International nurses’ adjustment to new workplaces

International nurses’ workplace adjustment has had less attention in the field of research but some studies have explored the topic (e.g. Huang & Yang, 2011;

Magnusdottir, 2005). Kawi and Xu (2009) argue that there is a scarcity of research focusing on issues that international nurses encounter in their adjustment to a foreign health care environment. Their study focused on identifying facilitators and barriers to international nurses’ adjustment by

reviewing the past research on the topic to summarize the most common factors that influence international nurses’ adjustment to new working environments. Findings of the study indicate that a positive work ethic, persistence, psychosocial and logistical support, learning to be assertive, and continuous learning helped the international nurses’ adjustment to their new workplace environments. Kawi and Xu found out that in contrast, language and communication difficulties, differences in culture-based lifestyle, lack of support, inadequate orientation, differences in nursing practice and inequality were identified as barriers for international nurses’ adjustment.

Spry (2009) believes that issues such as language, culture, technology, and terminology, as well as feelings of not being accepted, isolation, and loneliness can make adjustment difficult for international nurses.

While being in a new culture and working environment, they can be expected to deal with unfamiliar technology, appreciate unfamiliar cultural norms, speak in a foreign language, and not see family or friends (Spry, 2009). According to Ryan (2003), four major issues which are often overlapping areas that must be addressed in order to international nurses to adjust successfully to their new workplace are socialization to the professional nursing role, acquisition of language and other communication skills, development of workplace competence, both clinical and organizational, and availability of support systems and resources within the organization. Kawi and Xu (2009) point out how critical it is to address the adjustment issues of international nurses in new workplace environments when dealing with the global nurse shortage and increasing magnitude of their migration. They argue that the barriers that nurses encounter not only affect job satisfaction of international nurses and

therefore, their retention, but also patient safety and quality of care. They believe that multifaceted strategies involving concerted efforts to support the successful adjustment of international nurses are most likely to enhance job satisfaction and improve retention. Identifying the facilitators and barriers to the adjustment provides the essential information needed to design an evidence informed program to meet the unique needs of international nurses as they adjust to new workplaces. Kawi and Xu note that international nurses’

successful adjustment will not only benefit nurses themselves, but also their employers, and most importantly, the public cared for by international nurses.

Since adaptation to a new working environment can take a long time, Habermann and Stagge (2010) recommend that employers who want to attract and retain nurses should accompany the process over the years and to provide programs that are not only covering the first encounters of international nurses with their new work environment, but also support the adaptation process in the long run.

Employers and colleagues can significantly assist international nurses’ adjustment to new workplaces. Davis (2003) shares several practical advices for employees working with nurses from other countries on how to help nurses to adjust and make a smooth transition to a new workplace:

1. Take an initiative and welcome international nurses to the unit by introducing yourself and other team members to offset any language hurdles or reluctance to make a first move;

2. Explain how the system works by providing information on how much responsibility nurses have, how much technology to use, and how fast the pace is. Furthermore, it is important to help them to understand

health care team members’ roles and responsibilities so that they can understand how they fit into the unit and the hospital;

3. Clarify abbreviations, slang, and idioms when using them in practice to avoid communication problems and promote fitting in with others at the workplace;

4. Share the unit’s cultural norms such as reporting practices at the beginning and end of each shift;

5. Explain cultural aspects of care since international nurses may have to adjust to the ethnic and religious diversity. Likewise, it is also encouraged to ask international nurses’ advice on patients from their country or background;

6. Help them pronounce medical terms which can be challenging for non-native speakers. When international nurses know that they are communicating clearly, it might boost their confidence to speak up more with patients and colleagues;

7. Share good nursing resources so that international nurses can access the information needed to develop and maintain their clinical competence;

8. Offer help without being asked since international nurses might hesitate asking help which can be perceived as incompetence;

9. Provide positive feedback because it can make a difference and give international nurses an encouragement to believe in their abilities to work as a nurse in a foreign country;

10. Encourage them to share health care practices from their home country to appreciate and value their expertise;

11. Invite them to be part of the team as with any new member at the workplace.

It is logical that these tips also apply to any new member entering a new workplace but in particular, when it comes to international nurses it can make a huge impact on their adjustment and feeling welcomed to the workplace. Relevant themes associated with international nurses’ adjustment to the workplace seem to be dealing with issues such as language and communication, socialization in the workplace, and sharing and providing information.

4 WORK ORIENTATION