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Abstract The number of internationally educated nurses (IENs) in Ontario is growing. Given the predicted nursing shortage due to an aging nursing workforce and a short supply of nursing graduates, this trend will probably continue as international recruitment to meet nursing demands in Canada continues. Current Canadian research that examines IENs’ experience as they integrate into their workplaces is scarce. With an increasingly diverse Canadian and patient population due to rising immigration trends, a workforce that addresses the needs of the diverse patient population is valuable. Therefore an in-depth understanding of IENs’ experience, their contribution to nursing practice, and their distinct role in promoting health care access to Canada’s diverse population is necessary. A qualitative study using descriptive phenomenology was used to explore the integration experiences of eleven IENs within the Ontario, Canada health care system. Interviews were conducted to examine their experience of integrating into Canadian work settings. Thematic analysis informed by a descriptive phenomenological lens was used to uncover the essence of the IEN’s integration experience. The findings are categorized into five major themes including: Relationship with colleagues; Professional knowledge and experience; Organizational practices and work environment; Cross-cultural and linguistic competence; and IENs as an asset to nursing and patient care. These findings were nested within an overarching theme of resilience and an intrinsic motivation to establish their credibility as competent nurses. These findings highlight IENs’ unique integration experiences, and contribute to Canadian literature in the field, especially in terms of an understanding of IENs’ unique contribution to nursing in Canada. Implications and recommendations for nursing with regards to practice, education, research, and administration are presented.

After immigrating to Canada, some foreign-trained professional women (FTPWs) enrol in adult high schoollevel upgrading to begin to reestablish their careers if their international credentials are unrecognized. To explore this phenomenon, the theoretical framework of possible selves was used as a mechanism to examine the effect of context (i.e., upgrading) on their personally relevant goals. Semistructured qualitative interviews were conducted with four FTPWs who attended two postsecondary institutes in central Alberta. The participants salient possible selves were related to familial duties and employment; they viewed upgrading as a mechanism to work toward these hoped-for selves. Upgrading was also found to increase the number of and clarify their hoped-for selves. Because of the significant impact of immigration on the participants possible selves, upgrading should also include referrals to immigration services and support for the credential assessment process, help to build confidence, and encourage the development of social networks for immigrants.

Abstract The number of internationally educated nurses (IENs) in Ontario is growing. Given the predicted nursing shortage due to an aging nursing workforce and a short supply of nursing graduates, this trend will probably continue as international recruitment to meet nursing demands in Canada continues. Current Canadian research that examines IENs’ experience as they integrate into their workplaces is scarce. With an increasingly diverse Canadian and patient population due to rising immigration trends, a workforce that addresses the needs of the diverse patient population is valuable. Therefore an in-depth understanding of IENs’ experience, their contribution to nursing practice, and their distinct role in promoting health care access to Canada’s diverse population is necessary. A qualitative study using descriptive phenomenology was used to explore the integration experiences of eleven IENs within the Ontario, Canada health care system. Interviews were conducted to examine their experience of integrating into Canadian work settings. Thematic analysis informed by a descriptive phenomenological lens was used to uncover the essence of the IEN’s integration experience. The findings are categorized into five major themes including: Relationship with colleagues; Professional knowledge and experience; Organizational practices and work environment; Cross-cultural and linguistic competence; and IENs as an asset to nursing and patient care. These findings were nested within an overarching theme of resilience and an intrinsic motivation to establish their credibility as competent nurses. These findings highlight IENs’ unique integration experiences, and contribute to Canadian literature in the field, especially in terms of an understanding of IENs’ unique contribution to nursing in Canada. Implications and recommendations for nursing with regards to practice, education, research, and administration are presented.

Several studies have concluded that the use of nurses’ time and energy is often not optimized. Given widespread migration of nurses from developing to developed countries, it is important for human resource planning to know whether nursing education in developing countries is associated with more exaggerated patterns of inefficiency. Objectives First, to describe nurses’ reports on tasks below their skill level. Second, to examine the association between nurses’ migratory status (domestically trained nurse or foreign trained nurse from a developing country) and reports on these tasks. Design The Registered Nurse Forecasting Study used a cross-sectional quantitative research design to gather data from 33,731 nurses (62% response rate) in 486 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden and Switzerland. Methods For this analysis, nurse-reported information on migratory status and tasks below their skill level performed during their last shift was used. Random effects models estimated the effect of nurses’ migratory status on reports of these tasks. Results 832 nurses were trained in a developing country (2.5% of total sample). Across countries, a high proportion of both domestically trained and foreign trained nurses from developing countries reported having performed tasks below their skill level during their last shift. After adjusting for nurses’ type of last shift worked, years of experience, and level of education, there remained a pronounced overall effect of being a foreign trained nurse from a developing country and an increase in reports of tasks below skill level performed during the last shift. Conclusion The findings suggest that there remains much room for improvement to optimize the use of nurses’ time and energy. Special attention should be given to raising the professional level of practice of foreign trained nurses from developing countries. Further research is needed to understand the influence of professional practice standards, skill levels of foreign trained nurses from developing countries and values attached to these tasks resulting from previous work experiences in their home countries. This will allow us to better understand the conditions under which foreign trained nurses from developing countries can optimally contribute to professional nursing practice in developed country contexts. / Dr McIntosh is a member of the the RN4CAST Consortium.

De plus en plus d'intérêt est porté au recrutement d'infirmières formées à l’étranger dans plusieurs pays, surtout dans le contexte actuel de pénurie de ressources. Toutefois, il n’existe peu d’écrits sur leur expérience d’intégration ainsi que les facteurs favorisant leur rétention. L'objectif de cette thèse est d'explorer les facteurs explicatifs de la réussite de l'intégration et de la rétention des infirmières diplômées hors Québec (DHQ) dans le système de santé québécois. Cette étude s'est concentrée sur trois processus clefs, à savoir le programme de formation d'appoint, ou programme d'Intégration à la profession infirmière au Québec CWA0B0 (volet 1), la période de probation en emploi (volet 2) et la rétention en emploi des infirmières DHQ (volet 3). Afin d'explorer ceux-ci, un devis mixte, alliant entretiens individuels, groupes de discussion et questionnaires auto-administrés a été adopté. Ultimement, cette thèse a permis l'avancement des connaissances quant à l'intégration des professionnels de la santé immigrants. En effet, cette étude a permis de comprendre le processus d'intégration, définir les sous-processus qu'il sous-entend et proposer un modèle conceptuel adapté aux transitions qui leur sont associées. De surcroit, cette étude est la première à s'intéresser aux facteurs explicatifs de la réussite au programme de transition de pratique et à examiner les effets du recrutement actif sur l'intégration et la rétention à court et moyen terme des infirmières immigrantes. Enfin, elle explore la question de l'importance des différences de valeurs dans la réussite du processus d'intégration et de la rétention, arrivant au constat que leur importance a été largement surévaluée dans les études antérieures. / A shortage of qualified nurses within Quebec has spurred the recruitment of foreign-educated nurses (IENs). Despite this increased interest, foreign-educated nurses face numerous obstacles during their integration into the workplace as evidence by the high attrition rates for both full and part-time hires throughout the Quebec healthcare system. The objective of this thesis is to explain the factors underlying the successful integration and retention of foreign-educated nurses in order to formulate recommendations for the many actors involved throughout the transitional period. The study concentrates on three key phases: 1) the bridging program (Intégration à la profession infirmière au Québec CWA0B0); 2) the probationary period following initial employment; and lastly 3) the employment retention of foreign-educated nurses. A combination of methods was leveraged to investigate the above issues, including individual interviews, group discussions, and self-administered questionnaire. The study first outlines the difficulties associated with the successful integration and retention of foreign-educated nurses in western countries followed those specific to the Quebec healthcare system. Finally, the work examines how socio-demographic characteristics, workplace characteristics, external environment, and psychosocial factors can influence the success of the integration process.

Attracting and retaining strong faculty members in dental schools have long been challenges in the United States. Faced with an emerging crisis in the availability and quality of dental educators, many researchers have focused on analyzing data and trends related to this subject. Even though there are substantial studies that provide a picture of why domestic dentists choose to become dental educators, there are no dedicated studies investigating why foreign-educated dentists want to become dental educators. This distinct area is of particular importance as we witness increasing diversity of patients and an increased need for a more diverse health care workforce. The purpose of this study was to analyze the reasons why foreign-educated dentists became dental educators in United States and furthermore, at University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco, California. The research data was collected by means of surveys and in-depth interviews of foreign-trained faculty and IDS graduates on staff at Pacific. The data analysis was performed using descriptive statistics for the survey and a process of thematic analysis for interviews. The surveys' analysis yielded the following six factors that most positively influenced foreign-educated dentists in deciding to embrace a career as an academic educator: (1) Intellectual challenges and stimulation; (2) Opportunity to always be on the cutting edge; (3) Interest in science, new discovery, exploration; (4) Opportunity for regular interaction with other faculty dentists; (5) Desire to be a teacher. (6) Collegial environment of the university. There were two most negative factors identified, as follows: (1) Income differential compared to private practice; (2) Pressure to generate income for the university. Corroborated by analysis of the interviews, the following themes emerged: (1) Drive for research; (2) Desire to be on cutting edge. (3) Desire to share knowledge through teaching; (4) Social and personal factors and perceptions with emphasis on mentors' influence; (5) Negative influence of salary difference with respect to private practitioners. The findings of this study were similar to the available studies on foreign-trained dentists and to most of the studies already done on domestically trained dentists. The major factors found were comparable with the up-to-date literature. The elevated research drive, the intellectual challenges, the work environment, the desire to teach, and the mentors' influence were among those which mirrored almost perfectly the other studies. Some fine differences were found for foreign-trained dentists, such as a lighter financial burden caused by smaller student debt and the irrelevance of military practice experience. The study provides a number of suggestions for enhancing the recruiting and retaining process for dental academia: (1) Support and enhance the research capacity of dental schools; (2) Create structures to develop mentors; (3) Invest to build prestige; (4) Find creative ways to offset lower salaries; (5) Foster a pleasant academic working environment; (6) Use international activities to recruit international dentists. The study revealed factors that have been influential in participants' decisions to choose an academic career, in general and at Pacific. It is hoped that this study will be a useful reference in the increasingly difficult endeavor of adding and retaining world-class dental educators.