Ontario’s Nursing Regulation Changes Challenge International Applicants

Recent changes to nursing regulations in Ontario have left many internationally educated nurses (IENs) uncertain about their future in the profession. The College of Nurses of Ontario (CNO) has revised its “Evidence of Practice” (EOP) requirement, mandating that applicants demonstrate nursing experience within the past three years. This shift emphasizes paid roles over volunteer positions, a move that has drawn criticism from advocacy groups representing foreign-trained nurses.

New Requirements Create Confusion and Frustration

Adona Agcaoili, who arrived in Canada in 2014 and has been working as a personal support worker since 2017, is one of many affected by these changes. A graduate nurse from the Philippines, Agcaoili has long aspired to practice nursing in Canada. “It’s very important for me, especially, I know I have the calling,” she says. “I believe this is the one I need to pursue.” Yet, the new EOP regulations threaten to derail her plans, as they now require proof of recent paid nursing experience.

Mark Anthony Gravoso, co-chair of the Integrated Filipino Canadian Nurses Association (IFCNA), expressed concern regarding the feasibility of meeting the new standards. “It’s very unrealistic for us to meet this. I don’t know if this is, hopefully not, another barrier for us to become a nurse here in Canada,” he stated. The regulations now stipulate that nursing work outside Ontario must be through employed roles rather than volunteer positions, complicating the path for many IENs.

Impact on Personal and Professional Lives

Many nurses had initially planned to gain experience by volunteering in their home countries, but the new requirements have forced them to reconsider their options. Agcaoili shared her feelings of hopelessness, stating, “I’m waiting for this one for a long time, that time I had the courage to really pursue it, and then they suddenly change in a short period of time.” The tightened regulations have left numerous applicants unsure of their next steps.

Heidilyn Oroñgan, who works as an unregulated care provider, noted that the changes have disrupted her plans. “If the CNO wants me to study for a year, I’m not allowed. I’m only allowed to study for less than six months as a work permit holder,” she explained. This limitation places additional strain on her family’s financial situation.

For Joenna Mae Pahilanga, who arrived in Canada in 2024 after more than 15 years of nursing experience abroad, the changes have instilled doubt about pursuing her nursing license. “This changes all of my decisions,” she stated. “It is not easy to go to the Philippines to work and gain one year of experience because I have kids. Not everything can rely on my husband’s salary.”

The emotional toll of these changes is palpable. Pahilanga expressed her frustration: “I’m at the point where I’m thinking, will I still pursue it? Because I’m getting older, and the time it’ll take to study or spend going to the Philippines, it seems difficult.”

CNO Defends New Regulations

In response to the backlash, the CNO defended the changes, stating that many applicants have already submitted paid EOP documentation. They emphasized that insufficient EOP could pose a risk to public safety, highlighting the challenges in assessing nursing knowledge from volunteer experiences. The CNO noted that paid employment provides a more structured environment, facilitating the verification of an applicant’s work history.

“The EOP change allows CNO to quickly verify an applicant’s work history, since paid employment is generally structured. This helps the nursing registration process in Ontario move faster, leading to more nurses practicing in Ontario’s health system,” the CNO stated.

Furthermore, the regulatory body acknowledged its commitment to improving registration processes and assisting IENs in their transition to practice.

Advocacy for Fairness and Support

The IFCNA has called for a reassessment of the new requirements. Gravoso urged the CNO to recognize the sacrifices made by IENs. “I hope they could expand the eligibility criteria for the Supervised Practice Experience program, because safe practice will help evaluate the competency, and yet at the same time, this is a paid practice experience,” he said. He also suggested that the CNO provide the Objective Structured Clinical Examination (OSCE) to qualified IENs as a means of competency assessment.

Despite the hurdles, many nurses remain determined to achieve their goals in Canada. “It’s one of my greatest goals to practice my profession here in Canada, and it’s one of my unfulfilled promises to my mother, who passed away,” Pahilanga shared. “The fire is still there, but there are still lots of things to consider.”

Oroñgan echoed a similar sentiment, stating, “Those changes are just obstacles I need to pass.” Agcaoili added, “During the pandemic, you know, there’s a lot, especially those vulnerable people who really need help. That time, you could see the shortage of staff. That time, it gave me the courage to pursue my nursing.”

As these nurses navigate the complexities of the new requirements, their resolve to contribute to Ontario’s healthcare system remains strong. The road ahead may be challenging, but their commitment to their profession continues to drive them forward.