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12. Bumpy Roads: Tracing Pathways into Practice for International Students in Nursing: International Students in Canada, Their Families, and Structuring Institutions
... With no clear global system to compare nursing education and professional competency, inter- national credential recognition systems represent complex regionally distinct, and opaque labyrinthine processes. This exposes nurse migrants to multiple vulnerabilities when they become internationally mobile (Kingma 2006;Walton-Roberts and Hennebry 2018). In most western receiving nations, both Indian and Philippine nursing degrees are considered inferior to local and Anglo-American credentials, and nurses from India and the Philippines typically experience lower pass rates in professional registration exams. ...
... There is also another form of 'two-step' migration in terms of shifting from one visa category to another rather than from one geographical location to another. Research in Canada has explored this type of visa transfer for nurses from India and the Philippines who enter as on international student or temporary foreign worker visas and subsequently move toward securing working visas that allow them to move into a nursing position (with highly variable results) (Walton-Roberts and Hennebry 2018). ...
This paper examines nurse migration from India and the Philippines through the lens of the sustainable development goals (SDGs) 4.3 (access to training), 10.7 (orderly and responsible migration) and 3.c (retention of health workers). The international migration of health workers has increasingly featured on the agenda of global health agencies. Ameliorating the negative impact of international nurse emigration from low-income nations has been addressed by several western governments with the adoption of ethical recruitment guidelines, one element of an orderly migration framework. One of the challenges in creating such guidelines is to understand how the emigration of trained nurses influences health education and clinical training systems within nurse exporting nations such as India and the Philippines, and how these relate to various SDGs. This paper maps the connections between India’s and the Philippines’ increasing role in the provision of nurses for international markets and the SDGs related to training and migration governance and the retention of health workers. The paper calls for greater attention to the global structuring of migrant mobility in order to assess national abilities to meet SDG goals in these areas.
... Overall, reviewed publications identify the IEN registration process as lengthy, frustrating, and costly, amounting to $1900 -4000 CAD throughout the different workforce integration stages (Altorjai & Batalova, 2017;Blythe et al., 2009;Bourgeault et al., 2010;Ramji & Etowa, 2014). Internationally educated nurses face challenges due to complex and complicated credential and licensing processes (Walton-Roberts et al., 2019;Zikic et al., 2011). This review highlighted barriers encountered by IENs during their workforce integration, including the lack of recognition, and dissimilarities of IEN nursing education, difficulties navigating the regulatory system, language barriers -especially for IENs from non-English speaking countries-, and difficulty passing the RN licensing examination. ...
Background: Canada is less successful in integrating internationally educated nurses (IENs) into the nursing workforce than other developed countries like Australia. Objective & Design: This scoping review compares the integration trends of internationally educated nurses in Canada with those in Australia. Data Sources & Methods: Nine online databases were searched for English-language studies on the integration pathways of IENs in Canada or Australia. Results: Twenty-seven articles included in the review were completed in Canada (62.96%, n=17) and Australia (37%, n=10). The articles reported on internationally educated nurse integration in the workforce (18.5%, n=5) and workplace (66.7%, n=18), and four studies (14.8%) examined both workforce and workplace integration. This review highlighted the difficulties IENs encounter during their integration in Canada and Australia. Collaboration among stakeholders in Australia resulted in better integration of IENs. Conclusion: This review suggests Canadian ministries collaborate and align their policies to support better integration of internationally educated nurses into the Canadian health system.
... In Canada, these professional associations are organised at the provincial level, and in Ontario, the most populous Canadian province, the College of Nurses of Ontario (CNO) is the regulatory body. These bodies provide a standard against which international nursing education can be measured, but assessment metrics are often interpreted as ambiguous, leading to frustration for IENs who are blocked in their occupational goals (Joel, Pacquiao, and Navarro 2018;Walton-Roberts and Hennebry 2019). Sweetman, McDonald, and Hawthorne (2015) examine the implications of professional regulation for skilled migrants in Canada and Australia, and their findings are echoed in several European cases (see Schuster, Desiderio, and Urso 2013). ...
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.
... Research was conducted in India and Canada 1 over the last 10 years and tracks the gendered mobilities associated with the entry of males into nursing in India and Indian nurses into the Canadian nursing profession via international study to work migration pathways. These two countries offer important cases, since India has played an increased role in the provision of nurses for international markets and Canada has an active immigration system and a range of bridging and testing systems to incorporate internationally educated nurses (IENs) (Walton-Roberts and Hennebry 2019). In India data were collected in Kerala, which has a long history of nurse training and international migration (George 2005), and Punjab, which has recently invested in greater nurse training capacity, and is also a key source for international migrants to Canada (Walton-Roberts 2014). ...
Abstract: This paper examines masculinity, migration and the changing occupational status of nursing through the lens of therapeutic mobilities; health related mobilities of people (nurses) and products (credentials). Indian men have become increasingly interested in nursing as a career, and this interest is strongly associated with the profession’s international motility-its mobility potential. The research reported in this paper traces the migration trajectory across time (2008-2016) and over space (India to Canada) and reveals an overrepresentation of male nurses in international migration contexts (Canada), compared to the Indian context. Male nurses also disproportionally benefit from these mobilities in terms of their occupational success post-migration. Mobilities can be therapeutic for the status of nursing in India, which rises in line with the degree of international motility the profession offers, but gendered distinctions in the outcomes of the migration process illustrate the importance of highlighting uneven mobilities. International mobilities are also deeply implicated in ongoing transformations occurring in the ‘moorings’ of nursing educational, employment and regulatory structures in India.
Keywords: male nurses; occupational mobility; migration; India; Canada
Market-based migrant intermediaries play an important role in
skilled migration. Skilled workers, especially in regulated
professions such as nursing, face increasingly complex testing and
credential assessment systems. ‘Regimes of skill’ control and filter
membership to these professions by reproducing already existing
power imbalances in the global regulation of skilled labour. This
paper examines these processes in the case of Indian trained
nurses who use educational brokers to enrol in Canadian postgraduate
programmes with the intention of practising in the
Canadian health care system. The study elaborates on the ‘regime
of skill’ in nursing, revealing its maintenance through interactional
and transnational connections between intermediaries, educators
and regulators in terms of codifying and translating skills and
competencies between jurisdictions with different cultural and
professional histories and norms of nursing. Findings reveal that
intermediaries operate transnationally in a symbiotic manner with
more powerful actors in order to exploit regimes of skill and
expand their market share.
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.
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.
This chapter examines the changing role of nursing as a career option for young people in Punjab. The paper contextualizes the substantial growth of nursing education institutions in the context of international migration opportunities. Based on survey and interview data gathered at nursing schools and colleges across Punjab, the paper demonstrates how opportunities linked to the global nursing labour market substantially motivate the uptake of the profession in Punjab. The allure of working overseas is not just accounted for by salary differences, but also by the perceived advantages of continued training and career development that overseas employment (particularly in the west) offers. The chapter recommends policy changes in Punjab to enhance the attractiveness of the conditions and career development of nursing in order to compensate for the substantial draw the international market offers trained nurses.
When in the middle of the seventies, Indian nurses started to be hired for newly built hospitals in the Gulf, it was an unexpected opportunity for the most adventurous of them to ensure unexpected good wages. One generation later, thousands of young girls, predominantly Christians from Kerala, fill up the nursing schools all over India with the intention of migrating after graduation. Hence the nursing diploma is obviously considered as a passport opening the world not only to the nurse herself, but also to her relatives. Families encourage this female migration since it is very consciously regarded as a privileged opportunity to increase social mobility.The migration opportunity has consequently changed the status of nurses, which used to be rather low in India. It has also been a chance for the young nurses to set up life strategies, based on the experience of the older migrants. Migration to the Gulf is now considered as an intermediate step before further migration to the West, the new open line. For the young nurses, migration doesn't only mean a better status and a better economical situation, it is moreover a way to get more autonomy or agency, as women, than they can get in their own country.
This paper presents findings from an ethnographic study of the adjustment journey of international postgraduate students at a university in the South of England, which involved interviews and participant observation over a 12-month academic year. It was discovered that the initial stage of the sojourn1 was not characterised by feelings of excitement, as suggested by the U-curve model (and its successors): though such feelings were present, they were overwhelmed by negative symptoms more commonly associated with culture shock. The implications of these findings for support structures in higher education are discussed.
Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.
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.
Enrolments of overseas students have grown sharply, especially in hospitality courses in the Vocational Education and Training (VET) sector. Most VET sector students undertook their studies with the expectation that their qualification would lead to a permanent residence visa in Australia However, since late 2008, changes to Australia's migration policy mean that few will gain this outcome. This article explores the numbers of students affected and their options for staying on in Australia on a temporary or permanent basis. It argues that to be sustainable, the Australian international student industry must focus on providing qualifications that overseas students can take back to their country of origin with profit.
Migration of health workers from relatively poor countries has been sustained for more than half a century. The rationale for migration has been linked to numerous factors relating to the economies and health systems of source and destination countries. The contemporary migration of health workers is also embedded in a longstanding and intensifying culture of migration, centred on the livelihoods of extended households, and a medical culture that is oriented to superior technology and advanced skills. This dual culture is particularly evident in small island states in the Pacific, but is apparent in other significant migrant source countries in the Caribbean, Sub-Saharan Africa and Asia. Family expectations of the benefits of migration indicate that regulating the migration and attrition of health workers necessitates more complex policies beyond those evident within health care systems alone.
With a subtle yet penetrating understanding of the intricate interplay of gender, race, and class, Sheba George examines an unusual immigration pattern to analyze what happens when women who migrate before men become the breadwinners in the family. Focusing on a group of female nurses who moved from India to the United States before their husbands, she shows that this story of economic mobility and professional achievement conceals underlying conditions of upheaval not only in the families and immigrant community but also in the sending community in India. This richly textured and impeccably researched study deftly illustrates the complex reconfigurations of gender and class relations concealed behind a quintessential American success story. When Women Come First explains how men who lost social status in the immigration process attempted to reclaim ground by creating new roles for themselves in their church. Ironically, they were stigmatized by other upper class immigrants as men who needed to "play in the church" because the "nurses were the bosses" in their homes. At the same time, the nurses were stigmatized as lower class, sexually loose women with too much independence. George's absorbing story of how these women and men negotiate this complicated network provides a groundbreaking perspective on the shifting interactions of two nations and two cultures.
Many countries are involved in the "production" and overseas recruit-ment of care workers in a major international response to the "care crisis" affecting advanced industrialized economies. But the distribution of gains and losses from care-labour migration is becoming increasingly unequal, and the pressure to develop alternative policies is intensifying. The author assesses the relevance of dif-ferent policy approaches to nurse migration in promoting sustainability, social equity, the "care commons" and social development. She argues for sustained inter-national cooperation and coordination to address the major global challenges that nurse migration currently poses for public health, social reproduction and social development. he drivers, dynamics and impacts of migration for the purposes of providing T social and health care overseas have become a significant feature of schol-arly and policy debates about the social dimensions and impacts of contemporary globalization. Care-labour migration is not without historical precedent, but it has increased in magnitude and significance over the past two decades. The "glo-balization" of household and family survival strategies is driven by uneven devel-opment globally and capitalist dynamism generally, and also by processes of health and welfare restructuring in developed and developing countries. In this context, a major policy response among developing countries has been the adop-tion of export-oriented "care-labour production" strategies, often as part of their economic development plans, while developed countries have responded with strategies of active recruitment of overseas care labour to address the "care cri-sis" unfolding in their economies.
An international educational experience can enhance the curriculum of an undergraduate program in nursing and can promote student development. However, many students who participate in international programs experience the debilitating effects of symptoms that comprise a phenomenon that is sometimes labeled culture shock. The progress of American nursing students through the stages of adaptation to a different culture is examined through journal entries the students recorded while they were in England for a short-term experience in community health nursing. The benefits of participation in an international program are discussed. Also included are guidelines for faculty to help them recognize the symptoms described and to implement appropriate interventions.
Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.
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