This study aims to explore how internationally qualified nurses and Australian qualified nurses adapt to work together in the Australian healthcare system and develop a theory that explains this process.
The Australian nursing workforce is inclusive of people from over 150 different nationalities and cultures who deliver healthcare to a multicultural population (Hawthorne, 2014). Moreover, twenty percent of the registered nurses working in Australia are internationally qualified (Australian Institute of Health and Welfare, 2014). Successful integration of international nurses into the Australian healthcare system requires support for both the current workforce and internationally qualified registered nurses. There are few studies that identify the processes nurse leaders implement when creating or working with diverse teams. This presentation reports on one phase of a grounded theory study that identified the processes nurse leaders engage in to address adverse team dynamics in the workplace.
Methods:
The link to an online survey using Survey Monkey was disseminated to registered nurses via Australian nursing organisations. Concurrent data collection/generation and analysis was conducted between September 2015 and July 2017.
Survey responses n=182. Respondents included both Australian qualified registered nurses and internationally qualified registered nurses. Survey responses were received from all Australian states and territories. Fifteen respondents consented to an individual interview (n=15).
Results:
The findings have clear implications for nurse leaders and policy makers. Nurse leaders require excellent leadership skills to abate adverse team dynamics (Australian College of Nursing, 2015). Having an understanding of the processes nurse leaders use can circumvent any potential animosity from registered nurses who work with internationally qualified registered nurses.
Four broad themes were identified: (i) Connecting - Connecting with each other; understanding values and beliefs of organisations and individuals; shared understanding of expectations of the registered nurse role; enabling champions of new teams: (ii) Reconciling difference - Being different; becoming different; maintaining self; learning from others: (iii) Adapting and accepting change - Being reflexive, wanting change; accepting change, non-acceptance of change; adapting to change: and (iv) Becoming confident -Gaining trust; developing confidence with self or peers; feeling valued; fitting in; being accepted.
An understanding of these processes is essential for leaders to manage staff discord, create positive work environments, ensure provision of quality nursing care, maintain patient safety, and to improve retention of experienced nursing staff (Bawafaa et al., 2015, Sherwood and Shaffer, 2014).
Conclusion:
Effective integration of nurses into a new health service requires an understanding of what is occurring at the local and ward level (Chun Tie et al., 2017). Nurse leaders are required to identify and address workplace concerns that affect nursing staff or patients. Nurses work collaboratively in the provision of safe, quality, culturally congruent care (Queensland Government, 2012, Ong-Flaherty, 2015). However, nurse peer relationships can be constrained by lack of English language proficiency, divergence in communication styles, expectations around scope of practice, or cultural disparities with the model of person centred care practiced in Australia (Xiao et al., 2014). Adverse team dynamics can result in tensions, add pressure to nurse workloads, affect staff confidence, result in racism or bullying, affect patient safety, and create negative work environments resulting in retention issues. Nurse leaders and nurse managers are in a position to connect individuals within teams, reconcile differences, assist nurses to adapt and assent to the changing landscape, and mitigate any potential for adverse team dynamics. Strategies include: orientation programs that facilitate a shared understanding of the value and beliefs of the organisation and individuals through discussion; providing opportunities at work to connect with each other; sharing experiences, stories and the knowledge international nurses bring in informal settings; and fostering a shared understanding of role expectations of the registered nurse in Australia using real life scenarios. These strategies will guide culturally competent education, skill acquisition, facilitate approaches to create positive team dynamics, and improve nurse retention.
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