title: Internationally educated nurses in Canada: predictors of workforce integration.
abstract: Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs' workforce integration.
  
  
  
  A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs' workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment.
  
  
  
  The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment.
  
  
  
  Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a "one size fits all" model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries' nursing workforce.
authors.affiliation: Faculty of Nursing, University of Alberta, 5-301, ECHA, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada. christine.covell@ualberta.ca.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Covell
authors.affiliation: SETYM International, 80, Ste-Catherine Ouest, Montréal, Québec, H2X 3P4, Canada.
authors.forename: Marie-Douce
authors.initials: MD
authors.lastname: Primeau
authors.affiliation: Faculty of Nursing, Université de Montréal, Hôpital Maisonneuve-Rosemont, CSA-RC-Aile bleue-Room F121, 5415 boul. l'Assomption, Montréal, Quebec, H1T 2M4, Canada.
authors.forename: Kelley
authors.initials: K
authors.lastname: Kilpatrick
authors.affiliation: Department of Nursing, Université du Québec en Outaouais [UQO], 283 Alexandre-Taché, Room C-1601, Gatineau, Québec, J8X 3X7, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: St-Pierre
mesh_terms: D000069:Acculturation; D000328:Adult; D002170:Canada; D002568:Certification; D002983:Clinical Competence; D003406:Credentialing; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004506:Education, Nursing; D004641:Emigration and Immigration; D004651:Employment; D005260:Female; D006801:Humans; D007802:Language; D008004:Licensure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D064700:Nurses, International; D009739:Nursing Services; D009740:Nursing Staff / Q000600:supply & distribution*; D044469:Racial Groups; D012944:Social Support; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Canada; Cross-sectional survey; Employment; Human capital; Immigration; Internationally educated nurses; Policy; Professional recertification; Workforce integration