Attending a bridging program to obtain a Swedish nursing license: An interview study with internationally educated nurses

Hope, passion and perseverance: experiences of internationally educated nurses pursuing nursing authorisation in Norway-a qualitative study

BACKGROUND

The global nursing shortage is driving nursing professionals to migrate from their home countries to other regions of the world, leading to increased diversity in healthcare settings and nursing education across Europe. Although research on the experiences of internationally educated nurses has gained more attention in Norway, a substantial gap remains in understanding the challenges these nurses face when participating in bridging programs and seeking authorisation as registered nurses in the host country.

METHODS

The aim of the present study is to gain knowledge about the experiences of students in a digitised bridging program for nurses, related to being a nurse educated outside the European Union and a student with a Norwegian as a second language and migrant/refugee background. Oslo Metropolitan University initiated a decentralised education programme in 2021, offering a bridging programme for individuals with a nursing education from countries outside the European Union. This programme was conducted in a decentralised, gathering-based, and predominantly digitised format. The study has a qualitative descriptive design and includes a purposive sample of eight former nursing students enrolled in the programme. Data were collected through individual semistructured interviews conducted between November and December 2023. The data were analysed by employing thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research (COREQ).

RESULTS

Analyses revealed a main theme-the participants' ability to persist in their goal over the long term, maintaining their interest, overcoming challenges, working hard and finishing tasks rather than giving up. This theme is supported by three themes: (i) 'Navigating bureaucratic challenges - The struggle with authorisation and overwhelming requirements, (ii) 'An emotional journey - The ups and downs of participating in the program', and (iii) 'Achieving recognition - The journey to authorisation and professional confidence'.

CONCLUSIONS

The study underscores the numerous challenges encountered by internationally educated nurses seeking registered nurse' recognition in Norway. Despite these challenges, the participants displayed remarkable hope, passion and perseverance, remaining committed to their goal of becoming registered nurses in Norway.

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.

Recognition of nursing qualification and credentialing pathway of Filipino nurses in Finland: A qualitative study

AIM

To understand the experiences of Filipino internationally educated nurses (FIENs) on their recognition and credentialing pathway in the recruitment process in Finland.

BACKGROUND

The nursing shortage in Finland results in the recruitment of internationally educated nurses (IENs) such as those from the Philippines. In the context of migration, IENs experience a rigorous process to become qualified nurses in the destination country.

METHODS

A thematic analysis of the secondary data from qualitative interviews was conducted. Ten FIENs (n = 10) were recruited from university hospitals in Finland through purposeful and snowball sampling. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

Three main themes were identified. First, pre-migration victories and predicaments described the experiences of FIENs during the recruitment process and the pathway to acquiring a Registered Nurse qualification. Second, ambiguous integration implied integrating into the workplace while working on the top-up education programme as a prerequisite to nursing registration. Lastly, migration uncertainty discussed the interest among FIENs to continue practising as Registered Nurses (RNs) in Finland.

CONCLUSIONS

Pre-migration orientation and workplace integration experiences influenced FIENs' choice to practise as RNs in Finland. The licensure pathway for FIENs required collaboration from various stakeholders in Finnish society. It is recommended to structure the system for the recognition and qualification process of IENs by creating a national model in line with international standards and requirements in collaboration with higher education institutions.

IMPLICATION FOR NURSING POLICY

Recognition of previous education and clinical experience can facilitate the transition to becoming an RN for IENs, but the lack of a clear education model and recognition of foreign nursing qualifications leads to deskilling and hinders IENs from practising. Policies prioritising education and integration into the local healthcare system can facilitate the integration and professional growth of IENs, enabling them to contribute significantly to the healthcare system.

The impact of bridging education programs on internationally educated nurses becoming registered nurses in high-income countries: A mixed-methods systematic review

AIM

To synthesize the current literature on the impact of bridging education programs for internationally educated nurses (IENs) from low- and middle-income countries (LMICs) seeking to become registered nurses (RNs) in high-income countries (HICs).

BACKGROUND

The issue of qualification pathways for IENs through bridging programs has garnered significant attention in contemporary discourse. The growing population of IENs in HICs has made it imperative to streamline the qualification process to facilitate their integration into the healthcare system.

METHODS

Utilizing a structured review method, we sourced data between January 2023 and April 2024 from the CINAHL, Scopus, and MEDLINE databases with no year limitations. Out of 817 studies, eight were included. The mixed-methods systematic review was carried out by two authors who adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We employed a qualitative content analysis from a feminist standpoint to assess the impact of bridging programs on the transition of IENs to become RNs.

RESULTS

Eight studies were included (mixed methods = 1, quantitative = 3, qualitative = 4). Three themes revealed important key findings. Language proficiency emerged as a critical factor influencing success in bridging programs, with IENs needing to attain a certain level of proficiency in the local language required for licensure. Enhancing nursing competence highlighted skepticism and the need for tailored educational approaches. Transitioning into the workplace emphasized cultural challenges, highlighting the importance of targeted support for continuous integration.

CONCLUSION

Our findings revealed that despite previous higher education attainment in nursing and nursing experience in the home countries from LMICs, bridging programs aided IENs in transitioning and assimilating into the host country's healthcare employment sector.

IMPLICATION FOR NURSING POLICY AND PRACTICE

It is essential for policymakers in the education sector to integrate language instruction, cultural sensitivity training, and adapted educational approaches into bridging programs to enhance IENs' readiness for efficient healthcare delivery.

Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

Factors influencing job satisfaction and professional competencies in clinical practice among internationally educated nurses during the migration journey: A mixed-methods systematic review

BACKGROUND

The increasing migration of internationally educated nurses (IENs) from developing to developed countries highlights the importance of implementing integration strategies that facilitate their workplace transition, leading to improved job satisfaction and professional competence.

AIM

The mixed-methods systematic review aimed to synthesise the current literature on factors influencing job satisfaction and professional competencies among IENs throughout their transition process, including the pre-migration, migration, and post-migration periods.

METHODS

This study conducted a mixed-methods systematic review from 2013 to 2023, using the CINAHL, Scopus, and PubMed databases and employing a Population, Interventions, Comparisons, Outcomes (PICO) framework. Quality assessment employed the Mixed Methods Appraisal Tool (MMAT), and data analysis followed a convergent parallel design. Data synthesis was presented narratively, and the literature review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Out of 565 articles, eleven studies (eight qualitative, two quantitative, and one mixed-method) met the inclusion criteria. Three key themes that influenced job satisfaction and professional competencies among IENs were identified: pre-migration and pre-deployment demands, challenges in workplace integration, and post-migration career challenges and retention strategies.

LIMITATIONS

The study primarily focused on IENs recruited from developing countries, potentially limiting the generalisability of the findings to IENs from other regions or countries. Furthermore, the inclusion of nurses from developed countries who also migrated was limited in the available studies, which further restricts the applicability of the research findings.

CONCLUSIONS

It is essential to reconsider the pre-migration language requirements and evaluate the feasibility of completing them during the integration period to enhance the job satisfaction and professional competencies of IENs. Additionally, key factors for improving job satisfaction among IENs include providing personalised support, addressing managerial barriers, facilitating career advancement, efficiently managing workloads, and promoting effective communication within the healthcare team.

Transitioning experiences of internationally educated nurses in host countries: A narrative systematic review

Background

The shortage of nurses worldwide is a well-known issue that has changed the health and social workforce picture. Increased recruitment and migration of internationally educated nurses in the health and social care workforce pose many risks to successful integration into the healthcare system. Understanding the barriers and enablers affecting their integration in their host countries is imperative.

Objective

To critically and systematically review the current literature to explore the transitioning experiences of internationally educated nurses to understand the enabling influences affecting their workforce integration into their host countries.

Design

A narrative systematic literature review was conducted. This study was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD42023401090). The study results were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods

A comprehensive literature search using the search engines CINAHL, MEDLINE, PsycINFO, Academic Search, and PubMed was conducted. Only peer-reviewed papers written in the English language were included. Primary research studies published between 2019 and 2023, which explored the lived experiences of internationally educated nurses, were considered for review.

Results

Seventeen studies (16 qualitative and one quantitative) were included in the review. Three main themes were developed: (1) push and pull factors that mediated internationally educated nurses' migration experiences, (2) one-way integration logic, and (3) expectations versus reality.

Conclusions

There is a need for a comprehensive and collaborative organisational approach to enhance the integration experiences of internationally educated nurses into their host countries. This can also ensure their contribution is recognised and will help them fulfil the responsibilities of their role and become influential team members within their organisations. This comprehensive and collaborative approach is also required to tackle discrimination, racism, communication and language barriers. Addressing these challenges can improve internationally educated nurses' job satisfaction and, thereby, improve retention.

Tweetable abstract

A new systematic review study explores barriers and enablers for optimising internationally educated nurses' experiences of working in their host country @cathy_Henshall @clairmerriman9 @annemarieraffer.

Examining Workplace Practices Used to Facilitate Successful Integration of Internationally Educated Nurses Into Acute Care Settings: A Scoping Review

BACKGROUND

Although the recruitment of internationally educated nurses (IENs) seems to be an effective strategy to sustain a diversified nursing workforce, challenges with transition to practice continue to be documented in the literature. Prelicensure bridging programs purport to facilitate practice readiness; however, IENs who complete these programs also experience difficulties. Little is known about tailored workplace-based bridging programs. This scoping review maps out our current understanding of IEN integration and education strategies implemented within acute care settings and identifies areas for further research.

METHOD

Arksey and O'Malley's (2005) five-step scoping review was used to explore current literature and highlight gaps based on the needs of IENs during transition into acute care.

RESULTS

Two themes were identified: the need for tailored clinical practice bridging programs within acute care settings and the impact of corporate involvement and social structures on IEN integration.

CONCLUSION

Inconsistencies in IEN integration practices point to the significance of implementing tailored, workplace-based bridging programs to ensure safe and full scope of practice. [J Contin Educ Nurs. 2024;55(4):195-201.].

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.

Talent management of international nurses in healthcare settings: A systematic review

AIM

To identify and systematically review current scholarship on talent management of international nurses in healthcare organizations.

BACKGROUND

As nurse shortages persistently pose challenges for healthcare organizations globally, one of the primary strategies employed to address these shortages is employment of international nurses. To date little has been done to systematically review and collate contemporary research on talent management of this strategically important cohort. Talent management is a holistic construct that can support healthcare organizations to attract, develop, motivate, and retain talented employees to drive organizational performance. This systematic review isolates, appraises and collates available evidence on talent management practices for international nurses.

STUDY DESIGN

Systematic literature review.

DATA SOURCES

Searches of PubMed, EBSCO and Scopus were made covering literature from 2012-2022.

REVIEW METHODS

This study followed Cochrane protocol for Systematic Reviews and key search terms were developed in consultation with University of Limerick library. As a key aim of the review was to provide evidence for the development of effective talent management practices, only peer-reviewed academic papers and empirical studies were included. Initial articles screening was conducted by two reviewers and full articles review was conducted by the entire research team. Findings were combined in a data extraction template for further analysis.

RESULTS

This review includes 62 articles thematically analysed under the headings recruitment and selection, retention and turnover, career progression, professional development, discrimination and racism, culture and communication.

CONCLUSION

No articles were found that directly address talent management for international nurses. Although there are studies that address aspects of talent management independently, more research is required on talent management as a holistic process for international nurses to inform evidence-based practice.

IMPACT

This research emphasizes the importance of talent management for retention of international nurses in healthcare settings. It provides a knowledge base for healthcare organisations to enhance employee retention and ensure quality care for patients, as well as setting the foundation for future studies in this area.

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.

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.