Economic and Social Reports
Immigrant nurses in Canada: Alignment between intentions and employment outcomes

This study was jointly conducted by Immigration, Refugees and Citizenship Canada and Statistics Canada.

Abstract

This article uses data from the Integrated Permanent and Non-permanent Resident File and the 2021 Census of Population to examine the alignment between occupational intentions and employment outcomes among immigrants who intended to work as nurses.

The results show that among economic principal applicants who were admitted from 2010 to 2020 aged 18 to 54 and who intended to work as nurses, 63% found jobs in nursing occupations in 2021, while 25% worked in either lower-skilled health occupations or lower-skilled non-health occupations or were not employed. Pre-admission Canadian work experience was a strong predictor of alignment between intended and actual employment in nursing.

The article also finds that among immigrants who worked as nurses in 2021, 35% had intended to work as nurses at the time of admission. The remaining 65% of immigrant nurses were not initially selected for nursing but later entered the profession after becoming permanent residents in Canada. These results highlight the dynamic nature of immigrants’ career pathways.

Acknowledgments

This is a joint study conducted by Immigration, Refugees and Citizenship Canada and Statistics Canada. The authors would like to thank Chantel Goyette and Amélie Lafrance-Cooke for their advice and comments on an earlier version of this article.

Authors

Hanqing Qiu and Feng Hou are with the Economic and Social Analysis and Modelling Division, Analytical Studies and Modelling Branch, at Statistics Canada. Haozhen Zhang and Jianwei Zhong are with the Research and Knowledge Mobilization Division, Research and Data Branch, at Immigration, Refugees and Citizenship Canada.

Introduction

Canada is currently facing significant labour shortages in the health care sector, particularly in nursing. The COVID-19 pandemic exacerbated these shortages, leading to increased workloads, burnout and high turnover rates among health care workers (CIHI, 2024; ESDC, 2023). The job vacancy rate in nursing and residential care facilities reached 7.7% in the third quarter of 2022 and dropped to 4.6% by the third quarter of 2024. By comparison, the all-industry average vacancy rate was 5.6% in the third quarter of 2022 and 3.2% in the third quarter of 2024 (Statistics Canada, n.d.).

Immigration can play a vital role in addressing these labour shortages. The Canadian government has implemented policies to streamline the credential recognition process for internationally educated health professionals and to facilitate their integration into the workforce (ESDC, 2023). The 2025–2027 Immigration Levels Plan emphasizes economic immigration, with a significant portion of permanent resident admissions dedicated to skilled workers in critical sectors such as health care (Government of Canada, 2024). However, questions remain about the extent to which immigrants who intended to work as nurses prior to immigration realize this goal and how the immigrant nursing workforce is composed in terms of pre-immigration intentions and other characteristics.

The first research question focuses on the alignment between the intentions and actual employment outcomes of recent immigrants who aspired to work as nurses. It seeks to determine the proportion of these individuals who successfully entered the nursing profession after immigrating to Canada. Understanding this alignment is crucial for assessing the effectiveness of immigration policies and support systems designed to facilitate the integration of skilled immigrants into their intended professions.

The second research question addresses the broader landscape of immigrant nurses in Canada by examining those who were employed as nurses in 2021. It aims to identify how many of these nurses had initially intended to pursue a nursing career at the time of their immigration. Additionally, this study compares the sociodemographic characteristics of two distinct groups of immigrant nurses: those who intended to work as nurses and those who did not. This comparison will provide insights into the factors that influence career outcomes and the diversity within the immigrant nursing workforce.

Answers to these questions have implications for both immigration and workforce development policies, particularly in enhancing the use of immigrant talent and ensuring that the health care needs of the Canadian population are met effectively.

Data and measures

This study draws data from the Integrated Permanent and Non-permanent Resident File and the 2021 Census of Population. To answer the first question, the sample is restricted to the principal applicants in the economic class who were aged 18 to 54 at admission and were admitted as permanent residents from 2010 to 2020.^Note  The analysis is further restricted to immigrants who intended to work as nurses (as self-reported at the time of admission), including nursing co-ordinators and supervisors, registered nurses and registered psychiatric nurses (RNs), and licensed practical nurses (LPNs).^Note  These immigrants are then linked to the 2021 Census to access their actual occupations in 2021. Their occupational mobility, comparing intended and actual occupations, is grouped into six categories: (1) stayed in nursing occupations, (2) moved to other skilled health occupations, (3) moved to other lower-skilled health occupations, (4) moved to skilled non-health occupations, (5) moved to lower-skilled non-health occupations, and (6) did not work in 2020 and 2021.^Note 

For the second question, the analysis focuses on all immigrants who were admitted from 2010 to 2020 aged 18 to 54 and who worked as nurses in 2021.^Note 

Pre-admission Canadian work experience shapes immigrant nurses’ occupational outcomes

Table 1 shows the occupational distribution of economic principal applicants who were admitted from 2010 to 2020 aged 18 to 54 and who intended to work as nurses. About 63% worked in nursing occupations in 2021, while 2% found jobs in other skilled health occupations and 13% worked in lower-skilled health occupations such as nurse aides, orderlies and patient service associates or other assisting occupations in support of health services. Another 10% found jobs in skilled non-health occupations, and 8% held lower-skilled non-health jobs. Finally, 4% did not work in 2020 and 2021 and thus do not have an occupation code in the 2021 Census.

The alignment between intended and actual employment in nursing varied by immigrants’ sociodemographic characteristics. Women had higher alignment rates than men, and younger age at admission was associated with greater alignment. Immigrants who spoke English were more likely to realize their intention to work in nursing than those who spoke French or both official languages. Immigrants with a bachelor’s degree had a higher rate of working in their intended nursing occupations. Immigrants from Asia—who accounted for 84% of all immigrants intending to work as nurses—had significantly lower rates of actual employment in nursing, compared with immigrants from the Caribbean, Central and South America, the United States, and Europe. These observed differences mostly remained after differences in other characteristics in Table 1 were adjusted for.^Note 

Canadian work experience prior to admission significantly increased the alignment between intended and actual employment in nursing. Immigrants with Canadian work experience had an alignment rate that was 28 percentage points higher than those without. After adjusting for differences in other sociodemographic characteristics included in Table 1 using a multivariate regression model, this gap remained and became even bigger.

Similarly, immigrants with Canadian study experience had an alignment rate that was about 25 percentage points higher than those without. However, after adjusting for sociodemographic differences—primarily Canadian work experience—less than one-third of this gap remained. This reflects the fact that many individuals with Canadian study experience also had Canadian work experience (Crossman & Hou, 2022).

Furthermore, Canadian work experience prior to admission accounted for most of the observed differences in alignment across immigration categories. For example, immigrants in the Canadian Experience Class, a program targeting skilled temporary foreign workers, had an alignment rate that was 26 percentage points higher than those in the Federal Skilled Worker Program. However, after adjusting for Canadian work experience and other covariates, the difference between the two programs shrank to 4 percentage points and became statistically non-significant.

In Canada, RNs typically require a Bachelor of Science in Nursing and have a broader scope of practice, including patient assessments and care plan development. By contrast, LPNs complete a shorter practical nursing program and provide basic nursing care under the supervision of RNs or physicians. Table 1 shows that, among detailed nursing occupations, those intending to work as LPNs had the highest rate of employment in nursing (74%), while those intending to work as RNs had a lower rate (61%), reflecting the fact that becoming an RN is more difficult than becoming an LPN. However, this difference became not statistically significant after adjusting for sociodemographic differences.

Immigrants who intended to work as nurses accounted for 35% of immigrants who worked as nurses

Among immigrants admitted from 2010 to 2020 who worked as nurses in 2021, 35% had intended to work as nurses at the time of admission. This indicates that 65% of immigrant nurses did not initially intend to work as nurses but later entered the profession after becoming permanent residents in Canada (Table 2).

Immigrant nurses who intended to work as nurses differed from other immigrant nurses in some sociodemographic characteristics. The former group was predominately composed of principal applicants in the economic class, while the latter group was composed of a variety of classes, including spouses and dependants in the economic class, family immigrants, refugees, and other immigrants. Immigrant nurses who did not intend to work as nurses were younger at admission, increasing their likelihood of studying nursing after immigration. This is evident in the higher share of them who received their highest level of education in Canada than immigrants who intended to work as nurses. Compared with immigrants who intended to work as nurses, other immigrant nurses were less likely to work full time and had lower weekly earnings.

In summary, this study reveals a mixed picture regarding the skill use of immigrant nurses in the Canadian workforce. While over 60% of immigrants who intended to work as nurses did find employment in the field, about one-quarter worked in either lower-skilled health occupations or lower-skilled non-health occupations or were not employed. Notably, pre-admission Canadian work experience was a strong predictor of alignment between intended and actual employment. Furthermore, a substantial portion of immigrant nurses working in Canada in 2021 had not initially intended to pursue nursing careers at the time of their immigration, highlighting the dynamic nature of immigrants’ career pathways.

These results highlight the need to enhance and expand resources, policies and programs for immigrants entering the nursing profession, particularly those without prior Canadian work experience. This includes efforts to address social, educational, professional and personal challenges that internationally educated nurses may face. Additionally, recognizing and leveraging the potential of immigrants who did not initially intend to work as nurses are crucial. Although they are not admitted specifically to address nursing skill shortages, improved access to nursing education and training can enable spouses and dependants in the economic class, as well as family class immigrants and refugees, to contribute significantly to the nursing workforce and address Canadian labour shortages.

References

CIHI (Canadian Institute for Health Information). (2024). Balancing the needs of Canadians and our health workforce. Accessed January 28, 2025.

Crossman, E. & Hou, F. (2022). International students as a source of labour supply: Pre-immigration study in Canada and post-immigration earnings. Economic and Social Reports 2(2):1-12.

ESDC (Employment and Social Development Canada). (2023). Canada is addressing current and emerging labour demands in health care. Accessed January 28, 2025.

Government of Canada. (2024). 2025–2027 Immigration Levels Plan. Accessed January 28, 2025.

Statistics Canada. (n.d.). Table 14-10-0442-01  Job vacancies, payroll employees, job vacancy rate, and average offered hourly wage by industry sub-sector, quarterly, unadjusted for seasonality. Accessed January 28, 2025.