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.

Overseas recruitment activities of NHS Trusts 2015-2018: Findings from FOI requests to 19 Acute NHS Trusts in England.

Migrant nurses form an increasing proportion of the nursing workforce, with the United Kingdom (UK) being the third most popular destination for overseas nurses in the world. The migrant nurse workforce is highly susceptible to policy changes at the macro or professional level of the donor and recipient countries. Freedom of information requests were issued to 19 National Health Service [NHS] Trusts in England to determine their involvement in overseas nurse recruitment activity from 1998 onwards. These indicate a notable shift away from active European Union (EU) recruitment and towards overseas countries particularly the Philippines and India. Reasons given were as follows: diminishing returns from EU sources, high attrition among EU nurses and the introduction of English language tests for EU nurses in July 2016. This led to Trusts revisiting their recruitment strategies by increasing more direct/less resource-intensive methods and expanding their focus outside of the EU. Trusts frequently utilised private recruitment companies for their recruitment drives, including consulting and influencing the Trusts' workforce strategies. Policy adjustments have numerous influences on the composition of the overseas nursing workforce. While the NHS continues its efforts in expanding its international nursing workforce, this should not be at the expense of ethical and sustainable recruitment practices, which may be compromised indirectly as a result.

Disrupting Policy and Practice: Refugees Shaping the Future.

For decades, refugee policies on local, national, regional, and international levels have set the narrative surrounding refugees' identities and roles in society. Often, these policies negatively affect refugees and can hinder any effort for successful integration (ie, employment). The focus of this article is to identity how refugees, specifically refugee nurses, are reshaping standard policy practices when it comes to integration and inclusion, as well as economic and social well-being. With an estimated 68.5 million forcibly displaced persons worldwide (25.4 million of which are refugees), it is important to shed light on the importance of including their voices in the dialogue during all stages of the policy development process. They should be included in the dialogue, from agenda setting to evaluation, in order to challenge current beliefs and attitudes. It is critical for societies to recognize refugee nurses' professional qualifications, skills, and abilities in order to address the ongoing shortages of health professionals that many nations are facing today.

Migration of Latin American nurses to Spain 2006-2016: a case study.

AIM: To examine the migration of nurses from Latin America to Spain over the period from 2006 to 2016. BACKGROUND: This study examines the impact of the 2008 global economic crisis on migration flows of nurses to Spain from its major source countries of Latin America. METHODS: Using an exploratory case study, we present original data provided by the Ministry of Education, Culture and Sport of the Government of Spain upon request on applications and success rates for credential recognition of nurses intending to immigrate to Spain, with an extended analysis of Latin American applications which account for the 70% of skilled worker migration to Spain. RESULTS: Successful applications for credential recognition of overseas nursing qualifications plummeted from a peak of 1384 in 2007 to 55 in 2016. Migration intentionality also decreased but has undergone a slight increase in recent years. DISCUSSION/CONCLUSION: We found that the economic crisis effectively closed the door to internationally educated nurses to work as nurses in Spain. Moreover, the denial of official recognition of nursing credentials appears to be unaffected by the existence of bilateral trade and mobility agreements between Spain and source countries. We conclude that the level of nursing migration to Spain is a sensitive indicator of domestic labour market conditions. IMPLICATIONS FOR HEALTH POLICY: Despite the lack of any transparent policy on the credential approvals, in practice the government is limiting access to the nursing labour market by overseas education nurses. We urge that attention be paid by health human resource planners on the intersection between labour market and migration trends to support a transparent and data-informed discussion by all stakeholders on the current state of the nursing labour market in Spain and its future needs.

Brazilian and North-American nursing in the HOPE Project (1972): approximations and gaps.

OBJECTIVE: Understand the structuring and operation of the Nursing Service on the hospital ship HOPE and the relations between Nursing from North America and from Rio Grande do Norte. METHOD: Qualitative, sociohistorical research, developed by consulting documentary and oral sources. RESULTS: The analysis revealed the categories: The HOPE Project: impressions of its nurses and Nursing on the hospital ship SS HOPE: Brazilian impressions. These categories revealed a Nursing Service similar to that of a general hospital, ordered by scales and which functioned uninterruptedly in the three shifts. FINAL CONSIDERATIONS: The Nursing Service consisted exclusively of nurses; followed a hierarchical system; with accumulation of administrative and care functions; strict, precise and technical execution of the work. The language and cultural barriers do not seem to have compromised the Exchange and the work system in counterparts.

Brazilian and North-American nursing in the HOPE Project (1972): approximations and gaps / La enfermería brasileña y norteamericana del Proyecto HOPE (1972): aproximaciones y distanciamientos / Enfermagem brasileira e norte-americana do Projeto HOPE (1972): aproximações e distanciamentos

ABSTRACT Objective: Understand the structuring and operation of the Nursing Service on the hospital ship HOPE and the relations between Nursing from North America and from Rio Grande do Norte. Method: Qualitative, sociohistorical research, developed by consulting documentary and oral sources. Results: The analysis revealed the categories: The HOPE Project: impressions of its nurses and Nursing on the hospital ship SS HOPE: Brazilian impressions. These categories revealed a Nursing Service similar to that of a general hospital, ordered by scales and which functioned uninterruptedly in the three shifts. Final considerations: The Nursing Service consisted exclusively of nurses; followed a hierarchical system; with accumulation of administrative and care functions; strict, precise and technical execution of the work. The language and cultural barriers do not seem to have compromised the Exchange and the work system in counterparts.

RESUMEN Objetivo: Comprender la estructuración, el funcionamiento del Servicio de Enfermería del buque hospital SS HOPE y las relaciones entre la Enfermería norteamericana y la norte-rio-grandense. Método: Investigación cualitativa, socio-histórica, realizada a partir de consultas a fuentes documentales y orales. Resultados: El análisis llegó a las categorías: El Proyecto HOPE - impresiones de sus enfermeras y La Enfermería del buque hospital SS HOPE - impresiones brasileñas. Estas categorías revelaron un Servicio de Enfermería similar al de un hospital general, ordenado por escalas y que funcionaba ininterrumpidamente en los tres turnos. Consideraciones finales: El Servicio de Enfermería estaba compuesto exclusivamente de enfermeras, obedecía a un sistema de jerarquía con acumulación de funciones administrativas y asistenciales, la ejecución del trabajo se realizaba de manera rígida, precisa y técnica, y las barreras idiomáticas y culturales parecen no haber comprometido el intercambio y el sistema de trabajo en contrapartes.

RESUMO Objetivo: Compreender a estruturação, o funcionamento do Serviço de Enfermagem do navio-hospital SS HOPE e as relações entre a Enfermagem norte-americana e a norte-rio-grandense. Método: Pesquisa qualitativa, sócio-histórica, realizada a partir de consultas a fontes documentais e orais. Resultados: A análise chegou às categorias: O Projeto HOPE: impressões de suas enfermeiras e A Enfermagem do navio-hospital SS HOPE: impressões brasileiras. Essas categorias revelaram um Serviço de Enfermagem similar ao de um hospital geral, ordenado por escalas e que funcionava, ininterruptamente, nos três turnos. Considerações finais: O Serviço de Enfermagem era composto, exclusivamente, de enfermeiras, obedecia a um sistema de hierarquia com acúmulo de funções administrativas e assistenciais, a execução do trabalho era realizada de maneira rígida, precisa e técnica, e as barreiras idiomáticas e culturais parecem não ter comprometido o intercâmbio e o sistema de trabalho em contrapartes.

Nursing international student mobility in the University of São Paulo.

OBJECTIVE: To characterize the experiences of undergraduate students of the School of Nursing of the University of São Paulo (EEUSP) who participated in international mobility programs between January 2011 and July 2017. METHOD: Exploratory, descriptive study with quantitative approach. Of 68 reports, only 38 (56%) were considered valid and were submitted to descriptive statistical analysis. Data were categorized in general, institutional, academic and cultural aspects and cost of living. RESULTS: The main destination was Portugal and the years with most participation were 2012 and 2013. The mean stay was six months and the students took a mean of three to four courses. The main funder was the university of origin. CONCLUSION: Academic activities were limited to theoretical and practical courses, with little insertion in research. There is a need to increase investment in learning other languages and to expand partnerships with larger centers of foreign education and research.

International Nurses Day: cause for celebration.

Elizabeth Rosser, Acting Executive Dean, Bournemouth University, reflects on a symbolic moment in the nursing year and the progress made by nurses.

Advocating to Protect Our Nurses: Addressing Unethical Recruitment of Foreign-Educated Nurses.

Advocacy in the nursing sector is often about advocating for patients. However, nurses have begun to put more effort into protecting their rights as workers. Advocacy on behalf of foreign-educated nurses has been a critical component of this advocacy. While foreign-educated nurses can make our nursing workforce stronger, this can only happen if they are well-treated and well-trained. Organizations across diverse missions and perspectives have come together to promote fair treatment of foreign-educated nurses, which ultimately ensures that all nurses are working as effectively as possible and that patients receive proper care. The Alliance for Ethical International Recruitment Practices' Health Care Code for Ethical Recruitment and Employment Practices represents a bottom-up agreement on which market practices constitute ethical recruitment. From a top-down level, the World Health Organization's Code of Global Practice establishes obligations and reporting requirements for member states that commit to ensuring ethical recruitment. This combination of efforts, bolstered by strong advocacy, is gaining traction as nursing migration grows at the global level. The collaboration across diverse stakeholder groups and the combination of legal, voluntary, and global efforts to promote the rights of foreign-educated nurses provides a model to apply for advocacy in different areas.

Nursing international student mobility in the University of São Paulo / Movilidad internacional estudiantil de Enfermería de la Universidad de São Paulo / Mobilidade internacional estudantil de Enfermagem da Universidade de São Paulo

ABSTRACT Objective: To characterize the experiences of undergraduate students of the School of Nursing of the University of São Paulo (EEUSP) who participated in international mobility programs between January 2011 and July 2017. Method: Exploratory, descriptive study with quantitative approach. Of 68 reports, only 38 (56%) were considered valid and were submitted to descriptive statistical analysis. Data were categorized in general, institutional, academic and cultural aspects and cost of living. Results: The main destination was Portugal and the years with most participation were 2012 and 2013. The mean stay was six months and the students took a mean of three to four courses. The main funder was the university of origin. Conclusion: Academic activities were limited to theoretical and practical courses, with little insertion in research. There is a need to increase investment in learning other languages and to expand partnerships with larger centers of foreign education and research.

RESUMEN Objetivo: Caracterizar las experiencias de los estudiantes de graduación de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP), participantes de los programas de movilidad internacional, entre enero de 2011 y julio de 2017. Método: Se trata de un estudio exploratorio, descriptivo de abordaje cuantitativo, de 68 reportes. De estos, solamente 38 (56%) se consideraron válidos y se sometieron al análisis estadístico descriptivo. Los datos se recogieron según los aspectos generales de la experiencia: institucionales, académicos, culturales y costo de vida. Resultados: El destino principal fue Portugal, entre los años 2012 y 2013, con permanencia media de seis meses y cursando, promedio, de tres a cuatro disciplinas. La principal financiadora fue la universidad de origen. Conclusión: Las actividades académicas se limitaron a disciplinas teórico-prácticas, sin involucrarse mucho en la investigación. Existe la necesidad de aumentar las inversiones para el aprendizaje de otros idiomas y aumentar los convenios con los grandes centros de enseñanza e investigación extranjeros.

RESUMO Objetivo: Caracterizar as experiências dos estudantes de graduação da Escola de Enfermagem da Universidade de São Paulo (EEUSP), participantes dos programas de mobilidade internacional, entre janeiro de 2011 e julho de 2017. Método: Estudo exploratório, descritivo de abordagem quantitativa, de 68 relatórios. Desses, apenas 38 (56%) foram considerados válidos e submetidos à análise estatística descritiva. Os dados foram apreendidos em aspectos gerais da experiência, institucionais, acadêmicos, culturais e custo de vida. Resultados: O principal destino foi Portugal, entre os anos de 2012 e 2013, com permanência média de seis meses, cursando em média três a quatro disciplinas. O principal financiador foi a universidade de origem. Conclusão: As atividades acadêmicas limitaram-se a disciplinas teórico-práticas, com pouca inserção na pesquisa. Há necessidade de aumentar o investimento na aprendizagem de outros idiomas e ampliar parcerias com grandes centros de ensino e de pesquisa estrangeiros.

Recognition of foreign nurses degree in Germany ­ procedure, quantity, distribution and decision of applications / Anerkennung ausländischer Pflegeabschlüsse in Deutschland - Verfahren, Anzahl, Verteilung und Entscheidung der Anträge

Background: Qualified foreign nurses are entering the German nursing-care system. Aim: How has the migration of nurses been developing in recent years? Method: Evaluation of official statistics on recognition of qualifications. Results: There is a growing demand for recognition of nursing qualifications acquired abroad; this demand is concentrated on densely populated regions. Conclusions: Migration of care workers is increasing and needs to be analysed by nursing sciences.

Exploring longitudinal shifts in international nurse migration to the United States between 2003 and 2013 through a random effects panel data analysis.

BACKGROUND: No study has examined the longitudinal trends in National Council Licensure Exam for Registered Nurse (NCLEX-RN) applicants and pass rates among internationally-educated nurses (IENs) seeking to work in the United States, nor has any analysis explored the impact of specific events on these trends, including changes to the NCLEX-RN exam, the role of the economic crisis, or the passing of the WHO Code on the International Recruitment of Health Personnel. This study seeks to understand the impact of the three aforementioned factors that may be influencing current and future IEN recruitment patterns in the United States. METHODS: In this random effects panel data analysis, we analyzed 11 years (2003-2013) of annual IEN applicant numbers and pass rates for registered nurse credentialing. Data were obtained from publicly available reports on exam pass rates. With the global economic crisis and NCLEX-RN changes in 2008 coupled with the WHO Code passage in 2010, we sought to compare if (1) the number of applicants changed significantly after those 2 years and (2) if pass rates changed following exam modifications implemented in 2008 and 2011. RESULTS: A total of 177 countries were eligible for inclusion in this analysis, representing findings from 200,453 IEN applicants to the United States between 2003 and 2013. The majority of applicants were from the Philippines (58 %) and India (11 %), with these two countries combined representing 69 % of the total. Candidates from Sub-Saharan African countries totalled 7133 (3 % of all applications) over the study period, with half of these coming from Nigeria alone. No significant changes were found in the number of candidates following the 2008 economic crisis or the 2010 WHO Code, although pass rates decreased significantly following the 2008 exam modifications and the WHO Code implementation. CONCLUSION: This study suggests that, while the WHO Code has had an influence on overall IEN migration dynamics to the United States by decreasing candidate numbers, in most cases, the WHO Code was not the single cause of these fluctuations. Indeed, the impact of the NCLEX-RN exam changes appears to exert a larger influence.

The Complexities of Nurse Migration.

A call to curtail migration out of Latin America and the Caribbean raises questions.

Are nurses from the European Union able to get hospital jobs?

I am a Polish nurse with a master's degree and four years' experience. You kindly published a letter from me last year, 'I am banging my head against a brick wall to gain registration' (October 29).

Developing cultural sensitivity and awareness in nursing overseas.

Many nurses are choosing to work in other countries, providing an opportunity to broaden their experience and knowledge. However, it is important that nurses who have the opportunity to work overseas develop cultural awareness and sensitivity before arriving. This article provides a reflective account of the experiences of one of the authors of working overseas. From the reflective account and evidence available in the literature on cultural sensitivity, insights are offered to nurses who may be considering working overseas to ensure they are adequately prepared.