Internationally Educated Nurses Research Articles

Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis.

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

From EAP to ESP

English for Academic Purposes (EAP) and English for Specific Purposes (ESP) are language training pathways for students to meet target language proficiency requirements towards further tertiary studies (Keefe & Shi, 2017; Walková & Bradford, 2022). Yet, these can be highly debatable terms, controversial over their appropriate usage (Flowerdew, 2016; Li, 2020; Maleki, 2008; Mpofu & Maphalala, 2021; Wette, 2018). A main reason for this discord is a lack of firm definitions between these two constructs, which leads to vague and blurred boundaries. This article will describe the process where a small western Canadian university modified an existing EAP course consisting of broad reading and writing topics into an ESP one with a narrow culturally and medically themed focus towards internationally educated nurses (IENs). These modifications assisted in the identification of the similarities and differences of both EAP and ESP for the institution. The new ESP course, piloted over two terms was found to have strengthened student outcomes in their non-native target language, commonly known as L2 (Saville-Toike, 2012) while their disciplinary knowledge contributions also enriched the curriculum. Rooted within the debate between determining appropriate language pathways, recommendations to determine the suitability of an EAP versus an ESP course within a “negotiated syllabus” utilizing learner input are offered (Breen & Littlejohn, 2000; Prior, 2020).

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

The number of internationally educated nurses working in the NHS has skyrocketed over the past three decades. This study examines their experiences of working and living 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.

Innovative nursing employment initiatives to strengthen and sustain the health workforce in Canada.

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

Recognition of nursing qualification and credentialing pathway of Filipino nurses in Finland: A qualitative study

AbstractAimTo understand the experiences of Filipino internationally educated nurses (FIENs) on their recognition and credentialing pathway in the recruitment process in Finland.BackgroundThe 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.MethodsA 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.ResultsThree 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.ConclusionsPre‐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 policyRecognition 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.

A47Supporting internationally educated nurses reach their full career potential and deliver safe and effective patient care through simulation-based communication skills training

Between April and September 2022, 11,496 internationally educated nurses (IENs) registered with the NMC for the first time, which is 606 less than those domestically educated within the same timeframe [1]. To register, IENs must pass OSCEs and although globally assessed, there is no specific communication skills assessment [2]. A literature review identified challenges associated with integration into culturally different healthcare systems, most notably communication barriers; however, it found that with good support it is possible for IENs to achieve their full career potential [3]. To support local healthcare trusts and IENs, our organization designed a simulation-based educational programme to address the aforementioned barriers. To ensure a non-paternalistic approach, IENs lived experiences allowed the development of authentic, co-produced simulated scenarios. Actors were trained for the roles, and learning outcomes and debriefing processes were shared in advance. To assist participants with their skills, a model of communication was introduced, enabling them reference to a framework whilst participating and observing. Eight groups of six IENs have participated over eight months. Thematic analysis identified themes in which IENs wanted to be upskilled, these were integrated into multi-faceted simulated scenarios: Distressed relatives – IENs reported struggling setting appropriate boundaries and dealing with conflict with emotive relatives. Difficult conversations with patients – IENs felt ill equipped to communicate with challenging patients due to anxiety through language and cultural barriers leading to avoidance of engagement, further exacerbating the issues. Differing patient agenda – IENs struggled to manage patients who were not engaging with recommended multi-disciplinary interventions, due to a poor understanding of the MDT agenda. Hierarchical adjustment – IENs typically came from countries with a more established hierarchy and did not feel confident clarifying doctor’s decisions even if concerned. Evaluation linked to the learning outcomes; a rating scale from 1 (no ability/confidence) to 5 (excellent ability/confidence). 48 IENs have undertaken this training and all report progression in ability and confidence, with ongoing applicability of their learning within the workplace. The number of IENs is increasing within the NHS with recent records indicating NMC registrations being equal between domestic and internationally educated nursing staff. A repeatable simulation-based communication skills workshop has been developed based upon the lived experiences reported by IENs. Further deliveries are planned with subsequent quantitative and qualitative analysis. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Bilingual modified flipped learning in international nursing education: A discursive approach

Finland is experiencing a nurse shortage, leading to the recruitment of internationally educated nurses (IENs). The Finnish education system aims to attract more international students, including those in healthcare. International nursing students (INS) face challenges due to language barriers and cultural differences. This paper introduced the bilingual modified flipped learning (BMFL) approach to address these issues. The BMFL, grounded in constructivist learning theory, incorporated flipped learning and learning stations to facilitate INS integration. It emphasized autonomy and collaboration, with students engaging in pre-class content and in-class interactive activities. The strategy enhanced language skills, clinical decision-making, and communication. Policy and practice recommendations were proposed to support the integration of BMFL, targeting the alleviation of nurse shortages and facilitating the harmonious integration of INS into the Finnish healthcare workforce.

Linguistic racism towards internationally educated nurses in Finland: Critical reflective analysis.

The shortage of nurses in Finland has prompted the recruitment of Internationally Educated Nurses (IENs) from developing countries mostly with fragile health systems. However, linguistic racism has emerged as a growing threat to the safety and well-being of IENs in the country. To discuss the consequences of linguistic racism directed towards IENs and to propose solutions to address this issue. This discussion employed self-reflection as a means of engaging in critically reflective analysis. The discussion highlighted the factors contributing to linguistic racism, including poor language proficiency, misrepresentation of the nursing profession due to skin color, and political tensions. The phenomenon of linguistic racism affects IENs' communication with patients and colleagues and has a detrimental impact on the mental health and overall health of IENs. To address the issue of linguistic racism, this discussion proposed a comprehensive strategy that includes anti-racism training for healthcare personnel, the establishment of a conducive workplace culture that fosters diversity and inclusivity, and the provision of adequate assistance and support for IENs.

Internationally educated nurses' role in climate change: sustainability and mitigation practices.

There are three related factors affecting climate change and its relationship to the migration of IENs: 1) corporate social responsibility; 2) the code of ethics for nurses; and 3) nursing education. As the highest producer of carbon dioxide emissions, the Global North especially the Nordic Region must also consider its climate change responsibilities when recruiting nurses from the Global South. The aim of this article is to discuss the factors affecting climate change and its relationship to the migration of IENs, as well as possible solutions to mitigate its impact. Climate change is impacted indirectly by the movement of internationally educated nurses (IENs). The Nordic countries need to consider checking climate change measures in the sustainability plans for recruitment companies when approving permits allowing the recruitment of nurses. Policymakers and decision-makers need to consider climate change and GHG emissions factors when collaborating with recruitment agencies to recruit IENs from the Global South. International nurse recruitment policies must be ethical, economically sustainable, and planet-centered.

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce.

From Recruitment to Retention: Evaluating the Experiences of Internationally Educated Nurses in the Supervised Practice Experience Partnership.

Accompanied by an unparalleled nursing shortage, the COVID-19 pandemic has prompted a nationwide health human resource recruitment drive focused on internationally educated nurses (IENs). The Supervised Practice Experience Partnership (SPEP) is a provincial strategy that provides IENs the opportunity to attain their supervised practice experience in Ontario. In order to sustain the nursing workforce, there is a need to go beyond recruitment strategies and implement evidence-informed approaches that retain IENs after meeting their registration requirements. Mixed-methods surveys and focus groups were used to evaluate the experiences of IENs, their preceptors and nurse leaders working with the SPEP. The findings highlight the value of mentorship and support from nurse leaders in developing communication skills, building connections with teams, fostering cultural integration and establishing support networks for IENs. This paper enhances nurse leaders' understanding of the experiences of IENs and establishes a foundation for innovative ideas that facilitates their integration and retention.

Education Environment and Role Transition of Internationally Educated Nurses Enrolled in a Practical Nursing Bridging Program in Ontario, Canada

The purpose of this study is to explore a practical nursing bridging program’s education environment and the role transition of internationally educated nurses (IENs) who were enrolled full-time at a community college in Toronto, Canada, during the winter semester of school year 2018–2019. A survey questionnaire consisting of three parts was used to gather data from 68 IEN students who volunteered to participate in this study. Descriptive statistics and multiple regression analysis were used to analyze data. Participants’ responses to the open-ended question “Could you please list any problems/issues you have encountered in the bridging program?” were thematically analyzed. Results indicate that all bridging program education environment components, as well as role transition subscales, were described as “agree.” There is a significant relationship between the respondents’ perception of learning within their bridging program’s education environment and role transition. However, views on teachers and atmosphere, as well as academic and social self-perception, seemed insignificant predictors of role transition. Participants’ responses to the open-ended question were analyzed and grouped into four themes: concern with teachers, program content issues, program pace, and financial issues.

The Ethical Recruitment of Internationally Educated Nurses: A Leadership Perspective on Labor Migration

The trend in labor migration depends on variables such as the country’s economy, immigration policy, aging and population health, and the health care industry’s supply and demand prospects. The World Health Organization (WHO) and the Migration Policy Institute reported a steady rise in hiring international educated nurses with developed countries relying on foreign-born nurses to fill vacancies. According to a survey conducted by the International Council of Nurses in 2020, the National Nurses Association reported a 20% increase in nurses leaving the profession. The aging nursing workforce, heavy workload, insufficient staffing, burnout, stress, mass trauma, and the growing effects of COVID-19 on nurses’ psychosocial and emotional health exacerbated the nurses’ intention to leave. Although health care organizations are strained dealing with the outbreak, nurses are either retiring or quitting, leaving administrators to rely on temporary employees while struggling to fill permanent positions. This cyclical nursing shortage in the past, now exacerbated by the global pandemic crisis, has prompted policymakers to revisit the WHO’s Code on recruitment of health workers and its impact on sending and receiving countries.

Commentary: Transition of Internationally Educated Nurses into Practice: What We Need to Do to Evolve as an Inclusive Profession over the Next Decade.

Confronted with a pandemic amid a nursing shortage and an aging and culturally diverse patient population, nursing leaders need to explore innovative ways to meet increasing human resource demands to ensure patient safety. Internationally educated nurses (IENs) are an untapped resource to sustain the nursing workforce and provide culturally appropriate care. Based on the authors' lived experience and knowledge in supporting IENs, this commentary highlights the challenges that threaten the integration of IENs into the Canadian nursing workforce. It also recommends practical strategies to address these challenges, guide innovative and sustainable change and unpack systemic barriers to achieve organizational diversity and equity.

Multiorganizational Partnerships: A Mechanism for Increasing the Employment of Internationally Educated Nurses.

Internationally educated nurses (IENs) face multiple challenges in entering and integrating into the Canadian workforce. These challenges include getting to know the Canadian culture, nursing accountabilities, professional practice requirements and experience or qualifications deemed not equivalent to the Canadian standard. Hamilton Health Sciences' (HHS') IEN Integration Project has been funded by the Ontario and Canadian governments to support IENs in overcoming these challenges and contribute to the healthcare system. The aim of this article is to describe a multiorganizational project that prepares IENs for employment in Canadian healthcare. HHS invited partners in education and immigrant support services to co-design the project. A community collaboration employment model (CCEM) was developed to leverage each partner's strengths in targeted interventions to address the needs of IENs, as identified in focus groups. The interventions pertain to professional practice and accountability in the Canadian healthcare setting, workplace language, communication and selected clinical skills. Between project initiation in 2009 and early 2021, 591 IENs obtained employment. Multiorganizational partnerships can help build and sustain a strong nursing workforce, and IENs can fill gaps in care. A needs-based approach and the CCEM increased the likelihood of IEN employment. The ability of the CCEM to engage partners makes it relevant for healthcare organizations.

Diversifying the health workforce: a mixed methods analysis of an employment integration strategy

BackgroundHistorically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions.MethodsA mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted.ResultsIn total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer.ConclusionsThe project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

Reducing Barriers and Achieving Success in Registration Examination Among Internationally Educated Nurses: A Participatory Action Research Project.

Multiple challenges impede the Internationally Educated Nurses (IENs) professional development and success in writing the registration examination. This paper aims to explore these challenges and describes the educational program which adopts a tailored mentoring approach to facilitate their successful completion of the registration exam.Methodology: Participatory Action Research model informed the development and revision of the educational process. For this qualitative study, individual 1:1 audiotaped and telephone interviews were conducted among the initial participants to explore their experiences in the program. Findings from this study provided more insights as to participants' success in passing registration examination and enhanced performance in their clinical practices. From the thematic analysis, we interpreted the IEN's journey in their knowledge transition into four major themes: Acknowledging the barriers, Learning the new culture, Making progress, Transitioning into power. This project demonstrated that the integration of a strong mentor-mentee relationship that gives voice to the participants' learning experience so as to meet their knowledge gaps, engenders a deeper understanding of Canadian professional nursing practice, positions them for success in writing the registration examination and builds a sense of empowerment among them.

Experiences of nurses educated outside the European Union of a Swedish bridging program and the program\u2019s role in their integration into the nursing profession: a qualitative interview study

BackgroundCountries 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.MethodsA 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.ResultsTwo 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.ConclusionsThis 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.

Objective structured clinical exam: how clinical nurse educators can support internationally educated nurses.

Internationally educated nurses (IENs) require robust teaching programmes to support them through the objective structured clinical exam (OSCE) process to gain registration with the Nursing and Midwifery Council. There should be measures in place to support these nurses from a clinical and pastoral perspective. It is also important to learn from IENs, because moving to a different country is an emotional and life-changing experience that affects nurses and their families. Preparation is central to completing the programme successfully, alongside having the resources required in terms of time and a dedicated facility for practise. This article describes the development and implementation of an OSCE preparation teaching programme to support IENs, discusses the challenges for teachers and participants, and shows how having a dedicated facility and programme lead has led to excellent results.

Transition-to-U.S. Practice Experiences of Internationally Educated Nurses: An Integrative Review.

Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs' outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs' description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.