Adjusting to the U.S. Healthcare Workplace: Perceptions of Internationally Educated Nurses

Friday, 16 July 2010: 9:10 AM

Jane Greene-Ryan, PhD
College of Nursing and Health Professions, Drexel University, Philadelphia, PA

Learning Objective 1: Identify five barriers faced by Internationally Educated Nurses who are adjusting to the U.S. Healthcare Workplace.

Learning Objective 2: Identify five strategies to help Internationally Educated Nurses adjust to the U.S. Healthcare Workplace.

Purpose: , In 2008, twenty-three percent of all nurses who successfully passed the NCLEX-RN exam were nurses born and educated outside the United States.  This was a 16% increase in eight years.  This rapid growth in Internationally Educated (IE) nurses eligible for practice in the U.S. is expected to continue.  Unfortunately, nursing research has primarily focused on numbers of nurses migrating to the U.S. and little is known about their experiences.  

Methods: , Using naturalistic inquiry and a qualitative descriptive design this study revealed a non-linear, iterative, process of adjustment to the U.S. healthcare workplace by IE nurses working in the U.S. as registered nurses.  Purposeful sampling was conducted among IE nurses in the northeastern United States until data saturation was achieved.  Personal interviews were conducted with twelve IE nurses from eight countries: Ghana, India, Ireland, Nigeria, the Philippines, Poland, Romania, and Taiwan.  Constant comparative data analysis was conducted until themes, sub-themes, and categories emerged from the data. Trustworthiness was assured by reflexive journaling, an audit trail, and member checks.  

Results: , Five major themes emerged: 1) Reflecting on Being Here, 2) Struggling to Understand the Differences, 3) Connecting to Others, 4) Praying and Having Faith, and 5) Feeling Devalued.  This study suggests that IE nurses’ experience professional and personal challenges as they adjust to the U.S. healthcare workplace including adjusting to differences in communication, the culture of U.S. healthcare, and differences in nursing education/practice.  Feeling connected to others facilitated adjustment while feeling devalued hindered it.  

Conclusion: ,  Implications from this study include the importance of developing more comprehensive orientation programs for newly-arrived IE nurses, developing educational programs for American nurses about the experiences of IE nurses, and the role of mentoring in IE nurse adjustment.