One in 10 Ontario nurses are foreign-trained, with more than two in 10 in many of the province's urban centres, but their numbers are declining, says a new study from McMaster University.

Orientation programs on Canadian culture and health care, incentives to upgrade education and assistance with tuition are suggested by the McMaster researchers as part of the strategies that policy makers and workforce planners need to develop to insure more of the internationally-trained nurses meet the criteria for registered nurse (RN) or practical nurse (RPN) designation.

The study by Jennifer Blythe, senior scientist in the Nursing Health Services Research Unit (NHSRU) and Andrea Baumann, associate vice-president, Faculty of Health Sciences, International Health, and director NHSRU (McMaster site), found more than 10,000 of the province's 90,000 nurses are internationally-educated. Most work in the urban centres of central Ontario, making up almost a quarter of the RN workforce in Toronto and one in five in Mississauga/Halton.

Most international-trained nurses (IENs) in Ontario come from the Philippines, followed by the United Kingdom, India, United States, Poland, Yugoslavia, China, Russia, Iran and Romania. Almost all work in acute care and long-term care, most often as staff nurses. In the future, these patterns may change with more nurses coming from India and China, countries where nursing schools are proliferating and migration is encouraged.

In their report, Supply of Internationally Educated Nurses in Ontario: Recent Developments and Future Scenarios, the researchers note Ontario has experienced alternating increases and decreases in the numbers of foreign-trained nurses since the late 1990s.

While there is no clear explanation for this shift, the McMaster researchers suggest it may be, in part, an unintended consequence of the decision to make a four-year baccalaureate degree a criterion for entry to practice. More IENs are deciding to qualify as RPNs, which now requires a diploma in practical nursing from an Ontario College of Applied Arts and Technology or equivalent.

The report cites significant rates of attrition among internationally trained nurses.

“Although the numbers of IENs entering the Ontario workforce increased annually during the past decade, the total number of IENs in the workforce grew only modestly,” the report said.

Between 1997 and 2006, 6,800 IENs entered the Ontario workforce. However, 6,024 left during the same decade. In the late 1990s and in 2001, more IENs left than joined the workforce. As a result, only 824 more IENs were in the workforce in 2006 than in 1997.

Their report concludes by saying other countries with high rates of immigration have undertaken initiatives to help internationally trained nurses adapt to their new culture.

“Evaluation and adaptation of such programs to the Canadian context may be helpful,” the researchers said.