Stories of Ontario’s nursing shortage and its devastating impact on patient care are becoming worryingly commonplace. In the face of mounting calls to address the shortage, the government has looked to regulatory colleges to increase registration of internationally educated nursing professionals. At first glance, this seems like a win-win: the nursing shortage could be alleviated and individuals would be able to work in the field in which they are educated. However, the benefits of this approach become less clear-cut upon consideration of the concept of precarious employment.
Precarious work is often characterized as low paying, insecure, and unprotected. It has been connected to poor mental and physical health in workers, including increased stress levels and increased risk of chronic illnesses.[1] Yet, many precarious jobs, like in housekeeping, childcare, and manual labour, are essential to the basic functioning of society. Therefore, precarious workers exist in a dynamic of being essential but poorly treated.
Immigrants, particularly those of racialized backgrounds, have been found to be over-represented in precarious employment.[2] A variety of reasons are given for this trend, including discriminatory employment practices, language barriers, and a lack of recognition of foreign credentials.[3]
It is not much of a leap to assume that some precariously employed workers would fill the nursing shortage if the registration of internationally educated professionals is increased. A recent Statistics Canada study found that nearly half of immigrants with foreign health-related education are not employed or work in non-health occupations that require no more than a high school diploma.[4] In addition, a significant number of immigrants and visible minorities are already employed in front-line health service roles.[5]
As precarious workers move in to nursing jobs, their working conditions may not be wholly improved. As COVID-19 waves continue, high levels of stress and worker burnout are likely. Front-line health care workers are also particularly vulnerable to COVID-19 infection. Adding to this, Bill 124 capped wage increases for public sector workers to 1%. This legislation is currently being challenged in the Ontario Superior Court for violation of the Canadian Charter of Rights and Freedoms. Taken together, as it stands now, employment in nursing may have negative effects on mental and physical health, as well as suffer from what many believe is inadequate pay. The precarious workers that may fill the nursing shortage would once again exist in the dynamic of being essential but poorly treated.
In summary, increasing the registration of internationally educated nurses may not be as much of a win-win as it first appears. Even if immigrants have their foreign credentials recognized and work in nursing as they were educated for, the current state of the profession illustrates that they are not necessarily winning. Moreover, as retention in the profession may be difficult given the issues surrounding burnout and pay, this approach may not effectively solve the shortage either. While the registration of internationally educated nurses will likely be part of the solution, a more comprehensive approach is needed to ensure that nursing positions are filled and stay filled.
-MG
References:
[1] Stephanie Premji et al., “Precarious Work Experiences of Racialized Immigrant Women in Toronto: A Community Based Study” (2014) 22 Just Labour: A Can J of Work and Society 122 at 124, 132-37.
[2] Ibid at 123; Benjamin J Gray et al., “Differences in the Impact of Precarious Employment on Health Across Population Subgroups: A Scoping Review” (2021) 141:1 Perspectives in Public Health 37 at 38.
[3] Premji, supra note 1 at 136.
[4] Feng Hou & Christoph Schimmele, “Adults with a health education but not working in health occupations” (29 April 2020), online: Statistics Canada <https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00004-eng.htm>.
[5] Martin Turcotte & Katherine Savage, “The contribution of immigrants and population groups designated as visible minorities to nurse aide, orderly and patient service associate occupations” (22 June 2020), online: Statistics Canada <https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00036-eng.pdf?st=fckJbwxS>.
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