Back to top

A Framework for Integrating Internationally Educated Nurses into the Health Care Workforce and Winning the Green Health Care Game: Two Articles from the OHA

[Ed: This week’s feature includes two short features coordinated by the Ontario Hospital Association, one about Green Health Care Awards and one about internationally trained nurses.]

One: A Framework for Integrating Internationally Educated Nurses into the Health Care Workforce


I Introduction
II Internationally Educated Nurses (IENs)
III Ontario Hospital Association workshops
IV Conclusion
V Resources

--submitted by Dr. Andrea Baumann and Dr. Jennifer Blythe

I Introduction

Nurses play a vital role in health care teams in providing quality, person-centered care. With an aging workforce and the threat of nursing shortages, integrating new nurses into the health care system efficiently and effectively has become a priority issue for health service providers and the Ontario government. Evidence is needed to inform policy on issues related to recruitment, retention and integration of nurses across sectors and to support employers in hiring and orienting new nurses.

II Internationally Educated Nurses (IENs)

With immigrants projected to make up one-third of the workforce by 2031, internationally educated health professionals (IEHPs), including internationally educated nurses (IENs), are an increasingly important source of talent. Unfortunately, they often face barriers to employment.

Recognizing the value of these professionals and the challenges they face, the Ontario Hospital Association (OHA) in partnership with the Nursing Health Services Research Unit (NHRSU) at McMaster University, launched an online resource for employers in November 2011. Funded by the Ontario Ministry of Citizenship and Immigration (OMCI), this online resource presents resources to assist Ontario’s health care employers to successfully recruit and integrate these highly skilled nurses. The online resource (available at contains a wealth of information such as:

  • Why hire IENs – and what they bring to the workplace
  • How to create a harmonious workforce while optimizing skill sets
  • Case studies highlighting organizational leading practices
  • Links to useful resources and video interviews with health care organizations

The IEN Employer’s Guide (available at was designed to enhance integration of IENs into the workforce and help employers understand who they are, how to facilitate their entry, and how to support them as they manage challenges in entering the workforce.

This innovative resource was created from data collected through a literature review, as well as through surveys and interviews with key stakeholders (employers, educators, regulatory bodies, IENs).  This initiative helps to raise awareness of the need to recruit and integrate IENs and create buy-in among HR and nursing leaders to implement leading practices and strategies outlined in this online resource.  

A number of Ontario employers have taken the initiative to integrate IENs into their workforce and have shared their successful strategies. These leading practices are shared with colleagues across the province and country to illustrate some of the unique ways employers have embraced diversity.

IENs should be able to successfully integrate into the Canadian health care system and the organizational system and practice. To date, our findings indicate collaboration among key stakeholders (government, health care organizations, community agencies, regulatory bodies, educational institutions, nursing organizations) is essential to facilitate recruitment, integration and retention of IENs.

III Ontario Hospital Association (OHA) workshops

To facilitate better discussion the OHA has planned a series of free workshops that will focus on recruitment and orientation, barriers to integration, leading practices and a demonstration of the IEN online resource. The issues and strategies discussed are relevant to Ontario and other provincial and international jurisdictions that are struggling with nursing shortages and trying to capitalize on potential sources of workforce supply.

Workshops will be held in Toronto (October 25), Niagara (October 26), Ottawa (November 26) and Windsor (November 30) and will include keynote speakers including Dr. Andrea Baumann and Dr. Mabel Hunsberger to name a few.  Topics including Immigration and Labour Market trends, Proven Mentorship Models, Provincial New Graduate Models, Workforce Integration, Community Supports and Innovative Practices will also be presented.

IV Conclusion

Employers need to understand key issues affecting recruitment and retention and learn through leading practices for integration of IENs. Ultimately, it is integral for Ontario, and other provinces, to provide quality care through effective and efficient workforce integration.   

V Resources

To access the Internationally Educated Nurses (IEN) Employer’s Guide visit

To learn more about the upcoming free workshops visit the Ontario Hospital Association (OHA) website at

For more information about the IEN project, please contact:

Andrea Baumann,
Scientific Director, McMaster Site, NHSRU
905-525-9140 Ext 22581
[email protected]

Andreanna Grabham,
Project Manager, Internationally Educated Nurses Initiative
Ontario Hospital Association
[email protected]

Two: Winning the Green Health Care Game


I Introduction
II Energy Efficiency: London Health Sciences Centre
III Waste Management: Chatham-Kent Health Alliance
IV Overall Leadership: St. Joseph’s Care Group (SJCG)
V Conclusion
VI Resources

--submitted by Kent Waddington from the Canadian Coalition for Green Health Care

I Introduction

Each year at HealthAchieve, innovative organizations are recognized for their achievements in energy efficiency, water conservation and protection, waste management, and overall individual leadership. The annual Green Health Care Awards, organized by HealthAchieve in conjunction with the Ontario Hospital Association (OHA) and the Canadian Coalition for Green Health Care, hold a special place at this event, since it provides a chance to showcase leadership and excellence in reducing the sector’s environmental impact – a topic that is near and dear to the hearts of stakeholders throughout the sector. This year’s winners will be announced at HealthAchieve 2012, being held November 5 to 7 at the Metro Toronto Convention Centre. (For details on 2012 submissions, visit

The standouts in this area also provide an opportunity for others within the community to learn best practices. Following is a sampling of how some of the 2011 Green Health Care Award Winners excelled in their commitment to environmental stewardship and achieved award-winning status from their peers.

II Energy Efficiency: London Health Sciences Centre

The London Health Sciences Centre (LHSC) began a formalized Energy Stewardship Program in 2003 in order to develop a complete energy package. This comprehensive program consisted of several components: energy procurement, retrofits, and monitoring and tracking of energy costs, as well as staff engagement and behavioural change.

As part of the energy procurement initiative, LHSC worked with a consulting agency to establish goals, develop a risk management strategy, and compile a gas supplier portfolio. The purchasing review process involved a number of stakeholders in mapping out a future direction, taking into account changing consumption projections and adapting to new construction and equipment needs.

LHSC’s energy conservation efforts in fact go back much further than that. In 1998, Victoria Hospital was converted to a natural gas-based cogeneration site, thereby reducing reliance on the city power grid and emissions. Several retrofit phases followed, including upgrades to the lighting and building envelopes, as well as installation of energy-saving technologies such as variable speed drives and heat recovery systems.
The success at Victoria led to similar retrofits at the University Hospital campus. The most recent initiative (phase V) is focusing on water conservation as well as lighting retrofits, exterior LED lighting installations, fume hood control upgrades and the installation of a second gas-fired cogeneration unit bringing the on-site generation capacity at Victoria Hospital to 11 MW.

In tandem with the technical aspects, LHSC put extensive effort into establishing a dynamic employee engagement program that has been adopted by six hospitals in Ontario and two in Alberta.
Overall these projects have reduced LHSC’s electrical use by over 20% per year. Through constant monitoring and tracking, and with the support of employees, LHSC reports that it continues to reduce consumption per square meter. Annual savings from the five phases to date have exceeded $3 million, with a total annual greenhouse gas emission reduction of over 8 million kgs.

III Waste Management: Chatham-Kent Health Alliance

A waste reduction and recycling program is just one of several strategies in the Chatham-Kent Health Alliance’s (CKHA) environmental stewardship program. Led by the Green Team, this staff volunteer group has found ways to divert an enormous amount of waste through numerous initiatives including waste audits, environmental expos, and the outstanding efforts of departmental and individual champions.
CKHA’s waste audit program is focused on tracking recycling performance as well as establishing future waste reduction targets. This process has been commended by the Ministry of the Environment and is now being used as a template for other healthcare facilities.

For the past six years, the Green Team has also hosted an annual Environment Expo to allow Alliance members and suppliers to showcase their successes in recycling, energy savings and living healthy and environmentally friendly lives. Attendance and interest continues to grow from within and outside the organization. In 2011, the audience of over 600 attendees included employees, high school students and community agencies.

Departments and individual employees have executed a number of notable initiatives on their own, including an ultrasound gel bottle recycling program (Diagnostic Imaging Department staff) and a return to vendor program (Materials Management Department). Other recycling efforts include electronic waste, metal, fluorescent lamps and print cartridges.

Through their collective efforts, CKHA has scored a number of firsts for the healthcare industry, including an instrument tray wrap recycling program (a project that has been highlighted in a Ministry of the Environment Best Practice Case Study); and the implementation of reusable pharmaceutical medical collection containers for hospital units and medication carts.

CKHA also implemented a program called “Operation Green.” In many cases operating room items are readied for surgery, go unused and are eventually disposed of. Operation Green sets out to collect these clean unused items and re-direct them to the developing world. This project will not only decrease a large percentage of waste, but will also improve the lives of those less fortunate.

Other waste reducing measures include a clinical form standardization program that has reduced paper disposal by 40% and annual print and paper costs, and a Sharpsmart program in which disposable sharps containers were replaced with new recyclable ones. CKHA also developed an Energy Matters website in partnership with Honeywell to offer employees up to date information and tips on waste reduction, energy conservation and recycling programs.

IV Overall Leadership: St. Joseph’s Care Group (SJCG)

St. Joseph’s Care Group has gained a significant reputation in Northwestern Ontario/Thunder Bay community for its ongoing green efforts. In recent years the organization has won the Municipal Green Award, the City of Thunder Bay Clean Green and Beautiful Award, the Environmental Stewardship Award and the Green Healthcare Award for Overall Leadership at HealthAchieve 2011. These awards pay homage to SJCG’s commitment to energy conservation, greenhouse gas reduction, and recycling and reuse/waste management programs throughout its facilities.

The list of green accomplishments is extensive. The most recent green award was presented to The Sister Margaret Smith Centre for achieving LEED (Leadership in Energy and Environmental Design) Gold certification. The Sister Margaret Smith Centre has been designed to use 68% less indoor water and 42% less energy than conventional buildings. LEED standards are also being used in construction of new buildings. St. Joseph’s Care Group is now exploring the feasibility of rooftop solar panels for the CEISS (Centre of Excellence for Integrated Seniors’ Services) Sister Leila Greco Apartments and addition to the Hogarth Riverview Manor.

The focus on energy conservation continues, through the efforts of a dedicated Greening Health Care Committee that engages in environmental initiatives across all sites. The organization has also hired an environmental technician student to help develop and promote information and educational programs, as well as host presentations and events for new hires and existing staff to raise awareness and keep the momentum going.

Current recycling efforts are diverse, and include batteries, fluorescent light bulbs, cans, plastic bottles, paper, cardboard, printer cartridges, electronic waste, glass, and furniture, among other items. Recent waste audits were conducted to not only identify current diversion rates, but to seek out even more opportunities to reduce waste. (In 2011 sites diverted between 22.95% and 38.18% of their waste from landfill).

To drive more results, SJCG is now exploring the feasibility of composting for kitchen and cafeteria waste for an organic vegetable garden which was established to create employment opportunities for people with a serious mental illness and to support various food banks throughout the region. It is also looking at replacing Styrofoam and plastic containers with starch-based products.  

A recently introduced micro-fiber mop system has reduced chemical usage by 92% and water usage by 75%. Even communications are “green” through the availability of online resources, including an internal newsletter.

V Conclusion

Whether building a case for energy conservation, or recycling waste, these organizations have proven that despite budget constraints, dedication and commitment to green initiatives can make a significant difference.

The submission deadline for the 2012 Green Health Care Award is September 28, 2012. Ontario health service providers who are members of the OHA and/or the CCGHC may submit for multiple award categories. Visit for more information.

VI Resources

The HealthAchieve website includes an overview of the conference, program and speakers at

The 2012 Green Health Care Awards – Deadline for submissions is September 28, 2012. Ontario health service providers who are members of the Ontario Hospital Association and/or the Canadian Coalition for Green Health Care may submit for multiple award categories. Visit for more information.

Chatham Kent Health Alliance Energy Matters website in partnership with Honeywell is available at

Ontario Hospital Association website includes news, current issues and more at