When Nikka Reyes moved to Winnipeg from the Philippines in 2015, she was hoping for a promising future working as a registered hemodialysis nurse.
Eight years later, she's a Canadian citizen, but the 34-year-old is living and working in Tennessee because she was unable to get accredited in Manitoba.
She also wonders why provincial governments are going on recruiting trips to the Philippines instead of using those resources to help internationally educated nurses who are already here.
"Why are we wasting their skills and abilities … especially if the needs are immediate?" she asked in a recent interview.
Reyes is not the only internationally educated nurse with these concerns. CBC News spoke to several others in Canada who told similar stories.
One, a hemodialysis nurse who worked for a U.S.-based insurance company for six years, said she started her RN application after moving to Winnipeg in 2019.
The woman was referred to skills bridging course at a local community college but says she can't study full-time because she is a single mother, working as an aide in a Winnipeg personal care home. CBC is not identifying her because she fears for her job.
She has done some of the required courses online, at a cost of $1,500 each, but also used holiday time to return to the Philippines to upgrade. Still, she failed the listening portion of the English language assessment. She estimates she has spent $2,000 on competency assessments alone.
The woman said she is frustrated the Manitoba government is going on a recruiting mission to the Philippines, saying she feels forgotten and overlooked. She'd like the government to prioritize nurses who are already here.
In Canada, internationally educated health workers make up about nine percent of nurses and 26 percent of physicians. Over the past year, provinces have introduced incentives to recruit more, including targeted immigration streams. But up to 47 percent of those nurses and doctors are not working in the professions for which they trained.
Some find their qualifications and language skills don't meet Canada's requirements, while for others, lengthy and expensive licensing and registration processes can delay their ability to work in their field, sometimes for years.
The federal government's most recent budget included funding to help thousands of internationally educated health workers get their foreign credentials recognized.
Looking elsewhere
However, provincial governments continue to look elsewhere to attract nurses and healthcare staff.
A delegation from Manitoba is in the Philippines right now.
In an interview before leaving with the delegation, Jon Reyes, Manitoba's minister of labor and immigration, said he hopes a renewed memorandum of understanding with the Philippines government will "ensure the well-being of Manitobans being serviced by these services, but also the well-being of those Filipinos when they're coming here."
An official in the Philippines Department of Health has expressed concern about the exodus of healthcare staff. In a media briefing last fall, officer-in-charge Maria Rosario Vergeire said the country has a shortage of 106,000 nurses in public and private facilities and hospitals.
One of the reasons for the shortage is migration, she said, as nurses seek work abroad for better pay and working conditions.
In 2020, as a COVID-19 pandemic measure, the Philippines introduced an annual cap of 7,500 nurses allowed to leave the country for work. The cap is now being eased in stages but Vergeire said she wants to maintain it.
Reyes, the Manitoba labor and immigration minister is among those who acknowledge healthcare staffing is a global problem right now.
"I know it's a concern for the Philippines," Reyes said. "There's got to be fairness between Manitoba and the Philippines with regards to attracting more nurses here."
Manitoba Health Minister Audrey Gordon, who is not on the recruiting trip, said she's been assured by the Philippines government that "they actually have a quota of individuals that can leave their country and we're certainly not infringing on that in any way."
"We are very much respectful of the need to maintain services in these countries that we're talking with," she said.
Both Reyes and Gordon said the Manitoba government is working with regulatory bodies to make the accreditation process for internationally educated nurses faster and more efficient.
"To the individuals who've left, I'm saying to them, 'Come home, come back to Manitoba, because there are a lot of opportunities here,'" Gordon said. "To those individuals who are here in Manitoba, don't leave Manitoba, things are getting better."
Offering immigration support
During the five-day trip, 20 clinicians and recruiters hope to interview 400 pre-screened applicants in Manila, Iloilo, and Cebu. They're looking for nurses with at least two years of experience in a hospital or long-term care setting and healthcare aides.
They're offering paid travel to Manitoba, up to three months of accommodation, paid licensing and registration fees, and support through the immigration process. Those who come will also be given a mentor to help them during the first few weeks on the job.
"Our employers are very invested and excited," said Monika Warren, a chief nursing officer of Shared Health, the bureaucracy that manages Manitoba's healthcare system. She is responsible for making sure there are enough nurses in the province and is one of the 20 clinical leaders and recruiters from different health districts and hospitals doing interviews in the Philippines this week.
"They really see this as that glimmer of hope to help us sort of get us through what have been some really challenging times. So I would say in the coming months we're hopeful that we'll start to see some of those people arrive here in Canada so we can get working."
WATCH: Monika Warren describes what Manitoba needs and what she's looking for:
Warren estimates there are 1,500 to 2,000 nursing vacancies in Manitoba, many of them in rural areas.
"I feel the weight of that every day. It's absolutely critical."
While there are four applicants for every nursing education spot in Manitoba, "we need some time to kind of get through this tough time," Warren said. "And I think this Philippines recruitment is really going to help bridge us until we can start graduating more nurses in the province."
Working with the college
As for internationally educated nurses attempting to get provincial accreditation, Warren said she's working with the College of Registered Nurses of Manitoba to "make sure that path is as quick as possible and the door is as wide open for them as possible."
"I need them as well and I want them in the workplace as much as I do the nurses we're recruiting from the Philippines," she said, adding the longer someone is not working, the more upgrading they will need.
Ken Borce is going on the trip as an ambassador, an example of what is possible in Manitoba. He's an internationally educated nurse who moved to Winnipeg from Manila in 2008, worked in acute care, and has since risen to become chief of clinical operations at CancerCare Manitoba.
Borce said he will pitch the vibrant Filipino culture and unlimited opportunities for career development that he sees in Manitoba.
"I truly think Manitoba is the best place to build their dreams again. I'm one of the many stories of success and I'd like to share that story to offer that hope and optimism to the Filipinos that we will be interacting with for this mission."
WATCH | Ken Borce makes his pitch to Filipino nurses:
But there's a lot of competition for these nurses, internationally and across Canada.
Alberta has reached an agreement with the Philippines government to recruit nurses. It also recently announced a $15-million plan to train and support more internationally educated nurses, including $7.8 million in student bursaries and 600 new seats for programs helping nurses upgrade their skills and qualifications.
In December, the Saskatchewan government did its own recruiting trip to the Philippines, hosting 10 workshops and information sessions attended by more than 1,200 Filipino healthcare workers. At the end of the week, recruiters gave conditional offers of employment to 128 registered nurses and one continuing care aide.
A delegation from New Brunswick is also making plans to make a similar trip soon, a spokesperson from the provincial Health Department said.
'The process is just incomprehensible'
As they watch these recruiting efforts, some internationally educated nurses who have come to Canada are shaking their heads.
"The process is just incomprehensible. All of us are confused," Nikka Reyes said.
After she immigrated in 2015, she opened a file with the National Nursing Assessment Service (NNAS), a Canadian not-for-profit organization that offers a streamlined process for internationally educated nurses to submit their document
Reyes applied as both a licensed practical nurse and registered nurse in Manitoba and Ontario, took courses, and did skills assessment tests. The applications cost her $1,400.
But she failed the listening portion of her Canadian English Language Benchmark Assessment for Nurses (CELBAN) test three times. She has to wait another two years before she can try again.
Just last year, the benchmark scores for the listening and writing tests were lowered across Canada, which means Reyes and several other internationally educated nurses CBC News has spoken to would have passed.
"I tried my best to be licensed there, but it's not really working out. First step — negative. Second step — negative. It was a two- to three-year process and I can't see the end of the tunnel," she said.
"It came to a point where I told myself: 'Maybe this is not for me.'"
Reyes said she "paid so much, wasted so much of my time. My years of efforts were not being reciprocated or being acknowledged."
When U.S. state and hospital officials came to Winnipeg to recruit in 2019, offering free accommodation, moving expenses, training fees and more, she and a handful of others decided to give it a try.
Reyes passed an exam for the licensing of nurses in the U.S. on her first try.
She's been working near Nashville for nearly three years and is looking to have her contract renewed.
"I'm not getting any younger.… So that prompted my decision."
Reyes worries about Canada's healthcare system, with the shortage of nurses only expected to worsen. With fewer trained staff, she says wait times for tests and procedures will continue to grow.
Her advice to internationally educated nurses now in Canada who are struggling to get through the accreditation process?
"Don't close your doors. Open your own research and look for other opportunities where you can practice your nursing career. I know it will be hard, but there are a lot of countries that are looking for nurses," she said.
"Canada, it's a good country, but for the nursing profession, it is not a friendly country."
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