Playing the game: a grounded theory study of the integration of internationally qualified nurses in the Australian healthcare system

Abstract

Background Twenty-nine per cent of registered nurses in Australia received their first nursing qualification in a country other than Australia. Therefore, understanding the process of successfully transitioning internationally qualified nurses into a foreign healthcare system is vital to ensure the provision of safe, quality nursing care for all Australians. Aim The aim of this study was to explore how internationally qualified registered nurses and Australian qualified registered nurses adapt to working together in the Australian healthcare system and develop a theory that explains this process. Research question What is the process by which internationally qualified registered nurses are integrated into the Australian healthcare system? Methodology Grounded theory methodology was used in this study. Concurrent data collection/generation and analysis of online survey data (n = 186) and individual participant interviews (n = 15) was undertaken. Storyline was used as a technique of advanced analysis to integrate and present the theory. Two focus groups (n = 9 and n = 7) were held to evaluate and validate the theory. Findings International and Australian nurses work together to enable the successful integration of international nurses into practice. Four phases underpin professional socialisation, enculturation and adaption to the cultural norms of the workplace: (i) joining the game: adapting to context—observing and learning the cultural norms; (ii) learning the game: becoming socialised—receiving support; (iii) playing by the rules: aligning scope— communicating for quality care; and (iv) the end game—integration. These phases interconnect to form the final theory of 'playing the game'—a grounded theory of the integration of international nurses in the Australian healthcare system. Discussion Nurse migration trends to Australia have seen an increase in international nurses from developing countries. Context of the work milieu as the dynamic playing field is instrumental in understanding how authentic leadership and positive work environments support integration processes. Consequences for unsuccessful integration are significant and result in: negative work environments; patient dissatisfaction; adverse events; damaged reputations of registered nurses, organisations and the profession; and loss of skilled and experienced registered nurses from the profession. Conclusion The findings of the research are significant for the nursing workforce in Australia in relation to the recruitment, retention and integration of experienced registered nurses. Promotion of cultural responsiveness education and integration strategies prevents the attrition of experienced registered nurses. Recommendations are made to inform policies and practices for sustaining a workforce that will provide quality nursing care for all Australian citizens, regardless of the place of origin of the nurse or where they obtained their initial nursing qualification.