On 2015 May 22, University of Kansas School of Nursing Journal Club commented:

Team 1: Courtney Borchers, Elizabeth Bruns, Jesi James, Israel Mendoza, Elizabeth Murphy, Faith Nightingale, Kimberly Seals

Section 3 Journal Club: A review of Smith, C. A., Fisher, C., & Mercer, A. (2011) Rediscovering nursing: A study of overseas nurses working in Western Australia

Background Introduction:

The article by Smith, Fisher, and Mercer (2011) studied the work experience of internationally-educated migrant nurses with a non-English speaking background who came to practice in Western Australia (WA), Australia from various countries around the world.  This study was initiated in hopes to gain perspective from competent migrant nurses who must adjust their knowledge, skills, and attitudes about nursing to those of the host country for which they seek employment.  Our team chose this article because we have discussed the concept of migrant nurses in class; in addition, the movement to develop a more diverse nursing work force will impact our nursing careers as the United States becomes even more diversified in the years to come.  This article fills a knowledge gap by providing us with information about the importance of understanding the diversity in practice of internationally-educated migrant nurses and how to better facilitate the transition of the migrant nurse into the work environment.

Methods:

Our group utilized the CINAHL database to find this particular article. In this study, Smith, Fisher, and Mercer (2011) performed a qualitative study using transcendental phenomenology and Moustakas’ method of analysis for interpretation of results after conducting personal interviews. Open-ended questions about experiences and feelings were asked and responses were audio-taped and transcribed.

Recruitment in the form of posters and flyers were distributed in two hospitals and participants were ultimately recruited as a result of snowball sampling. Thirteen women from nine different countries who lived in WA between 4 and 20 years were selected for the sample. Countries of origin included China, South Africa, Japan, Taiwan, Zimbabwe, Hong Kong, the Philippines, Sweden, and Nepal. All nurses came from non-English speaking countries, had a non-English speaking background but were still linguistically competent, and were all qualified to work as nurses in Western Australia. Ethical approval was granted by the Human Research Ethics Committee of the University of Western Australia, participants were informed about the purpose of the study, and were promised anonymity and confidentiality.

Findings:

Key findings of this particular study by Smith, Fisher, and Mercer (2011) were summarized into four themes: preparedness to work, working with patients, working with doctors, and professionalism.  Regarding preparedness to work, it was concluded that although nurses were deemed competent, had gained registration to practice, and could identify the basic role of the nurse; they found many concepts of nursing in WA to be very different from nursing practice in their home country.  For example, some nurses felt that the scope of clinical skills were more limited and less advanced than the scope of practice in their home country.  However, nurses were puzzled that the broadened scope of practice in terms of emphasis on communication, holistic patient care, and the expectation to know about specialized services in WA was understood as a norm.  Regarding working with patients, nurses expressed that initially they were surprised at the decreased patient load compared to their home country, but eventually understood that the reasoning for this was to promote the holistic and patient-centered approach for which they were so astounded about previously.  In regards to working with doctors, some nurses expressed that the nurse-doctor relationship was more relaxed and less formal in WA, yet they still felt a strong hierarchy that did not exist in their home country.  When it came to professionalism, participants admitted that the working conditions and pay were more favorable in WA than in their home country and felt valued as nurses within the health care system, however, they felt a low level of respect in regards to nursing as a profession from patient’s and society in general.  The study group also felt a sense of lack of unity and motivation from native nurses in WA and contributed these themes to lack of professionalism enforced by the WA health system as a whole.  The results concerning the four themes discussed were consistent with the literature and findings from other studies conducted throughout the world. 

Limitations of the study were not discussed but should include a small sample size. 

Implications:

Similar to the US, migrant nurses who wish to work in Australia must pass certain eligibility criteria and may be required to take a competency test or pursue further education.  Migrant nurses in Australia must also pass the Occupational English Test or the International English Testing System (Smith, Fisher, & Mercer, 2011).  Regardless of the country in which an internationally-educated nurse wishes to work, all migrant nurses ultimately have to adjust their nursing practice to however the host countries contextual social, political, and economic constructs have made nursing as a profession to become.  According to Newton, Pillay, and Higginbottom (2012), “...Circumstances differ between countries to such an extent that there may be wide variation in the context of health care delivery and the education of health professionals, including nurses” (p. 535).  It is important to understand that the migrant nurse may feel many emotions as he/she may potentially learn about a very different set of nursing standards than his/her home country’s’ standards.

These particular types of studies are important to nursing and nursing practice because the findings demonstrate the need for awareness of nurses to aide in the integration and transition of internationally-educated migrant nurses into practice.  It is also important because educational efforts for cultural competency in the academic setting will continue to grow and become more necessary as the United States is continually becoming more diversified.  

In conclusion, our group feels this topic is important because we, as future nurses, will need to show compassion toward the migrant nurse’s concerns, as well as an eagerness to learn about what they already know.  We will also need to demonstrate a culture of unity and will ultimately need to assist migrant nurses as they go through the journey of becoming accustomed to the American nursing ways.

References

Newton, S., Pillay, J., & Higginbottom, G. (2012). The migration and transitioning experiences of internationally educated nurses: a global perspective. Journal Of Nursing Management, 20(4), 534-550. doi:10.1111/j.1365-2834.2011.01222.x

Smith, C. A., Fisher, C., & Mercer, A. (2011). Rediscovering nursing: A study of overseas nurses working in Western Australia. Nursing & Health Sciences, 13(3), 289-295. doi:10.1111/j.1442-2018.2011.00613.x

On 2015 May 22, University of Kansas School of Nursing Journal Club commented:

Team 1: Courtney Borchers, Elizabeth Bruns, Jesi James, Israel Mendoza, Elizabeth Murphy, Faith Nightingale, Kimberly Seals

Section 3 Journal Club: A review of Smith, C. A., Fisher, C., & Mercer, A. (2011) Rediscovering nursing: A study of overseas nurses working in Western Australia

Background Introduction:

The article by Smith, Fisher, and Mercer (2011) studied the work experience of internationally-educated migrant nurses with a non-English speaking background who came to practice in Western Australia (WA), Australia from various countries around the world.  This study was initiated in hopes to gain perspective from competent migrant nurses who must adjust their knowledge, skills, and attitudes about nursing to those of the host country for which they seek employment.  Our team chose this article because we have discussed the concept of migrant nurses in class; in addition, the movement to develop a more diverse nursing work force will impact our nursing careers as the United States becomes even more diversified in the years to come.  This article fills a knowledge gap by providing us with information about the importance of understanding the diversity in practice of internationally-educated migrant nurses and how to better facilitate the transition of the migrant nurse into the work environment.

Methods:

Our group utilized the CINAHL database to find this particular article. In this study, Smith, Fisher, and Mercer (2011) performed a qualitative study using transcendental phenomenology and Moustakas’ method of analysis for interpretation of results after conducting personal interviews. Open-ended questions about experiences and feelings were asked and responses were audio-taped and transcribed.

Recruitment in the form of posters and flyers were distributed in two hospitals and participants were ultimately recruited as a result of snowball sampling. Thirteen women from nine different countries who lived in WA between 4 and 20 years were selected for the sample. Countries of origin included China, South Africa, Japan, Taiwan, Zimbabwe, Hong Kong, the Philippines, Sweden, and Nepal. All nurses came from non-English speaking countries, had a non-English speaking background but were still linguistically competent, and were all qualified to work as nurses in Western Australia. Ethical approval was granted by the Human Research Ethics Committee of the University of Western Australia, participants were informed about the purpose of the study, and were promised anonymity and confidentiality.

Findings:

Key findings of this particular study by Smith, Fisher, and Mercer (2011) were summarized into four themes: preparedness to work, working with patients, working with doctors, and professionalism.  Regarding preparedness to work, it was concluded that although nurses were deemed competent, had gained registration to practice, and could identify the basic role of the nurse; they found many concepts of nursing in WA to be very different from nursing practice in their home country.  For example, some nurses felt that the scope of clinical skills were more limited and less advanced than the scope of practice in their home country.  However, nurses were puzzled that the broadened scope of practice in terms of emphasis on communication, holistic patient care, and the expectation to know about specialized services in WA was understood as a norm.  Regarding working with patients, nurses expressed that initially they were surprised at the decreased patient load compared to their home country, but eventually understood that the reasoning for this was to promote the holistic and patient-centered approach for which they were so astounded about previously.  In regards to working with doctors, some nurses expressed that the nurse-doctor relationship was more relaxed and less formal in WA, yet they still felt a strong hierarchy that did not exist in their home country.  When it came to professionalism, participants admitted that the working conditions and pay were more favorable in WA than in their home country and felt valued as nurses within the health care system, however, they felt a low level of respect in regards to nursing as a profession from patient’s and society in general.  The study group also felt a sense of lack of unity and motivation from native nurses in WA and contributed these themes to lack of professionalism enforced by the WA health system as a whole.  The results concerning the four themes discussed were consistent with the literature and findings from other studies conducted throughout the world. 

Limitations of the study were not discussed but should include a small sample size. 

Implications:

Similar to the US, migrant nurses who wish to work in Australia must pass certain eligibility criteria and may be required to take a competency test or pursue further education.  Migrant nurses in Australia must also pass the Occupational English Test or the International English Testing System (Smith, Fisher, & Mercer, 2011).  Regardless of the country in which an internationally-educated nurse wishes to work, all migrant nurses ultimately have to adjust their nursing practice to however the host countries contextual social, political, and economic constructs have made nursing as a profession to become.  According to Newton, Pillay, and Higginbottom (2012), “...Circumstances differ between countries to such an extent that there may be wide variation in the context of health care delivery and the education of health professionals, including nurses” (p. 535).  It is important to understand that the migrant nurse may feel many emotions as he/she may potentially learn about a very different set of nursing standards than his/her home country’s’ standards.

These particular types of studies are important to nursing and nursing practice because the findings demonstrate the need for awareness of nurses to aide in the integration and transition of internationally-educated migrant nurses into practice.  It is also important because educational efforts for cultural competency in the academic setting will continue to grow and become more necessary as the United States is continually becoming more diversified.  

In conclusion, our group feels this topic is important because we, as future nurses, will need to show compassion toward the migrant nurse’s concerns, as well as an eagerness to learn about what they already know.  We will also need to demonstrate a culture of unity and will ultimately need to assist migrant nurses as they go through the journey of becoming accustomed to the American nursing ways.

References

Newton, S., Pillay, J., & Higginbottom, G. (2012). The migration and transitioning experiences of internationally educated nurses: a global perspective. Journal Of Nursing Management, 20(4), 534-550. doi:10.1111/j.1365-2834.2011.01222.x

Smith, C. A., Fisher, C., & Mercer, A. (2011). Rediscovering nursing: A study of overseas nurses working in Western Australia. Nursing & Health Sciences, 13(3), 289-295. doi:10.1111/j.1442-2018.2011.00613.x