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Indirect pathways into practice: A comparative examination of Indian and Philippine internationally educated nurses and their entry into Ontario's nursing profession.
Abstract and Figures
In Canada half of all internationally educated nurses (IENs) are employed in Ontario, and in 2010 the top three countries where new IENs had received their training were the Philippines, India and China. This presentation reports on preliminary results from an ongoing research project examining the experiences of IENs from the Philippines and India who intend to enter Ontario's nursing profession indirectly via temporary migration streams. The preliminary survey results will be presented, including differences in the characteristics and experiences of the two groups as they follow migration and occupational pathways to enter Canada and the nursing profession in Ontario. The preliminary findings will highlight some of the issues the data reveal in terms of specific settlement experiences, issues of effective conversion of pre-migration training into professional practice post-migration, and how policy shifts toward temporary and two-step migration may be shaping the nature of IENs' indirect pathways into practice.
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... Prototypes of the mPreceptor program embedded into transition-to-practice models for IQNs, may further support IQNs adjustment to the Australian nursing environment beyond cultural and systems adaptations. mPreceptor programs could be designed specifically to support IQNs address issues experienced in a foreign nursing environment, including discrimination, stress and stereotyping around professional and social capabilities (Brunton and Cook, 2018;Higginbottom, 2011;Mitchell et al., 2017;Walton-Roberts and Hennebry, 2012). Social and financial issues, including employability concerns, have also been highlighted as areas of stress for IQNs, particularly as greater financial opportunities often underpin the decision for nurses to migrate for work (Aggar et al., 2019;Edgecombe et al., 2013;Walton-Roberts and Hennebry, 2012). ...
... mPreceptor programs could be designed specifically to support IQNs address issues experienced in a foreign nursing environment, including discrimination, stress and stereotyping around professional and social capabilities (Brunton and Cook, 2018;Higginbottom, 2011;Mitchell et al., 2017;Walton-Roberts and Hennebry, 2012). Social and financial issues, including employability concerns, have also been highlighted as areas of stress for IQNs, particularly as greater financial opportunities often underpin the decision for nurses to migrate for work (Aggar et al., 2019;Edgecombe et al., 2013;Walton-Roberts and Hennebry, 2012). mPreceptor programs could provide pre-arrival or off shore support particularly around those complex pre-migration processes for registration as nurse in Australia (Chok et al., 2018;Edgecombe et al., 2013;Mitchell et al., 2017). ...
Background
Internationally qualified nurses enrolled in Australian bridging programs to support professional registration lack confidence, and require support and time to develop communication and leadership skills in the clinical setting. Strategies that strengthen professional self-concept have been demonstrated to improve the nursing performance of internationally qualified nurses.
Objective
To evaluate an interactive mobile application called mPreceptor, specifically designed to support internationally qualified nurses' communication and leadership skills during a 6 week clinical placement. The application facilitated weekly learning content and activities in the areas of clinical communication and leadership, including self-assessment, goal-setting, case studies, and weekly detailed reflections while on placement.
Design
A quasi-experimental pre and post-test design with a non-equivalent comparison group was used to explore the effectiveness of mPreceptor on internationally qualified nurses' self-appraisal of professional self-concept, including leadership and communication skills, compared with standard clinical placement. The psychometrically tested Nurse Self-Concept Questionnaire, measured changes to perceived professional self-concept.
Results
Overall, there was a significant increase in Nurse Self-Concept following the clinical placement, confirming that the bridging program for internationally qualified nurses in Australia improves leadership and communication skills. Leadership skills were significantly greater for those internationally qualified nurses who engaged with mPreceptor.
Conclusion
Further research is required to investigate the application of interactive mobile applications, as effective education resources to facilitate internationally qualified nurses' transition of skills and knowledge to the Australian healthcare context.
... State and non-state actors organise and manage different channels of labour migration, and in the process specify the occupation and the type of work that will be undertaken. In some cases, the skills candidates have previously developed (such as English language and medical knowledge) are exploited in the recruitment process through insertion into less skilled occupations; 'why hire a nanny when you can hire a nurse' -is the mantra recruitment agencies might use to promote their services (Pratt 1997;Walton-Roberts and Hennebry 2013). The long term role of the migration pathway for care migrants can be demonstrated with the now disbanded Canadian Live in care Program (LCP), which until 2014 was a major pathway for many Filipino trained nurses to permanently settle in Canada (Boyd 2017). ...
... In the 1990s and 2000s the employment requirements for permanent status eligibility under the LCP combined with increasingly restrictive nursing credential regulatory changes to result in a generation of LCP migrants who were nurses, but who effectively forfeited their eligibility to ever apply for licensure as such (Walton-Roberts and Hennebry 2013). This is an important example of what scholars have termed boundary institutions; processes or structures that shape how workers are supplied to the labour market and their long-term experiences (Peck 2001). ...
The twenty-first century has witnessed a number of significant demographic and political shifts that have resulted in a care crisis. Addressing the deficit of care provision has led many nations to actively recruit migrant care labour, often under temporary forms of migration. The emergence of this phenomenon has resulted in a rich field of analysis using the lens of care, including the idea of the Global Care Chain. Revisions to this conceptualization have pushed for its extension beyond domestic workers in the home to include skilled workers in other institutional settings, particularly nurses in hospitals and long-term care settings. Reviewing relevant literature on migrant nurses, this article explores the labour market experiences of internationally educated nurses in Canada. The article reviews research on the barriers facing migrant nurses as they transfer their credentials to the Canadian context. Analysis of this literature suggests that internationally trained nurses experience a form of occupational (im)mobility, paradoxical, ambiguous and contingent processes that exploit global mobility, and results in the stratified incorporation of skilled migrant women into healthcare workplaces.
... A common criticism in this emerging literature is the larger role being played by employers in PR applications, which may leave workers hostage to abusive employers (especially when migrant workers' work permits are tied to one job and one employer-see, e.g., Aboim, 2009Aboim, , 2012Baxter 2010;Nakache and Blanchard 2014;Reitz 2010;Valiani 2010). At the same time, scholars and employers alike are increasingly advocating for more immigration opportunities for migrant workers in low-skilled occupations (see, e.g., Faraday 2012;Hennebry 2012). 31 There is a dearth of literature examining the immigration intentions and lived experiences of migrant workers (in both skilled and low-skilled jobs) who are transitioning to PR. ...
... The 10 percent cap is being phased in over two years: 30 percent or frozen at the current level (whichever is lower) as of Temporary or Transitional? Migrant Workers' Experiences with Permanent Residence in Canada 30 On this point, one study found that, of 444 SAWP migrants from Mexico and Jamaica interviewed in 2008-09, 60 percent indicated that they were interested in gaining PR in Canada ( Hennebry 2012). 31 As we explain in the section titled "Transition to Permanent Residence: Risks and Challenges," most immigration programs allowing migrant workers to make the PR transition are employer-driven, which means that either a job offer from a Canadian employer or a full-time paid work experience in Canada is a precondition. ...
Although more and more temporary migrant workers are becoming permanent residents in
Canada, their experience with immigration opportunities remains under-studied. This study
aims to fill that gap by examining the lived experience of migrant workers — in skilled and
low-skilled occupations — who transition to permanent residence. Authors Delphine Nakache
and Leanne Dixon-Perera rely on interviews and focus group discussions with 99 participants
(including current and former migrant workers who have become permanent residents,
nongovernmental organizations, employers and public servants) to address the following
research questions: What factors lead migrant workers to seek permanent residence? What
challenges do they face in their transition to permanent residence, and how do they overcome
them? What are the implications of two-step migration for settlement?
A considerable number of the migrant workers interviewed indicated that their decision to
seek permanent residence was not made before they arrived in Canada. Their decisions were
influenced by recruiters abroad, friends, family, settlement agencies and employers. Federal and
provincial governments’ policies have especially important implications for those decisions.
For example, the federal policy that allows migrant workers to stay in Canada for no more than
four years at a time (the “four-in, four-out” rule) has encouraged workers to pursue permanent
residence but has created risks — including seeking work underground — that may outweigh
the potential benefits. Once the decision to immigrate is made, however, migrant workers are
usually not willing to give up, despite the difficulties they face.
During their transition to permanent residence, migrant workers encounter several types of
obstacles. Especially difficult are language proficiency requirements and the often-stringent rules
of employer-driven streams that are an important part of most Provincial Nominee Programs.
Applying for permanent residence entails challenges such as navigating existing immigration
programs and intransigent decisions by some immigration officers. In addition, prolonged family
separation during the transition to permanent residence has negative impacts, especially for
workers in low-skilled occupations who had to leave their families at home to come to Canada.
Temporary workers do not have access to federally funded settlement services. Some provincial
governments and other players are filling this gap, but research participants agreed that migrant
worker legal services and language training need to be urgently addressed.
To facilitate linkages between temporary labour migrants’ experience and pathways to
permanent residence, the authors recommend removing the “four-in, four-out” rule, extending
the right to family accompaniment to migrant workers in low-skilled positions, reassessing
language requirements for migrant workers who transition to permanent residence, and
providing language training for migrant workers upon arrival. They also put forward two policy
ideas for further study and discussion: reconsidering the reliance on employer sponsorship and
introducing a federal pathway to permanent residence for workers in low-skilled occupations.
... Scholarly and university publications comprised the third source of information and provided empirical studies on international students during and after graduation. Furthermore, to add program-level context, we drew upon previous research, including a collaborative project with Conestoga College and previous research regarding internationally educated nurses who entered Canada as students and worked to gain entry into the profession in Canada (Walton-Roberts & Hennebry, 2012; Walton-Roberts et al., 2014). 2 This report draws upon this research to highlight the process of international student transition into the workforce in more detail. ...
... The focus on nursing is also relevant for understanding pathways into the labour market within a regulated profession and the significance of gender shifts currently evident in entry data. Conestoga College also exercised an active and early mandate to internationalize, building agreements with international recruiters in the nursing field (Walton-Roberts & Hennebry, 2012). ...
International students have become an increasingly important dimension of Canada‘s educational and immigration policy landscape, which has led to the development of pathways from educational to working visa status. In this report we present an analysis of international student numbers, visa transition rates, processes and government policy evolution with regard to international student entry to Ontario between 2000 and 2012. The report’s findings suggest four major areas of change: increasing male dominance in the number of student entries; the rise in international student entries into the college sector; the increasing importance of international students as temporary workers post-graduation; and the profound shift in source countries for Ontario-bound international students. Policy knowledge in areas related to these issues is vital to Ontario's ability to compete for international students, who can become potential immigrants, while maintaining high-quality postsecondary educational institutions.
... The fact that there are limited data on the migratory trajectories of Filipino nurses means there is uncertainty as to their exact geographies, but it is evident that they are diverse. Filipino nurse graduates often leave on careworker and student visas (Walton-Roberts & Hennebry, 2012) and, therefore, actual numbers leaving each year are likely to be several times higher than the 20,000 who leave with a position in nursing secured. Furthermore, Filipino nurses have been found to move between destinations, using temporary destinations as 'stepping stones' to other preferred destinations, often in the global north (Matsuno, 2009). ...
Investigating migration decision‐making raises certain methodological issues because of the complexity of these practices and the diverse possibilities that exist for aspiring migrants. Migrants are increasingly engaging in multiple migrations, moving between various locations in three or more international destinations. Particularly in Asia, where short‐term temporary contracts are increasingly the norm for labour migrants, it becomes counter‐productive to analyse migration decision‐making as a movement from one place to another. Based on research undertaken in Metro Manila, the Philippines, with 48 Filipino nurses, this article addresses how to do research related to the multinational migration pathways that structure migration goals and aspirations through demonstrating the benefits and practicalities of mental mapping, a participatory visual method. By exploring the geographical imaginations of migrants and aspiring migrants, multinational pathways are shown to be planned for at the earliest stage of migration. Overall, the work reported here leads to the conclusion that researchers need to consider multiple migrations in more multidirectional and messy terms.
... Their previous work experience (gained mostly in India) was an average of 1.8 years, which is a relatively short amount of work experience compared to most IENs, and suggests that these nurses were actively engaged in devising an early career strategy based around international migration. The majority of the sample came to Canada directly from India, which differs from many Filipino IENs who engage in two-step migration and enter Canada from other destinations such as Saudi Arabia or the United Arab Emirates before making their way to more desirable locations that usually offer opportunities for permanent residence (Walton-Roberts and Hennebry 2012;Percot 2006). ...
... Similar constrains were found in Canada by Walton-Roberts and Hennebry (2012), who investigated the experiences of internationally educated nurses from the Philippines and India who intended to enter Ontario's nursing profession indirectly via temporary migration streams (Walton-Roberts and Hennebry, 2012). Additionally, the authors argue that the complexity and diversity of migration pathways for IRNs open the door "to greater propensity for exploitation and abuse from employers, recruiters, and others who might profi t from these migrants while they attempt to navigate the system or complete eligibility requirements" (Walton-Roberts and Hennebry, 2012: 21). ...
Situated within the framework of the ILO’s Decent Work Across Borders Project, this study is primarily intended to investigate the recruitment experiences and the working conditions of migrant workers in the health sector. In particular, this study explores the experiences of Filipino-born and Indian-born nurses in the United Kingdom (UK). The objective is to understand the intersections between the institutional framework, which has evolved across time in response to changes in the political and economic priorities, and the work experience of the Internationally Recruited Nurses (IRNs).
The review of policy documentation and literature in the field is combined with interviews with 13 key informants who were identified among trade unions, professional unions, employers association, immigrant associations and governmental bodies. An on-line survey was also developed to hear from IRNs working in the UK; a total of 433 valid questionnaires were collected from March to June 2013.
Information and data collected during the fieldwork indicate a positive relation between satisfaction about recruitment experiences, motivations and working conditions of nurses. Respondents hired directly by the NHS tend to report more positive assessments than other respondents and especially compared with the ones recruited by private agencies to work in care and nursing homes.
The recruitment process is only one factor influencing IRNs’ working conditions, however. Changes in the situation of IRNs must be interpreted within the wider leverage of working conditions of healthcare workforce stemming from the economic crisis and consequential cuts in NHS funding starting in 2008 as recent surveys in the UK and in Europe demonstrate. Concerns about losing the job are common among nurses in the UK. IRNs interviewed in our survey also reported concerns; only 1 in 10 of them considers that job security has increased over the years. Many also feel operating in increasing unsafe working conditions. Most of the respondents arrived in the UK before 2006 as the result of NHS expansion and have therefore been witnessing cuts in NHS funding and structural reforms of the whole public health sector started after that period.
Overall, empirical evidence suggest that the easiest way for employers to deal with funding cuts in the public health sector has been reducing the personnel and intensifying work shifts and workloads. IRNs seem to be in a vulnerable position to such pressure. Changes in immigration rules, cuts in NHS funding and the progressive privatization of the health care system in the UK combine and shape employers’ utilization of migrant health workers in ways that may increase risks of unequal treatment in the workplace. A substantial proportion of IRNs who participated in our survey reported lacking professional and career prospects, their professional identity not adequately recognized and valued by the manager and lacking cooperation and solidarity from colleagues in the team. These feelings correlate with what IRNs reported about equality issues in the workplace – i.e. unequal treatment and discrimination in the workplace driven by ethnic considerations.
The consequences of such a situation are not limited to the working conditions of the IRNs but also extend to the quality of care as demonstrated by the correlation between disappointment reported by respondents about their working conditions and the quality of care they are able to provide to patients. Results of the fieldwork indicate a significant relation between the worsening of working conditions, experiences of ethnic discrimination and unequal treatment in the workplace. Empirical evidence also suggest that differences between IRNs in terms of working conditions significantly cut across issues of access to opportunities, equality and diversity management in the workplace. Finally, differences in working conditions reflect different IRNs’ orientations towards the UK labour market. Namely, disappointment about working conditions combined with a general feeling of uncertainty about the future in the UK turned out to be an important factor in influencing the decision of many IRNs interviewed of leaving the UK.
The present study aims to explore the challenges faced by Skilled Indian Women Immigrants (SIWI) when navigating COVID-19 pandemic and their use of agency to handle it. We argue for linking the pre-and post-migration lived experiences of aspiring and actual female immigrants to better understand how they used their everyday agency to handle restrictions in daily life intersected with uncertainty in immigration processes. The sample consisted of first-generation Indian women(29) immigrants to Canada who moved before or after the border closure and aspiring immigrants(10). Narratives about their lived experiences were collected using in depth interviews guided by two separate sets of structured guidelines. The findings suggest that SIWIs went through fear of losing their job, unemployment, networking difficulties, delays in receiving Permanent Residency and other visas, access to resources, and difficulty in compliance with Covid19 protocols. Mental health challenges included feelings of loneliness and anxiety about the Canada Emergency Response Benefit (CERB). Their everyday agency included upgrading skills, seeking therapeutic support, using digital platforms to connect with others, and seeking government support, and support from VISA consultancies, connections through social media platforms catering to Canadian immigrants. We recommend that the universities and colleges need to take more responsibility to support international students by offering robust programs, including cultural learning and job search training, to aid the success of international graduates after their studies. We suggest the policy makers provide equal access to the settlement services for all immigrant groups, including international graduates and that these immigrants should also receive ample information about how to access the settlement services.
Despite the links between health human resources policy, immigration policy, and education policy, silos persist in the policy-making process that complicate the professional integration of internationally educated nurses in Canada. Drawing on the literature on nurse migration to Canada through the Live-in Caregiver Program, this paper sheds light on the contradictions between immigration and health human resources policy and their effect on the integration of internationally educated nurses in Canada. The analysis reveals a series of paradoxes within and across immigration and health human resources policy that affect the process of professional integration of this group of health professionals into the nursing workforce in Canada. I will further link the discussion to the recently implemented Caregiver Program, which provides a unique pathway for healthcare workers, including nurses, to migrate to Canada. Given recent introduction of the Canadian Caregiver Program, major policy implications include the need to bridge the gap between health human resources policy and immigration policy to ensure the maximum integration of migrant nurses in Canada.
In this paper, I explore the migration of Indian-trained nurses enrolled in a post-graduate critical/geriatric care programme at a Canadian public college. Calling upon recent literature on gender, modernity and mobility in India, I examine the extent to which skilled transnational migration is shaped by gender relations established in India. While feminized international migration suggests increased autonomy of female migrants, this research highlights two important dimensions of such migration. The first is that family migration strategies are major determinants of the occupational choice and migration processes that daughters engage in, and the second is that the moral subjectivity of daughters is maintained through transnational methods of care and control.
Migration, Mobility and Multiple Affiliations studies Punjabi transnational life from perspectives that have relevance for contemporary policy, planning and governance. It analyses the spatially widespread, integrated and complex Punjabi diaspora while reflecting its vulnerability in an increasingly globalized world. Besides an overarching introduction and a historical overview, this book covers shifting contours of international migration, social structure and organizational links, the interrelationship between education and migration, and family networks of the Punjabi emigrants.
Rethinking Unequal Exchange traces the structural forces that have created the conditions for the increasing use, production, and circulation of temporary migrant nurses worldwide. Salimah Valiani explores the political economy of health care of three globally important countries in the importing and exporting of temporary migrant nurses: the Philippines, the world's largest supplier of temporary migrant nurses; the United States, the world's largest demander of internationally trained nurses; and Canada, which is both a supplier and a demander of internationally trained nurses. Using a world historical approach, Valiani demonstrates that though nursing and other caring labour is essential to human, social, and economic development, the exploitation of care workers is escalating. Valiani cogently shows how the global integration of nursing labour markets is deepening unequal exchange between the global North and the global South.
As American women have entered the labour force in greater numbers, the traditional work of wives and mothers - cleaning houses and caring for children - has gradually moved into the global marketplace. Paid domestic work has largely become the work of disenfranchised immigrant women of colour. This volume highlights the voices, experiences, and views of Mexican and Central American who care for other people's children and homes, as well as the outlooks of the women who employ them in Los Angeles.
