When I was growing up in Edinburgh, Scotland, my parents bought me a toy nursing kit with a plastic stethoscope and a blood pressure cuff. I would press the stethoscope to my friends’ chests and listening to their heartbeats. At just five years old, I was obsessed with becoming a nurse.
After high school, I enrolled in a three-year nursing program at Edinburgh Napier University. I already knew I wanted to work with kids and did a placement in a pediatric surgical ward, where I changed diapers and recorded heart rates. I enjoyed the work, but it was challenging: some shifts we had to work 12 hours straight.
When I graduated in October 2007, I got my first job in the neonatal intensive care unit (NICU) of a general hospital. I looked after three babies each shift and was responsible for administering medications, monitoring vitals and communicating with parents and doctors. It was daunting to work with such small and fragile babies, but as I gained more experience, I became better at my job. In the second NICU that I worked at, there was a baby girl born premature at just 24 weeks. She needed machines to help her breathe and antibiotics to prevent infection because her immune system wasn’t strong. She would thrive one day and get worse the next. Most babies with complex needs age out of the NICU after a few months, but she never grew enough to be transferred to a children’s hospital. I did everything for her, from administering her medications to updating her care plan to monitoring her oxygen levels. After six months, she was finally well enough to go home and it was an incredible and rewarding feeling to see her healthy again.
There are few general hospitals in Scotland that have NICUs offering the kind of complex care I wanted to provide. By 2016, I had already worked at two of them and was promoted to senior nurse. Advancing higher would have meant more paperwork and less time spent with patients, and I wasn’t interested in management positions. Where do I go now? I asked myself. Ten years into my career, I was at the top of the pay scale, yet I was only making $57,000 a year.
Over the years, I had heard countless colleagues describe their experiences working abroad in New Zealand, Australia, and the Middle East. I wanted to leave Scotland, but I couldn’t muster the courage to do it until I met my now-husband, Max McCoy, in 2013. He shared my dream to explore other countries, so in 2016, we decided to immigrate to Canada. My father-in-law lives in Philadelphia, and we had friends in Chicago and Sault Ste. Marie, so we settled on Ontario.
Through my research, I’d discovered that nurses in Canada are better paid than they are in Scotland. There are many hospitals with NICUs across the country, and the idea of practising in different provinces, in a vast and diverse country, appealed to me. I realized I would have to complete some retraining, but I thought, given my experience, it would be relatively easy to get certified. I had no idea how hard it would be until I got here.
First, I submitted an application to the National Nursing Assessment Service, or NNAS, a not-for-profit that processes the documents internationally trained nurses need to submit in order to practise in Canada. The NNAS evaluates your documents, including your education and employment history. Then it sends your file to the nursing regulation body in your province—in my case, the College of Nurses of Ontario—which decides what further education or training you’ll need on a case-by-case basis, if any, before you’re able to write the national nursing exam. I spent hours scouring online websites, forums, and social media, but couldn’t find any consistent information about the process for internationally trained nurses to become licensed in Canada.
We started our application for a permanent residency visa in early 2017. Most of the points on our visa application came from my nursing qualifications as an RN with 10 years of NICU experience. We landed in the summer of 2018 at Toronto Pearson Airport and for the first four months here, we lived all over Ontario. We earned a living by house-sitting for people we connected with online who were going on on holiday and needed someone to look after their pets. We bought a truck and a trailer to sleep in when we weren’t house-sitting and drove to Port Elgin, Fort Erie and Sault Ste. Marie. Exploring Ontario felt like a dream. We eventually rented a room in a house in London, Ontario. To pay the bills, my husband and I got jobs at a sales company in May of 2019—he started as a marketing manager and I worked as a customer service representative.
For a year and a half after I arrived, I received no update on my application to the College of Nurses of Ontario. In the summer of 2019, the college finally called. The nurse on the line admitted she didn’t know how to upskill me or what I would need to become a qualified nurse. She told me I could start by taking four courses, each 10 weeks long, costing about $1,100 per course. The deadline for the semester starting that fall had already passed, so I waited to apply the following year. I pooled together CERB payments and savings and was able to register for the courses in September of 2020. I completed them the following summer.
The next step to getting licensed was passing the NCLEX-RN exam, which nursing students trained in North America and internationally trained nurses are required to write. Each attempt cost $400. Since I specialized in paediatrics—choosing your specialty early is standard in Scotland—my knowledge wasn’t broad enough for the test. I had to teach myself four years’ worth of adult nursing education in a matter of months. After failing my first attempt, I hired a tutor. I did better on my second try, but still failed. I stopped seeing my friends and spent every weekend studying. The test asked about drugs I had never heard of, signs and symptoms for diseases common in adults, and the disease process in adult patients.
After I failed the test for a third time, I felt like asking, “What do you want from me?” I was mentally exhausted and financially drained. Between multiple exams, registration and application fees, I spent about $7,000 trying to get licensed. I’ve since given up on nursing—it’s the only career I’ve ever wanted but I just don’t have any fight left in me. I watched from the sidelines as doctors and nurses experienced staffing shortages during the pandemic. I heard them cry out for more nurses and saw how surgery backlogs and long ER wait times hurt patients. I was scared of contracting COVID-19, but it was frustrating to only watch when I knew I could help.
I’m now a full-time dog trainer at Doggo Den, a dog-training company I started with my husband in 2021. We’ve always loved dogs and hope to expand our business to work with rescues and open a private dog park. In the process of building our business, we’ve also built a community of friends in London. I wish I could have continued my nursing career, but if I knew then what I know now, I still would have come to Canada.
Reading a book and answering multiple-choice questions correctly doesn’t make you a competent nurse. You learn that on the job, and I have plenty of experience on that front. If Canada wants internationally trained nurses to help alleviate the shortage, it needs to revise its licensing system and take their experience into consideration. It shouldn’t be this hard.
—As Told To Leila El Shennawy