Internationally recruited nurses' experiences in England: A survey approach

Black African international nurses' experiences of pastoral support: A scoping review

Purpose

Overseas nurses are not new to the United Kingdom (UK), and neither is the concept of pastoral care. The immense contributions of international nurses are so obvious that it would be commonly assumed that there will be a strong literature base on pastoral care for these nurses. However, the opposite is very much the case. Pastoral support is crucial to the successful adaptation and integration of nurses who are recruited outside the United Kingdom to work within the NHS. To offer comprehensive fit-for-purpose support, the perspective of the nurses is important.

Objective

This scoping review aims to identify what is known about pastoral support for internationally educated nurses in the UK.

Methods

A scoping review method was used to review literature on pastoral support.

Results

Existing literature provided evidence on current practices, the challenges, and outcome criteria for successful pastoral support. It also provided evidence on how early pastoral support can fortify the nurses or deskill them. Finally, it revealed significant disparities in the support received by overseas nurses.

Conclusion

While the nurses' experience of the previous adaptation programme has been explored, evidence on the current pastoral care practices is mostly found in policy guidelines, trainers' reports, and opinion pieces. Since the inception of the NMC test of competence in 2014, the voice of the recipients of pastoral care is yet to be heard. This scoping review suggests that there is a difference in understanding of pastoral care practices. Therefore, the perspectives of specific groups such as Black African nurses should be explored on this issue.

Globalization: Migrant nurses' acculturation and their healthcare encounters as consumers of healthcare

Globally, one of every eight nurses is a migrant, but few studies have focused on the healthcare experiences of migrant nurses (MNs) as consumers or recipients of healthcare. We address this gap by examining MNs and their acculturation, barriers to healthcare access, and perceptions of healthcare encounters as consumers. For this mixed-methods study, a convenience sample of MNs working in Europe and Israel was recruited. The quantitative component's methods included testing the reliability of scales contained within the questionnaire and using Hayes Process Model #4 to test for mediation. The qualitative component's methods included analyzing interviews with iterative inductive thematic analysis. Quantitative findings on MNs (n = 73) indicated that the association between acculturation and perception of the healthcare encounter, which MNs experienced as healthcare consumers, was mediated by barriers to healthcare access, even after adjusting for age and gender (p = 0.03). Qualitative interviews with MNs (n = 13) provided possible explanations for the quantitative findings. Even after working in the host country's healthcare system for several years, MNs reported difficulties with their healthcare encounters as healthcare consumers, not only due to their limited knowledge about the culture and healthcare resources but also due to the biased responses they received.

[Immigrant nurses' experiences of discrimination by patients and nursing home residents: a narrative review]

Immigrant nurses' experiences of discrimination by patients and nursing home residents: a narrative review Abstract: Background and aim: Immigrant nurses are filling the shortage of skilled workers in many countries. Studies suggest that they may face discrimination in their destination countries. This paper aims to provide an overview of the experiences of immigrant nurses with regard to discrimination in their interactions with patients. Methods: A systematic literature review was performed by searching the databases PubMed and CINAHL. Additional articles were identified through a search in Google Scholar and by reviewing reference lists. Studies published between 1/2013 and 3/2023 were included. Results: The literature search yielded 103 studies, 18 of which were included in the narrative review. The review showed that immigrant nurses may experience discrimination in the form of rejection, questioning of their qualifications, unequal treatment, derogatory remarks, threats, as well as violence from patients. Discrimination is based on their ethnicity, country of origin, external characteristics, language, and accent. Conclusions: Overall, available data is insufficient. The results of this review can serve as a basis for further studies and help managers and policy makers to better understand discrimination against immigrant care workers, to develop strategies to support them and to implement appropriate prevention measures.

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.

Mapping factors that may influence attrition and retention of midwives: a scoping review protocol

INTRODUCTION

An appropriately staffed midwifery workforce is essential for the provision of safe and high-quality maternity care. However, there is a global and national shortage of midwives. Understaffed maternity services are frequently identified as contributing to unsafe care provision and adverse outcomes for mothers and babies. While there is a need to recruit midwives through pre-registration midwifery programmes, this has significant resource implications, and is counteracted to a large extent by the high number of midwives leaving the workforce. It is increasingly recognised that there is a critical need to attend to retention in midwifery in order to develop and maintain safe staffing levels. The objective of this review is to collate and map factors that have been found to influence attrition and retention in midwifery.

METHODS AND ANALYSIS

Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the review process and reporting of the review. CINAHL, MEDLINE, PsycINFO and Scopus databases will be searched for relevant literature from date of inception to 21 July 2023. Research from high-income countries that explores factors that influence leaving intentions for midwives will be included. Literature from low-income and middle-income countries, and studies where nursing and midwifery data cannot be disaggregated will be excluded. Two reviewers will screen 20% of retrieved citations in duplicate, the first author will screen the remaining results. Data will be extracted using a preformed data extraction tool by the first author. Findings will be presented in narrative, tabular and graphical formats.

ETHICS AND DISSEMINATION

The review will collate data from existing research, therefore ethics approval is not required. Findings will be published in journals, presented at conferences and will be translated into infographics and other formats for online dissemination.

Professional Adaptation Experiences of Chinese Migrant Nurses in Australia: A Qualitative Study

Chinese-educated nurses are increasingly important to the international labor market. This study aimed to examine how Chinese migrant nurses adapt and evolve professionally while pursuing nursing careers in Australia, using a qualitative descriptive approach. A total of 17 Chinese-educated nurses were recruited by purposive and snowball sampling in Australia during 2017. Data were collected by individual semi-structured interviews and analyzed using thematic analysis. Three central themes and eight subthemes were generated. Perceived differences in nursing involved: work options and flexibility, professional autonomy and independence, and freedom of expressing professional opinions. Elements comprising challenges to adaptation included communication barriers, nursing workload and responsibilities, and collegial relationships. Participants' professional transition journeys were accompanied by two key areas of self-evolution: Embracing the authentic self and embracing individual differences. Our findings have important implications for migrant-host nursing workforce integration in Australia and internationally.

A meta-synthesis of the transitioning experiences and career progression of migrant African nurses

INTRODUCTION

With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies.

METHOD

A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English.

RESULTS

The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one's feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth).

CONCLUSION

Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Foreign Healthcare Professionals in Germany: A Questionnaire Survey Evaluating Discrimination Experiences and Equal Treatment at Two Large University Hospitals

OBJECTIVE

To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector.

DESIGN

Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German university hospitals.

PARTICIPANTS

251 participants fully completed the questionnaires.

MAIN OUTCOME MEASURES

Experiences of discrimination and perception of inequality.

RESULTS

Fifty-five percent of migrant health workers had had at least some command of German before arriving in Germany. Members of all professional groups surveyed expressed experiences of discrimination related to language, nationality, race/ethnicity, and sex/gender. The proportions of staff with experiences of discrimination by peers differed significantly among occupational roles, with nurses and technologists having the most experiences of discrimination. The perception of inequality was reported more frequently than experiences of discrimination and had a negative impact on workplace satisfaction. Specifically, the compulsion to compete was a frequent feeling stated by participants.

CONCLUSION

The mechanisms of discrimination and structural inequality revealed by our survey could inform specific measures, for example at the management level, to increase workplace satisfaction and attract migrant health workers in the long term.

Attending to our conceptualisations of race and racism in the pursuit of antiracism: A critical interpretative synthesis of the nursing literature

Race and racism are matters of urgent concern for the international nursing community. Recent global events have presented the discipline with an opportunity to generate and sustain long overdue discussions. However, with this opportunity comes a need to consciously attend to what we mean by race and racism, especially in the context of the nursing literature. Indeed, the development of antiracism depends on how we conceptualise race and racism; it is these conceptualisations that actively shape the scope and priorities of antiracist organising and action. The aim of this critical interpretative synthesis (CIS) is to examine conceptualisations of race and racism in the nursing literature by drawing on contemporary race scholarship. The synthesis of diverse literature is enabled through the explorative and expansive process of the CIS method. This review generates three synthesising arguments-a problem 'of' not 'for'; conceptual inconsistencies and drift; and reliance on the lens of experience-that both critique and contribute to the nursing literature. In the pursuit of antiracism, this article urges us to pay close attention to our conceptualisations of race and racism by illuminating the pitfalls that occur when our conceptualisations are inconsistent, contradictory, or simply neglected.

Recommendations to support the mental wellbeing of nurses and midwives in the United Kingdom: A Delphi study

AIM

To use the Delphi technique to identify and prioritize recommendations for research and practice to improve the mental wellbeing of nurses and midwives in the United Kingdom (UK).

BACKGROUND

Although there is evidence that self-reported mental wellbeing among nurses and midwives in the UK is poor, interventions have not adequately considered the wider context in which they work. The wide range of individual, organizational, occupational and wider sector-level factors that can influence wellbeing requires the involvement of different stakeholders to identify the most pressing actions required.

DESIGN

A three-round Delphi technique was conducted in 2019.

METHODS

In the first round, 16 subject matter experts generated, reviewed and discussed recommendations from a review of the research evidence with potential to support the mental wellbeing of nurses. A second group with 23 stakeholder representatives then rated and provided feedback on the developed recommendations through two additional rounds. Recommendations that received an 'essential' or 'important' rating from at least 80% of participants were retained and prioritized.

RESULTS

In total, 45 recommendations met the consensus agreement and were retained. More than half (57%) involved action at the organizational level, 27% to public policy and 13% to research. Only one recommendation is related to the individual. Collectively, these recommendations highlight the importance of taking direct action to tackle poor mental wellbeing among the workforce and initiating change at the policy and organizational level.

CONCLUSION

Our findings emphasize the need to take a systemic approach to improving the mental health of nurses and midwives in the UK with input from different stakeholders. There is a clear consensus that action is needed at the organization and policy levels, rather than at the individual level as is current practice.

IMPACT

This study provides a framework, alongside a set of practical recommendations, that provides a starting point for different stakeholders to understand, address and support the mental wellbeing of nurses and midwives. Although UK-focused, it has relevance to healthcare workforces internationally.

It is like 'judging a book by its cover': An exploration of the lived experiences of Black African mental health nurses in England

The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub-Saharan Africa. They were interviewed using face-to-face semi-structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep-rooted discrimination and marginalisation. Aside from that, because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential.

African born black nurses' perception of their U.S. work environment: Race matters

BACKGROUND

Healthy work environment is essential to patients' safety, staff recruitment, retention, and organization's financial viability. It is imperative to examine, understand and mitigate any and all factors that may contribute to unhealthy work environment.

PURPOSE

This study aimed to describe how African-born Black nurses felt their race affected their experience of the work environment and whether these experiences contributed to perceptions of unhealthy work environments.

METHOD

Thematic analysis was performed on data obtained from unstructured interviews of 17 African born Black nurses in this qualitative descriptive study.

FINDINGS

Seven themes emerged from the study: disregard for personhood, poor communication, democratic disqualification, lack of recognition, missing authentic leadership, attrition, and finding control.

DISCUSSION

The finding suggests African born Black nurses' experiences are uniquely and qualitatively different from that of their American born counterparts. Creating healthy work environment require authentic nurse leaders who can influence and support others in its achievement.

Barriers to career advancement in the nursing profession: Perceptions of Black nurses in the United States

Background

There is a paucity of Black and minority ethnic group nurse leaders and faculty in the nursing profession, even though the overall number of nurses within this demographic has increased. This study aimed to examine Black nurses' perceptions of the barriers to career advancement in nursing profession in the United States.

Procedure

Participants included 30 Black nurses aged 25 to 65 from health care settings across five US states recruited through purposive sampling. The study used a focused ethnographic design with semi‐structured interviews to elicit responses about participants perceptions and experiences of seeking leadership and faculty positions.

Results

Thematic analysis revealed seven main themes: maintaining white comfort, distrust, no one like me, paving the way, worthy of representation, leadership role not expected of Black nurses, and an advanced degree does not equal advanced opportunities.

Conclusion

The findings suggest that Black nurses face significant challenges in entering leadership or faculty positions. They face racial discrimination and lack access to mentorship and support which discourages sufficiently qualified and experienced nurses from applying for high‐level positions. Ensuring all nurses are afforded equal opportunity for career advancement is essential for the nursing profession's continued growth.

Outsiders in Nursing - Voices of Black African Born Nurses & Students in the US: An Integrative Review

Purpose:

The purpose of this integrative review was to describe the experience of being outsiders in nursing as described by Black African Born Nurses and Student Nurses (BABN&SN) in the U.S., give voice to their experiences in U.S. academia and healthcare settings, discuss the implications of the BABN&SN othering on the U.S. healthcare systems, and offer recommendations to address the issues based on the literature.

Methods:

An integrative review approach discussed by Whittemore and Knafl was utilized to review literature from nursing journal published from 2008 to 2019.

Results:

Major findings include collegial/peer isolation and loneliness; racism and discrimination, unwelcoming environment, silencing of voices, personal resilience, and sense of belonging. The results of this review indicate that BABN&SN experience in U.S. nursing contribute to harrowing periods of feeling like ‘an outsider.’

Conclusions:

BABN&SN are integral part of the U.S. nursing workforce and the healthcare system. Academic and work environments that support all nurses and students, despite their perceived differences, are essential to promoting an inclusive environment. Understanding the relational pattern that guides the BABN&SN socialization into nursing is vital to developing targeted support especially when entering the clinical practice environment.

Accent bias: A barrier to Black African-born nurses seeking managerial and faculty positions in the United States

The purpose of this study was to examine the perceptions of Black African-born nurses (BABN) with non-native accents regarding their nursing career advancement in the United States. Data were collected using individual interviews. Fifteen nurses originally from three sub-Saharan African countries were included in the study. The findings were reported under six themes: perceived low level of intelligence, not suitable to lead, making fun of/belittling, prejudging without evidence, downgrading, and accent modification. The finding indicated that participants believed that their race and accent influenced their professional nursing opportunities. These results are relevant to BABNs, nurse educators, and healthcare organization leaders. BABNs are capable of participating in nursing leadership and education despite their non-native accent.

Lived experiences of international operating room nurses in organ procurement surgery: A phenomenological study

International operating room nurses come from different regions of the world with diverse social and cultural backgrounds, religions, personal beliefs, and education. They are likely to form unique attitudes toward multi-organ procurement that potentially might affect their opinions and clinical practices. The aim of this phenomenological study was to explore the lived experiences of international operating room nurses participating in deceased organ procurement procedures in Australia. Semistructured interviews were conducted with 18 international operating room nurses. van Manen's phenomenological data analysis method was adopted to uncover and interpret meanings from these nurses' descriptions. Four essential themes emerged and evolved to signify the meanings of participants' experiences in organ procurement procedures: the surreality of death, personal and professional challenges, becoming stronger, and personal beliefs and wishes. The present study highlights the importance of cultural awareness in dealing with death, organ procurement, and interprofessional collaboration in the multi-cultural perioperative context. It is essential to provide clinical education and support around culture and practice transition for international operating room nurses to increase and maintain their professional confidence, career satisfaction, health, and well-being during organ procurement surgery.

Dis/Integrating cultural difference in practice and communication: A qualitative study of host and migrant Registered Nurse perspectives from New Zealand

BACKGROUND

Several earlier studies have provided evidence of the difficulties nurses have had adapting to foreign workplaces, however few have considered wider perspectives of the workplace communication environment.

OBJECTIVE

The aim of this study was to examine the viewpoints and experience of both New Zealand qualified nurses and internationally qualified nurses in managing communication within teams and the clinical practice context in an increasingly diverse healthcare workplace in New Zealand.

DESIGN

Interviews with 53 nurses currently employed in the New Zealand healthcare sector were carried out over a period of 15 weeks to gain insight into their intercultural experiences and how they responded. The transcripts of the interviews were analysed thematically.

SETTING

The interviews were all held outside working hours in venues and at times nominated by respondents.

PARTICIPANTS

There were 53 participants (17 New Zealand registered nurses and 36 internationally qualified nurses) in the study. Respondents were nurses working in the health care sector who answered a call for participation in the study from an advertisement in the national nursing journal Kai Tiaki.

METHODS

A structured interview schedule was developed from the literature. The questions focused on cultural challenges and benefits, sources of learning, value-based differences accompanied by a description of critical incidents that were reflective of those events.

RESULTS

Qualitative thematic analysis of the data resulted in three primary themes: a polarized workplace (loss and learning); ethnocentrism 'othering' and empathy; and value based conflict. The results were discussed with a focus group of available respondents to verify the findings.

CONCLUSION

All nurses in this study struggled with a care-rationed work environment, complicated by increasing diversity in both patients and staff. Despite evidence of conflict and misunderstanding, nurses also appeared willing to learn to adapt to enhance their practice. However, this process requires opportunities and resources to facilitate mutual understanding and accommodation to occur. The alternative of maintaining the status-quo will remain costly in terms of retention problems, the extent to which teams collaborate, and the contribution of insider-outsider divisions to sentinel events.

Experiences of Nigerian Internationally Educated Nurses Transitioning to United States Health Care Settings

Introduction: Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Method: Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. Results: The three major themes identified from the participants’ stories were “fear/anger and disappointment” (FAD), “road/journey to success/overcoming challenges” (RJO), and “moving forward” (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. Discussion: NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

A literature review of research exploring the experiences of overseas nurses in the United Kingdom (2002–2017)

Objectives

The goals of this work were to critically explore the challenges faced by overseas nurses during their working careers in the UK, to critically explore the available support for overseas nurses, and to make recommendations on how to minimize the effects of these challenges, as well as how to provide more support for overseas nurses during their working careers in the UK.

Methods

A systematic and comprehensive literature review was conducted to explore the said objectives. A search was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Academic Search Complete databases for relevant research. Inclusion and exclusion criteria were used to select the included articles. A total of 8 studies including 6 qualitative studies, 1 quantitative study, and 1 mixed-method study were selected for literature review. The validity and reliability of these 8 studies were analyzed by using 2 appraisal tools.

Results

This review reveals 4 challenges, which overseas nurses experience in the past 15 years, including cultural differences, communication issues, unequal opportunities, and de-skilling. These challenges have a negative impact on overseas nurses’ emotions and career development. The formal and informal supports are revealed in this review. Various supports can help overseas nurses to work better.

Conclusions

This review reveals 4 challenges faced by overseas nurses, including cultural differences, communication issues, and unequal opportunities and de-skilling. These challenges naturally have a profound negative impact on the emotions and career development of overseas nurses. Additionally, the formal and informal support systems available to these nurses are reviewed. Various support systems can help overseas nurses work more effectively.

Internationally educated nurses in Canada: predictors of workforce integration

BACKGROUND

Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs' workforce integration.

METHODS

A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs' workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment.

RESULTS

The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment.

CONCLUSIONS

Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a "one size fits all" model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries' nursing workforce.

Challenges faced by international nurses when migrating: an integrative literature review

AIM

Results from this literature review were used to identify the challenges faced by international nurses in their host countries following migration.

BACKGROUND

The increasing strain of nursing shortages in the healthcare system has led to the recruitment of international nurses among many countries. However, following migration, international nurses are faced with challenges that may result in poor integration with their host countries.

METHODS

Using Cooper's five stages for integrative research reviews, a literature search was conducted across seven databases using a PRISMA search strategy. Additional manual searches were also conducted on the end-references of the retrieved articles. The authors then independently reviewed the selected articles using the Joanna Briggs Institute appraisal form to extract and generate the themes for the review.

FINDINGS

Twenty-four articles were selected for the review. The themes generated included: (i) difficulty orientating; (ii) a longing for what is missing; (iii) professional development and devaluing; (iv) communication barriers; (v) discrimination and marginalization; (vi) personal and professional differences; and (vii) a meaningful support system.

IMPLICATIONS FOR POLICY AND PRACTICE

By identifying the challenges faced by international nurses, interventions that ensure equal treatment (e.g. multifaceted transition programmes and culturally sensitive 'buddy' systems) can be implemented to help international nurses adapt to their new environments. Adequate communication can be achieved by encouraging international nurses to speak English and learn the colloquial language and non-verbal behaviours used by native nurses.

CONCLUSION

With good integration international nurses may be able to reach their full career potential as professional nurses in their host countries. The adaptation process is a dynamic process that requires effort from both international and native nurses. Thus, any strategies that are developed and implemented must be multifaceted.