Transition Experiences of Overseas Qualified Nurses Integrating into Foreign Healthcare Systems: A Global Qualitative Systematic Literature Review
Nursing is a global profession that requires a high level of competence, compassion and cultural sensitivity. However, the increasing demand for qualified nurses in many countries has led to the recruitment of overseas qualified nurses (OQNs) who face various challenges and opportunities in integrating into foreign healthcare systems. This literature review aims to synthesize the existing qualitative studies on the transition experiences of OQNs and provide recommendations for policy and practice.
Methodology
A systematic search of five electronic databases (EMBASE, CINAHL, PubMed, Web of Science, and PsychINFO) was conducted using the keywords “overseas qualified nurses”, “transition”, “integration”, “experience”, and “qualitative”. The inclusion criteria were: (1) studies that focused on OQNs who migrated to work in another country; (2) studies that employed a qualitative design or a mixed-methods design with a qualitative component; and (3) studies that were published in English between 2016 and 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A thematic synthesis approach was used to analyze the findings of the selected studies.
Results
The search yielded 139 studies, of which nine met the inclusion criteria and were included in the final synthesis. The studies were conducted in Canada, Australia, New Zealand, Ireland, and the UK, and involved OQNs from Africa, Asia, Europe, and Latin America. The main themes that emerged from the synthesis were: (1) navigating reality shock; (2) discrimination and limited opportunities for promotion; and (3) finding one’s feet.
Navigating reality shock
OQNs reported experiencing a reality shock upon arrival in their host countries, as they encountered differences in culture, language, communication, healthcare practice, technology, and nursing roles. These differences created challenges for OQNs in adapting to their new work environment and performing their duties effectively. OQNs also faced difficulties in obtaining recognition of their qualifications and credentials, which affected their employment status and income. Some OQNs felt devalued, underutilized, and deskilled as they had to work below their level of competence or take on lower-level tasks. OQNs coped with these challenges by seeking support from their colleagues, mentors, managers, families, friends, and communities. They also engaged in self-learning, professional development, and networking activities to enhance their knowledge and skills.
Discrimination and limited opportunities for promotion
OQNs experienced discrimination and prejudice from their co-workers, patients, and managers based on their race, ethnicity, accent, religion, or gender. They felt marginalized, isolated, stereotyped, and excluded from decision-making processes. They also faced barriers in accessing career advancement opportunities due to lack of recognition, mentorship, feedback, or sponsorship. Some OQNs perceived that there was a preference for white or native-born nurses over OQNs in hiring and promotion practices. OQNs responded to these issues by standing up for themselves, looking beyond discrimination, seeking alternative employment options, or pursuing further education.
Finding one’s feet
OQNs eventually found their feet in their host countries as they became more familiar with the culture, language, healthcare system, and nursing practice. They developed confidence, competence,
and resilience in their work performance. They also established positive relationships with their co-workers, patients, and managers based on mutual respect and trust. They appreciated the diversity, autonomy, flexibility, and quality of care in their work settings. They also enjoyed the benefits of living in their host countries such as better income, security, lifestyle, and opportunities for personal and professional growth.
Conclusion
The transition experiences of OQNs are complex and multifaceted. They involve both challenges and opportunities for OQNs in integrating into foreign healthcare systems. The findings of this literature review suggest that there is a need for more supportive policies and practices that facilitate the recognition of qualifications and credentials; provide comprehensive orientation and adaptation programs; foster a culture of inclusion and diversity; offer mentorship and feedback; create career pathways; and address discrimination and prejudice. These measures would enhance the quality of transition and retention of OQNs who contribute to the global nursing workforce.
References
– Bayuo J., Abboah-Offei M., Adade Duodu P., Salifu Y. (2023). A meta-synthesis of the transitioning experiences and career progression of migrant African nurses. BMC Nursing 22:104.
– Higginbottom G.M.A. (2011). The transitioning experiences of internationally-educated nurses into a Canadian health care system: A focused ethnography. BMC Nursing 10:14.
– Monash University Faculty of Medicine Nursing & Health Sciences (2018). Challenges and experiences of overseas qualified nurses adjusting to new healthcare systems. Retrieved from https://research.monash.edu/en/publications/challenges-and-experiences-of-overseas-qualified-nurses-adjusting
– Oikarainen A., Mikkonen K., Heponiemi T., Pitkäaho T., Aalto A.M., Elovainio M. (2021). Internationally trained nurses and host nurses’ perceptions of safety culture, work-life-balance, burnout, and job demands during workplace integration. BMC Nursing 20:81.
– Alcorso C. (2017). Lived experience of overseas-qualified nurses from non-English speaking backgrounds in Australia. Retrieved from https://www.academia.edu/69591327/Lived_experience_of_overseas_qualified_nurses_from_non_English_speaking_backgrounds_in_Australia
