JUNE 2026A Toolkit Development Guide for Bridging Programs and Healthcare Employers#1170, 105 – 12th Avenue SE Calgary, AB T2G 1A1 (587) 894-7583 Preparing Internationally Educated Nurses for the Canadian Workforce:

Makii, J. (2026). Preparing internationally educated nurses for the Canadian workforce: A toolkit development guide for bridging programs and healthcare employers. Calgary Region Immigrant Employment Council (CRIEC). Published by To Cite this Report The opinions, interpretations, and conclusions expressed in this publication are those of the authors and do not necessarily reflect the views of the Calgary Region Immigrant Employment Council (CRIEC), its funders, partners, Board of Directors, or affiliated organizations. Disclaimer Authored by: Jamila Makii, PMP®, BPH, MSML | Director, Case Management and Mental Health Support, Center for Newcomers | Former Senior Program Manager, CRIEC | CEO & Founder, Iconic Community Healthcare Network Authored By:

02Table of Contents Executive Summary0301 THE CHALLENGE0302 OUR APPROACH0403 WHAT WE BUILT0604 KEY LESSONS FROM THE CO-DESIGN PROCESS0705 RECOMMENDATIONS0906 WHAT'S NEXT10Acknowledgments11

This paper presents the rationale, methodology, and outcomes of CRIEC's workforce integration toolkit initiative for internationally educated nurses (IENs) in Canada. It is intended as a practical resource for bridging program coordinators, healthcare employers, nursing educators, community organizations, and policymakers. This work was conducted as part of an ESDC-funded initiative and reflects CRIEC's commitment to evidence-informed, equity- centred workforce development. About This Paper03 117,600 Projected RN shortage in Canada by 2030 15,000–20,000 IENs in Canada unable to access the nursing workforce 5 Evidence-informed toolkits developed through community co-design 01 THE CHALLENGE Canada is experiencing a deepening nursing workforce crisis. With a projected shortage of 117,600 registered nurses by 2030, the healthcare system faces mounting pressure to expand its workforce. Yet an estimated 15,000–20,000 internationally educated nurses (IENs) currently living in Canada remain underemployed or locked out of the profession entirely, not because of a lack of clinical knowledge, but because the systems meant to support their integration have not kept pace with the scale of the need. IENs arrive in Canada with substantial experience, managing wards, delivering primary care, working across specialties in countries with rigorous healthcare systems. What they encounter here is a fragmented web of credential assessments, bridging programs, and employment processes that were not designed with their realities in mind. The problem is not the nurses. The problem is the infrastructure.

Section 1: The Productivity Gap GAP 1 — Supply Side Existing bridging programs vary enormously in quality and content. Few address employment navigation, professional self-advocacy, or the practical realities of Canadian workplace culture alongside clinical competency. IENs graduate from these programs without the full toolkit they need to secure and sustain employment. GAP 2 — Demand Side Healthcare organizations want to recruit internationally trained nurses, but many HR teams and nursing managers lack the structured tools, knowledge, and processes to do it well. Inclusive intent without inclusive infrastructure produces poor outcomes for both IENs and employers.04 Alberta: Stronger but Still Lagging Key Insight Addressing only one side of this equation, preparing IENs without building employer capacity, or improving employer practices without strengthening IEN readiness, will not produce the systemic change Canada's nursing workforce needs. Both gaps must be addressed simultaneously. 02 OUR APPROACH CRIEC's response to these gaps was grounded in three evidence-based frameworks that together shaped both the process of development and the design of the resulting resources. Theoretical Foundation — Social Ecological Model (SEM) The SEM explains why IEN integration so frequently fails despite goodwill on all sides: health and professional outcomes are shaped not just by individual factors, but by interactions across multiple levels, individual, organizational, community, and policy. A nurse can be fully prepared and still be blocked by organizational hiring practices that haven't changed, or by regulatory timelines that create structural delays. Effective solutions must work across all these levels simultaneously.

05Methodological Approach — Community-Based Participatory Research (CBPR) CBPR positions IENs, employers, bridging program staff, and community organizations not as informants but as co-designers. This is a methodological choice with direct consequences: content that emerges from lived experience is more contextually relevant, more culturally responsive, and more likely to be used than content derived solely from the academic literature. CRIEC conducted six stakeholder consultations and three iterative co-design sessions between February and September 2023, engaging IENs, healthcare HR professionals, nursing managers, bridging program educators, and community organization representatives. Analytical Framework — RE-AIM RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) provided the analytical lens for translating community insights into implementation-ready tools. Each design decision was evaluated against RE-AIM dimensions: Who will be reached? Under what conditions will this be adopted? How will delivery be sustained? This framework oriented toolkit design toward active facilitation and program embedding rather than passive resource distribution. Evidence Base A scoping review of 47 peer-reviewed and grey literature sources (2010–2023) informed the content of all five toolkits, identifying what works, what doesn't, and where the evidence base for IEN integration is strongest and weakest.

0603 WHAT WE BUILT Five workforce integration toolkits were co-designed through the CBPR process. Each toolkit is structured for facilitated delivery within bridging programs and employer education session, not passive distribution. TOOLKIT 1 🩺 Employment Engagement for IENs For: IENs, bridging program instructors, and career counsellors A structured self-assessment framework, credential pathway maps, professional communication guidance, and interview preparation curriculum. Designed for facilitated delivery within IEN bridging programs, this toolkit helps nurses identify competency gaps, map provincial credential pathways, and develop the employment navigation skills Canadian healthcare employers expect. Sample tools: Competency gap analysis worksheet · Provincial regulatory requirement checklist · Mock interview scenarios grounded in Canadian healthcare contexts · Professional portfolio template. TOOLKIT 2 🏥 Path2Practice for IENs Employer Engagement For: Healthcare employers, HR professionals, nursing managers, and preceptors Inclusive job description design, competency-based interviewing frameworks, and a structured 90-day onboarding curriculum. This toolkit builds the organizational knowledge and process infrastructure that healthcare employers need to recruit, onboard, and retain IENs effectively, moving from inclusive intent to inclusive practice. Sample tools: Bias- reduction interview guide with standardized scoring · 90-day onboarding checklist · IEN mentorship matching template · Supervisor conversation guides. TOOLKIT 3 💬 Mentorship Toolkit for IENs in Alberta For: IENs, employers, team members, and clinical preceptors Cross-cultural communication strategies, feedback and performance frameworks, conflict resolution modules, and professional boundary navigation. Designed for joint use by IENs, mentors, employers, and preceptors, this toolkit builds the communication capacity and professional relationships needed for successful workplace integration and long-term career success. Sample tools: Communication style self-assessment · Scripts for professional conversations · Team integration activity guide · Preceptor quick-reference card.

07TOOLKIT 4 🗺 Navigating Nursing in Alberta For: IENs and bridging program coordinators Laddered career maps from LPN through to specialization, provincial bridging program navigation guides, financial planning resources for re-credentialing, and professional network-building tools. This toolkit gives IENs a clear, realistic picture of their pathway into the Canadian nursing profession and the concrete steps to get there. Sample tools: Provincial pathway flowchart with realistic timelines · Funding source directory · Professional association contact matrix · Mentorship connection guide. TOOLKIT 5 🤝 Pre-Arrival Toolkit for IENs For: Internationally Educated Nurses preparing to immigrate to Canada, community organizations, and bridging program administrators Practical guidance and resources to help Internationally Educated Nurses (IENs) prepare for their transition to Canada and navigate the nursing profession before arrival. Information on credential recognition, provincial licensing requirements, employment readiness, settlement planning, and career pathway navigation. Sample tools: Provincial licensing and credential recognition checklist · Pre-arrival employment readiness guide · Settlement and community resource directory · Nursing career pathway roadmap · Professional networking resource guide. 04 KEY LESSONS FROM THE CO-DESIGN PROCESS 1 You can't fix supply-side problems with supply-side solutions alone. Most IEN bridging programs focus on preparing the nurse. That's necessary — but not sufficient. If an employer doesn't have structured onboarding, culturally responsive hiring practices, or a preceptorship environment that accounts for the transition IENs are making, all the preparation in the world won't translate into retention. Effective integration requires building organizational capacity at the same time as individual readiness.

082 How you deliver resources matters as much as what's in them. Passive resource distribution doesn't change behaviour. These toolkits were designed for facilitated delivery; with workshop outlines, discussion guides, application exercises, and facilitator notes built into every component. An IEN who completes a self-assessment in a supported group setting, receives peer feedback, and practices interview responses will absorb and apply that learning differently than one who downloads a PDF and reads it alone. Implementation infrastructure is part of the intervention. 3 CBPR surfaces insights that the literature alone cannot provide. The employer-facing tools were prioritized after consultations revealed that healthcare HR professionals lacked practical guidance for IEN recruitment, a gap underrepresented in the academic literature but consistently named by employer stakeholders. The warm handoff protocols in Toolkit 5 emerged from cross-sector participants who identified fragmentation between bridging program completion and community employment services as a recurring point where IENs were lost. Community knowledge is a form of evidence. 4 Health equity is not a section in a toolkit. It's the reason the toolkit exists. IEN underemployment disproportionately affects racialized newcomers. It affects their economic security, their professional identity, and their mental health. And it affects the quality of care available to patients who benefit from culturally and linguistically concordant nursing practice. Bridging programs and employers that don't explicitly address structural racism and discriminatory hiring practices are not neutral, they are reproducing the problem.

0905 RECOMMENDATIONS 📋 For Bridging Program Developers Adopt CBPR as a standard methodology in curriculum development, not an optional supplement. Engage IENs and employers as co-designers from the outset. Build in iterative co-design cycles with adequate time for feedback and revision. Treat facilitation infrastructure, including workshop design, facilitator preparation, and feedback mechanisms, as a core curriculum component, not an afterthought 🏥 For Healthcare Employers Invest in structured IEN onboarding and mentorship programs supported by ready-to-use educational tools. Employer capacity building should be understood as an extension of nursing education, not a separate administrative function, and resourced accordingly. Participation in co-design processes is a strategic investment in retention. Organizations that build inclusive onboarding practices contribute to both IEN retention and overall workforce stability. 🏛 For System Planners and Policymakers Fund both IEN readiness programming and employer capacity building as inseparable components of provincial workforce planning. Institutionalize cross-sector coordination mechanisms, including shared outcome frameworks, interagency referral protocols, and joint data reporting, rather than depending on ad hoc organizational relationships. Clarify prospective ethics review processes for program development initiatives involving community consultations intended for publication. 🔬 For Researchers and Evaluators Conduct rigorous evaluation studies to assess whether CBPR-based toolkit development produces measurably better IEN employment, licensure, and retention outcomes than non- participatory approaches. Use RE-AIM and CFIR frameworks to assess not only whether toolkits work, but under what conditions and for whom. Engage directly with community- based program developers to build the evidence base for CBPR's contribution to IEN integration effectiveness.

1006 WHAT'S NEXT These toolkits are now being integrated into CRIEC's workforce integration programming. Planned next steps include: Facilitated workshops for IENs within bridging program delivery Employer capacity-building sessions embedded in nursing orientation and onboarding curricula Quarterly communities of practice for cross-sector learning and iterative toolkit refinement Formal evaluation of outcomes in IEN employment, licensure, and retention Adaptation of toolkit resources for additional regulated health professions facing similar integration challenges The toolkits will be made available through CRIEC's resource library for nursing educators, bridging program coordinators, healthcare employers, and community organizations across Canada. Organizations wishing to pilot or adapt these toolkits are encouraged to contact CRIEC directly. Get Involved If you work in nursing education, healthcare HR, bridging programs, or immigrant employment and would like to learn more about implementing these toolkits in your organization, please reach out to CRIEC at criec.ca.

11Acknowledgments CRIEC gratefully acknowledges Employment and Social Development Canada (ESDC) for funding support that made this initiative possible. Sincere thanks to Bow Valley College for its partnership and commitment to bridging education and workforce readiness for internationally educated professionals in Alberta. This work was shaped by the contributions of internationally educated nurses, healthcare employers, nursing educators, and community organization representatives who gave their time and expertise to the co-design process. Their lived experience and professional insight shaped every component of these toolkits. We acknowledge Sameer Nizamuddin for contributions to literature review and evidence synthesis. Special thanks to D’Andre Wilson-Ihejirika and Syed Musa Raza for their helpful comments on an earlier draft of this manuscript. Funding: This work was supported through an Employment and Social Development Canada (ESDC) initiative administered by CRIEC. Conflicts of Interest: The lead author was employed as Research, Evaluation and Learning Manager at CRIEC during the conduct of this work. ESDC, as a federal government department, has no commercial interest in the findings. No other conflicts of interest are declared.

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