6 Addressing Canada’s Nurse Shortage: The CARE Centre’s Role in Integrating Internationally Educated Nurses

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By: Shaista Karim Sadrudin Jaffer

April 12, 2024 / University of Ottawa – Telfer School of Business Management

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Imagine being a nurse with years of experience in critical care, eager to contribute to a country’s health system, only to be sidelined by an intricate web of bureaucratic processes. This is not a hypothetical scenario but the reality for many Internationally Educated Nurses (IENs) in Canada. Although Canada boasts a robust healthcare system, it is currently grappling with a critical shortage of nurses, a situation worsened by the COVID-19 pandemic that laid bare the vulnerabilities of global healthcare systems. The integration of IENs into the Canadian healthcare workforce reveals complex barriers (Lee & Wojtiuk, 2021).

In Canada, healthcare professionals are in demand and pivotal for the nation’s public health outcomes. The issue becomes more pressing in a global pandemic that has strained healthcare resources and magnified workforce shortages. For IENs, the journey to practice in Canada is obstructed by a complex series of requirements, including accreditation processes, language proficiency requirements, and cultural assimilation challenges, which can often leave their valuable skills underutilized.

The current status quo depicts a disparity where IENs, often equipped with years of experience and a willingness to serve, face an uphill battle for professional recognition. With the average process duration extending over a year due to administrative complexities and a lack of streamlined support, many IENs find themselves underemployed, occupying positions that underutilize their expertise and training.

World Education Services (WES) wrote Envisioning System-Level Strategies for Integrating Internationally Educated Health Professionals and Rebuilding Ontario’s Healthcare Workforce(Envisioning System-Level Strategies for Integrating Internationally Educated Health Professionals and Rebuilding Ontario’s Healthcare Workforce – World Education Services, n.d.). The article discusses the underemployment of internationally educated health professionals (IEHPs) in Canada in the context of the COVID-19 pandemic and the projected shortfall of 18 million health workers by 2030. The article states that 47% of IEHPs are unemployed or underemployed in Canada due to barriers related to immigration, professional licensure, and labor market integration.

CARE to the Rescue!

Established at the turn of the millennium, the CARE Centre for Internationally Educated Nurses (CARE) has become a pivotal institution in addressing the underemployment of skilled healthcare professionals in Canada. As a non-profit organization, CARE was conceived to bridge the gap between the qualifications of IENs and the Canadian healthcare industry’s standards. It is dedicated to assisting IENs with international nursing credentials through the complex process of obtaining their professional license to practice in Canada.

In the heart of Ontario’s bustling healthcare ecosystem, the CARE Centre has carved out a sanctuary where IENs chart new professional terrains. Their stories, though diverse in origin, converge at a common junction of aspiration and challenge. One nurse shares her journey: ‘Becoming a member of the CARE Centre helped me navigate the registration process for CNO and allowed me to meet other IENs here in Ontario.’ (CARE-Centre-Survey-Result-Summary-1.Pdf, n.d.)

The echoes of gratitude are a chorus of varied tones: ‘I’m so proud to be a CARE member, and I’m still attending some lectures'(CARE-Centre-Survey-Result-Summary-1.Pdf, n.d.) states a nurse who found her footing through CARE’s tailored guidance. And from the pragmatic appreciation of CARE’s exceptional customer service comes the reassuring voice of another nurse: ‘Customer service from my first contact with CARE centre until now has been excellent. My Case Manager is very insightful and tries to give me the best advice ensuring I am on the right path to assist me in getting my RN license.'(CARE-Centre-Survey-Result-Summary-1.Pdf, n.d.)

Such endorsements aren’t mere accolades; they are the lived experiences of IENs who found in CARE a compass to navigate the complexity of accreditation and integration into the Canadian healthcare workforce. As CARE continues to evolve, these stories serve as the foundational narrative, illustrating the Centre’s pivotal role in not just equipping IENs with credentials but also instilling in them the confidence to thrive.

CARE is targeted explicitly towards IENs either before or after their arrival in Canada, with two standout programs: the Pre-Arrival Supports and Services (PASS) program(PASS – Pre-Arrival Support Services for IENs, n.d.) and the post-arrival Support, Training, and Access to Regulated-employment Services (STARS) program.(STARS HOME, n.d.) The PASS program is designed for IENs still in their home countries, contemplating a move to Canada. It offers a variety of support, such as information on the Canadian healthcare system, assistance with the initial steps of the accreditation process, and preparation for the Canadian job market. Meanwhile, the STARS program aids IENs who have arrived in Canada with case management, job shadowing opportunities, and workshops to assist with licensing applications and familiarize them with the specific requirements based on the province they aim to practice in.

Despite the comprehensive support offered, the CARE Centre faces a persistent challenge: the intensive and time-consuming process of enhancing IEN resumes. This critical service ensures that IENs effectively present their international experience and qualifications to potential Canadian healthcare employers. However, with case managers dedicating an average of 1.5 hours per resume, the task detracts from the Centre’s capacity to provide direct, individual support and training sessions that are equally critical for successfully integrating IENs into the workforce.

As CARE continues to adapt to the evolving needs of IENs, it must streamline its processes for greater efficiency. Embracing AI technology in resume enhancement could revolutionize these services, significantly reducing the time spent per resume from the current average of 1.5 hours. This not only improves the speed and quality of service but also allows scaling efforts to impact a more significant number of IENs. Such advancements are pivotal as CARE strives to mitigate labor shortages in the healthcare sector and ensure that IENs receive the recognition and opportunities they deserve. Integrating IENs into the workforce is not just a matter of filling job vacancies but a critical enhancement to Canada’s public health infrastructure, promising improved outcomes across the healthcare system.

The persistent bottleneck at the CARE Centre is the time-consuming process required to enhance IEN resumes, significantly draining resources that could be deployed more effectively elsewhere. The ideal solution would automate much of this process, freeing case managers to focus on other critical support areas. This solution integrates an Artificial Intelligence (AI) tool designed explicitly for resume enhancement through advanced few-shot prompt engineering.

In response to the significant challenges IENs face in presenting their credentials effectively within the Canadian job market, CARE can pioneer an innovative solution to streamline the resume enhancement process. Leveraging the power of AI, mainly through the ChatGPT API and advanced techniques in prompt engineering, CARE developed the IEN Resume Enhancer—a tool designed to transform the laborious task of resume customization into an efficient, automated process.

Development and Implementation of the IEN Resume Enhancer

The journey to developing this tool begins with recognizing that the traditional method of manually enhancing resumes is not only time-consuming—requiring up to 1.5 hours per resume—but also a bottleneck that limits CARE’s ability to serve more IENs. The initial attempt to automate this process through zero-shot learning may provide unsatisfactory results. Thus, the exploration of few-shot learning techniques must also be considered. By utilizing a curated dataset of sample resumes—both before and after the CARE case manager’s manual editing—the AI-powered IEN Resume Enhancer can be trained to understand the nuances of effective resume construction for healthcare professionals.

The enhanced AI model can operate through a custom-built interface integrated into CARE’s systems via a Flask web application. This setup allows case managers to upload an IEN’s original resume alongside their target job description. The IEN Resume Enhancer can then process this data to produce a refined resume that not only aligns with Canadian healthcare standards but also highlights the IEN’s qualifications in a manner that resonates with potential employers.

Functionality and Features of the Resume Enhancer

The AI-driven IEN Resume Enhancer should meticulously adjust each resume by:

• Formatting critical contact information and identifying any missing details, ensuring that each resume meets professional standards right from the outset.
• Refining the objective statement to align closely with the target job’s requirements, utilizing relevant keywords and phrases that enhance the resume’s impact.
• Expanding the summary of qualifications to include a bullet-point list that showcases the IEN’s expertise, employing action verbs and healthcare-specific jargon that underscore their readiness and aptitude for the role.
• Detailing professional experiences precisely, turning basic job descriptions into compelling narratives of healthcare competence and dedication.
• Highlighting educational backgrounds and certifications, emphasizing the relevance of each credential to the nursing field.
• Enhancing additional sections like community involvement and other work experience, which round out the candidate’s profile and illustrate a comprehensive professional identity.
• Each section of the resume includes smart suggestions marked as “[Suggestion:]” for potential additions and “[Missing:]” tags where essential information is absent, guiding the IENs to provide complete and compelling applications.

The implementation of the IEN Resume Enhancer can represent a significant advancement in CARE’s service delivery. By reducing the time spent on each resume, the tool not only can improve operational efficiency but also allow CARE to assist a larger number of IENs simultaneously. This is particularly critical given the ongoing healthcare labor shortages in Canada. CARE can continuously refine the tool, incorporating feedback from both case managers and IENs to enhance its functionality and user experience. Therefore, This AI-driven solution has the potential to not only streamline an essential service but also enhance the quality of support offered to IENs, reinforcing CARE’s role as a leader in integrating internationally educated healthcare professionals into Canada’s workforce.

Operational Efficiency and Resource Allocation

Implementing the IEN Resume Enhancer at the CARE Centre can mark a pivotal shift in operational practices. By automating the resume enhancement process, the tool can significantly reduce the time spent on each resume, which traditionally takes case managers up to 1.5 hours. This reduction in manual labor can allow case managers to reallocate their efforts towards more personalized support services such as one-on-one coaching and interactive training sessions. These sessions are crucial for equipping IENs with the skills and knowledge required to successfully navigate the Canadian healthcare environment.

Furthermore, the automation of resume enhancement can free up organizational resources, enabling CARE to scale its operations. This scalability is vital for addressing the broader issue of labor shortages in Canada’s healthcare system by assisting more IENs in entering the workforce more swiftly. The enhanced efficiency can streamline the process for existing staff and potentially reduce the need to hire additional personnel to manage resume customization, thus optimizing operational costs.

Quality of Service and User Confidence

The IEN Resume Enhancer can significantly improve the quality of the resumes produced. By integrating sophisticated algorithms and machine learning techniques, the tool can ensure that resumes are professionally formatted and optimized with relevant keywords and job-specific details. This precision can enhance the likelihood of IENs securing interviews and positions, increasing their confidence and accelerating their professional integration into the healthcare sector.

The output from the IEN Resume Enhancer will include smart suggestions for additional content and flags missing information, which guides IENs to present a more comprehensive and appealing professional profile. This level of detail ensures that IENs can present themselves to potential employers in the best possible light, boosting their chances of successful employment. This will also allow the CARE case manager to offer one-on-one services to identify content to fill in the missing and suggested information to finalize the candidate’s resume.

Scalability and Broader Implications for Labor Shortages

The scalability of the IEN Resume Enhancer means that CARE can extend its support to a greater number of IENs simultaneously. This expansion is crucial when the healthcare sector is experiencing acute workforce shortages. By enabling more IENs to enter the workforce more efficiently, the tool can directly mitigate these shortages, rapidly responding to an urgent public health need.

Feedback Loop and Continuous Improvement

As CARE continues to refine the IEN Resume Enhancer, the incorporation of ongoing feedback from both case managers and IENs will be essential. This feedback loop will ensure that the tool adapts to the evolving needs of the users and the changing dynamics of the healthcare job market. Future iterations of the AI-powered enhancer could integrate more advanced features based on user interactions and suggestions, enhancing its effectiveness and user-friendliness.

The implementation of an AI-powered solution not only highlights CARE’s commitment to innovation but sets a new standard for supporting healthcare professionals transitioning their skills across international borders. The IEN Resume Enhancer will serve as a model for other organizations, suggesting that similar AI-powered tools could benefit various sectors where credential recognition and professional integration are challenges.

Recommendations for Policy and Collaboration

This case study highlights the importance of collaborative efforts between training institutions, regulatory bodies, healthcare employers, and advocacy groups to optimize the integration of IENs into the workforce. The expansion of AI applications in professional development within the healthcare sector illustrates a forward-thinking approach to overcoming systemic barriers and fosters an inclusive and efficient workforce.

The IEN Resume Enhancer not only can improve operational efficiency and enhance the quality of service at CARE but also sets a benchmark for the use of technology in supporting internationally educated healthcare professionals. Its success can provide a replicable model for other organizations not only in Canada, which are facing similar challenges, heralding a new era of AI integration in professional development and workforce integration strategies.

The Future of the IEN Resume Enhancer

The CARE Centre for Internationally Educated Nurses has pioneered a significant advancement in addressing the systemic challenges faced by IENs through implementing the IEN Resume Enhancer. This AI-driven tool streamlines the resume enhancement process, thereby enhancing the potential of IENs to integrate effectively into the Canadian healthcare workforce. The tool frees up valuable resources by automating the time-intensive aspects of resume customization, allowing CARE’s case managers to offer more targeted and impactful support to IENs. This operational efficiency bolsters CARE’s capacity to assist a larger number of IENs and elevates the quality of service provided, empowering IENs to present their qualifications confidently and effectively.

Moreover, the broader implications of this technological innovation extend beyond the immediate benefits of increased speed and efficiency. By enabling CARE to support more IENs, the Resume Enhancer addresses the urgent labor shortages in Canada’s healthcare system. This strategic deployment of AI technology illustrates a forward-thinking approach to overcoming significant barriers in professional integration, setting a new benchmark for the sector.

Looking ahead, the success of the IEN Resume Enhancer highlights the importance of continuous innovation and the need for adaptive solutions in support services for internationally educated professionals. It highlights the potential for similar AI-powered tools to be implemented across various sectors, revolutionizing how qualifications are recognized and integrated into professional settings globally.

In conclusion, the project at the CARE Centre is not merely about improving operational efficiencies; it is a beacon of innovation that showcases how targeted technological solutions can resolve long-standing systemic issues. As CARE continues to refine this tool and expand its capabilities, it sets a precedent for other organizations to follow, promoting a more inclusive and efficient integration process for internationally educated professionals. This initiative enhances the professional journeys of individual IENs and contributes to the broader goal of creating a resilient, diverse, and well-equipped healthcare workforce in Canada.

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