Incompatibility

This is me holding my coveted German nursing license that I got in the mail on Friday. I am crying because it’s been 9 months waiting for it. But it’s more than that, and it may be hard to understand just how valuable this is to me without understanding where it started.

The whole problem is my life’s incompatibility. My education has been a struggle because of the various countries involved. I dreamed of being a nurse just like my mum since I was about 14. I was in our little International boarding school in northern Pakistan, dreaming up the ways I’d change the world like Florence Nightingale once I was a nurse. I intentionally pushed myself through the hard courses, struggling through the higher sciences and maths, which did not at all come naturally to me. My parents purchased a special specific online chemistry course from Canada (which I barely passed) so I could get admission into a Canadian university.

First roadblock: despite my decently high GPA from high school, the universities wouldn’t accept my application because the core requirements were American AP courses, something only some universities in Canada recognized. My education from Pakistan was not compatible with Canada’s. After a lot of pushing and sending of documents (plus my dad making phone calls for me) in the end I met all the requirements but due to the competitiveness of the program and the delay in my application being accepted, I entered a semester behind. I was frustrated about the 6 month delay but once I finally started nursing I loved it. I was finally actually on the path to my dream. I worked hard over the summers so I could save up money for school, and tried to seek out opportunities that would supplement my nursing education. I soaked up the experience, very eager for the day I could actually function independently as a nurse, and all of the opportunities that would come with it.

A few years in I realised I would be marrying Frank and that meant leaving Canada possibly indefinitely. This wonderful milestone in my life carried the weight of an intimidating transition, but I had Frank and that’s what mattered. After our wedding I went BACK to Canada to finish my final semester alone. My preceptorship was not as hard as I expected it to be and I was feeling a lot more like a nurse. I was ready to join the workforce as a Registered Nurse!

I moved to Germany a few days after my last shift. As soon as I got to Germany I started studying for the NCLEX so I could get my registration as an RN in Canada, ultimately so I could be fully qualified to work in Germany (or so I thought). I studied for about 3 months and then flew to London, which was where the closest international testing centre was located. I wrote the exam, afterwards stepping out into busy London downtown completely shellshocked. As I waited for those results I started studying German full-speed ahead, knowing that was another requirement of working here. I took the first of a 3-part course but didn’t have time to complete the second 2, so I wrote the exam hoping I could make it. I needed to get a job ASAP since I was supposed to be supporting us financially, so fast-tracking through the course was the best option. I got my NCLX results, saying I had passed! Yay! I couldn’t believe I had made it, and that I was now officially a fully realised nurse. It was the peak of the climb, the summit of my nursing journey. What a nice conclusion to such a hard path. That’s what I thought. Shortly after I started a job on the University Hospital’s CVICU I also got the results for my German B-2 test. I had passed that as well. Things were moving forward, and I confidently sent in all my documents to the local nursing government, eagerly waiting for a positive response.

Nothing positive, it seemed, followed after that. Turns out the Canadian nursing system is incompatible with the German one. It was one response after another of requesting more documents, requesting paper proof of the NLCEX results (the NCLEX is paperless), requesting proof of my degree, which I also had to have mailed from MacEwan University to me in Germany. They requested a complete breakdown of every single course I took from high school through university, which Frank painstakingly translated. They lost documents that I had sent at the beginning of the process, and requested them again. All by snail mail, so each interaction took several weeks in between. They made mistakes in my application, at first denying it and referring to me by the wrong nationality and credentials I had sent. I pursued an option that was suggested, which was to send my case to the higher power, or headquarters of nursing in Germany, in Bonn. That cost 500 Euros, and in the meantime every month that passed I was earning the wage of a Healthcare Aid, as I had only been conditionally hired as a “studied nurse” until my registration was provided. The Bonn process was a flop. They agreed with the local goverment that my nursing education was incompatible with theirs.

The pay thing stung. But more than the pay thing, it was the scope/title. I have a lot of friends in Canada who I know have come from other countries and haven’t had their credentials recognised in the profession of their choice. For instance, medical doctors who’s years of training is not recognised and they therefore can’t practice medicine in Canada. But I never thought that would be an issue for me, coming from Canada, a ‘developed nation’, to Germany, another ‘developed nation’. It hurt my ego and pride, and having my status lowered to Healthcare Aid made me start doubting my own competency. I started thinking, if the German nursing government thinks I’m not qualified to work as a nurse here, then what am I qualified for? If 4.5 years of hard university education isn’t enough, what am I supposed to do? I was (still am) SO finished with the journey towards being a nurse. I just wanted to be a nurse! I had finally achieved the dream in Canada, but left before I got to live it even for one shift. And here I was, in a country that didn’t recognize my degree, and kept demanding more proof from me. I had several options to choose from, and I chose what I thought would be the least painful, which was to rotate on different units to experience German nursing. I was back to clinical rotations, feeling like a student all over again, being a fly on a wall on a random unit for a week at a time before moving on. I did not enjoy it. The nurses were nice enough, actually kinder than I expected, but I was extremely stressed by the steady onslaught of newness and unexpected situations, the language struggles, the way the units work in Germany. I had gotten used to the ICU and fell into a rhythm there, and I had no idea what to do on these other units. A surgical unit in Germany is not the same as a surgical unit in Canada. The nurses on these units tip-toed around the surgeons as if they were god, and I was told off more than once for having my hands in my pockets or for resting against a counter. Heaven forbid that nurses show their humanity in front of the almighty deity that is a surgeon!

Through all of this I have really struggled with wondering why my life has led me the way it has. Why did I have to fight to get accepted to school in Canada, and why again to be recognised in Germany? I have craved with all my heart to have one process just go smoothly and not be sabotaged by my complicated history. I have told Frank many times, “my life just isn’t compatible. With anything”.

I found it exhausting explaining my situation to every new face: I’m here to observe, no, not as a student, but I’m also not a nurse (in Germany). I’m from Canada, that’s why my German is so bad, and I have a degree in nursing but it’s not recognised here. I already have a positon on the ICU and I’m going back there.

Once I finally finished my required hours and rotations, I came back to my unit and carried on with my routine. My unit is wonderful, I realized that especially after experiencing the others. The team is supportive, kind, they are good nurses and good teachers and they are resilient to the constantly changing environment. I’m speaking both of the nurses, (as well as the management) and the doctors.

But this brought me to January, the beginning of Covid-19 and the last stretch of waiting for my registration. I sent in the final pieces and waited. I had a terrible feeling it would all be slowed by the virus and that the offices may not even be running. It’s now been 9 months since I started this process with the local nursing government, and my letter arrived on Friday. This piece of paper that is gold to me. Even more than my BScN or even the NCLEX, because this is the paper that has finally given me the freedom to work as a NURSE. My dream that I anticipated and hoped would be a linear journey from Point A (being the start of nursing school) to point B (being a qualified nurse) has been whatever the oppositve of linear is and has taken 6 years!

So that’s why I cried.

And my unit gave me this beautiful bouquet of flowers today to celebrate with me. I truly love this team, and I would not have made this fight for my registration if I hadn’t been surrounded by such a supportive group, or by such a supportive husband, or family or any number of the people who have prayed for me and encouraged me not to give up the process. I’m pretty sure the journey isn’t over. If I’ve learned anything, it’s that it’ll never be over and there are sure to be more incompatibilities ahead of me. But a small (well, huge for me) victory has been won and nobody’s taking away my fancy piece of paper that validates my nurse-ness.