Taking a Closer Look at Internationally Educated Nurses in Canada Presented by: Babita Gupta, Program Lead October 19th, 2016 bgupta@

Outline About Canadian Institute for Health Information Nursing Workforce data at CIHI Significance of analyzing IEN trends Share findings from the IEN analysis Trends to watch

About CIHI Independent not-for-profit corporation 27 data holdings Expertise in: Data collection and analysis Information standards Education and outreach About CIHI

Nursing Workforce Data at CIHI Regulated Nursing Contents Record-level supply and distribution information on RNs (including NPs), LPNs and RPNs Demographic, education, employment and geographic Aggregate data on nursing programs, including seats and graduates Data Source Provincial and territorial nursing regulatory bodies Canadian Association of Schools of Nursing, individual schools, Ministries of Advanced Education Data back to RN data: 1980 (NP data as of 2003 where legislation exists) LPN and RPN data: 2002 Nursing Education data: RN – 1997, NP – 2002 RPN – 1989 LPN – 2007

Internationally educated nurses in Canada

Setting the stage Challenges in responding to the growing demand for health professionals WHO Global Code of Practice for the Recruitment of Health Personnel OECD and WHO work on causes and consequences of the international mobility Factors that may impact future of Health workforce movement From Brain drain to Brain Gain

Facts - Migration to Canada 250,000+ people migrate to Canada each year 1 out of 5 people in Canada’s population is foreign born Canada has highest proportion of migrants among G8 countries >two thirds (69%) of net labor force growth in Canada attributable to migrants

Cumulative growth in the supply of regulated nurses, Canada, 2006 to 2015 113,367 5,766 Source: Health Workforce Database, CIHI, 2016

Proportion of IENs varies by nurse type, 2015 RNs LPNs RPNs Overall Supply 296,731 113,367 5,766 IEN Supply 26,459 5,712 387 % IEN 9.0% 5.1% 7.2% Source: Health Workforce Database, CIHI, 2016

Growth of RN/NP Supply, 2006-2015 Avg. Annual Growth 2006-15 IEN 2.2% CEN 0.9% Source: Health Workforce Database, CIHI, 2016

Growth of LPN Supply, 2006-2015 Avg. Annual Growth 2006-15 IEN 16.9% CEN 7.7% Source: Health Workforce Database, CIHI, 2016

Growth of RPN Supply, 2006-2015 Avg. Annual Growth 2006-15 IEN 1.1% CEN 0.6% Source: Health Workforce Database, CIHI, 2016

Variability by jurisdictions and nursing profession IENs – RN Canada = 9.0% IENs – LPN Canada = 5.1% IENs – RPN Canada = 7.2% 9.7% 7.4% † † 1.4% - 15.2% 5.5% 9.5% 7.9% 9.5% 1.2% 4.5% 1.3% 6.1% 10.6% 8.5% 10.1% 11.3% <1.0% 9.6% 1.3% 1.0% 9.3% 3.5% 3.1% Notes † Digit suppressed in accordance with CIHI’s privacy policy; digit is from 0 to 9. Source Health Workforce Database, 2016. 1.8% <1.0%

The Philippines and the UK remain the top country of graduation IE RNs 31% from Philippines IE LPNs 45% from Philippines IE RPNs 68% from the UK Source: Health Workforce Database, CIHI, 2016

Top Countries of graduation for all IENs, 2015 #3 UK 10.5% #5 France 4.0% #4 USA 6.7% #1 Philippines 34.1% #2 India 11.5% Source: Health Workforce Database, CIHI, 2016

Inflow and Outflow Rates, IE RN/NP, 2006-2015 Source: Health Workforce Database, CIHI, 2016

Inflow and Outflow Rates, LPN, 2006-2015 Source: Health Workforce Database, CIHI, 2016

Demographics and Employment Characteristics

Fewer IENs obtain Canadian license in early career but stay longer in the workforce Source: Health Workforce Database, CIHI, 2016.

IEN employment status seeking/not seeking employment, 2015 Source: Health Workforce Database, CIHI, 2016.

More IE RNs working in Nursing homes/LTC than CE RNs Source: Health Workforce Database, CIHI, 2016.

More IE LPNs working in Nursing homes/LTC than CE LPNs Source: Health Workforce Database, CIHI, 2016.

Regulated Nurses: Full-Time Employment, by Place of Work, 2015 Source: Health Workforce Database, CIHI, 2016.

Regulated Nurses: Proportion working in Urban areas Source: Health Workforce Database, CIHI, 2016.

Proportion of IENs employed in urban settings, 2015 IENs – RN IENs – LPN IENs – RPN 84.6% 39.2% 100.0% † 61.9% - 96.8% 79.2% 94.7% 88.8% 84.5% 83.4% 98.1% 87.5% 95.1% 95.4% 89.2% 80.7% 97.7% 100.0% 85.6% 90.9% 55.6% 98.0% 74.3% 81.1% Notes † Digit suppressed in accordance with CIHI’s privacy policy; digit is from 0 to 9. Source Health Workforce Database, 2016. 55.0% 66.7%

Trends to Watch Increasing flow of IENs in Canada to meet population needs Attrition of IENs Canadian-born internationally educated nurses Bilateral trade agreements on training and recruitment Alternative career pathways for IENs not meeting Canadian entry-to-practice requirements

bgupta@cihi.ca