Filipino nurses in the United States: recruitment, retention, occupational stress, and job satisfaction

The experiences of internationally educated nurses who joined the nursing workforce in England

OBJECTIVES

There is limited literature on the experiences of internationally educated nurses (IENs) who have joined NHS trusts in England in the past 20 years. The objectives of this integrative review included exploring and analysing the experiences of IENs in the NHS in England and identifying the cultural, pastoral and training needs of IENs during their first 2 years working in England and providing research-informed recommendations to better support IENs.

DESIGN

An integrative review of primary research studies using quantitative, qualitative, and mixed methods of data collection. Data source: CINAHL, British Nursing Index and Google Scholar.

RESULTS

Nine articles met the inclusion criteria for this integrative review. All articles contributed to the findings of three main analytical themes: expectations, challenges and belongingness.

CONCLUSION

Limited research fully met the search criteria. This was concerning since IENs have been working in the NHS for decades, yet so few primary studies have been conducted into their experiences. The findings were in line with previous studies, which found that IENs faced challenges both in the workplace and in settling into an English way of life, and often reported feeling that they were not treated equally to their English counterparts. This integrative review raises issues and increases awareness of how the NHS in England can better support IENs transitioning into their new life and ways of working, to further aid recruitment and retention of the international nursing workforce.

Occupational Stress: A Concept Analysis with Implications for Immigrant Workers' Mental Health in the United States

Background

Occupational stress is a phenomenon affecting people worldwide. Investigating occupational stress among immigrant worker populations will unravel some of the intricacies of this condition and its psychological effects on this population.

Aim

This paper conceptually examined occupational stress within the context of immigrant workers' mental health and offer an operational definition to aid nurse researchers, educators, and practitioners in assessing and managing patients and developing culturally appropriate interventions for this population.

Design

Walker and Avant's eight-step concept analysis is used as an organizing framework.

Data Source

MEDLINE, CINAHL, OVID, PubMed, and APA Psych Info.

Review Methods

Keywords job stress, immigrant work stress, occupational stress scale, immigrant work-related stress, and mental health were used. The search yielded 142 articles; 17 were selected based on the effect of work stress on mental health.

Results

This analysis found that occupational stress can be attributed to communication problems, alienation, discrimination, and barriers to work-life balance can cause negative consequences among immigrants. An operational definition is also provided.

Conclusion

There is a growing need to examine closely and differentiate between occupational and acculturative stress to navigate a more profound understanding of how these conditions negatively complement each other.

Demographic and work-related factors associated with burnout, resilience, and quality of life among healthcare workers during the COVID-19 pandemic: A cross sectional study from Malaysia

Introduction

The healthcare setting is a stressful and demanding work environment, and healthcare workers face a continuous expansion of their job roles and responsibilities. Past studies have shown that factors affecting burnout, resilience, and quality of life among healthcare workers merit further research, as there were inconsistent findings, especially with regards to the influence of demographic and work-related factors. Therefore, this study aims to determine whether demographic and work-related factors are associated with burnout, resilience, and quality of life among healthcare workers.

Method

This cross-sectional study was conducted between February 15, 2022 and March 15, 2022, among 394 healthcare workers from Putrajaya and Selangor hospitals, Malaysia. Maslach Burnout Inventory, World Health Organization Quality of Life-BREF 26 inventory, and Brief Resilience Scale were utilized to capture information on burnout, quality of life, and resilience, respectively.

Results

The mean score of physical health of participants who work more than 10 h (11.38) is lower than participants who work from 8 to 10 h (13.00) and participants who work 7 h daily (13.03), p-value < 0.001. Similarly, the mean score of psychological health of participants who work more than 10 h (12.35) is lower than participants who work from 8 to 10 h (13.72) and participants who work 7 h daily (13.68), p-value = 0.001. Higher income levels were associated with high resilience and quality of life.

Conclusion

It is imperative that healthcare practitioners and policy makers adopt and implement interventions to promote a healthy workplace environment, address ethical concerns, and prevent burnout among healthcare workers during the COVID-19 pandemic. Managing the issue of long working hours could possibly result in improved resilience, burnout, and quality of life among healthcare workers. Despite this study able to tickle out some policy specific areas where interventions are needed, identifying effective solutions and evaluating their efficiency will require larger and interventional studies.

From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens

In the United States, nursing is the largest healthcare profession, with over 3.2 million registered nurses (RNs) nationwide and comprised of mostly women. Foreign‐trained RNs make up 15 percent of the RN workforce. For over half a century, the U.S. healthcare industry has recruited these RNs in response to nurse shortages in hospitals and nursing homes. Philippines‐trained RNs make up 1 out of 20 RNs in this country and continue to be the largest group of foreign‐trained nurses today. Recently, the news media has publicized the many deaths of Filipino RNs as a result of the COVID‐19 pandemic in the United States. Given the imperial historical ties between these two countries in the context of the nursing profession and the enduring labor inequities that persist, this nationally representative study is one of the few to our knowledge to not only quantitatively examine the current work differences in characteristics and experiences of Philippines‐trained RNs and U.S.‐trained white RNs practicing in the United States today, but to also do so from an intersectionality lens. The overall aim of this paper is to illuminate how these differences may serve as potential factors contributing to the disproportionate number of Filipino nurses' COVID‐19 related vulnerability and deaths in the workplace.

Factors associated with job satisfaction among graduate nursing faculties in Nepal

Background

Job satisfaction among nursing faculty is critical to improving quality of nursing education, producing future nurses who will contribute directly to the health of patients at a local and national level. This study explores factors associated with job satisfaction among graduate nursing faculties in different universities of Nepal.

Methods

A cross-sectional study was conducted among nursing faculty with at least one year of teaching in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered online. The questionnaire was pre-tested with 30 faculties pooled from multiple institutions. Link to the final survey was sent via e-mail to 327 nursing faculties working in 39 nursing colleges. Respondents were contacted by phone as a follow up to the email to politely remind them about the survey. Data analysis was carried out with SAS University Edition software. Chi-Square test and t-test were used for simple descriptive analysis. A multivariate binary logistic regression model was used to identify the significant factors associated with nursing faculties' job satisfaction. Adjusted odds ratio was calculated and significance was considered at p ≤ 0.05 with 95% confidence interval.

Results

The response rate was 54.4%. After retrospective cleaning of data, usable response rate was 52.3% (n = 171). The average age of the nursing faculties was 36.8 ± 7.0 years. Based on the overall job satisfaction score, 36.8% nursing faculties were satisfied with their current job. The coefficient for Cronbach's alpha was 0.895 suggesting very good reliability of the overall measure. The significant factors associated with job satisfaction were the involvement of the faculties in decision making process related to the department (OR = 4.83) and adequate access to reference materials (OR = 2.90).

Conclusions

This study suggests that nursing faculties have positive attitude towards their job but are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, such as reference books, subscription to journals, and continuing education opportunities for nursing faculties through participation in professional meetings would be helpful in improving the quality of nursing education in Nepal.

Stress of working abroad: a systematic review

Purpose

Many companies target international markets to expand their business. Companies need to manage international teams with a wide variety of skills, knowledge and values to run their business effectively; however, there are many issues of acculturation stress. Not only business travellers and expatriates, but also immigrant workers have issues adjusting to foreign culture. The aim of the present study is to identify the stress factors affecting foreign-born workers via a systematic review.

Methods

The systematic review was conducted using PubMed, PsycINFO, Embase and Cochrane Library databases. Articles on the subject of workers living abroad, such as immigrants, expatriates and business travellers, were included. The risk of bias in the included articles was assessed using the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials (RCTs), RoBANS for non-RCT studies, and CASP for qualitative studies.

Results

For the systematic review, 45 out of 14,994 articles were analysed. Six components, communication, cultural differences in the workplace, daily life, relationships with family and colleagues, financial problems and social inequality, were extracted.

Conclusion

Foreign-born workers are suffering from acculturation and occupational stress. The results of the present study can help greatly with understanding of the stress structure of working abroad.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1333-4) contains supplementary material, which is available to authorized users.

The global Filipino nurse: An integrative review of Filipino nurses' work experiences

AIM

To understand the work-related experiences of Philippine-trained nurses working globally.

BACKGROUND

The Philippines is a major source country of foreign-trained nurses located globally. However, there is paucity of research on professional factors and career related issues affecting foreign-trained nurses' work experiences.

METHODS

An integrative review through a comprehensive search of literature was undertaken from November 2015 and was repeated in August 2016. Seven articles satisfied the selection criteria.

RESULTS

Filipino nurses experienced differences in the practice of nursing in terms of work process, roles and autonomy. Moreover, they encountered challenges such as work-related discrimination and technical difficulties within the organisation.

CONCLUSION

A clear understanding of Filipino nurses' work experiences and the challenges they have encountered suggests identification of important constructs influencing effective translation of nursing practice across cultures and health systems, which then form the basis for support strategies.

IMPLICATION FOR NURSING MANAGEMENT

It is critical to recognize foreign-trained nurses' experience of work-related differences and challenges as these foster favorable conditions for the management team to plan and continually evaluate policies around recruitment, retention and support offered to these nurses. Furthermore, findings suggest internationalization of nursing framework and standards integrating a transcultural paradigm among staff members within a work organisation.

Health situation of migrant and minority nurses: A systematic review

INTRODUCTION

Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health.

MATERIALS AND METHODS

A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT).

RESULTS

Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries.

DISCUSSION

Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.

An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study

BACKGROUND

Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses.

METHODS

This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists.

RESULTS

Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility.

CONCLUSIONS

Unless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Quality of life, job satisfaction and their related factors among nurses working in king Abdulaziz University Hospital, Jeddah, Saudi Arabia

PURPOSE

To assess Quality of Life, job satisfaction and their related factors among nurses working in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

MATERIAL AND METHODS

A cross-sectional survey was conducted among 268 nurses, 2014/2015. A validated, confidential data collection sheet was utilized. It contained the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Job Descriptive Index/Job in General (JDI/JIG) scales.

RESULTS

The majority of nurses (83.5%) perceived their general QOL as very good and good. Age, marital status, having children, nationality, income, education, residence, working experience, department and shift time were associated with QOL domains (p < 0.05). Similarly, working experience, income, shifts, working in inpatient and surgical departments were associated with job satisfaction. Positive correlations were found between job satisfaction and different QOL domains, and between different JDI/JIG subscales together.

CONCLUSION

Improvement of the modifiable factors as nurses' income and shift time is needed for better QOL and job satisfaction.

Relationship between occupational stress and job burnout among rural-to-urban migrant workers in Dongguan, China: a cross-sectional study

OBJECTIVES

In China, there have been an increasing number of migrant workers from rural to urban areas, and migrant workers have the highest incidence of occupational diseases. However, few studies have examined the impact of occupational stress on job burnout in these migrant workers. This study aimed to investigate the relationship between occupational stress and job burnout among migrant workers.

DESIGN

This study used a cross-sectional survey.

SETTING

This investigation was conducted in Dongguan city, Guangdong Province, China.

PARTICIPANTS

3806 migrant workers, aged 18-60 years, were randomly selected using multistage sampling procedures.

PRIMARY AND SECONDARY OUTCOME MEASURES

Multistage sampling procedures were used to examine demographic characteristics, behaviour customs and job-related data. Hierarchical linear regression and logistic regression models were constructed to explore the relationship between occupational stress and burnout.

RESULTS

Demographics, behaviour customs and job-related characteristics significantly affected on burnout. After adjusting for the control variable, a high level of emotional exhaustion was associated with high role overload, high role insufficiency, high role boundary, high physical environment, high psychological strain, high physical strain, low role ambiguity, low responsibility and low vocational strain. A high level of depersonalisation was associated with high role overload, high role ambiguity, high role boundary, high interpersonal strain, high recreation, low physical environment and low social support. A low level of personal accomplishment was associated with high role boundary, high role insufficiency, low responsibility, low social support, low physical environment, low self-care and low interpersonal strain. Compared to the personal resources, the job strain and personal strain were more likely to explain the burnout of rural-to-urban migrant workers in our study.

CONCLUSIONS

The migrant workers have increased job burnouts in relation to occupational stress. Relieving occupational stress and maintaining an appropriate quantity and quality of work could be important measures for preventing job burnout among these workers.

Job satisfaction, work environment and intention to leave among migrant nurses working in a publicly funded tertiary hospital

AIM(S)

This study sought to explore the job satisfaction level of migrant nurses working in a multicultural society and, more specifically, the relationship between their job satisfaction levels, work environment, their intentions to leave and the predictors of their intentions to leave.

BACKGROUND

Nursing shortages have led to the increasing trend of employing migrant nurses, which necessitated studies examining nurses' migration.

EVALUATION

A cross-sectional, correlational design using a stratified random sample was conducted on 495 migrant nurses working in a tertiary public-funded hospital in Singapore.

RESULTS

The results showed that migrant nurses were satisfied with their jobs; with job satisfaction negatively correlated with work environment. Interestingly, pre-existing groups of Chinese migrant nurses did not help newly arrived Chinese migrant nurses to assimilate better. Predictors of migrant nurses' intentions to leave included having supportive nurse managers and nursing practice environment.

CONCLUSIONS

The presence of a supportive work environment is essential to retain migrant nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Health administrators need to empower nursing managers with skills to implement career development plans as part of hospitals' retention strategies for migrant nurses. Information should also be provided during recruitment campaigns to enable migrant nurses to make informed choices.

Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study

BACKGROUND

Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse.

OBJECTIVES

The aim of this study was to examine interplaying relationships between social structures and nurses' actions that either enabled or inhibited workforce integration in hospital settings.

DESIGN

Giddens' Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses' perceptions of factors affecting workforce integration.

RESULTS

Four themes were identified from the data. These were: (1) employer-sponsored visa as a constraint on adaptation, (2) two-way learning and adaptation in multicultural teams, (3) unacknowledged experiences and expertise as barriers to integration, and (4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses' performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations.

CONCLUSION

Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host country. Learning from each other in multicultural teams and positive intergroup interaction in promoting intercultural understanding are enablers contributing to immigrant nurses' adaptation and workforce integration.

Double Whammy for a New Breed of Foreign-Educated Nurses: Lived Experiences of Filipino Physician-Turned Nurses in the United States

This phenomenological study examined the lived experiences of eight self-identified Filipino physician-turned nurses working in Las Vegas in the United States. Participants were interviewed, and audiotaped interviews were transcribed verbatim. Meanings of significant statements and clusters of themes and subthemes were then generated using the Colaizzi’s (1978) method. In addition, van Manen’s (1990) existentials of lived world was adopted to interpret the collected data. The results of the study revealed that the experiences of these Filipino physician-turned nurses involved multidimensional challenges captured in three themes in context of cross-national and transprofessional migration. As a result, they faced a “double whammy” adjustment to a new cultural and work environment common to all foreign nurses (cultural adaptation) and unique identity/role change from physician to nurse (transprofessional adaptation)—that made their transition especially challenging, resulting in short-lived nursing careers at the bedside. Tailored transition programs for physician-turned foreign nurses are needed to address their transprofessional adaptation. In addition, costs and benefits of recruiting and employing physician-turned foreign nurses as direct caregivers need to be reconsidered in light of this study’s findings.