Dr. Edward Cruz is pictured at the Faculty of Nursing, where his research includes advancing the integration and success of Internationally Educated Nurses within Canada’s healthcare system. (GAM MACASAET/University of Windsor)
By Sara Meikle
As Canada faces ongoing health-care worker shortages, internationally educated nurses (IENs) are increasingly relied upon to fill critical roles.
Research by Dr. Edward Cruz, a professor in the Faculty of Nursing at the University of Windsor, suggests many of these nurses continue to encounter systemic barriers that limit their ability to fully integrate into the workforce — even as they are actively recruited to meet demand.
“Internationally educated nurses are not just a stopgap,” said Cruz. “If we want them to succeed — and to stay — we have to support them beyond simply getting them registered.”
Canada’s reliance on IENs has grown alongside pressures from an aging population, strained hospitals and evolving immigration pathways. Yet integration supports remain inconsistent across provinces, employers and regulatory bodies.
Cruz’s research sheds light on how those gaps affect nurses’ careers.
He recently submitted a manuscript based on a study funded by the Social Sciences and Humanities Research Council, examining the employment trajectories of Philippines-educated nurses in Ontario compared with Canadian-educated nurses of Filipino descent.
The study found that Philippines-educated nurses were more likely to work in bedside roles and to be employed as registered practical nurses rather than registered nurses despite having baccalaureate degrees in nursing. They were also less likely to pursue leadership roles or career advancement.
By contrast, Canadian-educated Filipino nurses were more likely to work as registered nurses and aspire to leadership positions.
“One explanation is the experience of immigration coupled with the registration process itself,” Cruz said. “For many IENs, it’s lengthy and stressful. When they finally become registered, the priority becomes stability, not advancement.”
Limited access to mentorship also plays a role.
“Canadian-educated nurses often know who to turn to for guidance,” he said. “Many IENs don’t have those networks or may not even know those supports exist.”
Individual experiences unfold within broader policy decisions. In some provinces, expedited registration pathways were introduced in response to severe shortages — sometimes without adequate safeguards or support.
In one Western Canadian province, for example, nurses were once allowed to use a passed licensing exam as proof of recent practice, even if they had not worked as nurses for years. While the policy increased registration numbers, many nurses struggled to secure employment.
“It created a situation where nurses were licensed but not practice-ready,” Cruz said. “And when things went wrong, internationally educated nurses as a group were blamed.”
In another Canadian province, regulatory changes now require IENs to have Canadian nursing experience before registration — a policy Cruz said unfairly generalizes isolated incidents.
“There’s an assumption that education from developing countries is inferior,” he said. “That’s simply not true.”
Evidence suggests that when properly and ethically supported, IENs strengthen Canada’s health-care system. Research consistently links workforce diversity to improved patient outcomes, particularly in regions with large immigrant populations such as Windsor.
“A workforce that reflects the community it serves is better positioned to deliver safe and effective care,” Cruz said.
IENs also bring experience from multiple health systems, sometimes with more advanced technologies than those used in Canada.
“There’s a tendency to generalize education from developing countries,” he said. “That overlooks the depth of clinical experience many nurses bring with them.”
Cruz believes the challenge is not knowledge but helping nurses transition into Canada’s interprofessional model of care — something that requires investment from health-care organizations and regulators.
His own career illustrates both the barriers and the impact of institutional support.
Before immigrating to Canada, Cruz was a university professor and research centre director. In Canada, it took him 15 years to secure a university position, largely due to credential recognition challenges.
That changed when he joined the University of Windsor, where he said mentorship and research support allowed him to re-establish his academic career.
“At UWindsor, I was supported to pursue research, apply for grants and contribute nationally,” he said.
His work now informs nursing education and workforce policy discussions across Canada.
In 2025, Cruz was recognized as “Pinoy of the Year”, a prestigious award given to Filipinos who have made significant contributions to their field, for his contributions to nursing education and advocacy for internationally educated nurses.
He believes universities have a critical role in amplifying IEN voices and including them in policy conversations — particularly Filipino nurses, who make up about 40 per cent of IENs in Canada.
Cruz notes the pandemic has forced greater recognition of IENs but warns that real progress will be measured by long-term change.
“If we’re still debating whether internationally educated nurses belong here in 10 years, we’ve missed the point,” he said. “They are essential to the system, and the next step is making sure they’re supported, heard and valued.”