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Filipino internationally educated nurses (IENs) constitute a major portion of the IENs in Manitoba and Canada. Acculturating to Canada can be difficult and can affect job satisfaction and retention. The focus of this research is on Filipino IENs’ acculturation to Canada, sources of workplace support and perceived job satisfaction. Berry’s (1997) acculturation framework guided the study. A cross-sectional descriptive-correlational method was used. An on-line survey resulted in a study sample of 124 participants. Quantitative and qualitative analysis techniques were used to determine relationships among the variables and to identify recommendations to assist other IENs. Job satisfaction was positively associated with one dimension of acculturation and informal sources of workplace support by immigrants and Canadian co-workers, administration, and the union. When these independent variables were entered into a multiple regression model, only administration support significantly predicted job satisfaction. Implications for nursing practice, leadership and research are discussed.

Filipino internationally educated nurses (IENs) constitute a major portion of the IENs in Manitoba and Canada. Acculturating to Canada can be difficult and can affect job satisfaction and retention. The focus of this research is on Filipino IENs’ acculturation to Canada, sources of workplace support and perceived job satisfaction. Berry’s (1997) acculturation framework guided the study. A cross-sectional descriptive-correlational method was used. An on-line survey resulted in a study sample of 124 participants. Quantitative and qualitative analysis techniques were used to determine relationships among the variables and to identify recommendations to assist other IENs. Job satisfaction was positively associated with one dimension of acculturation and informal sources of workplace support by immigrants and Canadian co-workers, administration, and the union. When these independent variables were entered into a multiple regression model, only administration support significantly predicted job satisfaction. Implications for nursing practice, leadership and research are discussed.

Background: Internationally educated nurses (IENs) have become a significant source of nursing supply as a result of nursing workforce shortages, the aging population and patient acuity. However, IENs face substantial delays and barriers obtaining licensure and employment equivalent to their skills and experience. When IENs are unable to practice their profession, they experience a considerable loss of professional identity, earning potential and financial stability. The purpose of this scoping review was to identify and map key themes in the existing literature on the barriers and strategies to timely nursing registration for IENs. Methods: Arksey and O’Malley’s methodological framework was used for this study. Seven electronic databases were searched along with several grey literature sources in order to capture articles that discussed barriers and strategies to timely nursing registration for IENs. A numerical and thematic analysis was conducted to explore the scope of the literature and to present the findings. Results: After full-text screening, 38 pieces of relevant literature were selected for inclusion in the review. The majority (53%) were studies and most (42%) were qualitative. Seven key themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. Conclusion: While some IENs are able to successfully navigate the process for obtaining nursing licensure, it is clear that many IENs face obstacles at every step of the process and some never become registered as nurses. Further research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this scoping review have significant implications for nurse staffing and policies and practices to improve the strength, stability, and diversity of the nursing workforce. / Thesis / Master of Science in Nursing (MSN) / This study explores the literature on internationally educated nurses (IENs) and the difficulties they face, as well as the strategies they use to obtain nursing registration. Arksey and O’Malley’s framework was used to guide this scoping review. Seven databases were searched along with many grey literature sources in order to find articles on barriers and strategies to nursing registration for IENs. A numerical and thematic analysis was conducted to present the findings. Seven main themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. More research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this study are important for nurse staffing and policies and practices to improve the stability and diversity of the nursing workforce.

Internationally Educated Nurses (IENs) have been proposed as one solution to dealing with the nursing shortage in Canada. In addition to helping sustain the profession, IENs are reflective of the diverse patient populations in Canada. Investments will ensure healthy workplaces for and retention of IENs. There has been a growing interest about IENs’ experiences with migration and navigating through the regulatory process, but research on their post-transition experience is lacking. Workplace integration for IENs is not well understood and the role of the employer has received limited focus. Guided by critical social theory, an instrumental qualitative case study approach was used to examine a single organization, St. Michael’s Hospital, Toronto, with a history of supporting IENs. A purposeful sample of twenty-eight participants included diverse IENs who were post-transition, and stakeholders from various vantage points. Four forms of data collection were used: semi-structured interviews; socio-demographic survey; review of documents and focus groups. Thematic analysis was carried out to form a within subcase analysis first, followed by an across subcase analysis. The major themes are: (a) when “integrated”, an IEN is (i) being a “Canadian nurse with international experience”; (ii) progressing on the leadership journey; and (iii) persevering in overcoming challenges; (b) organizational factors that influence workplace integration of IEN are (i) workforce diversity; (ii) leadership commitment to equity; (iii) policies promoting equity principles; (iv) engagement with the broader community; and (v) avoiding common pitfalls. This research offers a definition and conceptual framework where workplace integration of IENs is a “two-way” process within an inclusive and valuing context, producing changes both at the IEN as well as organizational levels.

Despite evidence that suggests that nurses migrate to Ontario through the Live-in Caregiver Program, no research has been conducted on this group of nurses in Ontario. This study addresses that gap utilizing the transnational feminist concept of “global care chains” in a single holistic case study design to explore the experience of nurses who migrate to Ontario through the Live-in Caregiver Program (2001-2011), and examine the diverse perspectives of stakeholders on issues of rights and obligations of these nurses. Fifteen live-in caregivers and nine policy stakeholders were interviewed, and an analysis undertaken of immigration and nursing policy documents. Findings indicate that familial discourses and perspectives on global social status shape these women’s decision to migrate from the Philippines to Canada, often via a second country (especially Saudi Arabia), as well as their subsequent Canadian experiences. Results are consistent with Rhacel Parrenas’ idea of ‘contradictory class mobility’ that describes the phenomenon of decrease in social status coupled with an increase in financial status among immigrant care workers. As professional women undertaking unskilled work, the nurses’ contradictory class status was reinforced by the emotional labour and domestic work they were required to perform. Furthermore, as temporary workers on a path to permanent residency, their professional integration as nurses was complicated by Canada’s immigration policy and the paradox between the government’s stated short-term goal (to address labour force shortage of live-in caregivers) versus its long-term goal (to ensure the integration of permanent residents). Within this policy paradox immigration policy makers emphasized the short-term obligation of fulfilling labour needs, while live-in caregivers and advocacy groups emphasized the long-term obligations of the Canadian government related to gaining permanent residence status. The lack of congruence between the Live-in Caregiver Program policy and nursing policy concerning internationally educated nurses, as well as prioritization of their familial obligations complicated the process of professional integration for this group of women. Recommendations arising from the study concern the need to bridge these policy gaps and address the shortcomings of the Live-in Caregiver Program to leverage the integration of this group of internationally educated nurses in Canada.

Le but de la présente recherche est de documenter, à partir d’une approche de recherche pragmatique qui s’inspire d’une méthode de recherche de type mixte, ce qui influence la performance des personnes formées à l’étranger (ci-après « PFÉ ») à l’examen d’admission à la profession infirmière au Québec (ci-après « examen »). Un devis séquentiel explicatif permet de découper cette recherche en deux grandes phases qui s’intéressent, respectivement, à des données quantitatives et à des données qualitatives. Les objectifs de cette recherche sont de 1) déterminer s’il existe une différence entre les scores observés à l’examen du 12 septembre 2020 pour les PFÉ et les personnes formées au Québec (ci-après « PFQ »), 2) déterminer s’il existe une association entre certaines caractéristiques connues des PFÉ et les scores observés à l’examen du 12 septembre 2020 et 3) décrire les caractéristiques reliées aux PFÉ et aux items qui influencent la mise en œuvre du jugement clinique infirmier lors de la détermination des réponses aux items de l’examen du 12 septembre 2020. Les deux échantillons de la première phase contiennent 1 050 PFQ et 199 PFÉ en premier essai à l’examen de septembre 2020. La collecte de données pour cette première phase a été réalisée à l’aide d’un fichier d’information obtenu auprès de l’Ordre des infirmières et infirmiers du Québec. Des analyses comparatives des deux échantillons permettent de conclure qu’il existe une différence statistiquement significative entre les scores moyens observés à l’examen pour l’échantillon des PFQ et celui des PFÉ et que la taille de l’effet est considérée comme étant modérée. Des analyses additionnelles sont réalisées afin de déterminer s’il existe une association statistiquement significative entre certaines variables disponibles, notamment l’âge, le sexe, le délai depuis la diplomation, l’indice de développement humain (ci-après « IDH ») du pays de diplomation et les scores moyens observés pour les PFÉ. Ainsi, les résultats suggèrent l’absence d’association entre l’âge ou le délai depuis la diplomation et les scores observés à l’examen. Par ailleurs, les analyses permettent d’observer une association statistiquement significative entre les scores observés des PFÉ à l’examen et le sexe ainsi que l’IDH du pays de diplomation, même si la taille de l’effet est considérée comme étant faible. L’échantillon de la deuxième phase de cette recherche contient huit PFÉ en premier essai à l’examen de septembre 2020. La collecte de données s’est effectuée à l’aide d’entrevues individuelles semi-structurées réalisées à distance et enregistrées à l’aide du logiciel Microsoft Teams. Le guide d’entrevue, explorant les thèmes tirés du cadre de référence, est construit à partir de la littérature consultée au sujet des caractéristiques pouvant agir sur les réponses aux items d’un examen. Les données ont fait l’objet d’un codage thématique à l’aide d’une grille. Les résultats indiquent que la mise en œuvre du jugement clinique infirmier, incluant la mobilisation des savoirs appropriés lors de la résolution d’items de l’examen, constitue un défi pour les PFÉ qui participent aux entrevues (ci-après « PFÉP »). Ainsi, les savoirs infirmiers mobilisés s’appuient, en partie, sur des connaissances et des expériences acquises avant l’arrivée au Québec qui diffèrent des savoirs qui sont ciblés par les items de l’examen. Ceci n’est pas surprenant puisque les PFÉP constituent un groupe hétérogène d’individus avec des parcours professionnels extrêmement variés et le contenu de l’examen cible spécifiquement les aspects requis pour exercer au Québec. Bien que les savoirs acquis après l’arrivée au Québec soient aussi mobilisés lors de la résolution des items de l’examen, ces nouvelles connaissances sont parfois insuffisantes pour certaines PFÉP qui présentent de trop grands écarts de savoirs professionnels. Par ailleurs, l’état psychologique des PFÉP, les difficultés à lire et à bien comprendre les situations cliniques de l’examen et le manque de temps influencent certainement la capacité de choisir les réponses attendues aux items de l’examen. Les résultats de cette recherche contribuent aux connaissances en éducation puisqu’ils permettent une meilleure documentation des caractéristiques qui influencent la détermination des réponses à un examen en contexte d’immigration professionnelle. Ils contribuent aussi aux connaissances en matière d’intégration professionnelle des PFÉ en mettant en lumière le caractère hétérogène de ce groupe de personnes qui exerçaient la profession infirmière dans leur pays d’origine et l’importance d’adopter une approche individuelle aux défis de ces personnes qui souhaitent obtenir un permis d’exercice au Québec, notamment les outils de préparation à l’examen. Les résultats peuvent aider les instances touchées par l’administration d’un examen à considérer différentes caractéristiques reliées à la personne ou aux items qui influencent la détermination des réponses aux items. / The goal of this research project is to document, using a pragmatic approach inspired by a mixed-method paradigm, what influences the performance of internationally educated nurses (IENs) at the entry-level exam in Québec. As is done with an explanatory sequential design, this research is divided into two phases. The first phase relates to quantitative data and the second phase relates to qualitative data. The objectives of this research are 1) to determine if there is a difference between the scores observed at the exam for IENs and Québec trained nurses (QTNs), 2) to determine if there is an association between certain IEN characteristics and the scores observed at the exam and 3) to describe the characteristics of IENs that influence the use of nursing clinical judgement while responding to the items in the September 12, 2022 exam. The two samples for the first phase of this research are made up of 1,050 QTNs and 199 IENs who were first-time writers at the September 2020 exam. The data collection for this first phase was done using information obtained from the Ordre des infirmières et infirmiers du Québec. Comparative analysis of the two samples suggests that there is a statistically significant difference between the mean scores observed at the exam for the QTN and IEN samples with an effect size that is considered moderate. Additional analyses were used to determine if there is a statistically significant association between certain variables such as age, sex, time lapse since graduating, human development index (HDI) for the country of graduation and the mean scores observed at the exam for IENs. The results suggest the absence of an association between age or the time elapsed since graduation and the observed scores at the exam. Moreover, the analyses show that there is a statistically significant association between the mean scores observed at the exam for IENs, sex and the HDI for the country of graduation, although this effect size is considered weak. The sample for the second phase of this research is made up of 8 IENs who were first-time writers at the September 2020 exam. The data collection was done through individual semi-structured interviews held remotely and recorded using Microsoft Teams. The interview guide explored themes inspired by the framework based on available literature related to characteristics which can influence item response. The data collected was coded using a themed grid. The results suggest that the use of nursing clinical judgement, including the mobilization of appropriate knowledge to respond correctly to exam items, is challenging for the participating IENs. Moreover, the nursing knowledge mobilized during item response refers, partly, to knowledge and experience acquired before arriving in Québec, which are different from the knowledge tested in the exam items. This is not surprising since IENs are a heterogeneous group with a variety of professional pathways and the content of the exam targets specific aspects required for nursing practice in Québec. Although the knowledge acquired after arriving in Québec is also mobilized by the IENs during item response at the exam, this new knowledge is sometimes insufficient for some IENs who have an important knowledge gap. Also, the psychological state of IENs, challenges with reading and understanding the clinical situations presented in the exam, and the lack of time during the examen certainly influenced the capacity to respond correctly to the items. The results of this research will contribute to the educational knowledge base because they document some of the characteristics that influence exam item response in the context of professional immigration. These results will also contribute knowledge related to the professional integration of IENs who previously practised nursing in their country of origin by highlighting the heterogeneity of this group and the importance of adopting an individualized approach to the unique challenges ¬– such as those associated with exam preparation materials – faced by IENs who wish to obtain a nursing permit in Québec. These results can help all organizations involved in administering entry-level professional exams take into consideration the different personal characteristics or items that could influence the item response process.

Dans leur trajectoire d’intégration socioprofessionnelle (ISP), les infirmières formées à l’étranger (IFE) sollicitent des réseaux communautaires de pairs (RCP). Le but de cette recherche fut d’explorer la pertinence de ces réseaux. L’étude comporte un devis qualitatif exploratoire selon une posture constructiviste pragmatique. Réalisée dans deux RCP d’IFE ayant complété leur formation en France, 15 personnes ont participé à un entretien : 6 IFE, 4 pairs-bénévoles et 5 partenaires ou experts de l’ISP. L’analyse résulte en une conception de la notion de pertinence selon quatre thèmes : 1) une dimension temporelle qui traduit une dynamique apprenante des RCP, tant dans les réponses individuelles aux IFE qu’aux ajustements apportés suivant l’évolution de réalités politiques de l’ISP ; et 2) une visée de bien-être des IFE ; ceci dans 3) un contexte de rétention d’infirmières. Le quatrième thème suggère que la nature bénévole des RCP module leur pertinence. Une synthèse offre une compréhension systémique de la pertinence des RCP pour les IFE. Celle-ci se situerait surtout à un niveau individuel, en réponse aux réalités des IFE. Cette modélisation suggère, en outre, que l’accroissement de la pertinence des RCP enjoint de se concentrer sur leurs actions et finalités propres, avec l’aide de facilitateurs, plutôt que de mettre des énergies sur la création d’alliances incertaines avec des partenaires aux intérêts divergents. Cette recherche sur une stratégie de type grassroots par et pour des IFE illustre une pratique sociale d’infirmières engagées faisant appel au savoir émancipatoire de la discipline infirmière et aux visées politiques de la profession. / In their socio-professional integration (SPI) trajectory, internationally educated nurses (IENs) seek out support from community peer networks (CPNs). The purpose of this research was to explore the relevance of these networks. An exploratory qualitative study, guided by a pragmatic constructivist epistemology, was conducted in two CPNs of IENs who had completed their training in France. Fifteen persons participated in a semi-structured interview: 6 IENs, 4 peer-volunteers and 5 partners or SPI experts. Qualitative analyses result in four interrelated themes to describe the idea of relevance: 1) a temporal dimension reveals systemic learning capacities of CPNs in their provision of individual responses to IENs, in addition to their iterative adjustments to changing political realities of SPI and 2) a focus on the well-being of IENs in a 3) context of nursing manpower retention. A fourth theme suggests that the voluntary nature of CPNs modulates their relevance. Further synthesis provides an understanding of the relevance of CPNs that, primarily, appears in their timely responses to IENs’ realities, on an individual level. In particular, our resultant systemic model suggests that increasing the relevance of CPNs would require to further channel resources on their own specific actions and purposes, aided by facilitators; rather than attempting to build uncertain alliances with partners who, inevitably, pursue different interests. This research on a grassroots strategy by and for IENs draws attention to an engaged social nursing practice that illustrates the discipline’s emancipatory knowing, in acknowledgement of the political aims of the nursing profession.

Indiana University-Purdue University Indianapolis (IUPUI) / Nurse-physician collaboration has received much attention over the past decade in the USA. The release of three reports from the Institute of Medicine implicated poor communication and collaboration among nurses and physicians as a major contributing factor to the incidence of sentinel events and medical errors. Despite the growing awareness of the imperative related to collaboration between nurses and physicians to ensure patient safety, the problem of poor nurse-physician collaboration remains endemic throughout the country. Indian nurses, along with many other internationally educated nurses, comprise 12-15.2% of the nursing workforce in the USA. Little is known about how Indian nurses culture potentially influences their ability to effectively collaborate with physicians to ensure patient safety. The purpose of this study is to understand Indian nurses’ attitudes and perceptions about nurse-physician collaboration. Hermeneutic interpretive phenomenology as influenced by the work of Martin Heidegger guided this study through the use of interviews via Skype. The overall experience of the Indian nurses was of one experiencing a dramatic positive change in nurse-physician collaboration in the USA as compared to India. Four themes emerged describing this phenomenon: Respect/feeling heard, Being Trusted, Assurance of Accountability, and Finding Freedom. Indian nurses practicing in the USA find a freedom that empowers them to collaborate with physicians for patient safety. They, as all nurses may, benefit from continuing educational opportunities that demonstrate ways to collaborate more fully.