A group of us (final semester GNIE students) attended an Open House by a health authority yesterday evening. We found ourselves facing yet another set of systemic discrimination against us in the registered nursing job market. For the first time, I am truly angry, just like the rest of my classmates. It says a lot that I am angry, for I come from a country (Singapore) with an open floodgate to foreign labour, and as a result I understand the rationale and benefits behind some of the systemic barriers to entry in B.C., Canada. [Click here, here and here for examples.]
After tonight, I feel strongly that I have to raise the issues to the open. My classmates look to me to speak for them. I have been working hard to network with the right person(s) [and organization] to leverage upon to highlight our plight. In short, I am on the verge of advocating for ourselves, the GNIE students and graduates as a vulnerable population. Frankly, I do not like this feeling of having to push for justice and equality, for it is in my nature to withdraw and keep to my own quiet corner. But today, I feel like “人在江湖，生不由己” ["a person in society cannot always do as he/she wishes"] in that I feel compiled to bring the issues to light so as to right a wrong.
It is inevitable that countries take steps to discriminate against expats in general. I can think of 4 main reasons for their actions against GNIE.
ReplyDeleteThe education received is different and the way they practiced in that country is different from what other country practice.
The country is obliged to provide jobs for their citizens first, because at the end of the day, it is their citizen that they need to be accountable to.
When there are legal issues involve (Medical errors), it can take years for the outcome to be settled and it is unfair that the person had to stay jobless in their country and also there are chances where the expat flee from their country and they will have no idea how to track that person down.
The expected behaviors and ability to cope with the job scope in that country for nurses are different as well. Example, in Singapore they tend to want nurses who can handle high amount of workload, but less advocacy. While in places like Australia, they give nurses lesser workload, but want the nurses to advocate for their patients.
Anyway, the world is big and doesn't revolve around Canada. Nursing is a career where there are demands around the world, so had you ever take other countries into consideration?
Hi Seraphim,
DeleteThanks for visiting and sharing your views.
As I mentioned in this blog entry, "I understand the rationale and benefits behind some of the systemic barriers to entry in B.C., Canada". That said, I do not agree with the rationales that you suggest for the current specific discrimination that we GNIE graduates face.
> The education received is different and the way they practiced in that country is different from what other country practice... The expected behaviors and ability to cope with the job scope in that country for nurses are different as well.
This space is too short for me to share with you the details of the B.C. CRNBC (nursing board) requirements and the GNIE programme (a specially designed course to acclimatize internationally educated nurses into Canadian nursing standards). We are not talking about just any random internationally educated nurse entering the B.C. nursing job market. We are talking about nurses who have successfully undergone a 1-year Canadian training to make sure that we learn the Canadian nursing norms, practices, standards and ethics.
> The country is obliged to provide jobs for their citizens first... there are chances where the expat flee from their country and they will have no idea how to track that person down.
If that is the reason, then it could be stated explicitly that citizens have higher priority in the recruitment process. That means that my fellow classmate who is a Canadian citizen (he migrated as a child and attended school here) should not be discriminated against. As it stands, even his application will not even be considered simply because he went overseas for his nursing training.
> Nursing is a career where there are demands around the world, so had you ever take other countries into consideration? ... While in places like Australia, they give nurses lesser workload, but want the nurses to advocate for their patients.
To walk away in defeat as you suggest is a typical Singaporean approach. As I mentioned in a previous post, I have "Canadianized" over the 2 years that I am here. Here in Canada, we stand up and speak for the injustice that we encounter so that we can make this a better place for all of us to work and live in. E.g. I have brought up the matter to the BCNU (B.C. Nurses Union). E.g. My Canadian-citizen friend intends to tap into the political framework to fight the discrimination. E.g. Another of my classmate raised the issue with her Career Counsellor from the government funded immigrants integration project. So you see, the norm in Canada is to speak up and advocate for ourselves and social justice. As you've mentioned, in Canada, they "want the nurses to advocate for their patients", and part of advocating for our patients is to advocate for ourselves so that we can fully focus on providing safe and effective patient care.
Cheers, WD.
Hey WD,
DeleteThis is actually the first post I read in your blog. Got myself here via links from other blogs, I had never read any of your past blog beside this one.
Anyway, sorry for my mis-understanding on GNIE. Because 'Graduate nurse international educated' gives me the impression that it is formed by international students. I am still skeptic about the program even though you said that it is a strict requirements to match up with the Canadian standards. We all have our own opinions, so we will just leave it at that. =P
Expats tend to be disadvantaged when it comes to employment in almost every country, hence my reasoning. I didn't know citizens in that course were being penalized as well.
By taking other countries into consideration, it increases your choices and chances for employment. It also provide you with information that you can use to compare. (Wages and benefits given by different countries and organizations. Even different states of Canada itself gives different offers because of locations). Should the healthcare authorities refuse to budge, there are still other options available to you. So rather than to get yourself cornered because of one country, why not consider the alternatives while fighting for your own rights? Doesn't hurt to have a backdoor available for yourself while you fight the fire.
I support the fact that you should fight for what you believes in. However I also wish to clarify that I merely asked if you would consider other countries to practice your career in because of the reasoning above. So please don't lump it together as a 'typical Singaporean approach'.
You are free to choose not to consider other options if you see them as a sign of 'walking away in defeat'.
Just a question which I would like to clarify. How are the GNIE being discriminated? Do they employ the nurses from their own universities first? Or do they set different criteria for GNIE?
Best of luck.
Hi Seraphim,
Delete> This is actually the first post I read in your blog.
Welcome to my blog. Thanks for leaving your comments. You may wish to read through my block entries on "Nursing in Canada" (click the link on top-left) so that you can understand the journey that we have gone through to be at our current "Canadianized" position.
> I am still skeptic about the program even though you said that it is a strict requirements to match up with the Canadian standards.
The GNIE course is the one-and-only one in Metro Vancouver area run by a publicly-funded educational institution and specified by the CRNBC (B.C. nursing board) for selected foreign nurses whose education/training is recognized but who need some "Canadianization" to function effectively as an RN in a Canadian setting (and this is after a personalized skills evaluation done by the CRNBC). In fact, my GNIE cohort costs the B.C. government $425K because it is a special additional intake due to the projected increase in demand for RNs.
http://winkingdoll.blogspot.ca/2012/07/gnie-public-cost-of-training-iens.html
> Even different states of Canada itself gives different offers because of locations.
Each state has different requirements for RN qualifications to be recognized. There will be similar assessment requirements and possible additional "Canadianized" training requirements before we are recognized, which means that we have to re-start the whole process of being re-evaluated if we choose to move. Each evaluation cost us precious time and money because we need to submit various "recent" proofs of English ability (IELTS), conduct (police checks from home country and Canada), nursing qualifications, employment records, etc.
http://winkingdoll.blogspot.ca/2010/10/british-columbia-nursing-boards.html
> I didn't know citizens in that course were being penalized as well. Or do they set different criteria for GNIE?
Yes, they set different criteria for GNIE. There is a CRNBC requirement unique to internationally educated nurses (including GNIE graduates) for 250 hours of Canadian Employment while on a provisional license before we can become registered (even if we passed the CRNE -- Canadian RN exam). But to get that 250 hours, we need to find Canadian employment. At a certain health authority, we have been told if you are not ESN (Employed Student Nurse) -- which GNIE students are not allowed to be, or "B.C. Graduate Nurses" -- which GNIE are not considered as, or on the HSPnet -- which GNIE graduates are excluded from once they graduate; they will not consider us GNIE graduates in majority of the jobs.
Generalization of ALL GNIE students and blanket exclusion of us from various job options is discrimination. Any priority, such as for citizens, should be stated explicitly instead of a systemic series of "rules" that culminate in exclusion from jobs.
> Should the healthcare authorities refuse to budge, there are still other options available to you. So rather than to get yourself cornered because of one country, why not consider the alternatives while fighting for your own rights?
Oh, don't you worry about that. I am considered one of the "newer" immigrants in my class. For immigrants to adapt and survive in our new environment for years despite the challenges we face, we certainly have to be resourceful and hold a "big picture" outlook.
As for moving on to another country, frankly, which country do you know of that does not have barriers to entry? Our objection isn't against the barriers to entry, our objection is that we have jumped the hoops that were required of us, and yet we are still being shut out from job options. That is a strong point to fight against, even if we are unlikely to benefit from the "fight for equity" that we started. After all, things move at glacier pace here.
Cheers, WD.
Hey WD,
ReplyDeleteFrom what I understand from the comment is that, the GNIEs need to find a healthcare facility that is willing to take them in and allow supervised/monitored practice for 250 hours before being fully registered.
However, the hospitals do not want GNIEs because they are not fully registered nurse. It will also incur extra cost to the hospitals because GNIE need to be supervised/monitored for approximately 1.5 months (250 hours, 8hrs/day excluding sat/sun) before they get their registration.
If that is the case, the system does seems flawed.
1 of your post actually said 'B.C. has no shortage of students for their nursing course'. Which seems to imply there is no shortage of graduate nurses from their own universities/colleges. And this kind of environment doesn't exactly help your situation.
http://winkingdoll.blogspot.ca/2012/07/gnie-public-cost-of-training-iens.html
I read through the requirements for registration and theses seems to be the few things needed to get registered for international nurses. There is no mention of 250 hours of practice.
www.crnbc.ca
1) IELTS of 6.5 on average and 7 for speaking. (English test)
2) Pass CRNE (Canadian Registered Nurse Exam)
3) Pass SEC (Substantially Equivalent Competency. It also mentioned 'CRNBC does not approve any schools or programs that state they help prepare applicants for SEC assessments.')
4) Good criminal record history.
Correct me if I missed any information as it was really brief on the B.C. RN website. Or redirect me to the correct website as I looked at the registration for international nurses.
Anyway, all the best in challenging the system.
Hi Seraphim,
Delete> hospitals do not want GNIEs because they are not fully registered nurse. It will also incur extra cost to the hospitals because GNIE need to be supervised/monitored for approximately 1.5 months
You've hit the nail on the head. That is the challenge that we GNIE graduates are facing. I have heard from a GNIE graduate who completed her training last year that even when she applied to volunteer with a private facility, she had to wait several months before they were willing to let her work as an RN for free.
From what I understand, graduates from the local public universities/colleges do not have the same problem because there is a special funding for them. The fact that GNIE graduates are excluded from this funding is unfair because our course is also under a local public university (and the only one that runs this course in Metro Vancouver).
It is true that "BC has no shortage of students entering the nursing course", but the number of local nursing graduates is projected to be insufficient to replace the projected number of retiring nurses and to meet the needs of the growing (and increasingly culturally diverse) population. That is why the Ministry of Advanced Education provided a once-off special $425K funding to the university to accept an additional cohort of GNIE students (which coincidentally is my cohort).
> There is no mention of 250 hours of practice.
The 250 hours is specific-only to IENs (internationally educated nurses) and is mentioned in "Step 6: Issuing Provisional Registration (CRNBC does this)" of the following document.
https://www.crnbc.ca/Registration/Lists/RegistrationResources/468RegProcessIEN.pdf
The problem with the "250 hours" requirement is that it is applied across the board to ALL IENs, regardless if one excelled in the SEC, or if one has gone through the GNIE program (in which we had 488 hours of clinical experience at various Canadian public hospitals), or if one needs more clinical experience based on the SEC.
> IELTS of 6.5 on average and 7 for speaking. (English test)
Btw, the English requirement has been tightened since 2009 when my application was reviewed by the CRNBC. The IELTS score required is now Speaking 7.0, Listening 7.5, Reading 6.5, Writing 7.0, Overall 7.0. Alternatively, CELBAN (Canadian English Language Benchmark Assessment for Nurses) scores of Speaking 8.0, Listening 10.0, Reading 8.0, Writing 7.0 and above may also be used.
Personally English is the least of my worries. Although I cannot say the same for some of my classmates.
http://winkingdoll.blogspot.ca/2009/09/ielts.html
> Anyway, all the best in challenging the system.
Thanks, we need all the support we can get. I have started the ball rolling by bringing the issue to BCNU (B.C. Nurses Union). Our next plan is to bring the issue up through political representation (after all we have a classmate who grew up in B.C. and is naturalized Canadian). Of course, our course instructors also support our cause and some have openly vocalized their opinions that the 250 hours requirements is a form of discrimination that is unjust and should be challenged. If things still don't move, another option is to go to the press.
This is a good time to bring issues up politically. The General Voting Day for the next scheduled B.C. general election is Tuesday, May 14, 2013.
http://www.elections.bc.ca/
Cheers, WD.