"We Are the International Nurses": An Exploration of Internationally Qualified Nurses' Experiences of Transitioning to New Zealand and Working in Aged Care

Abstract

IntroductionWorldwide, a critical nursing shortage is predicted to occur within the next five years. Workforce projections from India, the European Union (EU), and the United States (US) collectively demonstrate approximately four million additional nurses will be required to care for increasingly aged populations (American Nurses Association, 2014; Royal College of Nursing, 2015; Senior, 2010). Traditionally, Western nursing shortages have been managed by recruiting Internationally Qualified Nurses (IQNs), who remain a significant source of labour in Australia, New Zealand (NZ), the United Kingdom (UK), and the US (Aiken, 2007; Brush, Sochalski, & Berger, 2004; Buchan, 2006; Li, Nie, & Lie, 2014). Many of these nurses are employed from India and the Philippines; a competitive process subject to influence from countries such as the US, where small changes in supply, demand, and policy have a substantial impact on the global nursing resource (Aiken, 2007; Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Aitken, 2006; Ball, 2004; Brush & Sochalski, 2007; Lorenzo, Galvez-Tan, Icamina, & Javier, 2007). Despite this market existing for over 60 years, experiences of IQNs working abroad are not always positive (Bland & Woodbridge, 2011; Daniel, Chamberlain, & Gordon, 2001; DiCicco-Bloom, 2004; Lorenzo et al., 2007). These experiences require consideration, as demand for international nurse labour is expected to continue - especially in smaller countries, such as NZ, where domestic capacity for workforce growth is limited (Nana, Stokes, Molano, & Dixon, 2013).BackgroundInternationally qualified nurses, or nurses who gained their first nursing qualification abroad (Nursing Council of New Zealand, 2013a), are a significant and important section of New Zealand's Registered Nurse (RN) workforce. Since 2010, IQNs have represented approximately 25 percent of this workforce, and in the 2014 to 2015 registration period, 40 percent of newly registered RNs were internationally qualified (Nana et al., 2013; Nursing Council of New Zealand, 2011; 2015). Over time, local IQN profiles have grown to include mostly nurses from India and the Philippines (Nana et al., 2013; Nursing Council of New Zealand, 2013b; 2015), and IQNs have become vital to aged care; comprising about 40 percent of RNs in this setting (Grant Thornton New Zealand Ltd., 2010; Nursing Council of New Zealand, 2013c). This contribution is expected to remain important as New Zealand's ability to increase domestically trained nurses remains constrained while a projected workforce shortage looms (Nana et al., 2013).Internationally, substantial literature explores experiences of IQNs from a range of countries that gain employment abroad (Alexis & Shillingford, 2012; Nichols & Campbell, 2010; Okougha & Tilki, 2010; Smith, Fisher, & Mercer, 2011; Wheeler, Foster, & Hepburn, 2013). Most of this research originates from Australia, Canada, the UK, and the US, and is rarely exclusive to Filipino and Indian nurses, yet often includes participants from these countries. The findings from the literature would likely indicate IQNs overcome a series of challenges as they enter nursing positions overseas. Common issues cited relate to: language and communication (Brunero, Smith, & Bates, 2008; Hawthorne, 2001; Konno, 2006; Magnusdottir, 2005; Takeno, 2010); cultural displacement and/or socio-cultural differences, including discrimination from patients, colleagues, and employers (Alexis, Vydelingum, & Robbins, 2007; Kawi & Xu, 2009; Tregunno, Peters, Campbell, & Gordon, 2009); credentialling (Allan & Larsen, 2003; Sochan & Singh, 2007); and adjusting to new health contexts (Xu, 2007). Despite this plethora of studies, no international publications exclusively investigate experiences in aged care, and very few exclusively explore experiences of Filipino and Indian IQNs. While limited, the few international publications regarding the specific experiences of Filipino and Indian IQNs report that: Filipino and Indian nurses migrate for social and professional reasons - not just economic incentive (Alonso-Garbayo & Maben, 2009; Daniel et al. …