Canada Has 21,000 Nursing Vacancies. India Has the Nurses. One Exam Stands Between Them.
Canada has over 21,000 unfilled nursing positions. India has 122,000 nurses working in OECD countries and millions more who want to leave. The CPNRE exam sits at the centre of this pipeline—and it is reshaping both countries’ healthcare futures.
There is a peculiar crisis unfolding across two countries separated by ten thousand kilometres. Canada cannot find enough nurses to staff its hospitals. India cannot retain the ones it trains. Caught between them is a licensing exam most people outside nursing have never heard of—the Canadian Practical Nurse Registration Examination, or CPNRE.
The numbers tell a story that is both urgent and deeply familiar to Indian families. According to OECD data published in late 2025, roughly 122,000 Indian-trained nurses are currently working in OECD member countries—a figure second only to the Philippines. Meanwhile, a multi-centre survey of practising nurses in India found that 63 per cent intended to emigrate, citing low wages and poor working conditions as primary motivators. The state of Kerala alone, which produces the largest share of India’s nursing graduates, has seen entire cohorts leave for the Gulf, the UK, Australia, and increasingly, Canada.
Canada’s Shortage Is Not Theoretical
Canada’s nursing crisis has been building for a decade, but the post-pandemic numbers are staggering. As of 2026, more than 21,000 registered nurse positions remain unfilled across Canada, and that count doesn't include the thousands of practical nurse and aide vacancies alongside them. The scale of the problem has ballooned — nursing vacancies rose 219 per cent between 2017 and 2022. Ontario, facing a projected shortfall of 33,200 nurses by 2032, has already put $56.8 million toward 2,200 new training seats.
Ottawa has responded by running healthcare-specific Express Entry draws in 2025, inviting nurses with lower Comprehensive Ranking System scores than general applicants. On the provincial side, British Columbia, Ontario, and Nova Scotia have carved out separate healthcare pathways within their nominee programmes to fast-track nursing applicants. The message is unambiguous: Canada needs international nurses, and it is building immigration pathways to recruit them.
The Certification Bottleneck
But immigration policy is only half the equation. Before an internationally educated nurse can practise in Canada, they must clear a credentialing process that takes six months to two years. The first step is an assessment through the National Nursing Assessment Service, which evaluates whether a foreign degree meets Canadian standards. Those applying as registered nurses sit for the NCLEX-RN. Those applying as licensed practical nurses—a category that accounts for much of the bedside care in Canadian hospitals and long-term care homes—must pass the CPNRE.
The CPNRE tests competencies across four major domains: professional practice, ethical practice, foundations of practice, and collaborative practice. It is administered by the Canadian Council for Practical Nurse Regulators (CCPNR), which oversees practical nurse standards across participating provinces. For Indian-trained nurses, the exam represents a fundamentally different testing culture—scenario-based, focused on Canadian healthcare law and patient safety protocols, and conducted entirely in English or French.
This is where many Indian applicants face their steepest challenge. The clinical knowledge may transfer well, but the exam format, legal frameworks, and emphasis on collaborative decision-making differ sharply from what most Indian nursing programmes teach. A growing number of aspirants are turning to resources like a CPNRE practice test to familiarise themselves with the question style and content areas before attempting the real thing—a practical step, given that a failed attempt means months of delay in an already lengthy credentialing pipeline.
What India Loses, and What It Might Gain
The brain drain question hangs over all of this. India’s own nursing density—roughly 3 nurses and midwives per 10,000 people—is well below WHO benchmarks. With one million doctors and two million nurses already working abroad, the country faces persistent healthcare shortages, particularly in rural areas. Kerala, Andhra Pradesh, and Tamil Nadu bear the heaviest outflow.
Yet the picture is not entirely bleak. Remittances from healthcare workers abroad contribute significantly to household incomes. Some states have begun treating nurse migration as an exportable skill—investing in training infrastructure with the understanding that a portion of graduates will leave, while expanded capacity also improves domestic staffing. Kerala’s 2018 decision to mandate minimum wages for nurses in private hospitals was partly an attempt to make staying more financially viable.
For the individual nurse weighing whether to make the move, the calculus is straightforward. A licensed practical nurse in Canada earns approximately CAD 66,000 per year—several times what a nurse with comparable experience earns in most Indian states. The pathway is demanding, the credentialing slow, and the exam not easy. But for tens of thousands of Indian nursing graduates each year, the door is measurably more open than it was five years ago.
