Comparative trend analysis of characteristics of internationally educated nurses and U.S. educated nurses in the United States

AIM: This study compares characteristics of internationally educated nurses (IENs) and US educated nurses in the USA and examines trends and implications. BACKGROUND: Internationally educated nurses have been an integral part of the US nurse workforce since the end of the Second World War, especially since the immigration reform in 1965. With the worsening nurse shortage, US employers are intensifying their recruitment efforts by targeting IENs. METHODS: Secondary analysis using datasets from the National Sample Survey of Registered Nurses conducted during 1977-2000 in the USA. RESULTS: Findings indicated that there were important differences between IENs and US educated nurses in their trends of demographical, educational and employment characteristics over time. As a group, IENs were younger but more experienced as nurses and better prepared educationally; worked more hours in both primary and secondary nursing positions; and were primarily employed in urban hospitals as staff nurses in direct care roles, with an increasing proportion working in extended care facilities. CONCLUSIONS: Inter-group and intra-group comparisons suggest that (a) IENs were likely to have longer, more productive nursing careers, (b) because of their demographical and employment characteristics, IENs had a greater impact on relieving the US nurse shortage per capita during 1977-2000, and (c) IENs were making increasingly important contributions to the care of Americans, particularly older Americans and those cared for in inner city hospitals.     

The migration and transitioning experiences of internationally educated nurses: a global perspective

newton s., pillay j. & higginbottom g. (2012) Journal of Nursing Management  20, 534–550 The migration and transitioning experiences of internationally educated nurses: a global perspective Aim To comprehensively review recent literature related to the migration and transitioning experiences of internationally educated nurses (IENs). Background Many developed nations are redressing nursing deficits by recruiting IENs. Acquiring credentialing is historically recognized as a barrier to obtaining meaningful employment, yet broader issues of transition into global health care contexts are also significant. Methods A database search of CINAHL, Medline, Scopus and Web of Science, and a hand-search of key nursing journals produced 239 combined hits, with 21 articles meeting the inclusion criteria. Results Five common themes were extracted and synthesized including: (1) reasons for and challenges with immigration, (2) cultural displacement, (3) credentialing difficulties and ‘deskilling’, (4) discriminatory experiences and (5) strategies of IENs which smoothed transition. Conclusions Although major reasons for migration are related to improved income and professional stature, these have overwhelmingly shown to erode upon relocation. Cultural displacement appears to largely stem from communication and language differences, feelings of being an outsider and differences in nursing practice. The deskilling process and discrimination are also key players which hinder transition and demoralize many IENs. Implications for Nursing Management The present study highlights that the huge advantages in professional skill and cultural diversity that IENs can bring to any nursing unit will not be fully realized without substantial efforts to reduce practice limitations (deskilling) and discrimination. Individual strategies for easing the transition should be taught to IENs, probably through mentorship by experienced IENs.     

Voices of internationally educated nurses: policy recommendations for credentialing

SINGH M.D. & SOCHAN A. (2010) Voices of internationally educated nurses: policy recommendations for credentialing. International Nursing Review 57 , 56–63
Background:  The authors advance general policy recommendations for credentialing Internationally Educated Nurses (IENs) who migrate to practice nursing in developed, high-income countries. While examples are drawn primarily from a qualitative study exploring IEN experiences in Canada, the suggestions presented have broader application to any nursing, or midwifery, internationally educated professionals wanting, or needing, to practice outside their home country of education. Examples of credential processing are drawn from Australia, the European Union, New Zealand, the UK and the USA.
Methods:  This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IENs volunteered to participate.
Results:  The IENs offered recommendations based on their personal experiences, all of which have policy implications to make transparent, standardize and harmonize the credentialing processes both prior to, and upon arrival in their destination country. Suggestions are offered to make relevant the content of IEN integration programmes.
Conclusions:  The authors also suggested that national immigration agencies and nursing regulatory bodies could better coordinate their activities when processing potential IEN migrant applications.     

The role of internationally educated nurses in a quality,safe workforce

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country.     

Immigration policy and internationally educated nurses in the United States: A brief history

Since the 1980s, U.S. policy makers have used immigration policy to influence the supply of nurses by allowing or restricting the entry of internationally educated nurses (IENs) into the U.S. workforce. The methods pursued have shifted over time from temporary visa categories in the 1980s and 1990s to permanent immigrant visas in the 2000s. The impact of policy measures adopted during nursing shortages has often been blunted by political and economic events, but the number and representation of IENs in the U.S. nursing workforce has increased substantially since the 1980s. Even as the United States seeks to increase domestic production of nurses, it remains a desirable destination for IENs and a target market for nurse-producing source countries. Hiring organizations and nurse leaders play a critical role in ensuring that the hiring and integration of IENs into U.S. health care organizations is constructive for nurses, source countries, and the U.S. health care system.     

Internationally educated nurses’ descriptions of their access to structural empowerment while working in another country's health care context

Aim

To examine internationally educated nurses’ experiences of empowerment structures using Kanter's theory of structural empowerment.

Background

There has been an increase in the number of nurses working in other countries worldwide and concerns have been raised regarding their working conditions.

Method

Semi‐structured interviews were conducted with a purposive sample of 11 internationally educated nurses. Directed content analysis was used to analyse the data and Kanter's theory of empowerment was used as a framework.

Results

Access to information was generally good. Access to support for their relationship with their managers varied. Regarding access to resources, nurses unfamiliar with clinical leadership found team leadership challenging. Access to in‐house learning opportunities were reported as good. Access to informal power was more common than access to formal power.

Conclusions

The findings support Kanter's theory and demonstrate that internationally experienced nurses encountered varying degrees of access to empowering structures. Access to information and formal power was more general and related to the unit. Access to resources, support, opportunities and informal power were related to both the unit and the informants’ specific situation as IENs.

Implications for Nursing Management

Managers need to support IENs when having a team leadership role, facilitate encounters between IENs and ordinary staff, and establishing mentorship for IENs.     

International nurse migration: U-turn for safe workplace transition

Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country. In this article, the authors report findings from an empirically grounded study that examines the experience of IENs who entered Ontario's workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as 'different' from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice and the role of patients and families in decision-making. In addition, problems with English language fluency cause work-related stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides important insights as policy and management decision-makers balance the tension between increasing the IEN workforce and the delivery of safe patient care.     

Acculturation and socialization: voices of internationally educated nurses in Ontario

BACKGROUND: This paper describes a study that explores the experiences of internationally educated nurses (IENs) in their efforts to gain entry to practice as Registered Nurses (RNs) in the province of Ontario, Canada. AIM: The aim was to uncover, in part, the issues related to professional nursing credentialling. METHODS: This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IEN students volunteered for this study representing the Philippines, Mainland China, Korea, Ukraine and India. FINDINGS: The findings were that the IENs progress through a three-phase journey in their quest for licensure in Ontario. These phases include: (1) hope - wanting the Canadian dream of becoming an RN in Ontario; (2) disillusionment - discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment - living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications. CONCLUSIONS: Professional regulatory nursing bodies and nursing educators, as well as practising nurses, must be aware of the potentially confusing and unpleasant processes IENs go through as they qualify for the privilege of practising nursing in Ontario.     

Ontario's internationally educated nurses and waste in human capital

Aim:  To analyse critically the waste in human capital of Ontario's internationally educated nurses resulting from unemployment or underemployment.
Background:  Globalization of the nursing workforce is resulting in more and more internationally educated nurses migrating to Canada every year. In Ontario, internationally educated nurses represent 11% of the total nursing workforce but many are unable to become registered in Ontario. According to the College of Nurses of Ontario (CNO), 40% of internationally educated nurse applicants never complete the application process and thus never become Registered Nurses in Ontario. Systemic barriers that prevent registration in Ontario can result from any of the seven requirements for completing the application process. The inability of internationally educated nurses to become registered is significant, considering the national and global nursing shortage. In addition, the inability to become registered results in tremendous waste of human capital, especially in developing countries that have invested financially in educating nurses. Although several programmes have been implemented in Ontario for internationally educated nurses, barriers exist in the design and administration of these programmes, and these are described.
Data source:  An opinion piece of international interest and a human interest piece.
Conclusion:  Internationally educated nurses face significant barriers, which prevent their integration into the Ontario healthcare system. Several policy and management strategies are outlined that could be implemented to ease their integration into the Ontario healthcare system.     

Nursing students on the frontline: Impact and personal and professional gains of joining the health care workforce during the COVID-19 pandemic in Spain

BackgroundFinal-year nursing students in Spain augmented the health care workforce during the COVID-19 pandemic.PurposeTo understand the lived experience of nursing students who joined the health care workforce during the first wave of the COVID-19 outbreak (March–May 2020).MethodQualitative content analysis of the reflective journals of 40 nursing students in Spain.FindingsThe analysis identified four main themes: 1) Willingness to help; 2) Safety and protective measures: Impact and challenges; 3) Overwhelming experience: Becoming aware of the magnitude of the epidemic; and 4) Learning and growth.DiscussionThe wish to help, the sense of moral duty, and the opportunity to learn buffered the impact of the students' lived experience. Despite the challenges they faced, they saw their experiences as a source of personal and professional growth, and they felt reaffirmed in their choice of career. Promoting opportunities for reflection and implementing adequate support and training strategies is crucial for building a nursing workforce that is capable of responding to future health crises.     

Patients’ lived experiences of a reduced intake of food and drinks during illness: a literature review

Scand J Caring Sci; 2013; 27; 184–194 Patients’ lived experiences of a reduced intake of food and drinks during illness: a literature review Aim: This study aims to identify patients’ lived experiences of having a reduced intake of food and drink during illness, through a literature review. Methods: Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink – patient experiences. (ii) Modifications related to illness – patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care – patient experiences. Findings: Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients’ individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients’ lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems. Conclusions: Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal‐related situations. Nurses need to refocus on fundamental caring.     

Experiences and management of breast cancer‐related lymphoedema: a comparison between South Africa and the United States of America

WANCHAI A., STEWART B.R. & ARMER J.M. (2011) Experiences and management of breast cancer‐related lymphoedema: a comparison between South Africa and the United States of America. International Nursing Review 59 , 117–124 Purpose: Approximately one third of breast cancer survivors are estimated to develop lymphoedema. This study was conducted in the midwestern region of the USA and in Western Cape, South Africa. The purpose of this study was to compare and contrast lymphoedema experiences and lymphoedema managements between breast cancer survivors from the two countries . Methods: Using a qualitative research design, data were collected from 29 women with a history of breast cancer‐related lymphoedema (18 women from the USA and 11 women from South Africa ) who consented to semi‐structured interviews. Findings: Six themes regarding effects of lymphoedema emerged from the study including difficulties with daily activities, unmet lymphoedema preparations, facing public curiosity, time‐consuming wrapping, trouble with fitted clothes and a reminder of breast cancer. Four themes regarding lymphoedema management included compression garments, physical activities and faith, as well as other strategies such as compression pumps or antibiotics for infection. Conclusion: Experiences about lymphoedema and its management for breast cancer survivors from both countries were somewhat similar and somewhat different. Collaboration between healthcare providers from both countries should be planned to develop culturally appropriate lymphoedema symptom management interventions for each country.     

Lived experience of medical veterans transitioning from military service to civilian nursing education

BackgroundMany veterans take advantage of the educational benefits afforded them after service. As veterans, students in higher education are a special population with subsequent needs.PurposeThe purpose of this study was to explore the lived experience of medic student veterans attending a full-time Bachelor of Science in Nursing (BSN) program.MethodThis study used the hermeneutic phenomenology research approach to explore the lived experiences of student veterans with military medic experience enrolled in a Bachelor of Science in Nursing (BSN) program.ResultsWhile our study revealed diverse student experiences among these veterans, common themes included staying true to military training, normal life, and fitting in as a university student.ConclusionsFindings in this study substantiate medic student veterans attending nursing school represent a unique cohort which can benefit from customized services from the university.     

A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom*/England

attree m., flinkman m., howley b., lakanmaa r-l., lima-basto m. & Uhrenfeldt L. (2011) Journal of Nursing Management 19, 786–802
A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom/England Aim Review nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and the United Kingdom * 1 Where UK national policies varied the English policy was reviewed.
. Background Imbalances in registered nurse (RN) supply and demand is a global, significant and recurring issue that impacts on healthcare systems, organizations, staff and patients. Method Policy Review using resources located by a systematic search of relevant healthcare databases and policies in Danish, English, Finnish and Portuguese over the time period 2003–2007. Content analysis was used to identify themes and compare policies. Results Common nursing workforce policy themes were identified across the five countries: (1) improving retention through effective human resource management, improving the practice environment and nurses’ working lives and (2) improving recruitment through attracting more new recruits and RNs back to practice, and international recruitment. The present study also identified methodological issues relating to data quality and quantity. Lack of an agreed definition and standardized measures of nursing need and shortage makes comparison and evaluation of policy effectiveness and impact difficult. Implications for Nursing Management Healthcare systems and organizations need to identify and implement effective policies that promote the retention of RNs in the workforce, or risk threats to healthcare system sustainability, as well as patient care quality and safety.