TRANSITION TO U.S. PRACTICE AMONG INTERNATIONALLY EDUCATED NURSES: A CONCEPT ANALYSIS
Keywords:
Internationally educated nurses, transition to U.S. practice, concept analysis, Walker and Avant’s approach, acculturationAbstract
Background: The World Health Organization estimated there is a shortage of 5.9 million nurses around the world. The United States (U.S.) alone predicted a shortage of almost one million nurses by 2030, which is exacerbated by the COVID-19 pandemic. It is not surprising that healthcare institutions recruit nurses from other countries to fill in for their nursing shortage. Recruiting internationally educated nurses (IENs) is not a new strategy since the U.S. has continuously used this strategy to fill since the Second World War. The concept of transition to practice among IENs is important because of the differences in nursing education and practices between the U.S. and other countries. These differences in nursing education and practice across the world make it more imperative to understand the concept of transition to practice among IENs.
Objectives: To conduct a concept analysis on the concept of transition to U.S. practice among IENs.
Methods: Walker and Avant’s approach to concept analysis was used. Electronic databases such as NCBI, PubMed, CINAHL, and Google Scholar were searched. A total of 320 articles were initially generated from the search of these databases; of which a total of 30 articles were used in determining the uses, the defining attributes, antecedents, consequences, and empirical referents of the concept.
Results: The defining attributes identified of transition to U.S. practice among IEN were 1) preparation, 2) onboarding, and 3) acculturation. Model, related, and contrary cases were developed. Antecedents and consequences were identified. Empirical referents of the concept were also discussed and presented the need for a tool specific for IENs. Based on the review of the literature and defining attributes that emerged, the new definition of transition to U.S. practice among IENs was developed.
Conclusion: A proposed first definition of the concept of transition to U.S. practice among IENs was developed based on the defining attributes. This concept analysis may be used to develop an instrument to examine the transition to U.S. practice among IENs as well as a guide for developing transition programs.
Impact: Internationally educated nurses play an essential role in the impending nursing shortage in the U.S. All IENs must transition to their new environment and workplace. This concept analysis helps understand the concept of transition to U.S. practice among IENs. Ensuring that IENs successfully transition to U.S. practice is essential to assure safe and quality nursing care. It also adds to the body of limited knowledge on the concept of transition to U.S. practice among IENs.
References
Adeniran, R., Rich, V., Gonzalez, E., Peterson, C., Jost, S., & Gabriel, M. (2008). Transitioning internationally educated nurses for success: A model program. Online Journal of Issues in Nursing, 13(2), 1-9. https://doi.org/10.3912/OJIN.Vol13No02Man03
Alibudbud, R. (2023). Addressing the Burnout and Shortage of Nurses in the Philippines. SAGE open nursing, 9, 23779608231195737. https://doi.org/10.1177/23779608231195737
Berg, M. (2022, November 21). Nursing in Canada vs US: A comprehensive comparison. Educational Records Evaluation Services. https://blog.eres.com/how-is-the-usa-a-better-country-for-nurses-than-canada/
Beriones, G. L. (2023). Nurse leaders’ strategies and tool kit for internationally educated Filipino nurses’ transition to practice in the United States. Nurse Leader, 21(1), 42-46. https://doi.org/10.1016/j.mnl.2022.10.014
Bola, T. V., Driggers, K., Dunlap, C., & Ebersole, M. (2003). Foreign-educated nurses: Strangers in a strange land .Nursing Management, 34(7), 39-42. https://doi.org/10.1097/00006247-200307000-00014
Brown, J., & Nocella, J. (2021) Developing a conceptual definition of the successfully transitioned newly licensed registered nurse (NLRN). Journal of Nursing, 8(1), 1-10. http://doi.org/10.7243/2056-9157-8-1
Casey, K., & Fink, R. (2008). Casey-Fink readiness for practice survey.
Cassar, C. (2023). Acculturation – A process of cultural change and adaptation. Anthropology Review. https://anthropologyreview.org/anthropology-glossary-of-terms/acculturation-process-of-cultural-change-and-adaptation/?expcassarand_article=1
Chick, N., & Meleis, A.I. (1986). Transitions: A nursing concern. In P. L. Chinn (Ed.), Nursing research methodology: Issues and implementation (pp. 237-257). Aspen Publication. https://repository.upenn.edu/cgi/viewcontent.cgi?article=1008&context=nrs
Chun Tie, Y., Birks, M., & Mills, J. (2018). The experiences of internationally qualified registered nurses working in the Australian healthcare system: An integrative literature review. Journal of Transcultural Nursing, 29(3), 274–284. https://doi.org/10.1177/1043659617723075
Commission on Graduates of Foreign Nursing Schools. (n.d.). How to work as a nurse in the U.S. https://www.cgfns.org/steps-to-working-as-nurse-in-united-states/
Cortes, P., & Pan, J. (2015). The relative quality of foreign-educated nurses in the United States. Journal of Human Resources, 50(4), 1009-1050.
Deng, F-F. (2015). Comparison of nursing education among different countries. Chinese Nursing Research, 2(4), 96-98. https://doi.org/10.1016/j.cnre.2015.11.001
Duchscher, J. (2008). A process of becoming: the stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441–450. https://doi.org/10.3928/00220124-20081001-03
Ea, E. A., Griffin, M. Q., L’Eplattenier N., & Fitzpatrick, J. J. (2008). Job satisfaction and acculturation among Filipino registered nurses. Journal of Nursing Scholarship, 40(1), 46-51. ProQuest. https://doi.org/10.1111/j.1547-5069.2007.00205.x
Germack, H. D., Griffiths, P., Sloane, D. M., Rafferty, A. M., Ball, J. E., & Aiken, L. H. (2015). Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals. BMJ open, 5(12), e009483.https://doi.org/10.1136/bmjopen-2015-009483
Geun, H. G., Redman, R. W., & McCullagh, M. C. (2016). Turnover and associated factors in Asian foreign-educated nurses. The Journal of Nursing Administration, 46(5), 271-277. https://doi.org/10.1097/NNA.0000000000000342
Ghazal, L. V., Ma, C., Djukic, M., & Squires, A. (2020). Transition-to-U.S. practice experiences of internationally educated nurses: An integrative review. Western Journal of Nursing Research, 42(5), 373–392. https://doi.org/10.1177/0193945919860855
Iheduru-Anderson, K. C., & Wahi, M. M. (2018). Experiences of Nigerian internationally educated nurses transitioning to United States health care settings. Journal of Transcultural Nursing, 29(6), 603–610. https://doi.org/10.1177/1043659618766225
International Council of Nurses. (2020). Report for the international council of nurses. https://www.icn.ch/system/files/documents/2020-07/COVID19_international supplyofnurses_Report_FINAL.pdf
Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press. DOI: 10.17226/12956
Jose M. M. (2011). Lived experiences of internationally educated nurses in hospitals in the United States of America. International Nursing Review, 58(1), 123–129. https://doi.org/10.1111/j.1466-7657.2010.00838.x
Juraschek, S. P., Zhang, X., Ranganathan, V., & Lin, V. W. (2019). United States nursing workforce report card and shortage forecast. American Journal of Medical Quality, 34(5), 473-481. https://doi.org/10.1177/1062860619873217
Kim, J., & Shin, S. (2022). Development of the nursing practice readiness scale for new graduate nurses: A methodological study. Nurse Education in Practice, 59,103298-103298. https://doi.org/10.1016/j.nepr.2022.103298
Kramer, M. (1974) Reality shock: why nurses leave nursing. C.V. Mosby Company.
Lin L. C. (2014). Filipina nurses' transition into the US hospital system. Journal of Immigrant and Minority Health, 16(4), 682–688. https://doi.org/10.1007/s10903-013-9793-9
Ma, C., Ghazal, L., Chou, S., Ea, E., & Squires, A. (2020). Unit utilization of internationally educated nurses and collaboration in U.S. hospitals. Nursing Economics, 38(1), 33-40,50. http://ezproxy.emich.edu/login url=https://www.proquest.com/scholarly-journals/unit-utilization-internationally-educated nurses/docview/2354888913/se-2?accountid=10650
Mahathevan, B., Balakumaran, J., Cruz, E., Innis, J., & Deer, N. (2023). Internationally educated nurses’ perceptions of interprofessional collaboration. OJIN: The Online Journal of Issues in Nursing, 28(2). https://devojin.nursingworld.org/table-of-contents/ volume-28- 2023/number-2-may-2023/articles-on-previously-published-topics/internationally-educated-nurses-interprofessional-collaboration/
Miyata, C. (2023). Challenges and career consequences of internationally educated nurses: Empirical research qualitative. Nursing Ppen, 10(11), 7244–7254. https://doi.org/10.1002/nop2.1977
Montayre, J., Montayre, J., & Holroyd, E. (2018). The global Filipino nurse: An integrative review of Filipino nurses' work experiences. Journal of Nursing Management, 26(4), 338–347. https://doi.org/10.1111/jonm.12552
Moyce, S., Lash, R., & de Leon Siantz, M. L. (2016). Migration experiences of foreign educated nurses: A systematic review of the literature. Journal of Transcultural Nursing, 27(2), 181-188. https://doi:10.1177/1043659615569538
National Council of State Boards of Nursing [NCSBN] (2023). NCSBN research projects significant nursing workforce shortages and crisis. https://www.ncsbn.org/news/ ncsbn-research- projects-significant-nursing-workforce-shortages-and-crisis
NCSBN (2015). Licensure of internationally educated nurses: A resource manual.
https://www.ncsbn.org/public-files/23_IEN_manual.pdf
Neff, D. F., Cimiotti, J., Sloane, D. M., & Aiken, L.H. (2013). Utilization of non-U.S. educated nurses in US hospitals: Implications for hospital mortality. International Journal for Quality Health Care, 25(4), 36-372. https://doi.org/10.1093/intqhc/mzt042
Neiterman, E., & Bourgeault, I. L. (2015). Professional integration as a process of professional resocialization: internationally educated health professionals in Canada. Social Science & Medicine (1982), 131, 74–81. https://doi.org/10.1016/j.socscimed.2015.02.043
Newton, S., Pillay, J., & Higginbottom, G. (2012). The migration and transitioning experiences of internationally educated nurses: a global perspective. Journal of Nursing Management, 20(4), 534–550. https://doi.org/10.1111/j.1365-2834.2011.01222.x
Ohr, S. O., Jeong, S., Parker, V., & McMillan, M. (2014). Organizational support in the recruitment and transition of overseas-qualified nurses: Lessons learnt from a study tour: Organizational support. Nursing & Health Sciences, 16(2), 255–261. https://doi.org/10.1111/nhs.12085
Online Etymology Dictionary. (n.d.). Etymology of transition. In Online Etymology Dictionary. Retrieved January 21, 2023, from https://www.etymonline.com/word/transition
Opoku, E. N., Van Niekerk, L., & Jacobs-Nzuzi Khuabi, L.-A. (2020). Exploring the factors that affect new graduates’ transition from students to health professionals: A systematic integrative review protocol. BMJ Open, 10(8), Article e033734. https://doi.org/10.1136/bmjopen-2019-033734
Pasche, P. (2022). Nurses from Philippines once again recruited to fill a need. The Oakland Press. https://www.theoaklandpress.com/2022/02/07/ nurses-from- philippines- once-again-recruited-to-fill-a need/#:~:text=Henry%20Ford%20applied%20to%20the%20Philippines%20in%20the,the%20United%20States%20was%20trained%20in%20the%20Philippines
Papastavrou, E., Efstathiou, G., Acaroglu, R., Da Luz, M. D. A., Berg, A., Idvall, E., Kalafati, M., Kanan, N., Katajisto, J., Leino-Kilpi, H., Lemonidou, C., Sendir, M., Sousa, V. D., Suhonen, R. (2012). A seven country comparison of nurses' perceptions of their professional practice environment. Journal of Nursing Management, 20(2), 236-248. https://doi.org/10.1111/j.1365-2834.2011.01289.x
Pung, L.-X., & Goh, Y.-S. (2017). Challenges faced by international nurses when migrating: An integrative literature review. International Nursing Review, 64(1), 146–165. https://doi.org/10.1111/inr.12306
Rosenkoetter, M. M., Nardi, D., & Bowcutt, M. (2017). Internationally educated nurses in transition in the United States: Challenges and Mediators. Journal of Continuing Education in Nursing, 48(3), 139–144. https://doi.org/10.3928/00220124-20170220-10
Rovito, K., Kless, A., & Costantini, S. D. (2022). Enhancing workforce diversity by supporting the transition of internationally educated nurses. Nursing Management, 53(2), 20–27. https://doi.org/10.1097/01.NUMA.0000816252.78777.8f
Schumacker, K. L., & Meleis, A. I. (1994). Transition: A central concept in nursing. Journal of Nursing Scholarship, 26(2), 119-127. https://doi.org/10.1111/j.1547-5069.1994.tb00929.x
Sherman, R. O., & Eggenberger, T. (2008). Transitioning internationally recruited nurses into clinical settings. Journal of Continuing Education in Nursing, 39(12), 535–568. https://doi.org/10.3928/00220124-20081201-04
Sherwood, G. D., & Shaffer, F. A. (2014). The role of internationally educated nurses in a quality, safe workforce. Nursing Outlook, 62(1), 46–52. https://doi.org/ 10.1016/j. outlook.2013.11.001
Sochan, A., & Singh, M. D. (2007). Acculturation and socialization: voices of internationally educated nurses in Ontario. International Nursing Review, 54(2), 130–136. https://doi.org/10.1111/j.1466-7657.2007.00564.x
Squires, A. (2017). A case example of a Transition Education Program for internationally educated nurses from Mexico. Nurse Economics, 35(1), 30-38.
Suhonen, R., Berg, A., Idvall, E., Kalafati, M., Katajisto, J., Land, L., Lemonidou, C., Välimäki, M., & Leino-Kilpi, H. (2008). Individualised care from the orthopaedic and trauma patients’ perspective: An international comparative survey. International Journal of Nursing Studies, 45(11), 1586-1597. https://doi.org/10.1016/j.ijnurstu.2007.12.005
U.S. Citizenship and Immigration Services. (2021). Health care worker certification, U.S. Department of Homeland Security. https://www.uscis.gov/ working- in-the- united-states/temporary-workers/health-care-worker-certification
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis (2020). Nursing Education and Training in the United States, Rockville, Maryland. https://bhw.hrsa.gov/sites/default/files/ bureau-health-workforce/data-research/nchwa-nssrn-nursing-education-training.pdf
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis (2019). Brief Summary Results from the 2018 National Sample Survey of Registered Nurses. http://bhw.hrsa.gov/health workforce/index.html
Valdez, A. (2008). Transitioning from novice to competent: What can we learn from the literature about graduate nurses in the emergency setting? Journal of Emergency Nursing, 34(5), 435–440. https://doi.org/10.1016/j.jen.2007.07.008
Viken, B., Solum, E. M., & Lyberg, A. (2018). Foreign educated nurses’ work experiences and patient safety—A systematic review of qualitative studies. Nursing Open, 5(4), 455-468. https://doi.org/10.1002/nop2.146
Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.
World Health Organization (2020, April 7). WHO and partners call for urgent investment in nurses. https://www.who.int/news/item/07-04-2020-who-and-partners-call-for-urgent-investment-in-nurses
Xu, X. (2010). Is transition of internationally educated nurses a regulatory issue? Policy, Politics & Nursing Practice, 11(1), 62-70. https://doi.org/10.1177/1527154410371382
Zhu, J. (2012). Towards an understanding of nurses leaving nursing practice in China: A qualitative exploration of nurses leaving nursing practice from recruitment to final exit. (Publication No. U609937) [Doctoral dissertation, The University of Edinburgh]. ProQuest Dissertations & Theses Global.
Zhu, J., Rodgers, S., & Melia, K. M. (2015). A qualitative exploration of nurses leaving nursing practice in China. Nursing Open, 2(1), 3-13. https://doi.org/10.1002/nop2.11
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