Internationally Educated Nurses in Transition in the United States: Challenges and Mediators

Impact of Nurse Manager's Attributes on Multi-Cultural Nursing Teams: A Scoping Review

BACKGROUND

As global migration increases, nurse managers' effectiveness in multi-cultural nursing work environments is crucial due to the rising cultural diversity within healthcare teams. Despite the increasing international recruitment of qualified nurses to address the worldwide nursing shortage, no studies have synthesised the impact of nurse managers' attributes on nurses in multi-cultural nursing teams. Therefore, it was conducted a literature review aimed to synthesise the available literature on how nurse managers' personality traits, competencies, behaviours, and leadership styles influence nurse outcomes in multi-cultural nursing teams.

METHODS

Scoping review conducted according to the Joanna Briggs Institute guidelines to map the relationship or influence of nurse managers' personality traits, competencies, behaviours, and leadership styles on the outcomes of nurses in multi-cultural settings across various clinical environments. Searches were conducted across electronic databases such as CINAHL and MEDLINE, along with grey literature.

RESULTS

This review included 39 studies, highlighting 29 personality traits, 9 competencies, 115 behaviours, and 5 leadership styles that impact nurses' outcomes. Key findings emphasise the importance of nurse managers being supportive, culturally competent, and effective communicators, with transformational leadership style being particularly beneficial.

CONCLUSIONS

These findings provide insights for planning and developing training programmes to equip current and future nurse managers with skills to effectively lead in multi-cultural care settings.

Internationally Educated Nursing Staff Caring for Older Adults: A Scoping Study

INTRODUCTION

Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings.

METHOD

Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted.

RESULTS

Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged.

DISCUSSION

Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches.

Transitioning experiences of internationally educated nurses in host countries: A narrative systematic review

Background

The shortage of nurses worldwide is a well-known issue that has changed the health and social workforce picture. Increased recruitment and migration of internationally educated nurses in the health and social care workforce pose many risks to successful integration into the healthcare system. Understanding the barriers and enablers affecting their integration in their host countries is imperative.

Objective

To critically and systematically review the current literature to explore the transitioning experiences of internationally educated nurses to understand the enabling influences affecting their workforce integration into their host countries.

Design

A narrative systematic literature review was conducted. This study was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD42023401090). The study results were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods

A comprehensive literature search using the search engines CINAHL, MEDLINE, PsycINFO, Academic Search, and PubMed was conducted. Only peer-reviewed papers written in the English language were included. Primary research studies published between 2019 and 2023, which explored the lived experiences of internationally educated nurses, were considered for review.

Results

Seventeen studies (16 qualitative and one quantitative) were included in the review. Three main themes were developed: (1) push and pull factors that mediated internationally educated nurses' migration experiences, (2) one-way integration logic, and (3) expectations versus reality.

Conclusions

There is a need for a comprehensive and collaborative organisational approach to enhance the integration experiences of internationally educated nurses into their host countries. This can also ensure their contribution is recognised and will help them fulfil the responsibilities of their role and become influential team members within their organisations. This comprehensive and collaborative approach is also required to tackle discrimination, racism, communication and language barriers. Addressing these challenges can improve internationally educated nurses' job satisfaction and, thereby, improve retention.

Tweetable abstract

A new systematic review study explores barriers and enablers for optimising internationally educated nurses' experiences of working in their host country @cathy_Henshall @clairmerriman9 @annemarieraffer.

Human Rights and Bioethical Considerations of Global Nurse Migration

There is a global shortage of nurses that affects healthcare delivery, which will be exacerbated with the increasing demand for healthcare professionals by the aging population. The growing shortage requires an ethical exploration on the issue of nurse migration. In this article, we discuss how migration respects the autonomy of nurses, increases cultural diversity, and leads to improved patient satisfaction and health outcomes. We also discuss the potential for negative impacts on public health infrastructures, lack of respect for cultural diversity, and ethical concerns related to autonomy and justice, including coercion and discrimination. This analysis is written from a rights-based ethics approach by referring to rights held by nurses and patient populations. Nurse migration highlights conflicts between nurses and between nurses and healthcare systems. Increased awareness of ethical challenges surrounding nurse migration must be addressed to enhance the well-being of nurses and patient populations.

Experiences of nurses educated outside the European Union of a Swedish bridging program and the program's role in their integration into the nursing profession: a qualitative interview study

BACKGROUND

Countries all over the world are experiencing a shortage of registered nurses (RNs). Therefore, some countries, including Sweden, have tried to solve this by recruiting internationally educated nurses (IENs). Countries offer bridging programs as educational support to qualify IENs for nursing work in the destination country. However, there is little research on IENs' experiences of bridging programs in European countries and how these programs facilitate their integration into the world of work and their new society. The aim of this study is to explore the experiences of nurses, originally educated outside the EU (European Union)/EES, of the Swedish bridging program and of the program's role in facilitating their integration into the nursing profession in Sweden.

METHODS

A qualitative descriptive design was used to explore the topic based on 11 informants' perspectives and experiences. Purposive sampling was used to recruit participants at one university in Sweden. Data were collected by individual interviews using a semi- structured interview guide during the year 2019 and were analysed using an interpretative thematic approach.

RESULTS

Two main themes emerged from the analysis: 1) Return to nursing, and 2) The bridging program as a tool for transition to nursing in Sweden. The first theme includes conditions and experiences such as personal motivation and determination, and support from others that the participants described as important in order to achieve the goal of re-establishing themselves as registered nurses in Sweden. Furthermore, the second theme describes the participants' experiences of the bridging program as mostly positive because it led to new learning and achievements that were valuable for the transition to nursing in Sweden; however, the participants also emphasised the challenges of their transition into the nursing profession, which were related to instances of misrecognition of their professional competence and the uncertain outcome of the program.

CONCLUSIONS

This study found that the bridging program facilitated integration into the nursing profession for nurses educated outside the EU/EES, especially knowledge gained in clinical-based training. Thus, it is important to recognise and value the IENs' experience and previous knowledge and training when developing the bridging program's curriculum.

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.

Breaking through the dilemma of whether to continue nursing: Newly graduated nurses' experiences of work challenges

BACKGROUND

Newly graduated nurses (NGNs) often encounter unique work challenges.

PURPOSE

To discover Taiwanese NGNs' experiences of work challenges.

METHOD

An interpretive qualitative design was chosen. In-depth interviews were completed with 25 NGNs working in clinical settings in Taiwan. Data were analyzed using content analysis.

RESULTS

The essential structure of NGNs' experiences of work challenges was described as struggling and breaking through the dilemma of deciding whether to continue nursing or quit. Four themes with ten subthemes were identified: 1. being tense as if walking on thin ice (fear of making mistakes, uncertainty of decision making for care practice); 2. suffering physical exhaustion and mental stress(work overload and shiftwork, the burden to be expected, unfamiliar work culture); 3. entering and adjusting to the profession (assessing self and deciding whether to stay in nursing, building up competency); and 4. gaining more confidence(problem solving, emotional control, finding an appropriate way for oneself).

CONCLUSIONS

Findings indicate the significance of such experiences, and the results are useful for clinical instructors and administration to help NGNs overcome challenges.

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.