Internationally educated nurses’ reflections on nursing communication in Canada

Improving communication among nursing staff at a children's hospital in the southern United States: a best practice implementation project

INTRODUCTION

Ineffective communication between health care professionals is one of the leading causes of medical errors and can result in adverse events and patient harm. Improving the effectiveness of communication in health care is a worldwide necessity.

OBJECTIVE

The aim of this project was to promote evidence-based practices regarding general communication principles among the nursing staff in one unit of a children's hospital in the southern United States.

METHODS

The project used JBI's Evidence Implementation Framework, together with two JBI audit tools (Practical Application of Clinical Evidence System and Getting Research into Practice). A baseline audit was conducted, followed by the implementation of targeted strategies. The project was completed with a follow-up audit to determine changes in practice.

RESULTS

Baseline data revealed 61% adherence with four audit criteria for effective communication in health care. Barriers included a lack of education of nursing staff regarding communication skills and less than optimal use of a structured communication tool. Targeted strategies to address the barriers included providing an educational module on communication to nursing staff and moving the structured communication tool to a more convenient location to increase its use. The post-implementation data revealed 81% adherence with the four audit criteria, a 20% increase from baseline results.

CONCLUSIONS

Optimizing communication and monitoring the use of a structured communication tool has the potential to decrease the risk of medical errors among health care providers.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A217.

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).

Culturally and linguistically diverse registered nurses' experiences of integration into nursing workforce - A qualitative descriptive study

BACKGROUND

The nursing shortage is a global and ongoing phenomenon that is expected to worsen. In many countries, imbalances in the nursing workforce will require international recruitment and plans to increase domestic and international nursing graduates. Nurses from culturally and linguistically diverse backgrounds have been reported to experience challenges while integrating into the workforce.

AIM

To describe culturally and linguistically diverse registered nurses' experiences of their integration into the Finnish nursing workforce.

METHODS

The study adopted a qualitative descriptive design. Data were collected during the spring of 2021 from 24 culturally and linguistically diverse registered nurses working in various healthcare settings in Finland. Data were analyzed using content analysis, which resulted in 596 open codes, 21 sub-categories, and 8 categories.

RESULTS

According to the performed analysis, culturally and linguistically diverse nurses in Finland face cultural, ethnic and linguistic challenges. Organizational acceptance and acknowledgement of culturally and linguistically diverse nurses' competence can help decrease the practice of deskilling and the perception that foreign nurses have purely opportunistic goals. Cultural and language learning support, tailored orientation programs, and mentorship are the most common organizational strategies for supporting integration and competence development. The role of the nurse manager and organizational strategies were also identified as essential components of smooth integration, work wellbeing and retention.

CONCLUSIONS

Finnish healthcare organizations need to implement strategies that support culturally and linguistically diverse nurses' integration into the workforce. Nurse managers are important leaders that can foster culturally and linguistically diverse nurses' competence development, ensure the efficient use of their specialized skills, promote work wellbeing, and improve nurse retention.

Assessing the contribution of immigrants to Canada's nursing and health care support occupations: a multi-scalar analysis

BACKGROUND

The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario's Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants.

METHODS

Descriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources.

RESULTS

The distribution of nurses in Canada, Ontario, and Ontario's Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations.

CONCLUSION

Immigrants comprise an important share of Canada's nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada's role in global health workforce distribution and utilization.

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.

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

BACKGROUND

Bridging programs have been created to facilitate internationally educated nurses' integration process. Thus far, studies on bridging programs have been few and have only been conducted in English-speaking countries. Due to language barriers, it may be a greater challenge to attend a bridging program in a non-English-speaking country.

OBJECTIVES

The aim was to examine internationally educated nurses' experience of attending a one-year bridging program to obtain a Swedish nursing license.

DESIGN

A qualitative study with a descriptive design was applied.

SETTINGS

The study setting was the five universities offering the one-year, full-time Swedish bridging program.

PARTICIPANTS

Purposive sampling was used. Eighteen nurses participated in the study at the end of the program.

METHODS

Semi-structured interviews were conducted and analyzed using qualitative content analysis.

RESULTS

Studying in a new environment and language was challenging and intensive, as were adapting to a new healthcare system and relearning some nursing practices. However, attending the bridging program was also rewarding and gave feelings of happiness and pride; the nurses developed their nursing skills as well as their language and academic skills. Moreover, they became familiar with Sweden's nursing practices, healthcare system, and culture. Good support was important, but not always enough.

CONCLUSIONS

By attending a bridging program, nurses can become familiar with the country's healthcare system and nursing practices. Moreover, develop their language skills and attain skills important to lifelong learning. Although the program may not eliminate all difficulties nurses often experience in a new country, it can offer the support nurses need to handle the challenges. However, for some nurses, due to different backgrounds and prerequisites, the support offered may need to be more individualized.

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.

Nursing Education in Catalonia: Novice Professionals' Appraisal of Its Quality and Usefulness. Does Mobility Play a Role?

The present study aimed to examine the relationship between the quality of undergraduate education perceived by novice nurses and their retrospective satisfaction with their education. It also studied the relationships between the perceived usefulness of their education for their current jobs and the quality of the jobs held by novice nursing professionals. The moderator role of mobility in this relationship was also analyzed, as it reflects a boundary condition in which additional preparation or job opportunities may occur. The study used data from the graduates’ survey carried out by the Agència per a la Qualitat del Sistema Universitari de Catalunya (AQU) in 2017. The analysis of data from 644 graduates of Catalan Universities in 2014 highlights different functions of two types of knowledge and skills; those directly related to science and the practice of nursing are stronger predictors of retrospective satisfaction with nursing education. In turn, the perception of the usefulness of horizontal skills, such as transversal and communication skills, plays a stronger role in predicting job quality. The results about the role of mobility were not conclusive, and more research is needed to clarify its influence on nursing education and subsequent professional practice.

Does Being a Visible Minority Matter? Predictors of Internationally Educated Nurses' Workplace Integration

STUDY BACKGROUND

Nurses continue to migrate to Canada. Majority are visible minorities. Once employed, internationally educated nurses can struggle to integrate into their workplaces. A comprehensive understanding of factors that support internationally educated nurses' workplace integration is lacking, limiting our ability to design appropriate policies and practices.

PURPOSE

The aim is to (1) examine internationally educated nurses' perceptions of the extent to which they have integrated in their workplaces and the individual and contextual factors that supported their workplace integration, (2) explore whether internationally educated nurses' perceptions differed by visible minority status, and (3) identify the key factors that predict internationally educated nurses' workplace integration.

METHODS

Cross-sectional survey of 1215 internationally educated nurses. All were immigrants, permanent residents, and employed as regulated nurses. Multiple linear regression was used to examine the influence of individual and contextual factors on perceived degree of workplace integration.

RESULTS

Visible minority status had a large, statistically significant negative association with workplace integration (ß = -0.236, p < .001). Good relationships with coworkers (ß =0.043, p < .005), and continuing to develop nursing knowledge and skills (ß =0.178, p < .003), had statistically significant, positive associations with workplace integration.

CONCLUSIONS

Internationally educated nurses' visible minority status can influence their workplaces. Providing education, managerial support, and mentorship fosters internationally educated nurses' workplace integration.

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.

Internationally educated nurses' and medical graduates' experiences of getting a license and practicing in Sweden - a qualitative interview study

BACKGROUND

The Swedish healthcare system has an increased need for nurses and physicians, and the number of International Educated Nurses (IENs) and International Medical Graduates (IMGs) seeking job opportunities and a license to practice in Sweden is rising. This study explored how IENs and IMGs describe their experience of getting a license to practice, their perceptions of working in Sweden and of how their intercultural competence is utilized.

METHOD

A qualitative study based on semi-structured interviews with 11 IENs and 11 IMGs. The interviews were conducted between 2015 and 2017. The data were analyzed using qualitative content analysis.

RESULTS

Three main themes were identified: 'Getting a license - a different story,' 'The work is familiar, yet a lot is new,' 'Trying to master a new language.' The time to obtain a license to practice and finding a job was shorter for IENs and IMGs coming from European countries than for those from non-European countries. Some of the experiences of getting a license to practice and of entering a new workplace in another country were the same for nurses and physicians. In general, both IENs and IMGs felt welcomed and used their intercultural competence at work. Lack of language skills was regarded as the main problem for both professions, while workplace introduction was shorter for IMGs than for IENs.

CONCLUSIONS

Problems related to language and culture are often underestimated, therefore organizations and managers employing IENs and IMGs should provide longer workplace introduction to facilitate the acculturation process. More time-efficient language courses specifically adapted to IENs and IMGs could make the transition easier and shorten the time to obtain a license to practice for both professions.

Internationally educated nurses in Canada: perceived benefits of bridging programme participation

AIM

To examine internationally educated nurses' perceptions of the extent to which participating in bridging programmes is beneficial for preparing to practise nursing in Canada.

BACKGROUND

Internationally educated nurses continue to migrate from low-income to high-income countries. Many experience challenges when attempting to practise their profession in the destination country. Canada and other top destination countries offer educational support, such as bridging programmes, to assist internationally educated nurses' with preparing to practise nursing in the destination country. The research evidence falls short in demonstrating the usefulness of bridging programmes.

METHODS

A subsample of 360 internationally educated nurse participants from a Canadian cross-sectional survey conducted in 2014. All were permanent residents, employed as regulated nurses and participants of bridging programmes. Multiple linear regression was employed to examine the influence of internationally educated nurses' human capital (academic preparation, language proficiency, professional experience) and the economic status of their source country on perceived benefits of bridging programme participation.

RESULTS

Regression model explained 11.5% of variance in perceived benefits of bridging programme participation. Two predictors were statistically significant: source country and professional experience.

CONCLUSION

Bridging programmes help internationally educated nurses address gaps in their cultural, practical and theoretical knowledge. Source country and amount of professionally experience influences the extent to which internationally educated nurses benefit from participating in bridging programmes in Canada.

IMPLICATIONS FOR NURSING POLICY

Provides emerging evidence for decision-makers globally when developing policies and supports to help internationally educated nurses integrate into the destination country's nursing workforce.

What do employers think their role is in ensuring language proficiency of internationally trained pharmacists

OBJECTIVES

Until 2016, internationally trained pharmacists (ITPs) from the European Economic Area (EEA) did not need to prove sufficient language proficiency to the pharmacy regulator upon registration. Pharmacists themselves have a professional responsibility to ensure they can communicate and work effectively, but some responsibility also rests with employers, yet very little research has explored this. The aim of this study was to explore employer views of the communicative proficiency of ITPs whose first language was not English, their role as employers and potential implications for patient safety.

METHODS

Semi-structured, telephone interviews were conducted with seven community and two hospital employers with experience of employing EEA pharmacists, between May and July 2010. Verbatim interview transcripts were coded and analysed in NVivo using the framework approach.

KEY FINDINGS

All participants mentioned the importance of having processes in place to assure EEA pharmacists' linguistic competency in the workplace. During recruitment, different strategies were used to assure language competency. Some employers only conducted interviews while others required candidates to pass English language assessments. Participants were most familiar with the International English Language Testing System, which was described as too general and not unique to pharmacy. Other pharmacy-specific tests such as the University of Bath English Language Test and Linguarama English Assessment Test for Pharmacists were alternatives.

CONCLUSIONS

Currently, there is no one standard procedure in place to check the communicative competency of EEA pharmacists. The findings from this study suggest that there is need to establish a uniform assessment system so all the EEA pharmacists could be tested justly and consistently.