A Systems Approach to Employment Integration: Trends in the International Nurse Supply

Canada’s healthcare system is increasingly reliant on Internationally Educated Nurses (IENs) to address workforce shortages. Despite an increase in the supply of IENs, their employment integration remains a challenge. The purpose of this article is to map IEN employment pathways and examine 5-year trends in the supply and employment of newly registered IENs in Ontario, Canada. A mixed methods design was used including systems mapping and a secondary analysis of regulatory data. The systems map highlights the complex system interactions between immigration, education, and health. Findings from the secondary analysis indicate an increase in IEN registrations, with growth outpacing the domestic supply. Newly registered IENs are less likely to be employed full-time compared to Ontario graduates. They are also disproportionately employed in the long-term care sector and underrepresented in hospital settings. Greater cross-sector coordination is essential to ensure that workforce integration pathways are not only efficient, but also sustainable and responsive to the long-term needs of the healthcare system.