Foreign educated nurses' work experiences and patient safety-A systematic review of qualitative studies

Self-rated professional competence and well-being at work after obtaining a Swedish nursing license: A longitudinal mixed-methods study of internationally and domestically educated nurses

BACKGROUND

An inclusive workplace is where everyone is supported to thrive and succeed regardless of their background. Supportive working conditions and general self-efficacy have been found to be important for nurses' perceived competence and well-being at work, however, in the context of being a nurse in a new country, research is limited. Moreover, knowledge is lacking about whether different paths to a nursing license are related to nurses' perceived competence and well-being when working.

OBJECTIVE

To examine determinants and experiences of nursing competence and well-being at work (thriving and stress) among internationally and domestically educated nurses.

DESIGN

A longitudinal descriptive and correlational design with a mixed-methods convergent approach was used.

METHODS

A longitudinal study was conducted between January 2019 and June 2022 with two groups of internationally educated nurses who had completed a bridging program or validation to obtain a Swedish nursing license and one group of domestically newly educated nurses. Data were collected on three occasions: Time1 at the end of the nursing licensure process (n = 402), Time2 after three months (n = 188), and Time3 after 12 months (n = 195). At Time3, 14 internationally educated nurses were also interviewed. Data were analyzed separately and then interpreted together.

RESULTS

Multiple regression models showed that greater access to structural empowerment (B = 0.70, 95 % CI [0.31; 1.08]), better cooperation (B = 3.76, 95 % CI [1.44; 6.08]), and less criticism (B = 3.63, 95 % CI [1.29; 5.96]) were associated with higher self-rated competence at Time3, whereas the variable path to a nursing license was non-significant (R2 = 49.2 %). For well-being, greater access to structural empowerment (B = 0.07, 95 % CI [0.02; 0.12]), better cooperation (B = 0.36, 95 % CI [0.07; 0.66]) and being domestically educated (B = 0.53, 95 % CI [0.14; 0.92]) were associated with higher thriving at work (R2 = 25.8 %). For stress, greater access to structural empowerment (B = -0.06, 95 % CI [-0.09; -0.02]), better cooperation (B = -0.30, 95 % CI [-0.51; -0.10]), and less criticism (B = -0.28, 95 % CI [-0.46; -0.05]) were associated with having symptoms less frequently while being domestically educated was associated with having stress symptoms more often (B = 0.44, 95 % CI [0.07; 0.81]) (R2 = 43.3 %). Higher general self-efficacy at Time1 was associated with higher self-rated competence at Time2 (B = 4.76, 95 % CI [1.94; 7.59]). Quantitative findings concurred with findings from interviews with internationally educated nurses. However, qualitative findings also highlighted the importance of previous education, working experience, the new context, and communication abilities.

CONCLUSIONS

Both quantitative and qualitative data showed that working conditions were important for nurses' self-rated competence and well-being at work. Although communication difficulties, previous education, and working experience were not statistically significant in the multiple regression models, in the interviews these factors emerged as important for internationally educated nurses' competence and well-being.

Factors influencing the transition of foreign-educated nurses to the US healthcare setting: A systematic review

AIM

This literature review examined the impact of the orientation or onboarding programs on the transition of foreign-educated nurses to a US healthcare setting and factors influencing their transition.

BACKGROUND

Recruitment of foreign-educated nurses has been a solution to the ongoing nursing workforce shortage in the United States. However, they face various challenges in their transition to employment in the United States. Adequate orientation and continued support are needed for the successful transition of foreign-educated nurses.

METHODS

A systematic literature search was conducted in 2022 across PubMed, CINAHL, Academic Search Complete, Google Scholar, and MEDLINE databases. This review selected only articles published between 2015 and 2022 in English that addressed foreign-educated nurses' transition issues in US healthcare settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the articles was appraised using the John Hopkins Evidence-based Practice tool.

RESULTS

This review of 14 articles revealed that the quality of orientation and organizational support were positively associated with foreign-educated nurses' job satisfaction and turnover. Factors influencing foreign-educated nurses' transition included peer support, job assignment and workload, credentialing, communication and cultural adjustment, psychological factors, safety perceptions, work environment, and coping strategies.

DISCUSSION

There was a lack of literature that evaluated orientation or onboarding programs for foreign-educated nurses. Further research is needed to explore the effectiveness of supportive programs in promoting their smooth transition.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Efficient onboarding or orientation programs and policies for foreign-educated nurses are crucial, considering the factors influencing their transition. Good programs and policies that prioritize the support, integration, and professional development of FENs will help maximize their contributions to health care.

Transfer of internationally qualified nurses' specialty skills to developed countries after immigration: A multicentre policy review

BACKGROUND

Internationally qualified nurses are highly sought after as a labour source due to continued shortages in the nursing profession in most developed countries. However, the lack of clear policies and procedures for nurses in the host country to use specialty nursing skills can result in the underutilisation of their expertise.

OBJECTIVES

To review the registration processes of internationally qualified nurses in 20 developed countries, with a focus on the transferability of specialised skills gained overseas.

METHODS

A multicentre policy review design was used, using the STROBE reporting guidelines. The study sourced policy information from nurse registration bodies in developed countries and reviewed and removed redundant policies.

RESULTS

Out of 34 policies initially identified, 26 were used to show the registration process of nurses after immigration to developed countries. Only four of the 20 countries reviewed indicated the option of specialised nurse registration on their website for internationally qualified nurses, with a university qualification required before years of experience. All other countries indicated the general registration pathway only.

IMPLICATIONS FOR NURSING POLICY

More attention is needed to address the lack of well-defined policies that guide the utilisation of internationally qualified nurses' specialised skills. Transparent procedures are essential to fully benefit from their expertise in the host country's health workforce.

Language confidence and job satisfaction among foreign-born nurses in Japan: mediating effect of workplace discrimination and moderating effect of immigration duration

AIM

This study explored the relationship between language confidence and job satisfaction, the mediating role of workplace discrimination, and the moderating role of immigration duration among foreign-born nurses in Japan.

INTRODUCTION

Job satisfaction is an important factor in preventing migrant nurses' turnover intentions; however, the relationships among language confidence, immigration duration, workplace discrimination, and job satisfaction among foreign-born nurses remain unclear.

METHODS

A cross-sectional study was conducted. Data were collected between June and August 2022 through an online survey of nurses who were born outside of Japan but were currently working as registered nurses in Japan. PROCESS v4.0 Macro for SPSS 28.0 was applied to analyze the effect of language confidence on job satisfaction, the mediator effect of workplace discrimination (model 4), and the moderator effect of immigration duration (model 15).

RESULTS

Data from 187 participants were analyzed. The results showed that 1) foreign-born nurses' language confidence was negatively correlated with workplace discrimination and positively correlated with job satisfaction; 2) workplace discrimination played a partially mediating role between language confidence and job satisfaction; and 3) immigration duration positively moderated the relationship between language confidence and job satisfaction.

CONCLUSION

Foreign-born nurses with stronger confidence in their proficiency in Japanese perceived less workplace discrimination and higher job satisfaction. Workplace discrimination acted as a mediator in the relationship between language confidence and job satisfaction, and this relationship was strengthened with longer migration periods. Managers and policymakers should implement policies and strategies to combat workplace discrimination and provide tailored support to improve foreign-born nurses' job satisfaction, which may contribute to their retention in Japan.

Internationally Educated Nursing Staff Caring for Older Adults: A Scoping Study

INTRODUCTION

Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings.

METHOD

Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted.

RESULTS

Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged.

DISCUSSION

Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches.

Socio-cultural factors influencing Indonesian nurses to stay working in Indonesia: A qualitative study

AIM

To explore push, pull and retention factors affecting indonesian nurses decision to stay in the nursing profession.

INTRODUCTION

Identifying influencing factors that determine Indonesian nurses' decisions to remain working in Indonesia gives a better understanding of nurses' migration and therefore are necessry to explore.

BACKGROUND

Studies examining nurse migration's push and pull factors have been carried out extensively. A study exploring factors that make nurses stay in their home countries, such as Indonesia needs to be conducted to provide different insights for related parties.

METHODS

A qualitative descriptive study was conducted with 52 managers and 181 nurses from hospitals and community health centres across four different regions in Indonesia, including DKI Jakarta, Lampung, South Kalimantan and West Nusa Tenggara. A purposive sampling method was used. The data were collected online (via Zoom) and offline through semi-structured interviews and focus group discussions. A content analysis was performed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed.

RESULTS

Five categories were developed: non-financial support, sense of togetherness, following the husband, social image and powerlessness.

DISCUSSION

Socio-cultural factors influence Indonesian nurses to stay working in their country despite their economic and career development difficulties.

CONCLUSION

Socio-cultural circumstances have become powerful factors affecting Indonesian nurses to stay working in Indonesia.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

There is a need for harmonisation of policies related to nursing migration between recipient and source countries. Moreover, policies should go beyond education, competency and credentialing regulations and include addressing social costs and needs, such as the possibility of migrating nurses' families to the recipient countries.

Why do male nurses choose to work in foreign countries? A qualitative study on Chinese male nurses working in Japan

Aim

This study aimed to examine foreign-educated male nurses' motivation to emigrate for work, as well as explore the contextual factors that shape their career trajectories.

Background

To that end, we interviewed Chinese male nurses working in Japan. No previous study has examined why male nurses seek employment abroad or the problems they face.

Methods

This study employed a qualitative and inductive research design. Sixteen Chinese male nurses working in Eastern and Western Japan were recruited using convenience and snowball sampling methods and were interviewed via video calls. Co-researchers of both genders from different occupational and cultural backgrounds coded the findings and identified common themes in participants' responses. We analysed our findings vis-à-vis various theoretical perspectives and developed an explanatory model.

Results

Participants' experience as nurses in Japan ranged from six months to eight years. The findings confirmed that factors identified in earlier reports influenced nurses' motivation and work. Two new factors emerged: influence by others and social reasons. Moreover, two factors that affected male nurses' motivation to work abroad, namely, external factors and the influence of others, were identified. Social reasons were identified as a pull factor.

Conclusion

Our study provides valuable insights into recruiting and retaining foreign male nurses in developed countries facing issues such as ageing populations and nursing shortages.

Implications for nursing policy

This study has important implications for nursing management. Our findings highlight the importance of orienting foreign-educated nurses regarding the local work culture to increase the recruitment and retention of foreign talent. Moreover, enhanced salary packages and benefits to improve motivation can lead to improved job performance, which can positively impact patient and safety outcomes.

Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review

BACKGROUND

Recruitment of internationally qualified nurses as a labour source is a long-standing human resource strategy being implemented to address the current and increasing global nursing shortage. Internationally qualified nurses transitioning into the health workforce of developed countries following immigration often possess specialty skills. A lack of a clear pathway of specialty skill utilisation makes recognising and using these specialty skills complex for many nurses. The ability for nurses to transition between countries and maintain specialty practice demands immediate attention in the current atmosphere of the global pandemic and the predictions to recruit more specialist nurses from overseas.

AIM

To identify and synthesise strategies taken by various developed countries in transitioning specialist internationally qualified nurses into practice.

METHODS

An integrative review was conducted to identify common themes, patterns, and best practices in order to inform policy development and improve the successful integration of internationally qualified nurses into the healthcare systems of developed countries. The study employed the Whittemore and Knafl five-stage integrative review approach. To conduct a comprehensive search, four electronic databases, namely Medline, CINAHL Complete, ProQuest Health, and EMBASE, were systematically searched in October 2021. The search was updated in March 2022 to ensure the inclusion of the most recent literature. Additionally, Google Scholar was utilised to avoid overlooking any important articles. Prior to the full-text review, three reviewers independently evaluated titles and abstracts. The included papers' quality was determined using the JBI critical appraisal tools.

RESULTS

This study included 10 papers, comprising three studies and seven reports. However, none of these documents provided information on how internationally qualified nurses could transfer their specialty skills acquired overseas to developed countries after immigrating. The guidelines and policies reviewed only offered generic advice on becoming a specialist nurse. Although some countries mentioned that post-graduate qualifications were not mandatory for nurse specialists, the majority of documents in this review emphasised the need for a national framework of education at level eight or higher (equivalent to a post-graduate level) to attain the status of a nurse specialist. Moreover, the included documents did not provide clear information on whether an international specialisation degree would be recognised during the registration process. As a result, confusion persists regarding the requirement of post-graduate qualifications for nurses aiming to specialise and the recognition of international specialisation degrees during the registration process.

DISCUSSION

The lack of consistency in defining nurse specialty and the skill transferability among institutions and state borders were evident in this review. According to all the 10 documents analysed, developed countries appear to have minimum policies on the transfer of internationally qualified nurse's specialty skills. Recommendations for policymakers, employers, and aspirant migrants have been proposed. Limited research has been done on how developed countries used their internationally qualified nurses' overseas-acquired specialist skills after immigration, indicating a lack of a distinct specialist skill transition pathway.

CONCLUSIONS

This review presents data to support the need for greater research in this area to better utilise the abilities that internationally qualified nurses bring from their home country and put them to constructive use in the host country, especially in the context of a global pandemic.

Supporting self-determination among internationally educated nurses: a discussion

Background: The COVID-19 pandemic has exacerbated the global nursing shortage. As the shortage worsens, reliance on internationally educated nurses is expected to increase, presenting challenges and opportunities for health care systems and nurse leaders worldwide. While internationally educated nurses bring cultural and ethnic diversity to domestic workforces, they face significant hurdles in successfully integrating due to racism, discrimination, and isolation, which can have a negative impact on their self-determination. The challenges encountered by internationally educated nurses can not only affect their self-determination, but they can also pose risks to patient safety.Objectives: This purpose of this paper was to examine the extant literature to describe the experiences of internationally educated nurses through the lens of Ryan and Deci's Self-Determination Theory. Another aim was to offer nurse managers and administrators strategies for supporting internationally educated nurses within their health care facilities.Design: Discussion Paper.Conclusions: Health care organizations should allocate time and resources to facilitate the professional transition of internationally educated nurses, promoting their psychological well-being and self-determination by fostering autonomy, competence, and relatedness.

Preceptors' experiences of supervising internationally educated nurses attending a bridging program: An interview study

BACKGROUND

Internationally educated nurses attending a bridging program must demonstrate clinical competence and meet requirements to apply for a nursing license in Sweden.

OBJECTIVES

To describe preceptors' experiences of supervising internationally educated nurses undergoing clinical practice education during a bridging program.

DESIGN

A qualitative descriptive study.

SETTINGS

Two universities offering the 1-year bridging program for nurses with a nursing degree from outside European Union/European Economic Area and Switzerland.

PARTICIPANTS

Fifteen preceptors, all registered nurses, who supervised internationally educated nurses were included.

METHODS

Semi-structured interviews were performed, and data were analyzed using qualitative content analysis.

RESULTS

Supervising internationally educated nurses was not the same as supervising nursing students and raised feelings of both joy and frustration. Preceptors had to adapt supervision to the student's nursing knowledge and skills. They had to help students communicate in Swedish and form good relationships with other students, patients, and other professionals. Most preceptors requested more information about the student's nurse education, country of education/cultural background, and previous work experiences. Mixed experiences of support from the university, first-line managers, and colleagues were reported.

CONCLUSIONS

Being a preceptor for internationally educated nurses is a challenge, and supervision training is important for managing preceptorship. To supervise students based on their level of knowledge and skills, more information must be shared with the preceptor. Encounters with others are of importance in the training, where teamwork and person-centered care must be in focus, both in prior theoretical education and in clinical practice education.

Linguistic racism towards internationally educated nurses in Finland: Critical reflective analysis

BACKGROUND

The shortage of nurses in Finland has prompted the recruitment of Internationally Educated Nurses (IENs) from developing countries mostly with fragile health systems. However, linguistic racism has emerged as a growing threat to the safety and well-being of IENs in the country.

AIM

To discuss the consequences of linguistic racism directed towards IENs and to propose solutions to address this issue.

METHOD

This discussion employed self-reflection as a means of engaging in critically reflective analysis.

DISCUSSION

The discussion highlighted the factors contributing to linguistic racism, including poor language proficiency, misrepresentation of the nursing profession due to skin color, and political tensions. The phenomenon of linguistic racism affects IENs' communication with patients and colleagues and has a detrimental impact on the mental health and overall health of IENs.

CONCLUSION

To address the issue of linguistic racism, this discussion proposed a comprehensive strategy that includes anti-racism training for healthcare personnel, the establishment of a conducive workplace culture that fosters diversity and inclusivity, and the provision of adequate assistance and support for IENs.

The Relationship Between Workplace Incivility and Patient Safety in Pediatric Nurses

BACKGROUND

Workplace incivility may directly influence nurses' involvement in patient safety; however, research on this topic in the pediatric setting has yet to be established.

PURPOSE

The purpose of this study was to address the prevalence of workplace incivility in pediatric settings in Saudi Arabia (SA) and examine its impact on patient safety culture.

METHODS

A cross-sectional study design was used. Surveys, including the Nursing Incivility Scale and Hospital Survey on Patient Safety Culture, were sent to nurses across 6 pediatric units in Taif, SA.

RESULTS

A total of 300 nurses completed the surveys. A significant negative modest correlation was found between incivility and patient safety domains ( P < .05). A higher stress score was associated with older age (>35 years), Saudi nationality, and subdegree education.

CONCLUSION

This study found that pediatric nurses experience high rates of incivility, mostly originating from patients and their families.

Investigating discrimination in the workplace. Translation and validation of the Everyday Discrimination Scale for nursing staff in Germany

BACKGROUND

The Everyday Discrimination Scale (EDS) is a frequently used questionnaire in the field of health and social psychology that aims to explore perceptions of discrimination, especially instances of injustice related to various diversity characteristics. No adaptation to health care staff exists. The present study translates and adapts the EDS to nursing staff in Germany and examines its reliability and factorial validity as well as its measurement equivalence between men and women and different age groups.

METHODS

The study was based on an online survey conducted among health care staff of two hospitals and two inpatient care facilities in Germany. The EDS was translated using a forward-backward translation approach. Direct maximum likelihood confirmatory factor analysis (CFA) was conducted to examine the factorial validity of the adapted EDS. Differential item functioning (DIF) related to age and sex was investigated by means of multiple indicators, multiple causes (MIMIC) models.

RESULTS

Data on 302 individuals was available, of whom 237 (78.5%) were women. The most commonly employed one-factor, 8-item baseline model of the adapted EDS showed a poor fit (RMSEA = 0.149; CFI = 0.812; TLI = 0.737; SRMR = 0.072). The model fit improved considerably after including three error covariances between items 1 and 2, items 4 and 5, and items 7 and 8 (RMSEA = 0.066; CFI = 0.969; TLI = 0.949; SRMR = 0.036). Item 4 showed DIF related to sex and age, item 6 showed DIF related to age. DIF was moderate in size and did not bias the comparison between men and women or between younger and older employees.

CONCLUSIONS

The EDS can be considered a valid instrument for the assessment of discrimination experiences among nursing staff. Given that the questionnaire, similar to other EDS adaptations, may be prone to DIF and also considering that some error covariances need to be parameterized, latent variable modelling should be used for the analysis of the questionnaire.

Barriers and enabling factors for workplace integration of internationally qualified nurses: A qualitative study of perceptions of German nurses

AIM

Examine perceptions of nurses who obtained a recognised nursing qualification in Germany about the integration of internationally qualified nurses (IQN) in the German nursing workforce.

DESIGN

Qualitative interview study.

METHODS

Semi-structured interviews with 21 state-qualified nurses who had graduated from a German nursing program were conducted either face-to-face or by telephone. Nurses were selected using the purposive sampling method. Additionally, to reach a sufficient sample size, snowball sampling was applied. Each interview was pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and sub-themes. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist for qualitative research.

RESULTS

Two main themes including sub-themes were identified: (a) Enabling Factors to Workplace Integration: motivated nursing team, structured orientation program, support by a preceptor, additional practical skills and specific language training and (b) Barriers to Workplace Integration: lack of language proficiency, cultural differences, othering and racism/discrimination. The findings of the study suggest that working in a diverse workplace can be challenging, it is therefore important for successful integration to recognise not only the experiences of IQN but also the perceptions of nurses who work with internationally qualified peers. No patient or public contribution.

REGISTRATION NUMBER

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (REDACTED).

Migration of nurses and doctors: pull factors to work in Saudi Arabia

BACKGROUND

Although Saudi Arabia is a common destination to which nurses and doctors migrate, few studies have explored the pull factors attracting them to work in the Middle East and Saudi Arabia. This qualitative study explores the pull factors drawing nurses and doctors to work in Saudi Arabian hospitals.

METHODS

The study utilized a qualitative approach with focus groups. The participants included 83 doctors and nurses at two government hospitals.

RESULTS

Five themes (rewards, job entry requirements, religion, influence of family and friends, and changing work environments) were identified based on the 10 focus group sessions.

CONCLUSION

Moving forward, health managers should proactively plan the state of healthcare as the need for migrant healthcare workers changes.

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

AIM

To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.

DESIGN

An integrated review was conducted.

METHODS

Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.

RESULTS

Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.

PUBLIC CONTRIBUTION

Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.

Working Conditions Among Chinese Nurses Employed in Japan: A Cross-Sectional Survey-Based Study

Introduction

Although the number of Chinese nurses employed in Japan is increasing, the situation regarding their work conditions has not been clarified. It is necessary to understand such conditions to consider support for Chinese nurses in Japan.

Objective

This study examined the professional nursing practice environment, occupational career, and work engagement of Chinese nurses in Japan.

Methods

Using a cross-sectional study design, 640 paper questionnaires were mailed to 58 Japanese hospitals that employed Chinese nurses and included a QR code for online responses. A survey request form and URL were sent to the Wechat app, where Chinese nurses in Japan communicate. The contents include attribute-related questions, the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Career Scale, and Utrecht Work Engagement Scale. Either Wilcoxon's rank-sum or the Kruskal-Wallis test was performed to compare scores of the study variables between subgroups.

Results

A total of 199 valid responses were obtained, of which 92.5% were female, and 69.3% had a university degree or higher. The PES-NWI score was 2.74, and the work engagement score was 3.10. The group with a university degree or higher had significantly lower scores on PES-NWI and work engagement than those with diplomas. Regarding the subscale of occupational career, scores of forming and coordinating interpersonal relationships, self-development, and accumulating a variety of experience were 3.80, 2.58, and 2.71, respectively. The scores were significantly higher with more than 6 years of nursing experience in Japan than those with 0-3 years or 3-6 years.

Conclusion

Most participants had university degrees or higher, and their scores of PES-NWI and work engagement tended to be lower than those with diploma degrees. Participants showed low self-ratings in self-development and lacked a variety of experience. Understanding Chinese nurses' work conditions in Japan enables hospital administrators to develop measures for continuing education and support.

A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses' recruitment to and working conditions in the United Kingdom

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non-European Union (EU) and non-White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices.

Residents' experiences of encounters with staff and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

BACKGROUND

The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes.

AIM

The aim of this study was to explore residents' experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic.

DESIGN

An exploratory study with an inductive approach.

METHODS

Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist.

RESULTS

Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls.

CONCLUSION

This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

Three paths to a Swedish nursing license: Two for internationally educated nurses and one for regular nursing students - A cross-sectional study of self-rated professional competence, self-efficacy, and thriving

BACKGROUND

Bridging programs are offered to support migrated nurses, but in some countries, nurses can also choose to validate their nursing competence. Thus far, little is known about how migrated nurses estimate their competence when they are about to enter working life in a new country and how this differs from regular nursing students.

OBJECTIVE

To compare two groups of internationally educated nurses' - those from bridging programs and those who chose validation - and one group of regular nursing students' self-rated professional competence when they are about to start working as registered nurses. The hypotheses were: 1) internationally educated nurses rate their competence higher than regular nursing students and 2) those from bridging programs rate their competence higher than those who chose validation. In addition, the aim was to compare the groups' self-efficacy and thriving.

DESIGN

A cross-sectional, comparative design.

SETTINGS

Five universities in Sweden.

PARTICIPANTS

Nurses educated in non-European countries from a bridging program (n = 128, response rate 79.0 %) or validation process (n = 61, response rate 59.2 %) and students graduating from the regular nursing program (n = 213, response rate 68.3 %).

METHODS

Data were collected with coded questionnaires (paper or online) between 2019 and 2021 and analyzed using non-parametric tests, e.g., Kruskal-Wallis.

RESULTS

Both groups of internationally educated nurses had higher median scores on total nursing competence (both groups p < 0.001), general self-efficacy (bridging programs p < 0.001, validation p = 0.020), and total thriving (bridging programs p < 0.001, validation p = 0.012) than regular nursing students did. However, comparing the groups of internationally educated nurses showed no significant differences.

CONCLUSION

Internationally educated nurses rated their competence high but with differences within the groups for different competence areas. More research is needed to investigate whether the different paths are important for nurses' competence later in working life, and some of the competence areas might need extra attention when nurses start working.

Ghanaian Erasmus+ students' experiences of a semester abroad during the COVID-19 pandemic

This article describes two Ghanaian students' experiences of connecting with learning, faculty, family and friends during an Erasmus+ semester abroad in Ireland during the COVID-19 pandemic. University faculty members' experiences are also explored. The students describe their experiences of adjusting to new ways of learning online and living through lockdown in a country far from home. These reflections highlight the students' positive learning experiences during a journey of both personal and professional development while also highlighting the challenges of converting to an online learning environment. These experiences illustrate the students' unexpected opportunities and challenges, demonstrating how support from the university faculty, Erasmus+ team and friends, both virtually and physically, helped them through this unprecedented time. This article presents an account of the students' and staff's learning experiences during a semester that was affected by the pandemic.

Cultural competencies in Polish and Lithuanian nurses: A cross‐sectional comparative study

BACKGROUND

Cultural competencies are known as a multidimensionalconstruct; however, they usually refer to an individual's sensitivity orcultural attitudes, cultural awareness, knowledge, and skills.

AIM

The aim of the study was to compare the cultural competences of nurses in Poland and Lithuania based on an adaptation of the Nurse Cultural Competence Scale (NCCS).

DESIGN

The design was a comparative cross-sectional study.

METHODS

A total of 383 Polish nurses and 184 Lithuanian nurses took part in the study. The questionnaires of the NCCS-Polish version (NCCS-v.PL) and the NCCS-Lithuanian version (NCCS-v.L) were used after linguistic adaptation and an evaluation of psychometric properties.

RESULTS

As a result of the comparative analysis, a higher general level of cultural competences (based on the NCCS) was found in the Lithuanian group M-148.09 (SD = 22.85). The results show statistically significant differences among the respondents in the subscale of Nurse Cultural Competence Scale-Cultural Knowledge (NCCS-CK; p ˂ 0.001); higher competences of the nurses were found in the Group LT (M = 31.05; SD = 6.75) than in the Group PL (M = 28.82; SD = 7.82). In the group of Polish nurses (Group PL), the intensity of cultural competences was found to increase along with age (NCCS-v.P r = 0.157, p < 0.05); this, however, was not observed in the Group LT (NCCS-v.LT, p > 0.05).

CONCLUSIONS

Both the nurses in Poland and in Lithuania are characterised by an average level of cultural competences. Diversity in the level of cultural competences was found in both groups depending on age, education and work experience.

Control of resources in the nursing workplace: Power and patronage relations

Immigrant nurses make up a large percentage of the Australian nursing workforce. Since the support in the workplace is expected to be inclusive for all nurses, the aim of this article is to explore how support and opportunities for professional growth, learning and development are distributed across different categories of nurses working in a neonatal intensive care unit (NICU). An ethnographic approach has opened an examination of the everyday workplace practices in the NICU to gain insight into how nurses made sense of the social and power relations occurring between themselves and their senior colleagues and how they experienced the support and opportunities they received in their workplace. As today's workplaces such as the NICU are diverse in races, culture and experiences, the concepts of intersectionality and cultural safety assisted in identifying inequality and injustice related to such diversity. The results showed how patronage relations rendered nurses with immigrant status with major disadvantage and left them clinically and culturally vulnerable. Such inequity defeats the reasons for encouraging skilled migration of nurses and poses questions on the cultural competency of recruiting organisations. Considering how cultural safety might guide staff development offers opportunities for authentic support to culturally diverse nurses.

Nurses' experiences of a recertification process involving a series of examinations to obtain a nursing license in a new country

AIM

To examine internationally educated nurses' (IENs') experiences of the recertification process when undergoing a series of examinations to test their nursing knowledge and skills and, thereby, obtain a Swedish nursing license.

DESIGN

A qualitative study with a descriptive design.

METHODS

A convenience sample of 15 IENs at the end of the recertification process was included. Data were collected using semi-structured telephone interviews between September 2019 and January 2021 and analysed using qualitative content analysis.

RESULTS

Conducting the recertification process to obtain a Swedish nursing license was challenging in many ways, and the nurses described a rollercoaster of emotions during the process: frustration, loneliness, stress and anxiety, but also happiness, pride and relief. The process was, for some, so demanding they almost gave up, and support was, therefore crucial for the nurses. However, many times, they had to struggle to find out where they could turn for help or guidance.

CONCLUSION

The nurses found the formal support during the recertification process to be inadequate and inaccessible. For this reason, and to decrease the risk of nurses dropping out and instead taking unlicensed jobs, there is a need to develop and introduce more supportive structures and to make the existing support and information more accessible for the nurses.

IMPACT

This study highlights the importance of offering accessible support during a demanding and challenging recertification process. These findings can help policymakers develop and introduce supportive structures in the process of recertification for IENs.

Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses

AIMS

To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses.

DESIGN

Multicentre cross-sectional study.

METHODS

Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations.

FINDINGS

Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses.

CONCLUSIONS

Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety.

IMPACT

On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.

Home and expatriate nurses' perceptions of job satisfaction: Qualitative findings

AIM

This paper is part of a larger doctoral study that investigated the impact of nationality on the job satisfaction of nurses and their intentions to leave Saudi Arabian government hospitals. The paper aims to gain an understanding of the impact of expatriate status on nurses' perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries.

BACKGROUND

Job satisfaction is a known predictor of nurse retention. Although there is a broad understanding of the factors that affect job satisfaction, little is known about how these vary between home and expatriate nurses working in countries which rely on a multicultural migrant workforce.

METHODS

A descriptive qualitative approach was taken, in which 26 semi-structured interviews were conducted with nurses selected from different nationalities, all of whom were working in Saudi Arabian hospitals. Eight participants were Saudi Arabian, six Filipino, four Indian, four South African, two Jordanian and two Malaysian.

FINDINGS

Five themes were identified that differentiated the perceptions of expatriates regarding their job satisfaction from those of the home nurses: separation from family, language and communication, fairness of remuneration, moving into the future and professionalism.

CONCLUSION

Focusing on the enhancement of job satisfaction experienced by expatriate nurses can result in a healthier work environment and greater retention of these nurses.

IMPLICATIONS FOR NURSING AND NURSING POLICY

To enhance nurse retention, policy makers in countries with migrant nurses should address their socio-economic needs. This includes providing both greater access to their dependent family members, and language lessons and cultural orientation to reduce linguistic and cultural challenges.

Internationally trained nurses and host nurses' perceptions of safety culture, work-life-balance, burnout, and job demand during workplace integration: a cross-sectional study

BACKGROUND

The shortage of qualified nurses is a problem of growing concern in many countries. Recruitment of internationally trained nurses has been used to address this shortage, but successful integration in the workplace is complex and resource intensive. For effective recruitment and retention, it is important to identify why nurses migrate and if their expectations are met to ensure their successful integration and promote a satisfying work climate for the entire nursing team. The aim of this study was to examine the perceptions of safety culture, work-life-balance, burnout and job demand of internationally trained nurses and associated host nurses in German hospitals.

METHODS

A multicentric, cross-sectional study was conducted with internationally trained nurses (n = 64) and host nurses (n = 103) employed at two university hospitals in the state of Baden-Wuerttemberg, Germany. An anonymous paper-based survey was conducted between August 2019 and April 2020. The questionnaire included sociodemographic questions, questions regarding factors related to migration, and the German version of the Assessment of your work setting Safety, Communication, Operational Reliability, and Engagement (SCORE) questionnaire. SCORE is divided into three sections: Safety Culture Domains (six subscales), Work-Life-Balance (one subscale), and Engagement Assessment Tool (four subscales).

RESULTS

Nurses who migrated to Germany were primarily seeking better working conditions, a higher standard of living, and professional development opportunities. Internationally trained nurses reported lower work-related burnout climate (Mean 55.4 (SD 22.5)) than host nurses (Mean 66.4 (SD 23.5)) but still at a moderately high degree (Safety Culture Domains). Host nurses indicated a higher workload (Mean 4.06 (SD 0.65)) (Engagement Assessment Tool) and a lower Work-Life-Balance (Mean 2.31 (SD 0.66)) (Work-Life-Balance) compared to nurses who trained abroad (Mean 3.67 (SD 0.81) and Mean 2.02 (SD 0.86), respectively). No differences were detected for the other subscales. The Safety Culture Domains and Engagement Assessment Tool showed room for improvement in both groups.

CONCLUSION

The study suggest that the expectations migrant nurses had prior to migration may not be met and that in turn could have a negative impact on the integration process and their retention. With increasing recruitment of internationally trained nurses from within Europe but also overseas, it is crucial to identify factors that retain migrant nurses and assist integration.

TRIAL REGISTRATION

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register ( DRKS00017465 ).

Shared goals, communication and mutual respect in multicultural staff teams: A relational coordination perspective

AIM

Task interdependence among staff in nursing homes is high, and staff teams are typically composed of employees from different cultural backgrounds with varying levels of skills and qualifications. By applying relational coordination theory as an analytic lens, we investigated how communication and cooperation challenges are experienced and dealt with.

DESIGN

This is a qualitative study.

METHOD

In-dept interviews with 31 members of staff in two nursing homes and thematic analysis of the material.

RESULTS

The study identified challenges in direct communication and collaboration difficulties related to understanding how to use professional discretion in daily care practices in both nursing homes. The management in one of the two nursing homes arranged frequent meetings to share knowledge about the residents, their care status and introduced initiatives to build competence among all members of staff, including substitute and temporary staff. This contributed to ensuring shared goals and mutual respect at the workplace.

Experiences of nurses educated outside the European Union of a Swedish bridging program and the program's role in their integration into the nursing profession: a qualitative interview study

BACKGROUND

Countries all over the world are experiencing a shortage of registered nurses (RNs). Therefore, some countries, including Sweden, have tried to solve this by recruiting internationally educated nurses (IENs). Countries offer bridging programs as educational support to qualify IENs for nursing work in the destination country. However, there is little research on IENs' experiences of bridging programs in European countries and how these programs facilitate their integration into the world of work and their new society. The aim of this study is to explore the experiences of nurses, originally educated outside the EU (European Union)/EES, of the Swedish bridging program and of the program's role in facilitating their integration into the nursing profession in Sweden.

METHODS

A qualitative descriptive design was used to explore the topic based on 11 informants' perspectives and experiences. Purposive sampling was used to recruit participants at one university in Sweden. Data were collected by individual interviews using a semi- structured interview guide during the year 2019 and were analysed using an interpretative thematic approach.

RESULTS

Two main themes emerged from the analysis: 1) Return to nursing, and 2) The bridging program as a tool for transition to nursing in Sweden. The first theme includes conditions and experiences such as personal motivation and determination, and support from others that the participants described as important in order to achieve the goal of re-establishing themselves as registered nurses in Sweden. Furthermore, the second theme describes the participants' experiences of the bridging program as mostly positive because it led to new learning and achievements that were valuable for the transition to nursing in Sweden; however, the participants also emphasised the challenges of their transition into the nursing profession, which were related to instances of misrecognition of their professional competence and the uncertain outcome of the program.

CONCLUSIONS

This study found that the bridging program facilitated integration into the nursing profession for nurses educated outside the EU/EES, especially knowledge gained in clinical-based training. Thus, it is important to recognise and value the IENs' experience and previous knowledge and training when developing the bridging program's curriculum.

The experiences of foreign-educated nurses in Japan: a systematic review

AIM

To conduct a systematic review to understand the experiences of foreign-educated nurses in Japan.

BACKGROUND

The experiences of foreign nurses in host countries, and the challenges they face, have been widely investigated around the world. However, no systematic review has focused on the experience of foreign-educated nurses in Japan.

METHODS

A systematic literature review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Japan Medical Abstract Society, Citation Information by National Institute of Informatics, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were used for the literature search. Inclusion criteria were research articles published between 2013 and 2020 written in Japanese or English. A quality assessment was performed using Version 2018 of the Mixed Methods Appraisal Tool. Selected articles were read repeatedly, and relevant contents were extracted and summarized thematically.

RESULTS

Twenty-five studies were selected for the review. The themes generated included (1) reasons for nurses to come to Japan, (2) experiences and current situations among the Economic Partnership Agreement nurses/nurse candidates living in Japan, and (3) experiences and current situation of nurses who had returned to their home countries. The second theme was classified into four categories: language and communication barriers, low pass rates for the national qualification exam, adaptation to workplaces and social environments, and psychological distress.

CONCLUSION

Foreign nurses in Japan face various challenges and difficulties, even after they return to their home countries. Solving these problems may improve the wellbeing of foreign-educated nurses in Japan.

IMPLICATIONS FOR NURSING POLICY

The results from the current review highlight the necessity for immediate intervention by policymakers to improve the current support system for Economic Partnership Agreement nurses/nurse candidates. A thorough pre-arrival orientation should be provided for the nurse candidates to able them to make a well-informed choice.

Telling their story: A qualitative descriptive study of the lived experience of expatriate palliative care nurses in the United Arab Emirates

PURPOSE

To explore the experiences of expatriate nurses caring for Muslim patients near end-of-life in a palliative care unit in the United Arab Emirates.

METHODS

A qualitative descriptive study, with data collected through semi structured individual interviews with nine expatriate nurses working in a palliative care unit in one hospital in the United Arab Emirates. Thematic analysis of the data transcripts used a structured inductive approach.

RESULTS

Analysis of the interview transcripts yielded three themes. First, language was a significant barrier in end-of-life care but was transcended when nurses practiced authentically, using presence, empathetic touch and spiritual care. Secondly, relationships between nurses, patients and families were strengthened over time, which was not always possible due to late presentation in the palliative care unit. Finally, nurses were continually in discussions with physicians, families and other nurses, co-creating the meaning of new information and experiences within the hospital policy context.

CONCLUSION

For expatriate nurses, palliative nursing in a Muslim middle eastern country is complex, requiring nurses to be creative in their communication to co-create meaning in an emotionally intensive environment. Like other palliative care settings, time can strengthen relationships with patients and their families, but local cultural norms often meant that patients came to palliative care late in their disease trajectory. Preparing expatriate nurses for work in specialist palliative care settings requires skill development in advanced communication and spiritual practices, as well as principles of palliative care and tenets of Muslim culture.

Education Strategies Supporting Internationally Educated Registered Nurse Students With English as a Second Language in Canada

INTRODUCTION

The purpose of this literature synthesis is to highlight some of the challenges faced by internationally educated nurses with English as a second language when integrating into the Canadian health-care environment and to suggest educational strategies that work to support these diverse learners to acculturate and fill gaps.Methodology: A search of Google Scholar, PubMed, CINAHL, MEDLINE, and ProQuest Nursing and Allied Health databases, as well as reference lists, conference presentations, and gray literature produced pertinent research studies and commentary published between 2008 and 2018.

RESULTS

Common themes in the literature include challenges relating to communication, cultural competence, and critical thinking.

DISCUSSION

Some strategies that should be included in bridging education programs to address these challenges are evolving case studies, simulation and role-play, and practice performing multiple-choice tests. Research is needed examining the effectiveness of experiential techniques in preparing internationally educated nurses for nursing in the Canadian context.

First Year's Work Experiences of Foreign Educated Nurses Coming to Norway From Other European Countries

Introduction

Nurses educated in the European Union and European Economic Area are automatically given professional authorization to work in all member states, facilitating workforce mobility between countries. Along with many other European countries, Norway faces nursing shortages in healthcare. European Foreign Educated Nurses are often recruited to work in Norway by agencies or apply for work themselves.

Aims

To explore the experiences Foreign Educated Nurses from European Union and European Economic Area had with their preparation and orientation programs and their first year of work in Norwegian elderly care institutions

Methods

The study followed a qualitative explorative design. Nine open, dialogue-based, semi-structured interviews were conducted with Foreign Educated Nurses from Poland, Lithuania, Latvia, Iceland, and Spain. Data were analyzed using qualitative content analysis.

Findings

One main theme, struggling to adjust to professional competence standards, and four subthemes emerged from our data (1) deficiencies in preparation and orientation by recruitment agencies and institutions, (2) language skills and communication challenges at work, (3) cultural differences in the nursing role in clinical practice, and (4) social interactions at work.

Conclusion

More comprehensive preparation and orientation programs regarding language skills and local healthcare systems are needed. Foreign Educated Nurses make important contributions to the Norwegian healthcare work force, but the challenges brought to light in this study negatively affected their work conditions and can possibly threaten patient safety. More research is suggested to address the lack of collaboration between agencies, healthcare institutions, and other stakeholders in establishing professional standards and appropriate support for Foreign Educated Nurses from European Union and European Economic Area.