hard for IENs to navigate, regardless of their immigration standing. Those necessities can inflate nursing registration prices and extend already long processing instances.

Processing Occasions and Registration Necessities

Image 2: A quote from an IEN focus group participant: “I was preparing for four years waiting for my PR to come. And during that time, I was saving all my money just to be in that [bridging] program.... If I had the opportunity right away, I could have grabbed it the minute I came to Canada and did the bridging course…. They should be expediting everything–timing is essential, especially in this pandemic.”

In step with our focal point staff members, IENs will have to transparent some other difficult hurdle earlier than rejoining their earlier careers: long processing instances. IENs are more likely to face this impediment early and steadily—lengthy processing instances are embedded into a number of phases of the nursing registration procedure.

For IENs, the registration procedure steadily starts with an professional evaluation in their instructional {qualifications}. IENs will have to gather and publish their instructional credentials to the Nationwide Nursing Review Carrier (NNAS), which evaluates the credentials and problems an advisory record this is utilized by CNO and different provincial regulatory our bodies to resolve whether or not a candidate is eligible to sign in.

This evaluation is an very important a part of the registration procedure, however it may take substantial time to finish. Whilst NNAS most often problems an advisory record about 12 weeks after receiving all of the required paperwork, the provider recognizes that different phases of the evaluation can take some distance longer. For instance, NNAS notes that merely gathering the specified documentation can take so long as 9 months. For a few of our focal point staff members, the method took even longer. A number of members remarked that from begin to end, their NNAS evaluation took greater than one year to finish.

However the NNAS evaluation is simply the primary of many steps within the registration procedure. CNO is in the long run answerable for figuring out an applicant’s eligibility for registration, however till it receives the advisory record from NNAS, it can not start to procedure a registration software. CNO makes use of the NNAS evaluation to resolve whether or not an applicant will wish to entire any further schooling classes or go through any more exams. To make that choice, CNO can ask candidates to publish further documentation and supply additional proof. This procedure can take a while. CNO notes that one year or longer could also be required earlier than it finishes reviewing an software and is able to factor a choice. A handful of focal point staff members reported even longer waits; some famous that it took CNO greater than two years to finish their registration.

The stairs had to fulfill most of the different CNO registration necessities may also be time-consuming. IENs will have to download Canadian citizenship, a piece allow authorizing them to paintings as nurses within the province, or, extra usually, PR standing. Relying at the cases, acquiring PR standing can take as much as 5 months.

Lengthy waits for PR standing can prolong many different very important steps within the procedure. Now not best can it stay candidates from temporarily finishing their nursing registration software, it may additionally stay them from registering in necessary government-funded employment methods and products and services, a problem showed via a number of focal point staff members. As famous above, PR standing is needed to get admission to many publicly funded career-bridging and career-laddering methods.

In combination, those steps could make for a protracted wait. For some IENs, the method of acquiring PR standing (4 to five months), NNAS evaluation (12+ months), and CNO registration (12+ months)—to not point out finishing any bridging or further instructional classes (6 to twelve+ months) they could also be required to take—can final for years.

The method can final goodbye, actually, that it reasons the eligibility of once-qualified candidates to lapse. To fulfill CNO’s recency of apply requirement, candidates are required to display proof that they have got practiced nursing prior to now 3 years. However, as famous above, the time had to fulfill all the different registration necessities can prolong way past that prohibit. If it does, registration will take even longer. CNO rules require that candidates who’ve no longer practiced nursing prior to now 3 years gain 400 hours of medical revel in and entire a nursing path.6

Those considerations aren’t merely hypothetical. Focal point staff members showed that long processing instances make it tough to effectively meet all of the registration necessities. Within the phrases of 1 player, they invent “an unending cycle … juggling the timelines of immigration standing and CNO software, with proof of apply.”

Registration Prices and Paintings-College-Circle of relatives Steadiness

The IENs we spoke with additionally recognized as a vital barrier the bills related to acquiring skilled registration. The prices related to the quite a lot of packages, qualifying examinations, and career-bridging methods and different vital classes upload up temporarily.

The low wages paid in most of the survival jobs taken via IENs all over the appliance procedure could make those prices much more unmanageable. For instance, whilst pursuing their nursing registration, many IENs paintings in well being care positions that don’t require skilled registration, as PSWs, as caregivers in non-public houses, or as different non-regulated well being care execs. However the wages paid in those roles could make it extraordinarily tough for IENs to concurrently duvet their residing bills and nursing registration charges, particularly in the event that they wish to take further nursing classes. In step with a residential care staffing learn about launched via the Govt of Ontario in 2020, PSWs running in LTC amenities earned a mean hourly salary of $22.69. The ones running within the homecare sector earned even much less, simply $17.30 an hour on moderate. A separate record discovered that the typical PSW wage in 2021 was once simply $19 an hour, or $37,050 a 12 months—an quantity very similar to the price of many nursing methods. The cost of a two-year nursing program, plus software and regulatory frame charges, will also be as top as $35,000.

Assembly those bills, whilst additionally masking the prices of a brand new existence in Canada, items a just about inconceivable monetary problem to many IENs. It will probably additionally provide a logistical nightmare, as IENs fight to race from house, to college, to paintings, and again once more. This was once very true for the ladies in our focal point teams, a lot of whom had school-age youngsters and different members of the family to maintain. One player famous that “… a few of us have encountered demanding situations with balancing paintings and college schedules with our households, particularly the ones people that experience children. It’s simply very laborious to control all of it and cross from position to put.”

Those demanding situations have been particularly laborious for IENs residing in small communities the place residential care amenities, childcare suppliers, instructional establishments, and public transportation choices have been steadily few and some distance between. IENs in those communities famous that lengthy go back and forth instances (in addition to top go back and forth bills) made managing their house, paintings, college, and circle of relatives existence particularly tough.

As a result of the top prices concerned, focal point staff members insisted that measures geared toward higher integrating IENs had to additionally cope with monetary obstacles. Even supposing resolving the problem is hard, members advised that the introduction of labor and be told or workplace-based instructional methods may, to some extent, reduce the consistent fight required to stability paintings, research, and residential existence.

Go back of Carrier Agreements

Image 3: A quote from an IEN focus group participant: “… As a nurse, you want to explore your skills, you want to learn more, you don’t want to be stuck in a place forever. But if you have a certain period that you will be working there, like three years, to return the favour from the government for tuition, then that would be fine. If you need to have five years or more, then maybe that’s not for everyone.”

Contributors additionally commented on some other association with the prospective to mitigate the disruptive have an effect on of top registration prices: go back of provider (RoS) agreements. In change for government-funded tuition grants or waivers, RoS agreements require beneficiaries to paintings within the residential care sector for a suite duration following the a hit final touch of career-bridging or -laddering methods. Crafted properly, the agreements have the prospective to learn all events, providing IENs a low cost pathway to acquiring their nursing schooling, and supplying steadily short-staffed residential care amenities with professional and trained nurses.

However RoS agreements have additionally proved arguable. In 2020, a gaggle of across the world trained scientific execs filed a grievance with British Columbia’s Human Rights Tribunal alleging systemic racism within the province’s residency methods. The grievance in particular identifies the unequal burden put on across the world trained scientific execs via the province’s RoS agreements. Whilst the province designates sure residency positions for across the world trained scientific execs, it calls for that the ones filling the positions signal an RoS settlement—a demand that doesn’t follow to residency positions designated for the ones trained in Canada or the USA. As soon as entered into, RoS agreements are just about inconceivable to again out of. The ones breaking those agreements, the grievance notes, face stiff monetary consequences—as much as nearly $900,000 in excessive instances.

Unsurprisingly, the evaluations of our focal point staff members on RoS agreements numerous. Their ideas on an excellent duration of time for the necessary paintings contracts ranged from one to 3 years, even though they expressed hesitancy towards contracts that tie folks to at least one employer for a longer duration. They famous that prolonged contracts may limit their talent to revel in a variety of task settings and be told new abilities.

Deficient running prerequisites within the residential care sector heightened members’ considerations about RoS contracts. They famous that worker retention in those amenities has been a prolonged worry for years, person who the pandemic has best exacerbated. In addition they famous that failing to fortify wages and dealing prerequisites and to supply profession development alternatives would make RoS agreements unattractive to IENs, and steered many to go out the sphere once their contracts finish.

Nonetheless, some members felt that supportive employers may make an RoS settlement profitable. One player famous that residential care amenities may spice up retention charges past the phrases of an RoS contract via providing quite a few alternatives for development. The significance of profession development alternatives could make greater amenities, the place quite a few profession paths exist, a herbal have compatibility for RoS agreements. Some IENs famous that that they had labored in hospitals of their nation of foundation and want to go back to a an identical surroundings in Canada at some point.

Contributors additionally famous different practices that employers may undertake to display their make stronger. Those incorporated structured task shadowing and mentorship alternatives, actions particularly advisable to IENs as they start to navigate a brand new well being care gadget.

RoS agreements, if well-designed, may assist alleviate one of the vital monetary pressures of the registration procedure. However to paintings, the agreements will have to believe IENs’ hobby in acquiring a variety of well being care studies and pursuing promising careers.

Integrating IENs and Their Voices: A Public Well being Precedence

Image 4: A quote from an IEN focus group participant: “I just processed my [NNAS] assessment. The work I can get right now is PSW and working in long-term care. I haven’t received my results yet.… We are already here–we have the skills. Money and time are very important. I am saving up for my daily expenses, for my tuition fees, for my miscellaneous costs and preschool.... We don’t have much. We’re not established here.”

Even supposing its have an effect on has been tragic, the COVID-19 pandemic additionally items Canada with a singular alternative to fortify the facility of its residential care amenities to draw and retain certified staff. Thankfully, given the numerous IENs already residing in Canada, those amenities have a big pool of skilled and trained execs to attract from. However, as members in our focal point staff made transparent, to be sure that those execs can rejoin their careers, necessary adjustments will wish to be made.

Policymakers and advocates will wish to cope with the visa regulations and eligibility standards that erect quite a few obstacles to employment and government-funded methods, relying on IENs’ immigration standing. They’re going to additionally wish to be able to shorten the long processing instances that may stay IENs out of labor for years. After all, they’ll wish to resolve, whether or not thru RoS agreements or different preparations, the steep monetary demanding situations which might be part of the registration procedure.

Thankfully, hobby in addressing those problems appears to be gaining momentum. In 2021, the governments of each Ontario and Manitoba introduced plans geared toward accelerating the mixing of IENs into the provinces’ well being care workforces. Plans come with measures that spice up the selection of spots to be had to IENs in post-secondary nursing methods and prolong monetary make stronger to IENs via masking tuition and different bills {of professional} registration.

The COVID-19 disaster and the urgent wish to rebuild the country’s human well being care useful resource base make it inconceivable to to any extent further forget about Canada’s huge inhabitants of underutilized well being care execs. Advocates and policymakers around the nation will have to broaden methods to prioritize getting the ones with much-needed abilities again to paintings. For that, they’ll in finding no higher position to begin than with IENs themselves.

Appendix: Method and Demographic Assessment

In Would possibly 2021, WES, aided via IEN co-facilitators, carried out 4 focal point staff periods with a complete of 25 IENs in Ontario (the focal point staff was once no longer a consultant pattern of all IENs in Ontario). Contributors ranged in age from 22 to 47 years outdated, with over part (52 %) within the 30 to 39 age vary. The bulk (23 of 25) have been ladies.

Maximum members (91 %) have been from the Philippines. The remaining have been from Nigeria and Jamaica. All members had acquired a nursing schooling of their international locations of foundation, even though 4 pursued further nursing schooling in other places: 3 in Canada and one in the UK. Roughly 74 % of members held a bachelor’s stage, 17 % held a school degree, and 9 % held a grasp’s stage.

1. Those amenities cross via a number of names, together with residential care amenities, long-term care amenities, nursing houses, seniors’ houses, and assisted residing amenities.

2. For extra detailed data on focal point staff composition and technique, see the Appendix on the finish of this newsletter.

3. Even supposing an identical in title, nurse aides, discussed in other places within the article, aren’t ruled via CNO. As a non-regulated career, nurse aides aren’t required to carry a qualified license, even though person well being care suppliers would possibly set minimal eligibility necessities that, as an example, require task seekers to have acquired a definite point of schooling or to have finished sure certification classes.

4. Nursing rules and terminology fluctuate moderately in different Canadian provinces and territories. For instance, out of doors of Ontario, provincial regulatory our bodies steadily govern Registered Psychiatric Nurses (RPNs) as a separate career. Different provinces and territories additionally steadily consult with what are identified in Ontario as Registered Sensible Nurses (RPNs) as Authorized Sensible Nurses (LPNs).

5. The LCP program was once closed to new candidates in 2014 to permit immigration officers to procedure a backlog of more or less 27,000 packages. It has since been changed via an identical live-in caregiver methods.

6. Further apply and academic necessities are even upper for many who haven’t practiced nursing in 10 or extra years.

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