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.

Talent management of international nurses in healthcare settings: A systematic review.

AIM: To identify and systematically review current scholarship on talent management of international nurses in healthcare organizations. BACKGROUND: As nurse shortages persistently pose challenges for healthcare organizations globally, one of the primary strategies employed to address these shortages is employment of international nurses. To date little has been done to systematically review and collate contemporary research on talent management of this strategically important cohort. Talent management is a holistic construct that can support healthcare organizations to attract, develop, motivate, and retain talented employees to drive organizational performance. This systematic review isolates, appraises and collates available evidence on talent management practices for international nurses. STUDY DESIGN: Systematic literature review. DATA SOURCES: Searches of PubMed, EBSCO and Scopus were made covering literature from 2012-2022. REVIEW METHODS: This study followed Cochrane protocol for Systematic Reviews and key search terms were developed in consultation with University of Limerick library. As a key aim of the review was to provide evidence for the development of effective talent management practices, only peer-reviewed academic papers and empirical studies were included. Initial articles screening was conducted by two reviewers and full articles review was conducted by the entire research team. Findings were combined in a data extraction template for further analysis. RESULTS: This review includes 62 articles thematically analysed under the headings recruitment and selection, retention and turnover, career progression, professional development, discrimination and racism, culture and communication. CONCLUSION: No articles were found that directly address talent management for international nurses. Although there are studies that address aspects of talent management independently, more research is required on talent management as a holistic process for international nurses to inform evidence-based practice. IMPACT: This research emphasizes the importance of talent management for retention of international nurses in healthcare settings. It provides a knowledge base for healthcare organisations to enhance employee retention and ensure quality care for patients, as well as setting the foundation for future studies in this area.

International Nurses Day: Nurses can change the world, given the investment and support they deserve.

Every year on International Nurses Day (IND), the International Council of Nurses (ICN) releases a report with resources that can be used by nurses around the world. This year's report responds to the World Health Organization's (WHO) latest strategy for nursing and midwifery, and the findings of the State of the World's Nursing report. In this article, ICN Chief Executive Officer Howard Catton describes the main points of the IND report and recommends that nurses everywhere read it, alongside the WHO strategy, and use that information to increase their knowledge of the global nursing workforce and influence global healthcare policy. It is a toolkit that can assist nurses, other healthcare providers, governments and international organisations to turn global strategy into meaningful local action and improved clinical practice on the ground.

A model operationalizing sustainability in global nursing.

BACKGROUND: The concept of sustainability has received growing attention since the adoption of the United Nations' (UN) Sustainable Development agenda. Yet, in the context of sweeping changes regarding the status and profile of global nursing, sustainability has not been fully conceptualized. PURPOSE: To explore the concept of sustainability in global nursing in order to develop an operational definition and model. METHODS: Concept analysis using Rodger's Evolutionary method to explicate the term "sustainability" in a global nursing context. FINDINGS: Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed. DISCUSSION: Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda.

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care.

BACKGROUND: Cultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand. AIM: The aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers. DESIGN: A pre- and post-evaluation design and a sub-group analysis. SETTINGS AND PARTICIPANTS: This study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study. METHODS: The intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups. RESULTS: One hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group. CONCLUSION: A nurse-led cross-cultural care program can improve aged care workers' cultural competence.

International Nursing Program Accreditation.

The Accreditation Commission for Education in Nursing (ACEN) is committed to being a supportive partner in strengthening the quality of nursing education for all levels of nursing programs domestically and internationally. With a longstanding history of accreditation dating back 66 years, the ACEN accredited its first international program in 2004 adding international accreditation to its repertoire. Recognizing geographic, cultural, and national differences, the ACEN common core of Standards and Criteria equip faculty with autonomy to embrace unique attributes of their programs regardless of location, culture, and nationality. Further, the ACEN review process fosters self-evaluation, peer review, and the promotion of educational equity, access, and mobility. As a result, the number of international nursing programs pursuing and attaining accreditation with the ACEN has increased thus validating the inclusiveness and relevance of the ACEN Standards and Criteria. The purpose of this article is to highlight ways in which ACEN Standards and Criteria apply to domestic and international nursing programs.

Diverse Representation in Nursing Leadership: Developing a Shared Position Statement on Allyship.

Diversity initiatives are being implemented widely within academia and society more broadly; however, the School of Nursing (SoN) at Dalhousie University in Halifax, Nova Scotia, Canada, is taking an innovative approach. Faculty members recognized the need to support students at the graduate and undergraduate levels from Black, Indigenous, LGBTQ2S (Lesbian, Gay, Bisexual, Transgender, Queer, and Two-Spirit), and International communities in a student-led initiative with the mission to promote diversity, inclusion, and equity within the SoN. This coalition seeks to offer students who are often rendered invisible within the academy and society more broadly in relation to dominant cultures and normative expectations an opportunity to build relationships and expose shared histories of oppression in such a way that issues of social justice are uncovered. In response to nursing students and faculty who self-identify as members of dominant groups and who sought inclusion as allies, the leaders of the student community groups recognized a need to develop a position statement on allyship. The collaboration that transpired between the four groups of communities to develop the position statement led to the formation of the Student Equity Coalition. This article begins with the authors' definition of allyship, followed by a description of the context in which this unique initiative is taking place, the rationale behind developing a shared position statement on allyship, and the significance of this work in positioning and supporting nursing students of minority status as emerging nurse leaders.

Experiences from Southeast Asia on nursing education, practice, mobility and influencing policy.

In this report from the field, we describe the challenges and opportunities for nursing practice and education, and ways to improve nurse mobility across Asia. We also explain the collaboration within the Southeast and East Asian Nursing Education and Research Network to influence policy development and review. The collaborative process was supported by evidence drawn from discussions at Network meetings, and with nursing and other leaders, an examination of literature and policy documents, and member surveys. We reviewed the region's regulatory statutes which all support diversity in the nursing workforce. The Southeast Asian Nursing Education and Research Network was established in 2015 to support policy development around the upgrading of nurse education, clinical competencies and research capacity, in hospital and primary health care; and facilitating the movement of nurses across national boundaries. Most countries have tried to address policy gaps and their efforts to implement changes are seen in policy expansion and development at the national level. We focus on two policies from the Association of Southeast Asian Nations from 2006 and 2012, that cover nurse mobility, information exchange, nurse capacity building and education and mutual professional recognition of nurses' credentials. However, we found significant variances in education, regulatory policies and clinical competencies that have restricted, and continue to restrict policy implementation. Nursing in South-East Asia has made significant progress in upgrading standards for education by increasing bachelor degree bridging programs, master and doctoral degrees. Participating countries have passed legislation on licensure, competencies and credentialing of internationally qualified nurses wishing to practice in various contexts. However, much work remains to be done. IMPLICATIONS FOR NURSING POLICY, EDUCATION AND PRACTICE: Governing bodies determine entry into practice law which requires dialogue to enhance policies for domestic and international practitioners for mutual exchange and recognition. Nursing practice and education are under government regulatory bodies but require new policies and laws to ensure adequate educational requirements for safe quality practice.

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.

Internationally qualified nurse communication-A qualitative cross country study.

AIMS AND OBJECTIVES: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. BACKGROUND: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. DESIGN: An exploratory qualitative study was conducted using face-to-face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. METHODS: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. RESULTS: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. CONCLUSION: Cultural value-based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention.

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.

The association between cross-cultural competence and well-being among registered native and foreign-born nurses in Finland.

BACKGROUND: A growing body of research indicates that cross-cultural competence in nurses can improve migrant patients' health-related outcomes, but little is known about the potential benefits of cross-cultural competence on the nurses' own well-being. OBJECTIVE: To examine whether cross-cultural competence (empathy, skills, positive attitudes, and motivation) is associated with perceived time pressure at work, psychological distress, and sleep problems among registered nurses in Finland, and whether there are differences in these potential associations between native and foreign-born nurses. METHODS: The present cross-sectional study was based on a sample of 212 foreign-born nurses licensed to practice in Finland and a random sample of 744 native Finnish nurses. Data were collected with a questionnaire and analyzed using multiple linear regression and structural equation modeling (SEM). RESULTS: Of all four dimensions of cross-cultural competence, only empathy was associated with perceived time pressure (ß = -0.13, p = .018), distress (ß = -0.23, p < .001), and sleep problems (ß = -0.14, p = .004) after the adjustment for gender, age, employment sector, and frequency of interacting with patients and colleagues from different cultures. There were no differences between native and foreign-born nurses in these observed associations (all ps > .05). CONCLUSIONS: Cross-cultural empathy may protect against perceived time pressure, distress, and sleep problems in both native and foreign-born nurses. Thus, the promotion of this component of cross-cultural competence among nursing personnel should be encouraged.

International Nursing: Needs Assessment for Training in Disaster Preparedness for Hospital Nurses: A Modified Delphi Study.

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.

Experiences of Nigerian Internationally Educated Nurses Transitioning to United States Health Care Settings.

INTRODUCTION: Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. METHOD: Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. RESULTS: The three major themes identified from the participants' stories were "fear/anger and disappointment" (FAD), "road/journey to success/overcoming challenges" (RJO), and "moving forward" (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. DISCUSSION: NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

Nursing qualification and workforce for the Association of Southeast Asian Nations Economic Community.

International nurse migration among Association of Southeast Asian Nations (ASEAN) countries has the potential to increase the effectiveness of health services and access for the ASEAN Economic Community. Providing equivalent nursing qualifications and licensure standards and increasing the availability of the nursing workforce has become a challenge for ASEAN members. The purpose of this study is: 1) to comparatively analyze information on nursing licensing examinations (NLE) across ASEAN countries; and 2) to present information on the human resources required for a successful nursing workforce. This study reviews all documents published on the subject within the ASEAN Economic Community. NLE systems exist in all ASEAN Member States (AMSs)s except Brunei, Vietnam, and Lao PDR. Nursing education systems also vary across ASEAN countries. Language as a means of general communication and nursing examinations also differs. The availability of a qualified health workforce at the regional level is above the threshold in some areas. However, at the national level, Indonesia, Myanmar, Cambodia, and Lao PDR fall below the threshold. Professional licensure requirements differ among ASEAN nurses as a part of the process to become a qualified nurse in host and source countries. Mutual Recognition Agreements on nursing services should address the differences in NLE requirements as well as the availability of nurses.

Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.

INTRODUCTION: A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses. AIM: To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran. METHOD: The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation. RESULTS: The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver. CONCLUSIONS: The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.