"A Nurse is not a Nurse is not a Nurse": The Social Construction of Skill Among Internationally Educated Nurses Through the Lens of Feminist Economy and Disablement

This dissertation examines policies from 2000 to 2024 regarding the assessment of internationally educated nurses' (IENs) skills, including credentials and work experience needed to enter Canadian nursing. I show that federal and provincial initiatives, like the National Nurses Assessment Service and fair access legislation, have made the process stricter, longer, and more expensive. As a result, many IENs are pushed into lower-tiered healthcare jobs, such as personal support work, characterized by high job insecurity, low wages, and increased risks of disability, including injuries, illnesses, and mental health distress.

I argue that IENs' downward occupational mobility extends beyond a policy failure or racial biases; it is intricately connected to the racialized and feminized segmentation of care work, underpinning Canada’s development as a settler-colonial capitalist state. It is a continuation of a gatekeeping mechanism where (a) white nurses enhance their power and privilege—like better pay, benefits, and social status—by upholding masculinist and colonial beliefs about skill, often marginalizing labour associated with poor, non-white women, and (b) settlers access a pool of easily exploitable labour to fulfill the nation’s social reproductive demands. Unlike past racially explicit exclusions, the current policy uses “managed” integration, marked by selectivity (higher scrutiny) and assimilation (limited to those who approximate Canadian nursing standards). This segmentation is masked by race-neutral policies focusing on public safety and upholding international applicants' rights to fairness.

Despite the advantages of racial segmentation processes, I illustrate how the downward occupational mobility of IENs adversely affects their health and the welfare of impoverished communities in their home countries, particularly the Philippines, and is closely linked to neoliberal privatization and declining care standards in Canada. By integrating insights from critical policy analysis, feminist political economy, critical race theory, and critical disability studies, I develop a framework to (a) examine the ideological and socioeconomic interests integration policy supports and (b) advocate for a fundamentally different approach to healthcare organization, specifically, one that challenges the hierarchical classification of skills (i.e., distinguishing between high-skilled and low-skilled jobs) as the mechanism that determines workers' unequal access to compensation, benefits, job security, legal protections, and social status.