Immigrant nurses in B.C. say language proficiency tests a barrier to practice

Some internationally educated nurses in B.C. say the language proficiency requirement to become a registered nurse is an unnecessary barrier forcing them to give up their career and look for other jobs. Amid the strain of the pandemic on other nurses, they say they feel frustrated, unable to help.

Anne Ignacio and her parents, all internationally educated nurses (IENs), immigrated to Canada from the Philippines almost a decade ago with hopes of continuing to work in their profession.

But after multiple attempts at passing the English proficiency exam, she said they had to make the difficult decision to switch careers.

"The required scores for the English exams, I find it ridiculous," Ignacio said. "They require an overall score ... and they also require you to meet a certain score for each category."

IENs can take one of two language tests — the Canadian English Language Benchmark Assessment for Nurses (CELBAN), or the International English Language Testing System (IELTS), which cost around $300 to $400 each to take. The results of both tests expire after two years.

Ignacio, who worked as an operating room nurse for two years before coming to Canada, said she would score above the overall minimum in the IELTS, but come up short by half a mark in one of its categories.

After seven attempts, she said she couldn't afford to take any more tests. 

"That's when I decided if nursing is not working out for me here in Canada, then I will just have to pursue another program," she said. "My job at the time, I only made $13 an hour and it wasn't full time work."

'It would be better if we would have ended up where we expected'

Ignacio's dad, Ramon, who has over 20 years of experience as a dentist in addition to a nursing degree, now works for an organization that helps patients with developmental challenges.

Her mom, Maria, who also has degrees in nursing and hospitality management, works in a housekeeping role at a retirement home.

"Still in the health care field-ish, but it would be better if we would have ended up where we expected with our profession," said the younger Ignacio.

She said before they left, they attended an immigration seminar where "they said there's a lot of opportunities for nurses and doctors because Canada is constantly needing professionals in the health care field."

Leilani Leonardo said she immigrated to Canada in 2011 with the same understanding.

Leilani said she worked for four years as a labour and delivery nurse, and an operating room nurse, at one of Manila's top hospitals.

She said she took the language proficiency test twice before learning she also needed to complete four more years of schooling.

"I just gave up," she said. "The whole system is so convoluted and it's really expensive ... and I had bills and expenses."

But after almost 10 years, Leonardo said she has decided to pursue her nursing registration again, now that her children are older and life is a bit easier to manage.

"I'm really excited and I'm hopeful. I managed to save up a little bit and I'm ready to do it again to at least prove that I can do it."

Petition for change

Sara Jackson, who has been teaching English as a second language to internationally educated health care professionals since 2000, said she's seen students try for years to meet the high language requirements and eventually give up to pursue another career.

"It was heartbreaking because they were just stuck," said Jackson, also a registered nurse. "The system is not designed to break people but it does."

In 2019, she said she decided to put out a petition to lower the required IELTS and CELBAN scores for IENs.

"I have sent this petition to every nursing regulatory body across Canada and to the Ministry of Health," she said.

In an email statement to CBC, the British Columbia College of Nursing and Midwives said they work with the Ministry of Health and the National Nursing Assessment Service (NNAS) — which evaluates the educational and professional credentials of IENs — to regularly update and streamline the registration process.

"We are working collaboratively with the Ministry of Health, NNAS, and other partners to continuously ensure that our processes protect the public and ensure that nursing standards are met," they said.

B.C.'s Ministry of Health said they are aware of concerns over test accessibility, costs, score requirements and delays, especially for immigrants.

"In response to processing delays due to English Language Testing requirements by National Nursing Assessment Service, effective July 8, 2021, applicants can defer their language assessment until they apply for licensing registration in B.C.," the ministry said in a written statement.