Return to Nursing: A Meta-Synthesis of Academic Bridging Programs’ Effect on Internationally Educated Nurses

This meta-synthesis explored the effect of bridging programs on internationally educated nurses (IENs). Eight papers that met the inclusion criteria were selected for this review. There were 437 participants from eight studies who come from different parts of the globe and who settled in either Australia, Canada, New Zealand, or the United Kingdom. Using a grounded theory approach for data analysis, four effects of bridging programs on IENs were identified. These are: (a) the concepts from the regulatory body, the client-centred care; (b) do something better for us, for our future; (c) we have to learn English; and, (d) faculty, program coordinator and preceptors that were willing to work with them. These effects were defined and explored in light of the study samples selected for this study

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. Résumé En 2014, une équipe d’infirmières et infirmiers enseignants en Ontario, au Canada, et défenseurs des infirmières et infirmiers formés à l’international, s’est réunie pour aborder la question du soutien à la transition des infirmières et infirmiers formés à l’international vers la pratique, comme une voie pour aider à remédier aux pénuries d’effectifs infirmiers. Des cours ont été élaborés grâce au financement du gouvernement de l’Ontario et au soutien en matière de politique et de coordination du Conseil des universités de l’Ontario, afin de piloter un cheminement éducatif de transition pour les infirmières et infirmiers formés à l’international. L’équipe du corps professoral de quatre universités ontariennes a utilisé une approche de consortium pour regrouper l’expertise provinciale en formation des infirmières et infirmiers formés à l’international. Ce qui a commencé comme une sélection de cours ciblés fondés sur les compétences a depuis évolué pour devenir un programme d’études complet de transition pour le développement des compétences attendues en Ontario, aligné sur d’autres programmes de transition offerts dans la province pour les infirmières et infirmiers formés à l’international. Cet article décrit le processus initial du groupe, de 2015 à 2018, pour créer des cours d’apprentissage essentiel fondés sur les compétences permettant de développer les compétences ciblées pour l’accès à la pratique infirmière par l’inscription au tableau de l’Ordre des infirmières et infirmiers de l’Ontario. Les obstacles qui les empêchent de satisfaire aux exigences de compétences pour accéder à la pratique et la façon dont étaient comblés les écarts existants pour les infirmières et infirmiers formés à l’international vers un baccalauréat en sciences infirmières en Ontario sont également abordés. Cet article explore comment l’Ontario peut répondre aux pénuries croissantes d’effectifs infirmiers et à la nécessité de s’engager de manière éthique et de retenir des infirmières et infirmiers formés à l’international dans la pratique. Les leçons tirées de l’élaboration des cours fondés sur les compétences s’ajoutent à l’ensemble croissant de connaissances sur les expériences des programmes au Canada pour les infirmières et infirmiers formés à l’international afin de permettre à davantage d’entre elles et eux d’intégrer les effectifs infirmiers de l’Ontario

Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments- an umbrella review

Aims The aim of this umbrella review was to establish recent evidence on integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments. Design Umbrella review conducted according to joanna briggs institute guidelines. Data sources Data were collected from CINAHL, PubMed, Medic, ProQuest and Scopus electronic databases in 2021. Review Methods Two researchers simultaneously screened studies' eligibility by title, abstract and full text. Quality appraisal for the selected studies was assessed according to joanna briggs institute critical appraisal. Data were synthesized by conducting content analysis. Results Twenty-seven reviews were included in the final synthesis. Strategies and models for supporting the transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments were structured as intra-organizational, sociocultural, and professional development. Intra-organizational strategies and models were unique to a particular organization and included policies and support, diversity, collegial and peer support, employee treatment and workplace environment. Sociocultural strategies and models addressed social, cultural and group dynamics using cultural training, learning and support, social support and friendships, language and communication, and personal skills development. Professional development enhanced nursing competence, ability to practice and workplace professional development. This was supported through licensure and orientation to work, career and competence development, and workplace mentorship and preceptorship. Conclusion There is a need to understand culturally and linguistically diverse nurses' needs and motivation to integrate, which is essential toward developing efficient integrational strategies and models. Strategies and models also need to support cultural and personal competence development of native nurses to aid efficient integration of culturally and linguistically diverse colleagues. Future studies can evaluate nursing workforce shortages and their implications on integration process

Bright future ahead – an online educational and vocational training program design for foreign-trained occupational therapist in the U.S.

Foreign-trained healthcare professionals consist of a sizable and important portion of the United States healthcare workforce (Chen et al., 2013; Farkas, 2003; Lowell, 2012). Foreign-trained healthcare workers often encounter various challenges in acclimating and integrating into the American society and workforce. Even though foreign-trained occupational therapists are considered essential, and their difficulties in adjusting are well-recognized, there are very limited bridging and training programs designated solely for this population that incorporate a comprehensive approach and meets their unique needs. Therefore, this doctoral project aimed to understand the barriers to integrating into the local workforce and proposed ways for supporting these highly- educated and experienced professionals in their new country. The resulting solution is A Bright Future Ahead, an online educational and vocational program designed for new foreign occupational therapists. The program’s content and structure are based on existing programs for adjacent health professionals while customizing the program’s layout and content to target occupational therapists. A Bright Future Ahead suggests a multi-layered solution that requires an enormous investment in the program’s development and implementation; however, this program can be expanded in the future to other professions that share similar professional credentialing processes and experience akin barriers

What innovations (including return to practice) would help attract, recruit, or retain NHS clinical staff? A rapid evidence map

National Health Service (NHS) waiting times have significantly increased over the past couple of years, particularly since the emergence of COVID-19. The NHS is currently experiencing an acute workforce shortage, which hampers the ability to deal with increasing waiting times and clearing the backlog resulting from the pandemic. Plans to increase the workforce, by recruiting new staff, retaining the existing NHS clinical workforce, and making return to clinical practice more attractive will require a number of approaches. This Rapid Evidence Map aimed to describe the extent and nature of the available evidence base for innovations (including return to practice) that could help attract, recruit, or retain NHS clinical staff, in order to identify the priorities and actions for a rapid review. Three options were proposed for a subsequent focused Rapid Review and discussed with stakeholders: (1) review of primary studies that have evaluated return to practice schemes; (2) review of reviews of factors that influence retention; (3) review of reviews of interventions for supporting recruitment and retention. A decision was made that option 3 would be useful to inform practice and a rapid review will be undertaken

Exploring the Experiences and Understanding of Clinical Judgement of IENs Transitioning to Nursing Practice in Ontario

Clinical judgment is increasingly discussed in the nursing education literature as it is critical to the development of professional knowledge, and it provides a structure for the reasoning necessary for nursing practice today. It is well indicated in the literature that a significant number of novice practitioners in health care do not meet entry-to-practice expectations for clinical judgment and have difficulty transferring knowledge and theory into practice—regardless of educational preparation and credentials. Internationally Educated Nurses (IENs) are also considered novice practitioners in the Ontario health-care environment. The purpose of the study was to explore IENs’ experience and understanding of clinical judgment when engaged in a simulated clinical environment. The research question guiding the study was, What is the experience and understanding of clinical judgment of IENs when engaged in High Fidelity Patient Simulation (HFPS) and stimulated recall and reflective practice? The research employs qualitative descriptive, open-ended exploratory and interpretive methods informed by constructivism and transformative learning theories. Qualitative research seeks to understand and explain participant meaning. The participants in this study were four IENs, aged 27–37, who were attending a university academic bridging program. They participated in a) a preliminary interview to collect data regarding their demographics and information associated with their educational, clinical, and professional background; b) three interactive simulated clinical activities comprising of high-fidelity SimMan™ manikins; and c) three stimulated recall sessions followed by three focus groups. The interactive simulated activities were videotaped and stimulated recall and focus groups were audiotaped. Tanner’s Model of Clinical Judgment was used to guide this process. The thematic analysis uncovered six themes pertaining to IEN’s experience and understanding of clinical judgment: the shift from expert to novice, the need to rethink cultural competence and culturally competent care, the acknowledgement that culture and diversity are integral to understanding clinical judgment, the role of communication as a means to understanding clinical judgment, the recognition of unlearning as a way to understanding clinical judgment, and the phenomenon of unknowing as a dimension of understanding clinical judgment. The concepts of reflection-beyond-action and intercultural fluency emerged as implications for the teaching and learning of IENs

Philippine nurse migration to the Canadian prairies: challenges and opportunities

Internationally Educated Nurses (IENs) from the Philippines comprise the highest proportion of IENs working as regulated nurses in Canada, yet many report challenges integrating into the Canadian nursing workforce. The purpose of this mixed methods study was to explore and describe the integration of Registered Nurses (RNs) from the Philippines into the nursing workforce in the Canadian Prairies. A total of 182 IENs from the Philippines who had migrated to Manitoba, Saskatchewan or Alberta between 2008 and 2013 participated. Data were collected through an online survey comprised primarily of fixed response questions and through semi-structured interviews. The findings of the mixed analysis revealed that participants identified four main reasons for migrating to Canada and the Prairie Provinces. These included the presence of family in Canada, the demand for nurses in the Prairie Provinces, ease of migration, and the opportunity for a better life. Upon entry into Canada, IENs encountered challenges in both the pre-licensure and post-employment phases. Financial constraints, obtaining the necessary English language proficiency levels, and meeting the RN licensure requirements were the key pre-licensure challenges identified. Post-employment, IENs reported challenges with language and sociocultural communication, obtaining the required knowledge and skills, adjusting to different resources, conflicting values, and professional and collaborative practice. IENs from the Philippines were employed in the Prairie nursing workforce as RNs, Licensed Practical Nurses (LPNs), and unregulated health workers (URHWs). IENs pursued LPN practice as a Stepping Stone, Parallel Process, or Alternate Career Path, to RN practice. The main reason cited for working as a URHW was the need to find a survival job while working through the nursing licensure process. Nursing workforce integration was a complex process and the cultural, financial, and social capital the IEN possessed, along with the availability of the host country programs and supports, were important resources to facilitate the process.sub_iihdunpub2844_ethesesunpu

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

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

Understanding the Reentry Experiences of Immigrant Nurses in the U.S. A Qualitative Case Study

Labor market projections see a growing need for nurses to satisfy demand in the U.S. health care sector into the next few decades. It is assumed that this demand will be met in part by immigrant nurses who received their nursing education outside the United States. Like many immigrants to the United States, internationally educated nurses face a number of challenges that make it difficult for them to obtain a nursing license and practice nursing in a U.S. health care setting. Learning to surmount these barriers represents a learning and a coping process.This qualitative case study was designed to explore how a sample of internationally educated nurses learned to reenter the nursing profession in the U.S. The participants consisted of alumni of a retraining program for internationally trained health care professionals housed in a community college in the Northeastern United States. The primary sources of data came from semi-structured interviews consisting of questions about their experiences pursuing reentry into the nursing profession. The study’s major findings included the following: (1) Participants described being dissatisfied with their initial employment upon immigrating to the United States. (2) Participants reported that the language barrier and the nursing certification process, including the licensure exam, were major challenges to reentering the profession. (3) Participants reported that the most important things they learned were the difference between nursing practice in their countries of origin and in the U.S., and professional skills, including National Council Licensure Examination (NCLEX) test-taking skills. (4) Participants reported that they learned in both informal and formal methods. (5) Participants reported that having a positive attitude, support from others, and time management enabled their learning, while gaps in their practice hindered it.The findings of the study suggest that the participants learned to surmount the barriers they faced through a learning process characterized by increasing professional autonomy and self-directedness, as well as critical reflection on prior education and training. This process is facilitated by educators who are able to both help them develop professional autonomy and provide emotional support along what is a difficult and prolonged journey toward RN licensure