Table 1 - uploaded by Christine L Covell
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We used interview data to explore internationally educated nurses’ perceptions of the factors that facilitated their integration into the registered nursing workforce in Canada. The participants perceived that a variety of interrelated factors facilitated their integration. The identified factors seem to reflect forms of capital. Economic capital (...
Citations
... During recent years, the strongest growth in the immigrant population has occurred in the Nordic EU/EFTA countries (OECD, 2019). Previous research on IENs' experiences of the recertification process has, however, mainly been conducted in English-speaking countries such as Canada (Covell et al., 2015;Salami et al., 2018), the US (Liou & Cheng, 2011), the UK (Allan & Westwood, 2016) and Australia (Chun Tie et al., 2019), which differ from the Nordic countries in, for example their language, culture, migration policies, recertification processes and the nursing profession. Furthermore, there has been some research on bridging programmes (Hadziabdic et al., 2021;Högstedt et al., 2021), but less on IENs who undergo recertification mainly by taking examinations to obtain a nursing license. ...
Aim
To examine internationally educated nurses’ (IENs’) experiences of the recertification process when undergoing a series of examinations to test their nursing knowledge and skills and, thereby, obtain a Swedish nursing license.
Design
A qualitative study with a descriptive design.
Methods
A convenience sample of 15 IENs at the end of the recertification process was included. Data were collected using semi-structured telephone interviews between September 2019 and January 2021 and analysed using qualitative content analysis.
Results
Conducting the recertification process to obtain a Swedish nursing license was challenging in many ways, and the nurses described a rollercoaster of emotions during the process: frustration, loneliness, stress and anxiety, but also happiness, pride and relief. The process was, for some, so demanding they almost gave up, and support was, therefore crucial for the nurses. However, many times, they had to struggle to find out where they could turn for help or guidance.
Conclusion
The nurses found the formal support during the recertification process to be inadequate and inaccessible. For this reason, and to decrease the risk of nurses dropping out and instead taking unlicensed jobs, there is a need to develop and introduce more supportive structures and to make the existing support and information more accessible for the nurses.
Impact
This study highlights the importance of offering accessible support during a demanding and challenging recertification process. These findings can help policymakers develop and introduce supportive structures in the process of recertification for IENs.
... On the other hand, the IENs realized the importance of language proficiency to being able to complete the program. Good language proficiency has previously been found to facilitate the integration process, because it makes it easier to take advantage of existing educational resources (Covell et al., 2015). Given that the IENs in the present study reported improved language skills during the program, this may also be beneficial in their upcoming working life. ...
Background
Bridging programs have been created to facilitate internationally educated nurses’ integration process. Thus far, studies on bridging programs have been few and have only been conducted in English-speaking countries. Due to language barriers, it may be a greater challenge to attend a bridging program in a non-English-speaking country.
Objectives
The aim was to examine internationally educated nurses’ experience of attending a one-year bridging program to obtain a Swedish nursing license.
Design
A qualitative study with a descriptive design was applied.
Settings
The study setting was the five universities offering the one-year, full-time Swedish bridging program.
Participants
Purposive sampling was used. Eighteen nurses participated in the study at the end of the program.
Methods
Semi-structured interviews were conducted and analyzed using qualitative content analysis.
Results
Studying in a new environment and language was challenging and intensive, as were adapting to a new healthcare system and relearning some nursing practices. However, attending the bridging program was also rewarding and gave feelings of happiness and pride; the nurses developed their nursing skills as well as their language and academic skills. Moreover, they became familiar with Sweden’s nursing practices, healthcare system, and culture. Good support was important, but not always enough.
Conclusions
By attending a bridging program, nurses can become familiar with the country’s healthcare system and nursing practices. Moreover, develop their language skills and attain skills important to lifelong learning. Although the program may not eliminate all difficulties nurses often experience in a new country, it can offer the support nurses need to handle the challenges. However, for some nurses, due to different backgrounds and prerequisites, the support offered may need to be more individualized.
... This is a finding not previously described in European research on IENs. However, the struggles of integration into nursing for IENs in Canada and the importance of perseverance are discussed by Covell et al. [21] which lends support to our results. This study thus found that awareness and engagement, changing of attitude and the positive meaning of obtaining a nursing license facilitated a healthy transition into the workplace [22]. ...
Background
Countries all over the world are experiencing a shortage of registered nurses (RNs). Therefore, some countries, including Sweden, have tried to solve this by recruiting internationally educated nurses (IENs). Countries offer bridging programs as educational support to qualify IENs for nursing work in the destination country. However, there is little research on IENs’ experiences of bridging programs in European countries and how these programs facilitate their integration into the world of work and their new society. The aim of this study is to explore the experiences of nurses, originally educated outside the EU (European Union)/EES, of the Swedish bridging program and of the program’s role in facilitating their integration into the nursing profession in Sweden.
Methods
A qualitative descriptive design was used to explore the topic based on 11 informants’ perspectives and experiences. Purposive sampling was used to recruit participants at one university in Sweden. Data were collected by individual interviews using a semi- structured interview guide during the year 2019 and were analysed using an interpretative thematic approach.
Results
Two main themes emerged from the analysis: 1) Return to nursing, and 2) The bridging program as a tool for transition to nursing in Sweden. The first theme includes conditions and experiences such as personal motivation and determination, and support from others that the participants described as important in order to achieve the goal of re-establishing themselves as registered nurses in Sweden. Furthermore, the second theme describes the participants’ experiences of the bridging program as mostly positive because it led to new learning and achievements that were valuable for the transition to nursing in Sweden; however, the participants also emphasised the challenges of their transition into the nursing profession, which were related to instances of misrecognition of their professional competence and the uncertain outcome of the program.
Conclusions
This study found that the bridging program facilitated integration into the nursing profession for nurses educated outside the EU/EES, especially knowledge gained in clinical-based training. Thus, it is important to recognise and value the IENs’ experience and previous knowledge and training when developing the bridging program’s curriculum.
... At the same time, for other mobile professions, competence in the local language is essential to be able to perform work-related tasks (Covell et al., 2015). Scholars suggest that in this case highly-skilled as well as transnational elites who are more likely to know several languages are again more likely to have a larger pool of potential destination countries (Portes et al., 2001;Amit, 2007). ...
... Knowing the local language may not only be imperative for obtaining a job in the country of destination, but also help to establish contacts with the local population and allow individuals to integrate more easily (Cederberg, 2014;Gimenez and Morgan, 2017). For instance, high command of English language and competence in professional vocabulary has helped internationally trained nurses from various countries of origin to integrate into the Canadian labour market, and has seemed to simplify the relocation and integration process (Covell et al., 2015). The role of local language competence on migration was also discussed in the EU context. ...
... In contrast to what was suggested by other scholars (Portes et al., 2001;Amit, 2007;Thorn and Inkson, 2013) who have argued that language competence may be a less relevant factor in explaining highly-skilled migration (as they are more likely to adapt to foreign languages), my study suggests that for some mobile professionals language may still play a role when considering relocation and determining destination countries. Furthermore, such findings support other studies (Covell et al., 2015;Gimenez and Morgan, 2017) by showing that for some professional migrants proficiency in the local language reduces barriers to integration into the local labour market. ...
The aim of the DPhil thesis is to explore the particular case of the migration decision-making and experiences of German professionals in Britain. Not only is the mobility of professionals an integral factor for the economies, but it is also promoted and facilitated on the national and EU levels. Mobile professionals may be regarded as the ideal type of mover: invisible, young, highly-talented, competent in the local language, well-integrated. Indeed, due to these characteristics, they are assumed to integrate easily and enjoy the mobile lifestyle. However, some empirical studies highlight the complexities of this mobility suggesting that even those highly-desired mobile professionals are not immune to challenges, which may lead to instability, insecurity, and stress, suggesting that such migration is not as frictionless and easy as may be suggested.
In this thesis, I aim to address these aspects. Based on the qualitative analysis of 64 interviews with professionals and some of their partners, I draw our attention to the complexities in the lives of these privileged mobile professionals. On the one hand, German professionals moving to Britain may exemplify the notion of frictionless mobility, as they enjoy the right to move freely, they are educated, young, competent in the English language, employed according to their qualifications, and well-integrated. On the other hand, their mobility is more constrained than it first appears and their migratory experiences are not immune to challenges or unanticipated obstacles, such as Brexit. Furthermore, having partners or children may present additional challenges for the households, and not only impact the relocation strategies of the household but also impact the migratory experience of each partner. Discussing these aspects contributes to our understating of the particularities of the experiences of mobile professionals relocating between affluent countries, as well as highlights the realities and complexities of mobility and the lives of these highly-desired professionals.
... Besides the crucial role of language proficiency, knowledge of professional vocabulary, and the acquired credentials and professional competencies from the source countries, findings show that access to financial resources was significant integrative factor that allowed IENs to further develop their human capital attributes and increase their employment prospects. In addition to economic capital as facilitator to IENs' integration (as factor to ease financial burden during educational upgrade),Covell et al. (2015) reported that a substantial number of participants were able to take the nursing examination (and eventually enter the workforce) following successful recognition of credentials from their countries of origin. The adequate amount of education satisfactory to the provincial regulator, allowed IENs to become registered nurses without attending any bridging programs while avoiding additional financial strains.However, to cautiously place these findings in the context of human capital and cultural capital and regulatory licensing within Canadian healthcare labour market, it is important to note that more than half of the IENs participants in the study conducted byCovell et al. (2015) came from Western Europe, the United States, and Australia. ...
... In addition to economic capital as facilitator to IENs' integration (as factor to ease financial burden during educational upgrade),Covell et al. (2015) reported that a substantial number of participants were able to take the nursing examination (and eventually enter the workforce) following successful recognition of credentials from their countries of origin. The adequate amount of education satisfactory to the provincial regulator, allowed IENs to become registered nurses without attending any bridging programs while avoiding additional financial strains.However, to cautiously place these findings in the context of human capital and cultural capital and regulatory licensing within Canadian healthcare labour market, it is important to note that more than half of the IENs participants in the study conducted byCovell et al. (2015) came from Western Europe, the United States, and Australia. On the other hand, the Canadian Institute ...
Exploring workforce integration of internationally educated nurses.
... More recently northern India has also become active in the training and migration of nurses (Walton-Roberts, Bhutani, and Kaur 2017), and Canada, a settler society with an active and highly selective permanent immigration system (Banting 2010), has emerged as an important destination. One migration route increasingly used by Indian nurses to enter Canada is the two-step pathway of first entry as an international student, then subsequent conversion into a working visa and entry into the labour market as an IEN (Hawthorne 2010;Covell, Neiterman, and Bourgeault 2015;Covell et al. 2019; Walton-Roberts and Hennebry 2019). ...
... The Government of Indian facilitates, even encourages, this two-step pathway through its support for private sector investment in nurse training (Walton-Roberts 2015). Research on this two-step pathway suggests it offers some advantages over other migration channels for IENs interested in gaining the right to work in Canada (Covell, Neiterman, and Bourgeault 2015). By entering the two-step migration pathway, IENs engage with the national training systems they wish to find employment within, and from this position, they can more effectively negotiate the regime of skill. ...
... The top source countries for Canadian IENs include India and the Philippines. Research on international students in Canadian regulated health professional programmes (nursing, medicine, dentistry and pharmacy) showed that 71% remained in Canada after their studies, contrasting with 55% for international students in all health care programmes of study (Covell, Neiterman, and Bourgeault 2015). This suggests the use of two-step migration pathways for immigrants interested in working in regulated health care professions is a promising strategy. ...
Market-based migrant intermediaries play an important role in
skilled migration. Skilled workers, especially in regulated
professions such as nursing, face increasingly complex testing and
credential assessment systems. ‘Regimes of skill’ control and filter
membership to these professions by reproducing already existing
power imbalances in the global regulation of skilled labour. This
paper examines these processes in the case of Indian trained
nurses who use educational brokers to enrol in Canadian postgraduate
programmes with the intention of practising in the
Canadian health care system. The study elaborates on the ‘regime
of skill’ in nursing, revealing its maintenance through interactional
and transnational connections between intermediaries, educators
and regulators in terms of codifying and translating skills and
competencies between jurisdictions with different cultural and
professional histories and norms of nursing. Findings reveal that
intermediaries operate transnationally in a symbiotic manner with
more powerful actors in order to exploit regimes of skill and
expand their market share.
... Il s'agit d'un atout que tous les répondants ont trouvé précieux. L'expérience en milieu de travail canadien, même brève, est effectivement associée à de meilleures perspectives de requalification et d'emploi dans la littérature (Covell et al. 2015). Ces personnes partagent d'autres caractéristiques qui ont facilité leur processus : une maitrise de l'anglais acquise avant leur immigration, des ressources financières suffisantes, un réseau personnel de soutien, une bonne maitrise du processus, et une grande persévérance. ...
... Le marché de l'emploi est généralement favorable aux employés, en particulier dans le domaine de la santé, notamment en raison du vieillissement de la population. Il en résulte que, pour les étudiants étrangers ayant choisi une profession dans le domaine de la santé, les perspectives d'embauche et de rétention au Canada sont plus favorables que dans les autres domaines (Covell et al. 2015). Par exemple, les infirmières qui étudient pour obtenir leur baccalauréat peuvent, en principe, obtenir un emploi comme infirmière après deux ans d'étude, celles-ci pouvant exercer comme infirmière auxiliaire (niveau collégial) avant d'exercer comme infirmière autorisée (baccalauréat). ...
Ce rapport présente les résultats d’une recherche portant sur l’insertion professionnelle des personnes immigrantes francophones dans le domaine de la santé en situation linguistique minoritaire. Par le biais d’entretiens auprès de personnes immigrantes francophones travaillant ou souhaitant faire carrière dans le domaine de la santé en Nouvelle-Écosse, en Ontario et en Alberta, ce projet examine les défis auxquels ces personnes font face dans le cadre de leur parcours d’insertion professionnelle. La littérature sur l’intégration professionnelle des immigrants, des données issues du Recensement de 2016 et des résultats d’études quantitatives ont également été mobilisés. La recherche montre notamment que la nécessité de compétences importantes en anglais constitue un obstacle majeur, et ce, aux différentes étapes du parcours d’insertion. Les entretiens précisent par ailleurs que les services d’aide à l’emploi en français s’avèrent peu outillés pour faire face à la complexité des parcours des professionnels formés à l’étranger et pour l’identification de carrières alternatives. Lors des stages ou en début d’emploi, les appuis favorisant l’insertion des personnes immigrantes (mentorat, ateliers de formation pour employeurs, etc.) sont très limités en français. Les recommandations formulées s’adressent principalement à l’instigateur de cette étude, soit le ministère Immigration, Réfugiés et Citoyenneté Canada. Elles visent à améliorer l’appui offert à la population à l’étude à chacune des étapes de son insertion professionnelle en santé, soit dès l’amorce de son projet migratoire, jusqu’à la rétention dans son milieu de travail.
... This was also reported in the integrative review studies conducted by Chok et al. (2018). Language barrier has caused IENs to be ignored (Alexis 2013) in the workplace, result into susp icions of being backstabbed by local nurses as they speak slang (Brunton & Cook 2018), issues with both patients and workmates most especially the elderly group (Buttgieg et al. 2018) and serious implications of workplace safety not only by the patients handled but to themselves as well (Holmes & Grech 2014) , communication problems with other healthcare providers (Covell & Bourgeault 2015) and being judged because of the notable accent (Iheduru-Anderson & Wahi 2018). Native nurses may also experience feelings of tension when IENs are allowed to speak their mother tongue in the work environment (Nichols et al. 2015). ...
... The research study is evident that the reason for migration among FIENs is to provide a better future for their family members, an implication of limited financial resources in the country of origin. In general, it can be costly for IENs to migrate if they intend to seek for a RN position overseas (Covell et al. 2015). From the point of view of the host organisation most especially who are following the direct recruitment model, it could also be costly hiring IENs. ...
... Although Finland compared to other countries such as the USA and Canada (Baptiste 2015;Covell et al. 2015) does not require licensure examination for Registered Nurses, the process in recognising the qualifications as a means to protect the RN title (Health Care Professionals Decree No. 564/1994), needs to be further studied by experts. There is also a need to do consultations from the different sectors of the Finnish government and the resource countries not only to protect the interests of the public, citizens and patients but also the IENs who will undergo several challenges and will have an impact on patient's safety (Holmes & Grech 2014;Sherwood & Shaffer 2014;Baptiste 2015;Moyce et al.2016) and healthcare teamwork effectiveness (Brunton & Cook 2018). ...
Background: The nursing shortage in Finland leads to the recruitment of Internationally Educated Nurses. The migration of Filipino nurses to Finland is a new phenomenon in the coun-try and challenges encountered by them give rise to adversities in the Finnish social and health care services.
Aim: The aim of the study is to investigate the challenges during the transition and integration phases of the Filipino Internationally Educated Nurses recruited to work as Registered Nurses in the Finnish social and healthcare services. This also intends to examine how these challenges take into account the retention of their nursing competencies in the field of expertise and then produce solutions for future recruitment agencies, employers, and policy and decision-makers.
Method: The research study utilised a qualitative descriptive approach. Study participants were Filipino nurses who have been hired to work as Registered Nurses (Sairaanhoitaja) in Finland. The snowball sampling method was used to recruit 10 Filipino Internationally Edu-cated Nurses currently living in the country. The data collection was completed between December 2018-February 2019. Eight individual semi-structured interviews and one joint interview were performed. Interviews were audio-taped, transcribed verbatim, and analysed through qualitative content analysis. The data were analysed with the Atlasti 8.3 software.
Results: Transition phase challenges were recruitment hardships, mismatched Finnish language training, family migration, contract matters, and insufficient and unclear pre-departure information. Integration phase challenges were collegiality and work culture, culture differences, development of non-communicable diseases and other work health-related issues, intrapersonal conflict, language, and communication licensing journey, racism and discrimination, and nursing competencies for general care.
Recognition of challenges encountered by the Filipino Internationally Educated Nurses in the recruitment process and during the integration period enhances a stronger collaboration between different sectors in the Finnish social and healthcare services in the decision to recruit more Filipino nurses in the future.
... These findings suggest that familiarity with Canadian health care context supports a positive assessment of competencies. The finding that the basic credential received may be a significant factor in the outcome of the SEC assessment process is consistent with previous research (Newton et al., 2012;Covell et al., 2014Covell et al., , 2015Covell et al., , 2017. ...
Purpose
The purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explored.
Design/methodology/approach
This is a secondary statistical analysis of a subset of IEN application data from a previous study in combination with assessment data from an additional database. Application data between 2008 and 2011 were analyzed using univariate/bivariate analyses and regression models to explore the relationship of performance in the assessment process and outcomes of the registration process.
Findings
Competency categories IEN applicants had difficulties with (from least to most) were Professional Responsibility and Accountability, Ethical Practice, Self-Regulation, Service to the Public, Knowledge-Based Practice: Specialized Body of Knowledge and Knowledge-Based Practice: Competent Application of Knowledge. IENs educated in the UK and USA had the highest scores and odds of meeting competencies. Applicants educated in India and Asia had lower scores and odds ratios. All national entry-to-practice examination and registration eligibility competencies were significantly related to registration outcomes. Applicants passing the exam had higher competency scores while applicants ineligible for registration had lower competency scores.
Research limitations/implications
Limitations include integrity of data extracted from active databases, IEN motivation to complete the RN registration process and conversion of assessment scales for research analysis.
Originality/value
Results inform regulation policies that improve IEN registration processes and may be informative to regulators, assessment centers, educational institutions and IENs.
... Becoming acquainted with the different sectors and settings within the Canadian healthcare system and learning how to apply for jobs and to complete the interview process [31] are strategies IENs can use to accelerate their employment. Oftentimes, IENs rely on their social network of friends and family in Canada to help them navigate the job search and hiring process [32]. ...
... These strategies may be most helpful to IENs who are unfamiliar with the exam content and testing methods used for the licensure exams and the processes used to search for employment in Canada. This finding is confirmed by previous qualitative research that theorized social capital as an important facilitator of IENs' integration into the nursing workforce [32]. It also supports the higher weights post IRPA given to immigrants who have social networks in Canada [19]. ...
... However, those who had help from friends and colleagues in Canada were 1.9 more likely to have experienced difficulty. This suggests when IENs struggle to secure employment, they seek assistance from their social network in Canada to help them navigate their job search and the hiring process [32]. Bridging program participation may provide assurances to employers that IENs are prepared to work in Canada [9]. ...
Background
Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs’ workforce integration.
Methods
A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs’ workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment.
Results
The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment.
Conclusions
Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a “one size fits all” model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries’ nursing workforce.
