A courageous journey: Experiences of migrant Philippine nurses in Norway

[Academically educated nurses from third countries: Professional self-concept versus working life in Germany. A qualitative study using the example of migrant nurses from the Philippines]

BACKGROUND

The recruitment of internationally educated nurses is gaining relevance in Germany in response to the growing shortage of nurses. Differences in nursing qualifications and practices between the country of origin and of destination can irritate the professional self-concept and hinder professional integration.

PURPOSE

The study objective was to examine the development of the professional scope of action to unfold the professional self-concept of academically qualified nurses in Germany.

METHODS

In accordance with the episodic interview, eight guided interviews were conducted with Filipino nurses who had migrated to Germany. Data was analyzed by thematic coding.

RESULTS

The analysis shows two dimensions that impact the professional scope of action: perceived systemic constraints in the transition process and perspectives on professional development. The recruitment and recognition process is associated with high financial and time-related uncertainties and professional devaluation experiences. Migrant nurses experience both a loss of competence and a sense of foreignness in their nursing role in Germany. In order to regain professional scope of action, strategies of continuing education and focusing on more technology-intensive nursing care areas are pursued; only a minority can adapt their self-concept to the circumstances of nursing practice in Germany.

DISCUSSION

The study results demonstrate the importance of paying attention to both the competence profile and the professional self-concept of academically educated nurses in order to offer migrant nurses professional career prospects in Germany. Especially in long-term care, this has proved to be a structural problem.

CONCLUSION

To provide an attractive destination for international academically qualified nursing professionals in Germany, the ratification of international standards, the provision of transparent and independent information, utilization of existing nursing expertise as well as the establishment of career opportunities are recommended.

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.

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.

Nurse educators' views of integrating culturally and linguistically diverse future registered nurses into healthcare settings: A qualitative descriptive study

AIM

To describe nurse educators' views of how culturally and linguistically diverse future registered nurses are integrated into healthcare settings.

DESIGN

A qualitative descriptive design was adopted.

PARTICIPANTS

A total of 20 nurse educators were recruited from three higher education institutions in Finland.

METHODS

Participants were recruited in the spring of 2021 through snowball sampling. Individual semi-structured interviews were held and recorded. The collected data were analysed using inductive content analysis.

RESULTS

The performed content analysis identified a total of 534 meaning units from the data, which were categorized into 343 open codes and 29 sub-categories. Furthermore, nine categories were identified and categorized into three main categories. The first main category was pre-graduation and represented a time point during which educators experienced early integration, nurse educator support and cooperation with stakeholders. The second main category was integration strategies into healthcare settings, which included workplace strategies, language competence and individual competencies and attributes. The third main category was the post-graduation experience, during which educators reported organizational readiness, migration and efficacy of the integrational model.

CONCLUSIONS

The results revealed a need for increased resources linked to how nurse educators support the integration of culturally and linguistically diverse future registered nurses. Moreover, a nurse educator's presence during the last clinical placement, early transition and integration was found to exert a significant effect on the smooth integration of culturally and linguistically diverse future nurses.

IMPACT

This study establishes the need to enhance stakeholder cooperation between universities and other organizations towards supporting the integration process. Maximizing nurse educators' support during the final clinical practice, early transition and post-graduation allows for successful integration and intention to stay.

REPORTING METHOD

This study was reported according to the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC PARTICIPATION

Participating educators shared their experiences of culturally and linguistically diverse future nurses' integration.

Draining the specialized nursing brains, the emigration paradigm of Ghana: A cross-sectional study

AIM

The study aimed to determine the emigration intentions of specialist nurses (SNs) and ascertain the influencing factors, implications and mitigating factors in Ghana.

DESIGN

A cross-sectional study.

METHODS

The sample was composed of 225 participants conveniently selected from a tertiary facility in Ghana. A turnover intention scale and the researchers' developed questionnaire were used to collect the data between June 1 and September 30, 2021. Data were analysed through descriptive statistics and linear regression.

RESULTS

The composite mean score for specialist nurses' intention to migrate was high (mean = 3.43); and the push factors accounted for the intentions explaining 48.6% of the variation (R2  = 0.486, F(5, 219)  = 38.46, p < 0.001). The associated challenges of specialist nurses' emigration are increased cost of training new specialist nurses, poor quality of specialist nursing care, burnout syndrome among staff and poor patient health outcomes.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

Ex-Migrant Nurses Empowerment after Recovery from Covid-19 Pandemic: An Analysis of Reflective Cycle Gibbs Model

During the Covid-19 outbreak, many ex-migrant nurses who had resigned and were living in Indonesia were unable to return to work. The objective of this study is to develop strategies for empowering ex-migrant nurses in the sustainable healthcare sector following the recovery from the Covid-19 pandemic. The Reflective Cycle Gibbs (RCB) model was employed during the research, which comprised six stages that began with a document review and PRISMA analysis. The PRISMA Analysis utilized Google search engines to filter documents from Google Scholar, Research Gate, and other sources. The RCB model examined 10 eligible journals and discovered records of nurses who returned to their home country due to inadequate pay, career development, workforce protection policy, and empowerment facilities. We concluded 4 problems encountered by returnee nurses i.e. lack of protection policy, poor wages, less career development, and lack of empowerment facilities.

Internationally educated nurses and resilience: A systematic literature review

Aim

To synthesize knowledge extracted from the literature about protecting factors and challenges to resilience, among migrant nurses, and specifically how knowledge synthesized through the process of the literature review is relevant to nursing and health policy.

Background

How nurses, in general, face challenges is well documented and is often linked to the concept of resilience; however, there seems to be a lack of systematic knowledge synthesis focusing on the resilience of internationally educated nurses following migration.

Method

The review was guided by the PRISMA guidelines, and a systematic search of peer‐reviewed qualitative and mixed‐method articles reporting empirical research was performed in the MEDLINE, CINAHL, PsycINFO and Academic Search Ultimate databases. Methodological rigour was assessed by the Joanna Briggs’ checklist, and a structured theme‐based ecological framework, inspired by Ungar's model of resilience, was chosen.

Results

Following critical appraisal, 37 studies were included that identified both challenges and individual, contextual and structural protective factors in host countries and are linked to resilience.

Discussion

Resilience of internationally educated nurses depends on a combination of individual and contextual protective factors, with the major emphasis being placed on individual protective factors. It is crucial to consider resilience in ensuring that internationally educated nurses’ experience is appreciated, as this is necessary if nurses are to deliver the best possible health service while integrating into their host country.

Implication for nursing and health policy

Authorities, managers in clinical practice and education, trade unions and nurses in general should be aware of the coping strategies, the strengths and supportive factors that can promote resilience and be aware of the challenges that undermine resilience and negatively impact internationally educated nurses’ practice and social interactions.

Centering Black feminist thought in nursing praxis

Femininity and whiteness dominate Western nursing, silencing ontologies and epistemologies that do not align with these dominant norms while perpetuating systemic racism and discrimination in nursing practice, education, research, nursing activism, and sociopolitical structures. We propose Black feminist thought as a praxis to decenter, deconstruct, and unseat these ideologies and systems of power. Drawing from the work of past and present Black feminist scholars, we examine the ontological and epistemological perspectives of Black feminist thought. These include (i) the uniqueness and particular experiences of people, (ii) the acceptance of ontological and epistemological pluralism of truths and ways of knowing, and (iii) the mandate for equity in the health, social, political, and environmental structures of society. By focusing our attention on lived experiences and voices of those systematically excluded in nursing practice, education, research, and society, Black feminist thought offers an anticolonial, antiracist, and antidiscriminatory foundation for more effectively upholding nursing's disciplinary mandate for social justice and equity.

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.

Surviving the employment gap: a cross-sectional survey of internationally educated nurses

AIM

To examine the extent to which the type of financial assistance (personal resources, social programmes and earnings) and source country influence the length of time for internationally educated nurses to secure employment as regulated nurses in Canada.

BACKGROUND

Internationally educated nurses must professionally recertify in order to work as regulated nurses in Canada. For many, it can be a lengthy, cumbersome and costly process that delays employment, while others recertify and secure employment quickly. Financial assistance in the form of personal resources, or from social programmes or earnings from working could contribute to the length of time to recertify. When internationally educated nurses cannot readily recertify, they turn to survival jobs where they can remain and never practice their profession in Canada or leave the country to work in jurisdictions where it easier to obtain professional credentials.

METHODS

Data were collected via cross-sectional survey of internationally educated nurses (n = 1186) who were immigrants, permanent residents and employed as regulated nurses. Multiple linear regression was employed to examine the influence of the type of financial assistance (personal resources, social programmes and earnings) and source country on time to regulated nurse employment.

RESULTS

Regression model explained 9.3% of variance in time to regulated nurse employment. Three predictors were statistically significant: source country, social programmes and earnings. Personal resources was not a significant predictor.

CONCLUSION

Financial assistance helps internationally educated nurses survive the regulated nurse employment gap. The type of financial assistance and source country influences the length of time to regulated nurse employment.

IMPLICATION FOR NURSING AND SOCIAL POLICY

Provides initial evidence to support the development of policies, and educational and social programmes to assist internationally educated nurses with financially surviving the gap in regulated nurse employment.