The Internationally Educated Nurses’ (IENs’) Integration Experiences During the COVID-19 Pandemic in Ontario: A Multi-Method Study

Abstract

Background. Integrating internationally educated nurses (IENs) into Ontario’s healthcare workforce is crucial for addressing nurse shortages, meeting high demands, and ensuring quality patient care. However, IENs encounter significant challenges in integrating into the Canadian healthcare system. Limited research exists on their experiences following the 2015 licensing requirement changes and during the pandemic. This study aimed to map IEN integration pathways in Canada, explore sociodemographic factors associated with success, and describe their integration experiences and support needs in Ontario. Methods. A multi-method study explored IEN integration experiences in Ontario. This study contains three phases: a) scoping review, b) quantitative analysis of primary and secondary data, and c) qualitative description studies using semi-structured interviews with twelve IENs and six stakeholders. Data collection and analysis were guided by the Braun and Clarke framework, Transition Theory, and the Fourfold Model of Acculturation Theory. Results. Collectively the findings from all phases intersected highlighting key points affecting IEN integration into the Canadian healthcare system. The scoping review of 27 studies revealed similarities between IEN integration pathways in Canada and Australia, with Australia being more successful. The key recommendation is to better align Canadian policies for improved integration. The quantitative analysis found that successful outcomes were associated with completing registration within the safe practice period and affiliation with an IEN initiative in Ontario. The qualitative analyses from IEN and stakeholder interviews identified interrelated themes. Three main themes from IENs: IEN experiences pre-registration, experiences post-registration, and support and call for improvements and stakeholder themes included insights on the IEN workforce and workplace integration pathways. Conclusion. This thesis highlights the complex challenges IENs face when integrating into the Canadian healthcare system. Stakeholders valued IENs’ expertise and demonstrated a commitment to improving the licensing processes to accelerate their integration. Findings from this study thesis emphasize the need for collaboration among stakeholders, including IENs, to overcome challenges of licensure and facilitate smoother integration processes for IENs.