Beyond Transition: Understanding Workplace Integration of Internationally Educated Nurses - A Qualitative Case Study

Abstract

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.