Changes to the Registration and Licensing Process for Internationally Educated Nurses (IENs)

As Nova Scotia’s nursing regulator, the Nova Scotia College of Nursing (NSCN) role is to ensure that all nurses providing nursing services for Nova Scotians are qualified to do so. The public depends on NSCN to ensure that we only grant licences to those who demonstrate they have the knowledge, skill and competence required to safely and ethically practice as a nurse. NSCN does this by establishing registration requirements all applicants must meet.

NSCN continues to comprehensively review all registration and licensing processes to ensure they are relevant, flexible and positively contribute to the supply of nurses while simultaneously meeting NSCN’s legislated mandate to protect the public. 

Changes have been primarily focused on five areas that lead to more streamlined processes: 

  • More ways to meet the English language proficiency registration requirement
  • Earlier Access to the Registration Exam
  • Earlier Entry to Practice
  • Earlier Return to Practice
  • Policy and Process Changes

Policy Changes

  • In early 2022, we updated our English language proficiency (ELP) registration requirements policy to include more ways for IENs to demonstrate ELP.  (Click here to review all the changes.)
  • In addition to achieving the required score on either one of the English language proficiency examinations, IENs can also meet the requirement through the completion of post-entry nursing or other education or employer assessment of their capacity to work or practice in English.
  • Using a principles-based approach, we will consider evidence of English language proficiency from a variety of source documents.
  • Expiry dates of documents are important, however under our principles-based approach, we consider the expiration of the document in context of each IEN’s unique situation.
Impact on IENs
  • Most IENs can meet the ELP registration requirement through their work as a CCA or other health care provider by submitting an Employer Confirmation of EL Proficiency Form.
  • The new ways IENs can meet the English language requirement are quicker and less costly.
  • Since its implementation, 95% of IENs have met the EL registration requirement under the new policy.

National Nursing Assessment Service (NNAS)

  • Since late 2020, we have been enabling NNAS to allow an IEN applicant to defer their English language proficiency (ELP) assessment to the NSCN registration and licensing process on a case-by-case basis.
  • In March of 2021, we formerly requested NNAS let all IEN applicants coming to NSCN defer the assessment of their ELP to NSCN.
  • At the same time, we created an internal process whereby international applicants can request to defer the assessment of their ELP to the NSCN registration and licensing process while NNAS is making the internal changes to their process.
  • Once the ELP assessment has been deferred out of the NNAS process, NCSN can assess the IENs ELP under our broadened and expanded policy.
Impact on IENs
  • Deferring the EL assessment to the registration and licensing process allows NSCN to use our polices to determine if the applicant meets the registration requirement.
  • Deferral enables NNAS to release their advisory report quicker which lets NSCN can assess the application quicker.
  • Assessment under NSCN policies is quicker and more cost effective.

Applicants with Non-Comparable NNAS Advisory Reports

  • The NNAS advisory report includes the findings of the applicant’s educational assessment. The purpose of the educational assessment is to evaluate the content of an IENs core nursing program to determine if it is comparable to a Canadian nursing program. Traditionally, applicants with a non-comparable NNAS advisory report have been required to complete some education to ensure their foundational nursing knowledge will support competent practice in the Nova Scotia context.
  • Applicants with practice currency and meeting attributes of the most critical dimensions on their NNAS advisory report are given at least 1 opportunity to write the registration examination despite the overall non-comparable status of their NNAS advisory report.
  • Passing the exam may be used to satisfy the nursing education equivalency missing in the NNAS advisory report. Depending on the applicants’ unique circumstances some remediation may still be required. In addition, IENs qualify for another conditional license, so they may remain in practice while completing any outstanding education.
  • Unsuccessful applicants are required to complete remediation before authorized to write the registration exam again.
  • In addition to being given earlier access to the registration exam, some IENs may also qualify for a conditional license so they enter practice while preparing to write the exam.
Impact on IENs
  • To date, 59 IENs were made eligible to make one attempt at their registration exam under this approach.
  • Of the 59 IENs made eligible to write their registration exam, 12 (20%) have written and 11 (92%) have successfully passed and moved on to the registration and licensure process.
  • 47 IENs (80%) have not accepted the offer to write the registration exam early.
  • Traditionally IENs with Non-comparable NNAS Advisory Reports would be required to complete 12-18 months of bridging education before being enabled to write the registration exam. The significance of this approach is that it allows nurses to enter practice much sooner. 

Use of Conditions and Restrictions

The Nursing Act is flexible and nimble and authorizes NSCN to enable applicants with certain outstanding registration requirements to enter practice by applying conditions and restrictions to the license while they complete the outstanding requirements.

Conditions and restrictions are additional safeguards that allow NSCN to meet our public safety mandate when the IEN enters practice while completing any outstanding registration requirements.  Below are some innovative ways we have used Conditions and Restrictions to enable IENs and domestically educated nurses to enter (or return to practice) sooner:

  • In addition, to be given earlier access to the registration exam as described above, some IENs also qualified for a conditional license so they enter practice while preparing to write the exam.
  • Some international applicants with specialty nursing education qualified for a conditional license restricting their practice to their area of education while they complete the required education.
  • Applicants registered and licensed in good standing in another Canadian judication are eligible to enter practice while completing the registration and licensing process.
Impact on IENs
  • Enabling the IEN to enter practice while preparing to write the registration exam may increase their likelihood of success.
  • The application of conditions and restrictions reduces the amount of time (which varies by circumstance) and cost it takes for the international or domestic application to enter practice.
  • Of the 52 IENs made eligible for a conditional license while they prepare to write their registration exam, 4 (7%) moved forward with this process.
  • Of the 61 nurses registered and licensed in good standing elsewhere in Canada made eligible to receive a conditional license enabling them to enter practice in Nova Scotia while completing the registration and licensing process, 28 (45%) moved forward with this process.

Re-Establish Currency of Practice

The most innovative use of conditions and restrictions has been in a process developed to enable internationally and domestically educated nurses to establish or re-establish currency of practice.

In Nova Scotia, every nurse must have and maintain currency of practice. Currency means the nurse is active in their nursing knowledge and practice. Currency is established when an individual graduates from a nursing program. Currency is maintained when a nurse is actively engaged in practice of their designation. Currency is lost over time when a nurse does not practice after graduation or leaves nursing practice for an extended period. The lack of currency can cause competence drift putting the public at risk.

Currency can be re-established when a nurse completes a bridging or nursing re-entry program, competence assessment or a period of practice mentorship.   

  • We developed a process to enable nurses not fully meeting the practice currency requirement to enter practice with several conditions and restrictions as a layer of public protection to support the nurse while transitioning back into practice.
  • The main condition is that each nurse must complete at least 120 hours of 1:1 mentorship with another nurse of the same designation in their place of employment and their employer must provide the College with updates on their progression.
  • Other conditions require the nurse to complete a self-assessment of their individual competence, develop and implement a learning plan, meet with a NSCN Practice Consultant to discuss their learning plan and submit a copy to NSCN for review when it’s complete.
  • Successful completion of this process not only re-establishes a nurse’s currency of practice but can also be used to demonstrate English language proficiency if its required.
Impact on IENs
  • Since March 2022, 35 internationally and domestically educated nurses have been deemed eligible to return to practice under this new process.
  • 25 (74%) have currently in practice under this new process.
  • This process eliminated the need for the applicant to complete a bridging program reducing the time it takes to return to practice and out-of-pocket expenses.

Policy and Process Change

  • We consider multiple sources of data to determine if an applicant meets the registration requirements, recognizing a “one-size-fits-all" approach is not always as flexible as needed.
  • Using online verification of registration rather than waiting on forms to be mailed to NSCN when and when appropriate.  
  • Using applicant attestations and declarations rather than requiring applicants to resubmit a document that is passed its expiration date.
  • Reducing the number of documents an applicant is required to submit when coming to Nova Scotia from another Canadian regulatory body.
Impact on IENs
  • This process eliminates duplication, redundancy, delays and the applicants out of pocket expenses.

Quick Facts

  • NSCN has registered more international applicants in the first eight months of 2022 than we did in 2019, 2020 and 2021!
  • As of July 31, 2022, NSCN registered and licensed 212 international applicants as an RN or LPN. For nearly half of these nurses, this was their first time being licensed in Canada. 
  • Currently, NSCN has 185 IEN applicants in its registration and licensing process.
  • Registering applicants faster does not mean cutting corners. NSCN requires all applicants to meet the same registration requirements to demonstrate they are qualified to practice. 
  • NSCN is actively collaborating with key partners, including government towards solutions to positively impact the supply of qualified nurses in Nova Scotia.