Labour mobility applicants are registered nurses already licensed and in good standing in another Canadian province or territory.Graham Hughes/The Globe and Mail
Manitoba’s nursing regulator is raising the alarm over the “nursing incompetence” of some internationally educated nurses first licensed in other provinces, including highlighting two cases in which RNs trained abroad are alleged to have contributed to preventable deaths.
The College of Registered Nurses of Manitoba (CRNM) is going public with its concerns in hopes of convincing the provincial government to rescind a directive ordering it to abide by the Canadian Free Trade Agreement and other laws that are supposed to make it easy for nurses licensed in one province to get licensed in another.
The problem, according to the CRNM, is that fierce competition for nurses after the height of the COVID-19 pandemic prompted some provinces to relax their standards for foreign-trained nurses, leading recent immigrants to “jurisdiction shop” for quick licenses in places where they never intended to practise.
“We absolutely support nurses coming from other jurisdictions, but we do feel that this is a patient safety issue,” Deb Elias, the chief executive officer of the CRNM, told The Globe and Mail. “The public needs to be aware labour mobility can come at the expense of public safety.”
Manitoba Health Minister Uzoma Asagwara pushed back against the college’s accusations, saying the licensing body erected unnecessary hurdles that hurt the province’s quest to recruit nurses.
The conflict in Manitoba comes as Canadian politicians of all stripes are vowing to tear down barriers blocking the movement of goods and workers across provincial boundaries in response to U.S. President Donald Trump’s tariffs and annexation threats. Prime Minister Mark Carney and the premiers renewed those vows at a first ministers’ meeting this week.
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The Manitoba situation shows labour mobility is sometimes easier said than achieved, particularly when a balance must be struck between a licensing body’s obligation to protect patient safety and a government’s obligation to find enough health workers to keep hospitals open.
“Manitoba was a jurisdiction with one of the worst reputations in the country for supporting [internationally educated nurses] and Manitobans paid the price,” said Minister Asagwara, a registered psychiatric nurse by training. “We’re working hard to improve that reputation while also ensuring safe patient care.”
Manitoba Health Minister Uzoma Asagwara said the nursing regulator erected unnecessary hurdles that made it difficult to recruit nurses.David Lipnowski/The Canadian Press
The conflict in Manitoba dates back to 2022, when the Progressive Conservative government then in power in the province issued a compliance order under the 2017 Canadian Free Trade Agreement that forced the nursing regulator to accept “labour mobility” applicants without further assessment.
Labour mobility applicants are registered nurses already licensed and in good standing in another Canadian province or territory.
Ms. Elias of the CRNM said allowing for labour mobility is simple with Canadian-trained nurses, and it was straightforward enough for those educated abroad when the rules were similar across Canada.
But as the worst of the pandemic receded to reveal an unprecedented health staffing crisis, some provinces created expedited pathways to licensure for internationally educated nurses (IENs). Manitoba did not lower barriers in the same way, prompting a surge in jurisdiction shopping, Ms. Elias said.
The CRNM reported on the phenomenon in a report quietly posted online in February.
The report found that, before 2022, most labour mobility applicants were living in other provinces when they applied to the Manitoba college.
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By contrast, in 2023 and 2024, most foreign-trained nurses applying as labour mobility applicants had Manitoba addresses, meaning it would have made sense for them to apply to the Manitoba regulator directly.
Instead, Manitoba-based IENs were applying to be licensed first in provinces where they did not live and had never worked.
In 2018, for example, 80 IENs applied directly to the Manitoba college and 19 applied as labour mobility candidates. In 2024, 67 IENs applied directly, and 554 applied as labour mobility candidates before mid-November.
Ms. Elias declined to name the provinces where IENs most often jurisdiction shopped.
The report notes that the college received 35 formal complaints against 33 nurses who were labour mobility registrants between Sept. 11, 2023, and the end of last year. The most common complaint was “global nursing incompetence,” including allegations the nurses couldn’t take vital signs, operate IV pumps or safely administer medication.
In 2024, new labour mobility registrants were the subject of 8.5 per cent of complaints, despite representing only 4.2 per cent of registered nurses in Manitoba.
Ms. Elias alleged that, last November, there were two cases in which the incompetence of recent labour mobility registrants contributed to the “preventable deaths” of two patients.
She declined to provide details because disciplinary proceedings are not yet complete. One surrendered their Manitoba licence voluntarily and the other’s licence is suspended.
In the wake of those incidents, the CRNM revived the requirement that new labour mobility applicants demonstrate “currency of practice” – the extra layer of scrutiny it scrapped in response to the 2022 compliance order.
Nurses can demonstrate currency of practice by asking an employer in the province where they were originally licensed to provide proof they worked a certain number of hours, or they can undergo a clinical competence assessment or take remedial education.
Minister Asagwara said those changes led a lawyer to contact the government office to plead the cases of some nurses who were already successfully practising in Manitoba.
The CRNM’s refusal to follow the Canadian Free Trade Agreement, “was on the verge of costing these respected nurses their jobs and forcing them out of Manitoba,” the minister said. (A spokesman for the CRNM said no RNs registered in Manitoba lost their licences as a result of the December policy change.)
Minister Asagwara issued a directive on April 30 ordering the regulator to reverse the change. The directive took effect May 30 and the college has reluctantly agreed to follow it. The minister said the government has no intention of changing course.