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.

Managing for quality aged residential care with a migrant workforce

Given the growing demand for aged residential care facilities in Western industrialised economies, the adequate staffing of these facilities is a growing concern. Increasingly migrant care workers are being employed to fill the local labour shortfall. In this paper we present findings of a qualitative study exploring how managers of aged residential care facilities work to ensure consistent delivery of quality care through their migrant care workers. The issues raised by the 16 managers cluster around three themes: communication and language barriers; racism by residents, families and managers; and underemployment of tertiary qualified migrant care workers. In addition to issues of quality care delivery, concerns around migrant employee well-being are seen to be difficult to avoid.

Working with difference: Thematic concepts of Japanese nurses working in New Zealand

The purpose of this study was to compare the differences experienced by Japanese nurses working in New Zealand from an organizational and personal perspective, using a qualitative approach. Interview data was analyzed using a thematic method to abstract increasing levels of themes until one main theme explained the data: finding a voice. This core theme demonstrated that Japanese nurses had to learn to accommodate difference while learning to speak up. Moreover, this needed to occur through a number of cultural filters. The principal conclusion was that migrant nurses face multiple personal and organizational challenges when working in a new environment. Finding a voice is the method in which nurses learn to communicate and work within new healthcare settings. Nurses use a number of filters to manage the transition. The host country needs to recognize these differences and accommodate them through orientation modules.

Nurse migration from India: a literature review

BACKGROUND

A profound nursing shortage exists in India where nurses are increasingly outmigrating to practice nursing in surrounding countries and abroad. This is important globally because countries with the lowest nursing and healthcare workforce capacities have the poorest health outcomes.

OBJECTIVE

This review sought to synthesize and unify the evidence about nurse migration from India and includes a look at nurse retention within India.

DESIGN

A comprehensive literature review was performed to synthesize and unify both qualitative and quantitative research.

DATA SOURCES

Bibliographic databases searched included CINAHL, MEDLINE, PsycINFO, and EconLit using associated keywords for empirical and descriptive literature published between January 2004 and May 2014. Hand searches of the Nursing Journal of India from 2004 to February 2014 and the Journal of Nursing Research Society of India from its inception in 2007-February 2014 were also completed.

REVIEW PROCESS

29 studies were selected and analyzed for the review. Data were appraised for quality; reduced through sub-categorization; extracted; and coded into a framework. Thematic interpretation occurred through comparing and contrasting performed by multiple reviewers.

RESULTS

Findings included an exponential growth in nurse recruitment efforts, nurse migration, and a concomitant growth in educational institutions within India with regional variations in nurse migration patterns. Decision-making factors for migration were based on working conditions, salience of family, and the desire for knowledge, skill, technology, adventure and personal enrichment. Challenges associated with migration included questionable recruiting practices, differing scopes of practice encountered after migration and experiences of racism and cultural differences. A shift toward a positive transformation of nursing status in India has resulted in an increased respect for individual nurses and the profession of nursing. This was attributed to the increased globalization of nursing.

CONCLUSIONS

Results from this review can be used to shape health policy and advocate for nursing reform in India. As India's healthcare infrastructure continues to evolve, effective programs to improve conditions for nurses and retain them in India are needed. Additionally, as the globalization of nurses increases, more research is needed to develop effective programs to aid in a smooth transition for nurses who migrate from India.