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.

Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP).

BACKGROUND: To test the validity of the Finnish version of the Bernhard et al.'s Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP). METHODS: The study sample comprised registered nurses (N = 810) from the Finnish "Competent workforce for the future" -project (COPE). Exploratory factor analyses and structural equation modelling were applied to test structural validity of the CCCHP. Internal consistency of the sub-scales was evaluated using the Cronbach's alphas. Criterion validity was explored in terms of received education for multicultural work, perceived difficulty of patients, and job satisfaction variables. RESULTS: The revised version of the instrument including four (motivation/curiosity, attitudes, skills and emotions/empathy) of the five original dimensions provided satisfactory psychometric properties (internal consistency, a good model fit of the data). Of the four remaining competence sub-scales, motivation/curiosity, attitudes and emotions/empathy were associated with the amount of received education for multicultural work, and all with perceived difficulty of patients, and all but attitudes with job satisfaction. CONCLUSION: This revised Finnish version of the CCCHP provides a useful tool for studies focusing on the healthcare personnel's cross-cultural competence in delivering effective and culturally sensitive healthcare services for patients from different cultures.

Predictors of Turnover Among Asian Foreign-Educated Nurses in Their 1st Year of US Employment.

OBJECTIVE: The aim of this study was to investigate factors affecting turnover of Asian foreign-educated nurses (FENs), which may lead to improvements in retention strategies. BACKGROUND: Asian FENs working in the United States have considerable rates of turnover. Little is known about which factors are related. METHODS: A cross-sectional design was used. A convenience sample (n = 201) of Asian FENs completed surveys by regular mail and through a website. Backward multivariable logistic regression was performed to identify factors associated with turnover in their 1st year of employment. RESULTS: Most participants were from the Philippines and Korea. Perceived quality of orientation predicted organizational-level turnover and trended toward predicting unit-level turnover. CONCLUSIONS: Healthcare institutions may benefit from developing organizational programs for FENs that are sensitive to their unique needs, in the interest of reducing rapid or early turnover and accompanying negative effects on hospital finances and patient care.

Internationally educated nurses' and medical graduates' experiences of getting a license and practicing in Sweden - a qualitative interview study.

BACKGROUND: The Swedish healthcare system has an increased need for nurses and physicians, and the number of International Educated Nurses (IENs) and International Medical Graduates (IMGs) seeking job opportunities and a license to practice in Sweden is rising. This study explored how IENs and IMGs describe their experience of getting a license to practice, their perceptions of working in Sweden and of how their intercultural competence is utilized. METHOD: A qualitative study based on semi-structured interviews with 11 IENs and 11 IMGs. The interviews were conducted between 2015 and 2017. The data were analyzed using qualitative content analysis. RESULTS: Three main themes were identified: 'Getting a license - a different story,' 'The work is familiar, yet a lot is new,' 'Trying to master a new language.' The time to obtain a license to practice and finding a job was shorter for IENs and IMGs coming from European countries than for those from non-European countries. Some of the experiences of getting a license to practice and of entering a new workplace in another country were the same for nurses and physicians. In general, both IENs and IMGs felt welcomed and used their intercultural competence at work. Lack of language skills was regarded as the main problem for both professions, while workplace introduction was shorter for IMGs than for IENs. CONCLUSIONS: Problems related to language and culture are often underestimated, therefore organizations and managers employing IENs and IMGs should provide longer workplace introduction to facilitate the acculturation process. More time-efficient language courses specifically adapted to IENs and IMGs could make the transition easier and shorten the time to obtain a license to practice for both professions.

Experiences of registered nurses from a refugee background: A scoping review.

AIMS AND OBJECTIVES: This scoping review presents an exploration of international literature on the factors that impact refugees' personal and professional experiences during their journey to being registered nurses in a new host country. BACKGROUND: Governments of host countries receiving refugees seek to develop strategies that facilitate the successful resettlement, employment and enculturation of refugees that arrive as skilled professionals. There is a scarcity of studies focussing on issues faced by refugees that are RNs or those pursuing nursing registration and employment in a new host country. This study is relevant for resettlement services, nursing registration authorities and education providers and informs the international nursing workforce. DESIGN: Scoping review. METHODS: Databases such as MEDLINE, EMBASE, Cochrane Library, CINAHL; Google Scholar; PubMed; Scopus and Web of Science were searched for qualitative studies published up to and including 2017. Articles that did not specify explicitly the participants as registered nurses and/or refugees were excluded. All eligible articles were analysed for collective findings, and impact factors were extracted, synthesised and illustrated diagrammatically. RESULTS: This review explored six eligible articles and six impact factors were identified. The challenging impacts were as follows: loss of control; shock in a new environment and bleak employment prospects. Equally three impact factors: reconciling new reality; establishing a new identity and hope for the future, facilitate positive experiences for nurses in their successful transition into society and the nursing workplace. CONCLUSIONS: This scoping review reports the small number of international studies on the experiences of refugees seeking to become registered and employed as registered nurses. The six impact factors identified influence the lives of the nurse participants socio-economically in and out of the workplace. RELEVANCE TO CLINICAL PRACTICE: Policymakers, managers and educators providing resettlement, registration and employment services could develop strategies that enhance integration and transition experiences of refugees aspiring to be registered nurses.

The attitudes of Turkish nurses towards the employment of internationally educated nurses.

AIM: To define the attitudes of nurses working in public hospitals towards the employment of internationally educated nurses. BACKGROUND: The employment of internationally educated nurses is expected to be an important strategy for solving the nursing shortage in Turkey and many other countries. METHODS: This descriptive and cross-sectional study was conducted with nurses working in seven public university hospitals in different geographical regions of Turkey in September 2015. The data were collected from 1061 nurses in these hospitals using a self-report questionnaire. Data analysis was performed using descriptive statistics, t-test and the Mann-Whitney U test. RESULTS: The participants generally did not have positive attitudes towards the employment of internationally educated nurses citing the possibility of experiencing cultural and professional difficulties. They also indicated that the employment of internationally educated nurses is not a real solution for the nursing shortage unless working conditions for nurses are improved. However, younger nurses have more positive attitudes towards employment of internationally educated nurses than older ones. IMPLICATIONS FOR NURSING POLICY: Defining the attitudes of the nurses working in clinical fields towards the employment of internationally educated nurses is an important issue, because it provides data for reviewing the existing policies and evaluating the possible issues that require attention during implementation of these policies. Policymakers may focus on both creating better working environment conditions and helping both the native and internationally educated nurses during the recruiting process.

Turnover and Associated Factors in Asian Foreign-Educated Nurses.

OBJECTIVES: The purposes of this study are to (1) describe the gap between expected and perceived organizational experiences among Asian foreign-educated nurses (FENs) in the United States and (2) to examine factors associated with turnover in their 1st year of employment. BACKGROUND: Little is known about factors associated with turnover among Asian FENs. METHODS: A cross-sectional design with a convenience sampling was conducted. Subjects (n = 201) responded either via Web-based or mail survey. A series of simple and multivariable logistic regressions were used. RESULTS: Expectations of FENs before organizational entry were significantly higher than their experiences. The FENs who reported less organizational responsibility than expected were more likely to leave their 1st employment to move to another organization or unit. CONCLUSION: This study may contribute to our understanding of the potential factors that assist or interfere with the organization's administrative retention plan for Asian FENs.

Reduced withdrawal and failure rates of accelerated nursing students enrolled in pharmacology is associated with a supportive intervention.

BACKGROUND: To reduce nursing shortages, accelerated nursing programs are available for domestic and international students. However, the withdrawal and failure rates from these programs may be different than for the traditional programs. The main aim of our study was to improve the retention and experience of accelerated nursing students. METHODS: The academic background, age, withdrawal and failure rates of the accelerated and traditional students were determined. Data from 2009 and 2010 were collected prior to intervention. In an attempt to reduce the withdrawal of accelerated students, we set up an intervention, which was available to all students. The assessment of the intervention was a pre-post-test design with non-equivalent groups (the traditional and the accelerated students). The elements of the intervention were a) a formative website activity of some basic concepts in anatomy, physiology and pharmacology, b) a workshop addressing study skills and online resources, and c) resource lectures in anatomy/physiology and microbiology. The formative website and workshop was evaluated using questionnaires. RESULTS: The accelerated nursing students were five years older than the traditional students (p < 0.0001). The withdrawal rates from a pharmacology course are higher for accelerated nursing students, than for traditional students who have undertaken first year courses in anatomy and physiology (p = 0.04 in 2010). The withdrawing students were predominantly the domestic students with non-university qualifications or equivalent experience. The failure rates were also higher for this group, compared to the traditional students (p = 0.05 in 2009 and 0.03 in 2010). In contrast, the withdrawal rates for the international and domestic graduate accelerated students were very low. After the intervention, the withdrawal and failure rates in pharmacology for domestic accelerated students with non-university qualifications were not significantly different than those of traditional students. CONCLUSIONS: The accelerated international and domestic graduate nursing students have low withdrawal rates and high success rates in a pharmacology course. However, domestic students with non-university qualifications have higher withdrawal and failure rates than other nursing students and may be underprepared for university study in pharmacology in nursing programs. The introduction of an intervention was associated with reduced withdrawal and failure rates for these students in the pharmacology course.

Transforming the nursing profession in Saudi Arabia.

AIM: To discuss the impact of health-care policies and regulations on hospitals' journey towards the Magnet designation in Saudi Arabia. BACKGROUND: Saudi Arabia, like many other countries, faces several challenges in achieving 'the Gold Standard' in nursing practice. Centralised management, the absence of a regulatory professional body, lack of a national benchmarking database and a nursing shortage are all major challenges in advancing nursing practice. KEY ISSUE: The presence of two Magnet-designated hospitals in Saudi Arabia (not affiliated with the Ministry of Health) is an opportunity to explore how this has been achieved within the organisational and professional context. The nursing leaders in the Ministry of Health could be accountable to address the barriers in advancing nursing practice and to raise nursing awareness regarding the adoption of a new culture of excellence. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers in the Ministry of Health hospitals are encouraged to assess the hospitals' readiness to apply for Magnet status. Their readiness must include having a high level of nursing satisfaction and low turnover rate, which goes along with assessing cultural and organisational climates to understand the gaps in work environment and driving evidence of readiness toward achieving Magnet status. CONCLUSION: Health-care policies and regulations, both nationally and globally, can result in several challenges to achieving 'the Gold Standard' in nursing practice. These challenges may not be possible to resolve within an organisational level. Collaborative effort and transformational changes are needed to drive the nursing profession toward the best outcomes for our patients and nurses.

How many IQNs will New Zealand need?.

Around 26 per cent of the nursing workforce are internationally qualified nurses. As the population increases and ages, and nurses retire, that proportion will probably be needed for quite some time.

Building 'super-diversity'.

Building a health workforce that reflects the cultures it serves is key to improving health outcomes for diverse populations.

Examining differences in nurses' language, accent, and comprehensibility in nursing home settings based on birth origin and country of education.

As nursing homes turn abroad to fill vacancies, the diverse linguistic backgrounds of nurse hires are creating new challenges in comprehensibility between nurses, providers, and residents. Accents are a natural part of spoken language that may present difficulty even when the parties involved are speaking the same language. We surveyed 1,629 nurses working in 98 nursing homes (NHs) in five U.S. states to determine if and how language difficulties were perceived by nurses and others (e.g. physicians, residents and family members). We found that when participants were asked how often other care team members and residents/families had difficulty understanding them due to language use or accent, foreign born nurses were significantly more likely to report that they experienced difficulty at least some of the time across all groups. This study supports an assessment of nurses' language, accents, and comprehensibility in these settings.

The (mis)management of migrant nurses in the UK: a sociological study.

AIM: To examine Nepali migrant nurses' professional life in the UK. BACKGROUND: In the late 1990 s the UK experienced an acute nursing shortage. Within a decade over 1000 Nepali nurses migrated to the UK. METHOD: A multi-sited ethnographic approach was chosen for this study. Between 2006 and 2009, 21 in-depth interviews with Nepali nurses were conducted in the UK using snowballing sampling. RESULT: Nepali migrant nurses are highly qualified and experienced in specialised areas such as critical care, management and education. However, these nurses end up working in the long-term care sector, providing personal care for elderly people - an area commonly described by migrant nurses as British Bottom Care (BBC). This means that migrant nurses lack career choices and professional development opportunities, causing them frustration and lack of job satisfaction. CONCLUSION: International nurse migration is an inevitable part of globalisation in health. Nurse managers and policy makers need to explore ways to make better use of the talents of the migrant workforce. IMPLICATIONS FOR NURSING MANAGEMENT: We offer a management strategy to bring policies for the migrant workforce into line with the wider workforce plans by supporting nurses in finding jobs relevant to their expertise and providing career pathways.

The multiple imputation method: a case study involving secondary data analysis.

AIM: To illustrate with the example of a secondary data analysis study the use of the multiple imputation method to replace missing data. BACKGROUND: Most large public datasets have missing data, which need to be handled by researchers conducting secondary data analysis studies. Multiple imputation is a technique widely used to replace missing values while preserving the sample size and sampling variability of the data. DATA SOURCE: The 2004 National Sample Survey of Registered Nurses. REVIEW METHODS: The authors created a model to impute missing values using the chained equation method. They used imputation diagnostics procedures and conducted regression analysis of imputed data to determine the differences between the log hourly wages of internationally educated and US-educated registered nurses. DISCUSSION: The authors used multiple imputation procedures to replace missing values in a large dataset with 29,059 observations. Five multiple imputed datasets were created. Imputation diagnostics using time series and density plots showed that imputation was successful. The authors also present an example of the use of multiple imputed datasets to conduct regression analysis to answer a substantive research question. CONCLUSION: Multiple imputation is a powerful technique for imputing missing values in large datasets while preserving the sample size and variance of the data. Even though the chained equation method involves complex statistical computations, recent innovations in software and computation have made it possible for researchers to conduct this technique on large datasets. IMPLICATIONS FOR RESEARCH/PRACTICE: The authors recommend nurse researchers use multiple imputation methods for handling missing data to improve the statistical power and external validity of their studies.

Workplace Discrimination: An Additional Stressor for Internationally Educated Nurses.

Discrimination against internationally educated nurses (IENs) remains a seldom-explored topic in the United States. Yet, the literature describing experiences of IENs indicates that some do experience workplace discrimination as an additional workplace stressor. IENs view this discrimination as an obstacle to career advancement and professional recognition. Consequences of workplace discrimination affect IENs' physical and psychological well being, the quality of patient care, and healthcare organizational costs. In anticipation of future nursing shortages, understanding and minimizing workplace discrimination will benefit nurses, patients, and healthcare organizations. In this article the author addresses motivation and challenges associated with international nurse migration and immigration, relates these challenges to Roy's theoretical framework, describes workplace discrimination, and reviews both consequences of and evidence for workplace discrimination. Next, she considers the significance of this discrimination for healthcare agencies, and approaches for decreasing stress for IENs during their transition process. She concludes that workplace discrimination has a negative, multifaceted effect on both professional nursing and healthcare organizations. Support measures developed to promote mutual respect among all nurses are presented.

The globalization of the nursing workforce: Pulling the pieces together.

The "globalization" of health care creates an increasingly interconnected workforce spanning international boundaries, systems, structures, and processes to provide care to and improve the health of peoples around the world. Because nurses comprise a large sector of the global health workforce, they are called upon to provide a significant portion of nursing and health care and thus play an integral role in the global health care economy. To meet global health care needs, nurses often move within and among countries, creating challenges and opportunities for the profession, health care organizations, communities, and nations. Researchers, policy makers, and industry and academic leaders must, in turn, grapple with the impacts of globalization on the nursing and health care workforce. Through this special issue, several key areas for discussion are raised. Although far from exhaustive, our intent is to expand and stimulate intra- and interprofessional conversations raising awareness of the issues, uncover unanticipated consequences, and offer solutions for shaping the nursing and health care workforce of the future.

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.

Internationally educated nurses in the United States: Their origins and roles.

Despite the importance of the internationally educated nurse (IEN) workforce, there has been little research on the employment settings of IENs and other aspects of their employment. We analyzed data from the 2008 National Sample Survey of Registered Nurses to characterize IENs in the United States using descriptive statistics and multivariate ordinary least squares regression. We find notable differences in the decade of immigration, current age, and highest nursing education across the countries in which IENs were educated. IENs are more likely to be employed in nursing and to work full-time. They receive higher total annual earnings and earn higher average hourly wages. However, when demographic, human capital, and employment characteristics are held constant, IENs from every country except Canada earn no more than U.S.-educated nurses. Future research should seek to identify the causes of these employment and earnings differences to understand the role and impact of the IEN workforce.

A comparison of the education and work experiences of immigrant and the United States of America-trained nurses.

AIM: This study examined the education and work experience of immigrant and American-trained registered nurses from 1988 to 2008. BACKGROUND: The USA increasingly relies on immigrant nurses to fill a significant nursing shortage. These nurses receive their training overseas, but can obtain licenses to practice in different countries. INTRODUCTION: Although immigrant nurses have been in the USA workforce for several decades, little is known about how their education and work experience compares with USA-trained nurses. Yet much is presumed by policy makers and administrators who perpetuate the stereotype that immigrant nurses are not as qualified. METHODS: We analysed the National Sample Survey of Registered Nurses datasets from 1988 to 2008 using the Cochran-Armitage trend tests. RESULTS: Our findings showed similar work experience and upward trends in education among both groups of nurses. However, American-trained nurses were more likely to further advance their education, whereas immigrant nurses were more likely to have more work experience and practice in a wider range of healthcare settings. DISCUSSION: Although we discovered differences between nurses trained in the USA and abroad, we theorize that these differences even out, as education and work experience each have their own distinct caregiving advantages. CONCLUSION: Immigrant nurses are not less qualified than their American-trained counterparts. However, healthcare providers should encourage them to further pursue their education and certifications. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Even though immigrant nurses' education and work experience are comparable with their American counterparts, workforce development policies may be particularly beneficial for this group.

Internationally Educated Nursing Staff Caring for Older Adults: A Scoping Study.

INTRODUCTION: Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings. METHOD: Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted. RESULTS: Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged. DISCUSSION: Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches.