Reforming licensure pathways for internationally educated nurses in Canada: A comparative analysis of four provinces

Amid longstanding nursing shortages, exacerbated by the COVID-19 pandemic, federal, provincial, and territorial governments across Canada prioritized the recruitment of internationally educated nurses (IENs). As a result, nursing regulators were strongly encouraged to implement a range of policy shifts to reduce licensure barriers. The nature and scope of these reforms have varied across jurisdictions.

To identify and compare the policy processes, drivers, and outcomes of IEN licensure reforms in the Canadian jurisdictions of British Columbia, Alberta, Ontario, and Nova Scotia between January 1, 2020, and November 28, 2024.

A qualitative comparative policy analysis of six nursing regulators in four Canadian provinces was conducted using publicly available documents. The study was conducted using the 3I+E framework, guided by an analysis of power and the punctuated equilibrium model of policy change.

Although the implementation of new licensure pathways varied in design and implementation across provinces, the underlying factors driving reforms were consistent. Licensure policies and processes were identified as both barriers to and mechanisms for improving the integration of IENs. Most reforms occurred rapidly between 2022 and 2023, driven by nursing workforce shortages, political attention and public pressure, actor power dynamics, and differences in regulators' re-interpretations of risk and the public interest.

The rapid implementation of licensure reforms illustrates the growing tensions between government direction and regulatory autonomy, shifting conceptualizations of what constitutes public interest, the importance of harmonized approaches across nursing regulators in a federated system, and the value of continuous improvement and innovation in regulation.