Relaxed nursing requirements jeopardize patient safety, Manitoba regulator warns health minister

The College of Registered Nurses of Manitoba says the province is putting labour mobility and its support for interprovincial free trade ahead of patient safety and lives.

Health Minister Uzoma Asagwara ordered the college to stop requiring that “labour mobility applicants” — nurses recently licensed in other provinces who applied to nurse in Manitoba — must have 450 hours of nursing experience in Canada in the past two years or 1,125 hours in the past five years.

The minister told the college in an April 30 letter that it was breaking internal trade laws, including the Canadian Free Trade Agreement and the New West Partnership Trade Agreement’s labour mobility rules, and legislation requiring regulated professions to ensure their registration practices comply with obligations of a domestic trade agreement.

Asagwara’s letter said no jurisdictions in Canada have approved labour mobility exceptions for registered nurses, and directed the college to drop its “currency of practice” requirement within 30 days.

With no avenue to appeal the minister’s order, the college spoke out Wednesday, saying patients are at risk and that two have died as the result of Manitoba not requiring labour mobility applicants recently licensed out of province to have current Canadian nursing experience.

College registrar Deb Elias said she can’t provide details of the two preventable deaths reported in November because those cases are going through the college’s professional conduct process. One of the nurses surrendered their licence voluntarily and the other was suspended, the college confirmed.

It said it has seen a significant increase in complaints about nursing incompetence linked to the labour mobility applicants, such as a lack of nursing knowledge, skill and judgment, the inability to take or interpret vital signs, perform a health assessment, safely administer medication or prioritize patient care.

That occurred after the college was told by former Tory health minister Audrey Gordon in 2022 not to demand that out-of-province nurses have current hours of Canadian practice under their belt.

“We stopped that practice and then monitored it for a period of time,” Elias said. “At the end of last year, 2024, we were very alarmed at the trend that we saw, with a substantial increase in complaints and the significant, gross nursing incompetence that we were seeing.”

In 2023, the cohort accounted for 15 per cent of practice-related complaints despite representing a much smaller number of the total number of registered nurses.

In 2024, the same group of nurses lacking current Canadian experience accounted for 50 per cent (27 of 54) of the complaints. In December, the college notified Asagwara that it was reverting back to its policy of requiring nurses have Canadian experience.

Manitoba, which is dealing with a critical health-care staffing shortage is competing with other jurisdictions to recruit professionals. At the same time, it’s also committed to interprovincial free trade and removing barriers to labour mobility throughout Canada in response to a trade war launched by the U.S.

Asagwara did not respond to repeated requests for comment Wednesday.

Elias said the college will keep talking to the health minister and the Health Department about its concerns and look for alternate solutions.

“We absolutely support labour mobility and welcome nurses and (nurse practitioners) from across the country. But we also want to uphold patient safety. That is our mandate. And we know that these two things can happen,” she said.

“What we’re talking about here is, really, a group of nurses who’ve obtained registration elsewhere but haven’t practised in recent years, so aren’t up to date.”–Deb Elias

“What we’re talking about here is, really, a group of nurses who’ve obtained registration elsewhere but haven’t practised in recent years, so aren’t up to date, and that we’re working to resolve it.

“Once people are registered, they can work anywhere, and that is really part of our concern. The public should be concerned, but they should also know that the vast majority of registered nurses on our register have met all the standards, maintain currency and are required to do professional development.”

Manitoba Nurses Union president Darlene Jackson said more nurses are desperately needed, but only if they’re trained and can do the job.

“What I’m hearing from nurses is that this is absolutely unfair to these nurses that are coming in because they are not prepared properly for our health-care system,” Jackson said Wednesday.

“There’s no ability for them to prepare properly because there’s no way for the college to assess to see if they need that preparation.”

She said the situation is difficult for for nurses working alongside the recent additions.

“You’re not only doing your own job, but you are continuously trying to ensure that these nurses are supported and, through no fault of their own, doing what they need to be doing,” she said.

“I think it’s in the best interest of the public to allow the college to do what they need to do to follow their mandate to ensure that Manitoba nurses, everyone practising in the Manitoba system as a nurse, is practising safely.”

carol.sanders@freepress.mb.ca