Foreign-Trained Nurses’ Experiences and Socioprofessional Integration Best Practices: An Integrative Literature Review

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.].

Dialectical Pluralism for Nursing Knowledge Development

The purpose of this paper is to explore the potential of dialectical pluralism (DP) for nursing knowledge development. Nursing scholars have discussed ways of developing nursing knowledge, exploring the fit and relevance of various worldviews for knowledge development and examining the dynamic and perpetual processes of knowledge development. Scholars have argued that knowledge development occurs under a certain worldview to which the researcher adheres. Many nurses employ various worldviews, which can give rise to ontological and epistemological conflicts. DP can help nurses appreciate the diversity of worldviews and recognize the importance of implicit worldviews to generate more practical nursing knowledge. DP as a philosophical approach can enable nurses to communicate between diverse worldviews, become tolerant of conflicting differences, and develop an array of nursing knowledge.

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.

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.

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.

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 ).

Discourse of race and racism in nursing: An integrative review of literature

BACKGROUND

Race is a barrier and source of inequality affecting ethnic minorities in nursing practice and education.

PURPOSE

This integrative review study aimed to determine whether racism and institutionalized racism are explicitly named in the titles and abstracts of peer-reviewed publications on nursing education, leadership, and the nursing profession, and to explore the depth of discussion of racialized concepts in peer-reviewed nursing literature.

METHOD

Whittemore and Knafl's integrative review approach was used to review 23 studies published in nursing journals published from 2008 to 2020.

FINDINGS

Four themes were extracted: the context of racism discussions in the literature; consequences of experiences of racism; emotional and physical effects of racism on nurses and students of color; and scholars' recommendations.

DISCUSSION

Nursing must start to openly acknowledge the issue of racism within the profession, and to address it by providing safe spaces for authentic dialogue in academic and practice settings.

Operationalist and inferentialist pragmatism: Implications for nursing knowledge development and practice

Philosophical inquiries in nursing are useful for analysing and critiquing existing practices, exploring contextual factors affecting practice, adapting to and sustaining ongoing changes in knowledge development, and facilitating the linkages between theory, research and practice. Nurse scholars used several philosophical schools of thought to guide knowledge development and practice. Pragmatism has been described as essential for bridging the theory-practice gap, for engaging in the inquiry-based practice and for translating knowledge into practice. The existing descriptions of pragmatism rely on rudimentary descriptions of "what works" and "inquiry-based action" aspects. However, the operationalist and inferentialist aspects of pragmatism and their worth for nursing knowledge development and practice are yet to be discussed. This paper explores the operationalist and inferentialist pragmatism and highlights the implications of these aspects for nursing knowledge development and practice. It has been argued that the dual aspect of pragmatism offers an approach to develop practical lines of action, evaluate actions in terms of their usefulness and assimilate already learned actions with the new actions. I suggested that moving beyond the rudimentary understanding of pragmatism and embracing and utilizing the dual aspect of pragmatism can bring more significant benefits for nursing. Embracing the dual aspect of pragmatism can enable nurses in developing philosophical reflexivity, emphasizing the experiential context of nursing, generating actionable and ready to use knowledge, and utilizing nursing theories to their fullest potential.

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.