Originally published here.
Internationally educated nurses (IENs) migrate toCanada from many countries worldwide (Covell et al.,2017), bringing with them significant amounts of nursinghuman capital, acquired through their education andprevious professional work experience (Covell et al.,2015). However, IENs are a heterogeneous group, inthat their level of education and type and amount ofprofessional experience can vary dramatically. SomeIENs quickly enter the profession and integrate intotheir workplaces, while others encounter obstacles andsetbacks (Neiterman & Bourgeault, 2015).
As a major receiving country of internationally edu-cated health professionals, Canada has created supportsto assist IENs with overcoming the barriers to profes-sional recertification and employment (Covell et al.,2018). Some of these supports, such as bridging pro-grams, have been found to significantly influence IENs’success on nursing licensing examinations and securingemployment as regulated nurses (Covell et al., 2017,2018); however, once employed IENs can continue toexperience challenges (Primeau, 2014).Upon entering their first jobs many IENs discoverhow nursing is practiced in Canada and how it differsfrom what they are accustomed (Murphy, 2008).
It isduring this time when IENs become aware of the need to continue to advance their nursing knowledge andskills, perfect their language and communication skills,while striving to develop a sense of belonging and com-fort at work (Murphy, 2008). This process is referred toas workplace integration—the need to culturally “adapt,or change certain ways of thinking, speaking and actingin the workplace” (Holmes, 2012, p. 6).Recognizing workplaces and the nursing practice candiffer dramatically from what IENs expect, someCanadian stakeholders have put supports in place toassist employers with easing IEN’s integration into theworkplace (Baumann et al., 2015; Ontario HospitalAssociation, 2015).
At the organizational level, supportscan vary from time-limited employer-sponsored orienta-tion programs (Primeau et al., 2016), or larger systemwide initiatives designed to facilitate IENs’ workplaceintegration, career development, and retention(Hamilton Health Sciences, 2019). However, due tofunding constraints, these types of initiatives are sporad-ic or not readily available across all health-care sectorsor Canadian jurisdictions.Several qualitative studies have explored IENs’ expe-riences when trying to integrate into their workplaces(Babenko-Mould & Elliott, 2015; Lum et al., 2016).
The findings from these studies identified individual fac-tors and contextual barriers to IENs’ workplaceintegration.The individual factors identified by IENs primarilyfocus on the need to improve their communicationskills and gain an understanding of how nursing is prac-ticed in the host country, which may differ from theircountry of origin. In particular, IENs find the natureand tone of interprofessional communication, thescope of nursing practice, and the autonomy affordedto Canadian nurses to be different from what they areused to (Covell et al., 2015; Neiterman & Bourgeault,2013).
IENs who are attached to traditional genderroles have deep-seated respect for older adults(Neiterman & Bourgeault, 2015) or are unprepared toact as patient advocates (Neiterman & Bourgeault, 2015)find they need to acquire additional knowledge to devel-op the required professional behaviors or practices. Eventhose who are native English or French speakers reportdifficulty understanding local expressions and unfamil-iarity with the occupational-specific vocabulary used inthe workplace (Cheung et al., 2013). Thus, perfectingtheir communication skills and learning about how nurs-ing is practiced in the host country by continuallyadvancing their nursing knowledge may help IENs inte-grate more smoothly into their workplace.
The contextual factors that act as barriers to work-place integration center around behaviors and practicesIENs perceive as discriminatory or racist. These includeIENs having limited opportunities to participate in pro-fessional development, being socially excluded ormarginalized by their colleagues (Babenko-Mould &Elliott, 2015; Walani, 2015), and being subjected toracist behaviors or comments from patients and families(Baptiste, 2015). Despite having professionally recerti-fied as regulated nurses, IENs often report feeling deval-ued in the workplace, in that they believe theirpreviously acquired professional knowledge and skillsgo unacknowledged (Samali et al., 2017).
IENs alsobelieve racial discrimination plays a role in their inabilityto secure leadership positions (Ramji & Etowa, 2018) oradvance their careers (Baptiste, 2015). When askedabout their preferences for achieving career goals, themajority of IENs indicate that they have already mettheir goals of mentoring other nurses and being givenmore responsibility; however, they had yet to attainhigher level positions (St-Pierre, Covell, Primeau,Ndengeyingoma, et al., 2015). Having good relation-ships with their coworkers support from their managers(Salma et al., 2012) and mentorship from other nurseshave been identified as factors that can ease IENs’ work-place integration.
The reasons for IENs’ encountering racism and dis-crimination in the workplace are not fully understood. Itis surmised that changes in demographic profile of IENsin Canada, in that higher proportion of IENs are migrat-ing from low-income countries, have created an IENpopulation diverse in educational preparation, profes-sional experience, language and communication skills,and race and cultural backgrounds (Covell et al.,2017). This diversity suggests that IENs are a heteroge-neous group in that some IENs are job-ready uponhiring, while others require more time and support toadjust to how nursing is practiced in the host country.Consequently, many organizations across the country donot fully understand the unique needs of newcomers,especially those who are visible minorities, or how tohelp them integrate smoothly into their workplaces(Holmes, 2012).
Understanding the type and amountof support required by IENs is integral for ensuring allIENs, regardless of their race, ethnicity and professionalbackground have the opportunity to become valuedmembers of their workgroups and are retained withinthe organization and the host country’s health-caresystem.The Conceptual Framework of Support for IENs’Workplace Integration was developed for this study(Figure 1).
We conceptually defined workplace integra-tion as IENs becoming members of a workgroup withina nursing organization where they can use their nursingknowledge and expertise (Covell et al., 2014, 2016) tofulfill their patient care responsibilities in collaborationwith other health-care providers. The framework identi-fies key individual and contextual factors as supportiveof IENs’ workplace integration.
IENs’ workplace inte-gration was conceptualized as being supported by the individual factors of communication competency andnursing knowledge and contextual factors of education,support, and mentorship in the workplace and positivework relations.For this study, we operationalized the individual fac-tors of workplace integration as communication compe-tency, that is, perfecting communication skills andnursing knowledge as continuing to develop nursingknowledge and skills. The contextual factors were oper-ationalized as factors that occur in the IENs’ workplace.
They include (1) continuing professional education oper-ationalized as participating in employer-sponsored ori-entation programs, (2) receiving mentorship fromcolleagues, (3) receiving support from managers andthe staff union, and (4) positive work relationshipswith coworkers.Our study aimed to (1) examine IENs’ perception ofthe extent to which they have integrated in their work-places and the individual and contextual factors thatsupported their workplace integration, (2) explorewhether IENs’ perceptions of workplace integration dif-fered by visible minority status, and (3) identify key indi-vidual and contextual factors that predict IENs’workplace integration.
Workplace integration is a reciprocal relationship betweenthe IEN and their employer, with each having specificobligations to fulfill. A collegial work environment char-acterized by openness and fairness engenders feelings ofacceptance and belonging; which can be accomplished byvaluing IENs’ unique contributions to patient care. IENswho are visible minorities may need more time and assis-tance during the integration period, and therefore, organ-izations and managers must commit to providing IENswith the necessary support through extended orientationand mentorship programs, and equal or greater access tocontinuing education and career advancement opportuni-ties. Facilitating the integration of IENs not only benefits IENs but also patients and their families, the organization,and wider community.
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