Ontario’s Healthcare System: The Indispensable Role of International Nurses
For years, the steady influx of internationally educated nurses has been a critical lifeline for Ontario’s strained healthcare system, filling persistent staffing gaps and bringing diverse expertise to the front lines of patient care. These professionals have traditionally navigated a complex but manageable pathway to licensure, a journey that acknowledged the unique challenges of re-establishing a career in a new country. The system relied on their skills to meet the province’s growing healthcare demands, creating a symbiotic relationship where Ontario gained skilled practitioners and immigrant nurses found opportunities to serve their new communities.
This established process allowed IENs to demonstrate their recent competency through various means, including volunteer work, a practical option that many depended on. This route was essential for those who had been out of direct practice while settling in Canada, often working in other healthcare-adjacent roles. It provided a flexible way to refresh clinical skills and satisfy regulatory requirements without uprooting their lives, forming the bedrock of many nurses’ long-term plans to join the provincial workforce.
A Sudden Shift: Unpacking the CNO’s New ‘Evidence of Practice’ Mandate
From Volunteerism to Paid Contracts: The End of a Viable Pathway
A significant policy revision from the College of Nurses of Ontario (CNO) has dismantled a crucial pathway for these aspiring nurses. Effective January 2026, the regulator’s “Evidence of Practice” (EOP) requirement was updated to mandate that any nursing experience gained within the last three years must come from an employed or paid position. This change explicitly invalidates the use of volunteer work to demonstrate recent competency, a method previously considered a practical and accessible solution for many IENs.
The prior allowance for volunteerism provided a lifeline, enabling nurses to travel to their home countries for short periods, typically a month, to engage in clinical practice. This strategy allowed them to refresh their hands-on skills and meet the EOP standard without sacrificing their Canadian employment, family responsibilities, or financial stability. With the new mandate, this well-established and logical route has been closed, leaving many feeling that their carefully laid plans have been rendered obsolete overnight.
The Human Toll: Personal Stories of Disrupted Dreams and Financial Strain
The immediate consequences of this policy shift are not abstract; they are felt deeply by individuals who have invested years and significant resources into their Canadian nursing dream. Adona Agcaoili, a nursing graduate from the Philippines who has worked as a personal support worker in Ontario since 2017, now finds her path blocked. Her story echoes the widespread distress reverberating through the IEN community, where hope is quickly turning to uncertainty and despair.
This sentiment is shared by Heidilyn Oroñgan, who juggles multiple jobs as an unregulated care provider and personal support worker to make ends meet. She highlights the logistical nightmare created by the rule, from work permit restrictions limiting study options to the sheer financial impossibility of forgoing her income to chase an elusive short-term paid contract abroad. For nurses like Joenna Mae Pahilanga, who brings over 15 years of international experience, the policy forces an unbearable choice. The necessity of a dual income to support her family in Ontario makes leaving her job and family to seek paid work in the Philippines a threat to their financial stability, pushing her to question if her professional goals are still achievable.
An Insurmountable Hurdle: The Practical Realities Facing IENs
The CNO’s new mandate presents a formidable, if not impossible, challenge for the very professionals it is meant to regulate. The consensus among IENs and their advocates is that securing a formal, paid international nursing contract for a brief duration is logistically unrealistic. Foreign healthcare systems are not structured to offer short-term employment to individuals who have established residency elsewhere, creating an immediate and impassable barrier.
Furthermore, this requirement directly conflicts with the realities of Canadian immigration. Many IENs are in Canada on work permits tied to specific employers, which restricts their ability to simply leave the country for extended periods or pursue other opportunities without jeopardizing their status. The policy also fails to acknowledge the profound financial burden it places on these families. Most rely on two incomes to afford life in Ontario, and the suggestion that one partner should stop working to pursue an unpaid, uncertain path abroad disregards the socio-economic realities of new immigrants who often support relatives both here and in their home countries.
Behind the Mandate: The CNO’s Rationale for Stricter Standards
From the regulatory perspective, the CNO’s policy change is rooted in a stated commitment to public safety and administrative efficiency. The organization explains that volunteer settings can lack the rigorous oversight, standardized protocols, and formal documentation inherent in paid employment. This variability, they argue, makes it difficult to consistently and reliably assess an applicant’s recent application of nursing knowledge, skill, and judgment.
The CNO contends that by focusing exclusively on verifiable paid employment, it can better ensure that every nurse entering the profession meets a clear, high standard of practice, thereby mitigating potential risks to patient safety. Moreover, the regulator suggests this shift is intended to streamline the registration process. Verifying formal employment histories is often faster and more straightforward than assessing the quality of diverse volunteer experiences, a change the CNO believes will ultimately help get qualified nurses into Ontario’s healthcare system more quickly.
Forging a New Path: Advocacy and Proposed Alternative Routes
In response to the widespread concern, advocacy groups are championing fairer and more practical solutions. The Integrated Filipino Canadian Nurses Association (IFCNA), a prominent voice for the community, argues that the CNO’s rigid rule overlooks viable in-province assessment methods. Mark Anthony Gravoso, the association’s co-chair, emphasizes the need for pathways that evaluate skills within the Canadian context rather than erecting external obstacles.
The IFCNA has put forward two concrete alternatives. First, they propose expanding eligibility for the Supervised Practice Experience (SPEP) program, which allows IENs to gain paid, supervised clinical experience directly within Ontario’s healthcare system. Second, they advocate for offering the Objective Structured Clinical Examination (OSCE) to qualified IENs as a direct and standardized method for assessing their clinical competency. These proposals represent a shift in focus toward integration and assessment, rather than exclusion.
A Test of Resilience: The Unwavering Commitment of Aspiring Nurses
The central conflict between the CNO’s administrative goals and the socio-economic realities of IENs created a period of profound uncertainty. The policy, while intended to uphold standards, inadvertently placed a heavy burden on a group of professionals eager to contribute to Ontario’s healthcare system. Despite the significant setbacks and emotional toll, the affected nurses demonstrated a remarkable and unwavering commitment to their professional aspirations.
Their motivations remained deeply personal, driven by everything from a promise made to a parent to a profound sense of calling that was only strengthened by witnessing the system’s strain during the pandemic. This powerful determination to overcome the new obstacles underscored their dedication. Their stories became a testament to a resilient spirit, highlighting a continued desire to apply their skills where they are most needed, even when the path toward that goal had become monumentally more difficult.
