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Collegian 25 (2018) 247–253

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Collegian
journal homepage: www.elsevier.com/locate/coll

The factors impacting personal and professional experiences of


migrant nurses in Australia: An integrative review
Harrison Ng Chok a,b,∗ , Judy Mannix c , Cathy Dickson d , Lesley Wilkes a,b
a
School of Nursing and Midwifery, Western Sydney University/Nepean Blue Mountains Local Health District, Australia
b
Centre for Nursing Research and Practice Development, Nepean Hospital, First Floor – Court Building – Nepean Hospital, PO Box 63, Penrith, NSW 2751,
Australia
c
School of Nursing & Midwifery, Building 7/G 55, Campbelltown Campus, Australia
d
ACA Master of Child and Family Health – Karitane, School of Nursing and Midwifery, Building EB/Room LG.43, Parramatta South Campus, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Objective: This integrative review presents an exploration of the literature on the factors that impact
Received 24 April 2017 on internationally educated nurses’ personal and professional experiences during their journey into the
Received in revised form 7 June 2017 Australian health workforce.
Accepted 13 June 2017
Background: Over the past few decades there has been an increase in the number of internationally
educated nurses migrating to work in other developed countries. In Australia, these nurses have been
Key words:
sought to curb nurse shortages to support the forecasted ageing population. Using a validated integrative
Integrative review
review framework, databases such as Scopus; MEDLINE; CINAHL; PubMed; Web of Science and Google
Qualitative study
International nurses
Scholar were searched for qualitative studies published before 2016. Reviewed articles were analysed
Transients and migrants for data that was reduced, compared and synthesised and outlined in a figure.
Cultural Competency Methods: Using a validated integrative review framework, databases such as Scopus; MEDLINE; CINAHL;
Professional competence PubMed; Web of Science and Google Scholar were searched for qualitative studies published before 2016.
Reviewed articles were analysed for data that was reduced, compared and synthesised and outlined in a
figure.
Findings: From the twenty-two articles that met the inclusion criteria-eight factors were identified. The
majority (n = 6) of these were challenging factors common to personal and professional experiences,
which include: pre-migration processes; recognising and adapting to a new reality; living and working
in the English language; economic and social stress; discrimination and feeling like an ‘outsider’ and
resolving issues and finding meaning in the new reality. The remaining two factors facilitated nurses’
experiences personally with personal support systems and professionally with recruitment and working
conditions.
Conclusion: This review reports that internationally educated nurses predominantly face challenging
factors that impact their lives socioeconomically in andout of the workplace. Policy makers, managers
and educators working with these nurses could develop strategies that minimise challenging factors and
maximise facilitating factors leading to successful transitions.
© 2017 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Summary of relevance What is already known?


The international literature reports that IENs experiencea mul-
Problem
titude of complex issues that impact on their migration and
In Australia, the factors impacting the personal and professional
transition experiences when travelling to settle in a new country.
experiences of internationally educated nurses (IENs) are poorly
What does this paper add?
understood.
This integrative review adds tothe evidence that IENs migrating
to work in Australia disproportionately face more systemic chal-
lenges that negatively impact on their personal and professional
∗ Corresponding author at: Centre for Nursing Research and Practice Develop- experiences. While the factors that facilitate more positive experi-
ment, Nepean Hospital, First Floor – Court Building – Nepean Hospital, PO Box 63, ences are reported, this study highlights that policies and programs
Penrith, NSW 2751, Australia.
can enhance the Australian IENs in their transition journey.
E-mail addresses: h.ngchok@westernsydney.edu.au (H. Ng Chok),
j.mannix@westernsydney.edu.au (J. Mannix), c.dickson@westernsydney.edu.au
(C. Dickson), l.wilkes@westernsydney.edu.au (L. Wilkes).

https://doi.org/10.1016/j.colegn.2017.06.004
1322-7696/© 2017 Australian College of Nursing Ltd. Published by Elsevier Ltd.
248 H. Ng Chok et al. / Collegian 25 (2018) 247–253

1. Introduction 4. Methods

Skilled nurse migrants are nurses who travel to another This review utilises an integrative review framework developed
country to seek employment opportunities (Newton, Pillay, & by Whittemore & Knafl (2005), which permits the synthesis of
Higginbottom, 2012; Xu & He, 2012). They also represent one of literature from a wide range of sources and diverse methodolo-
the largest and most internationally mobile occupations (Adeniran gies. Integrative reviews are the “broadest type of research review
et al., 2008; Kodoth & Kuriakose Jacob, 2013). There have been method” that allows the review of qualitative theoretical and
various articles that document the ‘push’ and ‘pull’ factors that empirical studies as well as experimental and non-experimental
motivate these nurses to seek work in other countries (Blythe & research studies (Whittemore & Knafl, 2005; p. 546). In integrative
Baumann, 2009; Hardill & MacDonald, 2000; Kingma, 2007) and reviews, as opposed to other review types, the inclusion of arti-
over the past decade, greater migration has occurred subsequent cles with a range of different study methodologies provides a more
to improvements in working conditions and recruiting strategies rounded portrayal of a complex issue (Souza, Silva, & Carvalho,
from recipient countries (ICN, 2007International Council of Nurses 2010; Torraco, 2005; Whittemore & Knafl, 2005).
[ICN], 2007). These changes, however, have impacted negatively on
lesser developed donor countries that are themselves affected by 4.1. Literature search strategy
nurse shortages (ICN, 2007). In Australia, Internationally Educated
Nurses (IENs) are a significant workforce resource to supplement A list of relevant terms was compiled and used in the literature
the shortage of domestic nurses apportioned for the increasing search that includes searching qualitative and quantitative research
ageing population (Australian Bureau of Statistics, 2014; Blythe & studies. All articles that mentioned nurses or registered nurses
Baumann, 2009; International Council of Nurse, 2015). However, (RN’s) explicitly were flagged to be screened further in the literature
the number of IENs who are currently in the nursing workforce is review. Due to the abundance of international literature regarding
not collected by the Immigration Department, census data or the the nursing workforce and global migration of nurses, over 17,000
Australian Health Practitioner Regulation Agency (AHPRA). In the citations were initially found on a Google Scholar search. Inclu-
literature, skilled migrant nurses are also commonly referred to sion criteria were set for articles reporting studies from Australia;
as Overseas Qualified Nurses (OQN) or IENs. For clarity purposes, published up to and including 2016, written in English and elec-
IENs will be used throughout the review to describe these skilled tronically available. The University licensed electronic databases
migrant nurses. This integrative review will provide an overview of were searched which include: Scopus (includes 100% of Medline
the current situation for IENs who travel to Australia and the factors coverage); CINAHL; PubMed; Web of Science, and Google Scholar.
that impact on their personal and professional experiences. The literature search was undertaken from early July to December
2016 and the terms used included: “Australia”; “nurs$”; “back-
2. Literature review ground”; “experience”; “health professionals”; “international”;
“migrant”; “overseas”; “pathway”; “registered nurse”; “stories”;
In the literature, descriptive studies have been conducted inter- “training”.
nationally to understand the experiences of IENs. These studies A total of 672 citations were found using the parameters in the
categorise the migration experience of IENs in three ways: either search strategy. Following the first screening, search results were
positively (Alonso-Garbayo & Maben, 2009), negatively (Brunero, scanned and irrelevant articles were excluded (n = 652). This ini-
Smith, & Bates, 2008), or as a set of chronological stages of bar- tial screening process identified 20 articles as potentially eligible, a
riers to be overcome during the transition to a new country further 15 articles were added after checking references to undergo
(Magnusdottir, 2005). Framing the stages of experiences described another screening. The inclusion criteria were applied to filter out
in the latter have been undertaken in previous integrative reviews nine articles from the 35, leaving 26 articles. Subsequent in-depth
from developed countries such as the United Kingdom (UK), Canada analysis based on whether the studies addressed the research aims,
and the United States of America (USA). For instance, in an inte- resulted in a final set of eligible articles (n = 22) included in this
grative review of the experiences of IENs who migrated to the integrative review (Fig. 1) (Moher et al., 2009). All the final eligible
UK, Nichols & Campbell (2010) reported five themes: motivation articles were reviewed by the research team to ensure rigour and
for migration, adapting to British nursing, experiences of first world that ongoing fortnightly meetings allowed for inter-rater reliability
healthcare, feeling devalued and deskilled and vectors of racial dis- throughout the review process.
crimination. The study reported mainly negative issues of migrating
and working in the UK which impacted on IEN job satisfaction and 4.2. Data evaluation
subsequent nurse retention (Nichols & Campbell, 2010). These find-
ings were similar to a Canadian review by Newton et al. (2012) that The methodological quality of the included studies was
reported five themes from 21 articles which include: reasons for and appraised and evaluated of their research designs, rigour and
challenges with immigration, cultural displacement, credentialing dif- methodology used. This is an important step when assessing the
ficulties and deskilling, discriminatory experiences and strategies of quality of articles (Whittemore & Knafl, 2005). The included liter-
IENs which smoothed transition. A study conducted by Jose (2011) ature was appraised using the Critical Appraisal Skills Programme
in the USA on the lived experiences of 20 IENs reported six themes: (CASP) checklist tool for reviewing qualitative studies and all of the
dreams of a better life, a difficult journey, a shocking reality, rising articles scored a high quality rating using the tool (Critical Appraisal
above the challenges, feeling and doing better and ready to help oth- Skills Programme [CASP], 2017).
ers. The meta-themes from these three studies indicate analogous
experiences that are depicted in a sequential manner as they under- 4.3. Data analysis
went their migration journey.
Based on the Whittemore & Knafl (2005) integrative review
3. Aim methodology, this analysis phase consisted of data reduction, data
presentation and data comparison. The data reduction refers to the
To review the literature that explores the factors that impact reduction of data to determine the factors which impact on the
on the personal and professional experience of IENs migrating to personal and professional experiences of migrant nurses. Data is
Australia. presented in a table that covers the factors that impact on the
Table 1
Included articles (n = 22).
No. Title and Author (Year) Location Sample Size Design Method
1. Lived experience of overseas-qualified nurses from non-English-speaking Adelaide 24 IENs Qualitative: phenomenology Semi structured interviews thematically analysed
backgrounds in Australia.
Konno (2008)
2. The Experience of China-Educated Nurses Working in Australia: A Symbolic Brisbane and 28 IENs Constructivist Grounded theory Literature review and 46 in-depth interviews
Interactionist Perspective Adelaide
Zhou (2014)
3. Overseas trained nurses working in regional and rural practice settings: do we – – Integrative Literature Review A search of electronic databases and relevant web pages for
understand the issues publications period 1995–2008. Thematic analysis and
Wellard and Stockhausen (2010) synthesis
4. Migration matters: The experience of United Kingdom registered nurses migrating to Western 21 IENs Qualitative study-Heuristic Literature review and 21 in-depth interviews with UK nurses
Western Australia Australia inquiry
Vafeas (2013)
5. The experiences challenges and rewards of nurses from South Asia in the process of Victoria 16 IENs Qualitative: phenomenology Literature review and 16 in-depth interviews with Sth Asia
entering the Australian nursing system nurses
Walters (2008)
6. Migration of nurses: Finding a sustainable solution – – Discussion Article Discussion of nurse migration.
Armstrong (2003) Personal account
7. Ambivalence and the experiences of China educated nurses working in Australia Brisbane and 28 IENs Qualitative study Twenty eight in-depth interviews

H. Ng Chok et al. / Collegian 25 (2018) 247–253


Zhou et al. (2010) Adelaide
8. The Lived Experience of Non English Speaking Background Overseas Qualified Nurses Perth 13 IENs Qualitative: phenomenology Thirteen in-depth interviews from five WA metropolitan
Working in Western Australian Metropolitan Hospital Workforce hospitals
Smith (2010)
9. Resuming the ‘Skilled Worker’ Identity: The Filipinas’ Strategies in Labour Market Melbourne 20 IENs Discussion paper Twenty in depth interviews with Filipina immigrants
Participation in Melbourne, Australia
Limpangog (2016)
10. Black nurse in white space? Rethinking the in/visibility of race within the Australian Sydney 14 IENs Qualitative descriptive study Fourteen in-depth interviews with black African migrant nurses
nursing workplace.
Mapedzahama et al. (2012)
11. Lived experiences of immigrant nurses in New South Wales, Australia: searching for New South 5 IENs Qualitative: phenomenology Semi-structured in-depth interviews with immigrant nurses
meaning Wales
(Omeri & Atkins, 2002)
12. Expectations and experiences of recently recruited overseas qualified nurses in Sydney 56 IENs Descriptive survey Postal surveys sent to 150 newly arrived nurses. Fifty six
Australia surveys returned (37% response rate)
Brunero et al. (2008)
13. Overseas qualified nurses in Australia: reflecting on the issue Victoria Researcher Discussion paper Literature review and authors personal experience
Stankiewicz and O’Connor (2014) perspective
14. The concept of difference and the experience of China-educated nurses working in Brisbane and 28 IENs Constructivist Grounded theory Literature review and 46 in-depth interviews
Australia: A symbolic interactionist exploration Adelaide
Zhou et al. (2011)
15. Rediscovering nursing: A study of overseas nurses working in Western Australia. Perth 13 IENs Qualitative: phenomenology Interviews with 13 female Non English Speaking Background
Smith et al. (2011) (NESB) OQN from five different WA metro hospitals
16. The globalisation of the nursing workforce barriers confronting overseas qualified Melbourne – Discussion paper Discussion piece on migrant nurse arrivals also a Filipina case
nurses in Australia study and barriers for NESB nurses
Hawthorne (2001)
17. Facilitating the transition of Asian nurses to work in Australia Adelaide 5 IENs Qualitative methodology In-depth semi-structured
Takeno (2010) Interviews with five east Asian nurses
18. Constructing nursing practice: Country of Origin culture and competency Sydney 9 IENs Qualitative methodology In-depth interviews with NESB nurses and discussion of
Jackson (1995) overarching issues.
19. Expert to novice: experiences of professional adaptation reported by non-English Melbourne 13 IENs Modified grounded theory In depth interviews, observation in clinical practice and
speaking nurses in Australia. approach. personal journal entries.
Deegan and Simkin (2010)
20. Support for overseas qualified nurses in adjusting to Australian nursing practice Adelaide 12 papers Literature Review Search of qualitative and quantitative papers using appraisal
Konno (2006) identified tools.
21. United Kingdom educated migrant midwives’ experience of working in Queensland. QLD 18 IEMs Qualitative: phenomenology In depth interviews with 18 midwives and reflective journal
Sidebotham (2010) analysis.
22. The multicultural workplace: comfort, safety and migrant nurses. NSW – Qualitative study NESB nurses using in-depth interviews.
Jackson (1996)

249
250 H. Ng Chok et al. / Collegian 25 (2018) 247–253

in Australia. Of these, six factors were identified to challenge IENs


Records idenfied in both their personal and professional experiences which were:
Idenficaon through database pre-migration processes; recognising and adapting to a new reality;
searching (n=672)
living and working in the English language; economic and social stress;
discrimination and feeling like an ‘outsider’ and resolving issues and
Records excluded aer finding meaning in the new reality. The remaining two factors found
tle and abstracts to be facilitators of both personal and professional positive expe-
checked (n=652)
Screening riences were personal support systems and recruitment and working
conditions respectively (see Fig. 2).
Records remaining aer
screening (n=20) Records added based 6. Factors impacting both personal and professional
on reference check of
screening (n=15) experiences
Eligibility
6.1. Challenges
Full text assessed aer
eligibility (n=35) Records not fit inclusion
criteria (n=13) 6.1.1. Pre-migration processes
The decision making process for migrating to Australia is
Studies included to be important and complex for IENs. Bearing in mind the future cir-
Included included in literature
review (n=22) cumstances of themselves as well as the family, and the decisions
to move away from family and friends from their original coun-
try are difficult decisions (Vafeas, 2013). Other challenges include
Fig. 1. Literature Flow chart (n = 22).
the location for settlement, fulfilling requisite qualifications and
experience and choice of short or longer term visas for working
personal and professional experiences of these eligible articles and living in Australia (Hawthorne, 2001; Stankiewicz & O’Connor,
(Table 1). The factors were synthesised and sorted into challenges 2014; Vafeas, 2013). Pre-migration qualification screening issues
and facilitators for these nurses (see Fig. 2). were reported as some nurses did not get their qualifications recog-
nised (Hawthorne, 2001). Stress from the uncertainty and drawn
5. Findings out waiting times for mail to arrive detailing the outcome of nurse
applications were also reported and led to stress regarding when to
This integrative review identified 22 articles that were eligible give enough notification to employers on when they would leave
based on the inclusion criteria (Fig. 1). The articles were categorised, their job (Vafeas, 2013).
tabulated (see Table 1) and assessed of their quality using the CASP
checklist (CASP, 2017) and all articles were found to be of high qual- 6.1.2. Recognising and adapting to a new reality
ity. The themes were synthesised and presented diagrammatically It was reported that IENs face a significant ‘cultural shock’
as recommended by Whittemore & Knafl (2005) (see Fig. 2). when they arrive in Australia (Konno, 2008; Sidebotham, 2010;
Overall eight factors were found to impact IENs’ personal and Vafeas, 2013; Zhou, 2014). Some IENs even reported the realisation
professional experiences on their journey to living and working as a traumatic experience (Jackson 1996). However, to overcome

Fig. 2. Facilitating and challenging factors that impact on IEN personal and professional experiences. Refer to Table 1 for superscript References.
H. Ng Chok et al. / Collegian 25 (2018) 247–253 251

these new environments, it was reported that IENs needed to a strong sense of resilience and a feeling of contentment in their
develop a new identity to “facilitate the ongoing – active process role after overcoming the various challenges in and out of the
of making sense of a new reality” (Konno, 2008). Old expectations workplace. The IENs reported that their final acceptance after the
and preconceived notions, value systems and psychosocial struc- struggles was worth it and that it “all works out in the end” (Smith,
tures from past experiences need to be replaced by new systems 2010, p. 25) stating that they also would not want to return home.
when migrating to, living in and working in new environments in These findings were similar to other studies (Jackson, 1996; Konno,
Australia (Jackson, 1995; Konno, 2008; Stankiewicz & O’Connor, 2008; Walters, 2008) that reported successful transitioning after
2014; Vafeas, 2013; Zhou et al., 2010). Zhou’s (2014) study sum- IENs reconciled the differences in their new reality, established
mates this sequentially stating that these nurses undergo a process their new identity and found a comfortable sanctuary for them-
of “realising, struggling and reflecting” (p. 2) as necessary steps to selves in and out of their workplace.
reconciling these new realities.
7. Factors impacting personal experiences
6.1.3. Economic and social stress
This factor impacts IENs throughout their migration journey. 7.1. Personal support systems
The decision to migrate to Australia brought about significant finan-
cial and social stress to IENs and their families, making it difficult for 7.1.1. Challenges
them prior to leaving for Australia (Armstrong, 2003; Limpangog, One of the main challenges that impacts negatively on IENs’ per-
2016; Stankiewicz & O’Connor, 2014; Takeno, 2010; Zhou, 2014). sonal experiences is migrating alone. Some IENs reported travelling
For some IENs, ongoing economic stress was reported when pay- and arriving to little or no personal support leaving their entire
ing for visa documents, application fees, nursing skills assessment family and social connections behind (Jackson, 1996; Konno, 2008;
materials and costly agency services (Hawthorne, 2001; Vafeas, Takeno, 2010; Vafeas, 2013; Walters, 2008). Another challenging
2013). Furthermore, financial stress was also reported by IENs who factor that impacted on personal experience was reported in Zhou
felt discriminated and manipulated by bogus recruitment agen- et al.’s (2010) study of Chinese educated nurses who arrived with
cies as nurses would spend considerable amounts of money to deep conflicts with their extended family, citing diverging inter-
work in Australia only to be exploited (Walters, 2008; Wellard ests which were left unresolved prior to arriving and these issues
& Stockhausen, 2010). Stress was also reported by IENs in their impacted negatively on their personal experience.
attempt to gain a working visa as they must pass mandatory occu-
pational English tests or International English Language testing
(Walters, 2008). These nurses felt a variety of initial feelings of 7.2. Personal support systems
doubt, personal fear, frustration, shock, incompetence and sadness
at leaving their country to work in Australia (Sidebotham, 2010; 7.2.1. Facilitators
Vafeas, 2013; Zhou et al., 2011). The IENs who migrate to Australia where they have family and
personal support systems reported positive experiences (Jackson,
6.1.4. Living and working in the english language 1996; Konno, 2008; Takeno, 2010). In the study by Vafeas (2013),
It is useful for new migrants travelling to Australia to get a grasp it was reported that familial support and social connections are
of the English language, as poor competencies in English create important for gaining a sense of belonging and feeling at home
barriers that hinder successful resettlement and transition of IENs with familiar connections, especially during resettlement. Walters
into the Australian workforce and wider society (Armstrong, 2003; (2008) argues that IENs should be supported with accommodation
Deegan & Simkin, 2010; Hawthorne, 2001; Konno, 2008; Omeri & and important settlement needs such as social support systems to
Atkins, 2002; Takeno, 2010; Walters, 2008; Wellard & Stockhausen, maximise the experience and integration of IENs. Motivating fac-
2010). The nuances in the use of ‘Australian-style’ English in and out tors such as having a better quality of life with warm weather,
of the workplace were also reported to be difficult for IENs adapt- beaches and friendly people are also some of the personal aesthetic
ing to living and working in Australia (Deegan & Simkin, 2010; motivations noted by IENs (Vafeas, 2013).
Smith, 2010; Takeno, 2010). Moreover, complications in under-
standing English were found to affect the social acceptance of IENs 8. Factors that impact professional experience
in the workplace (Konno, 2008; Mapedzahama et al., 2012; Omeri
& Atkins, 2002). 8.1. Recruitment and working conditions

6.1.5. Discrimination and feeling like an ‘outsider’ 8.1.1. Challenges


The IENs expressed feeling like ‘foreigners’ and ‘others’ in In this review, a number of challenges were reported for IENs
Australia (Konno, 2006; 2008; Smith, 2010). In Konno’s (2006) the- seeking to adapt to working in Australia. These include: the need to
sis, IENs felt a degree of loneliness travelling to Australia without relearn and adopt new skills such as providing holistic care, learning
familial support or social connections. Nurses that had established new technology, working in new worker dynamics, workplace cul-
themselves in Australia felt ambivalent and homesick, given their ture, working with doctors and other health professionals, patients
negative experiences during resettlement (Brunero et al., 2008; and their families (Jackson, 1995; Konno, 2008; Smith, 2010). Some
Omeri & Atkins, 2002; Walters, 2008; Zhou et al., 2010). Workplace IENs reported difficulties in letting go of past held value systems
bullying was also reported to limit the professional advancement of (Zhou et al., 2010). In regards to recruitment, it was also reported
IENs (Sidebotham, 2010). In a study by Mapedzahama et al. (2012) in Limpangog’s (2016) study that IENs who fall short of gaining
who interviewed 14 skilled African migrant nurses, racial preju- employment seek lesser paying jobs to support their family in the
dice was experienced in everyday life and in workplace interactions interim as they seek out employment in nursing.
with co-workers which was found to impact negatively on these Poor supportive work environments were reported by IENs try-
nurses. ing to conform and conduct themselves in the ‘western-way’ in the
workplace (Jackson, 1995; Zhou et al., 2010). The nurses in Deegan
6.1.6. Resolving issues and finding meaning in a new reality and Simkin (2010) study felt disempowered when their nursing
This factor was highlighted in Smith’s (2010) study who qualifications were not recognised by local nurses. Professional loss
reported IENs who adapted well to their new reality developed and negation of skills leading to poor retention were reported by
252 H. Ng Chok et al. / Collegian 25 (2018) 247–253

IENs placed in unfamiliar roles in speciality areas, leading to neg- The stress of resettlement by IENs establishing themselves in
ative professional experiences such as feeling ‘deskilled’ and like a Australia is exacerbated by IENs who arrive with poor English skills
‘learner’ (Jackson, 1996; Omeri & Atkins, 2002; Sidebotham, 2010; (Armstrong, 2003; Deegan & Simkin, 2010; Omeri and Atkins, 2002
Smith, 2010; Walters, 2008; Wellard & Stockhausen, 2010). Omeri & Atkins, 2002). Moreover, the difficulties in understand-
ing English impede the social acceptance of IENs (Konno, 2008;
8.2. Recruitment and working conditions Mapedzahama et al., 2012). The feelings of being viewed as ‘for-
eign’ are not exclusive to nurses but are also expressed by many
8.2.1. Facilitators skilled migrants who travel to other countries (Adams & Kennedy,
The IENs who migrate from less developed countries to Australia 2006). In this review, IENs felt like ‘others’ or ‘novices’ harbour-
expressed the advantage of working in improved environments ing feelings of incompetence which lead IENs to become fearful of
with improved workloads, better resources, higher salaries and their abilities in and out of the nursing environment (MacIntosh,
greater autonomy (Konno, 2008; Zhou et al., 2010). Nurses reported 2003; Sidebotham, 2010; Zhou et al., 2011). Some nurses experi-
feeling a sense of satisfaction in new working conditions, being enced feeling bullied, discriminated against and racial prejudice in
exposed to supportive environments and the capacity for con- everyday life (Mapedzahama et al., 2012; Omeri & Atkins, 2002;
tinuing education, training opportunities in nursing practice and Sidebotham, 2010; Vafeas, 2013). However, it was also reported
getting away from undesirable work environments (Brunero et al., that nurses develop a sense of resilience, regardless of having no
2008; Takeno, 2010; Vafeas, 2013). In Limpangog’s (2016) study, familial support systems (McDonald et al., 2012).
the sharing of work spaces with other health professionals was said Analysing the findings in this integrative indicate that nurses
to facilitate positive experiences among IENs. Reflecting on their undergo a multitude of struggles that challenge them. On a per-
journey, some IENs reported prior to migrating that there was low sonal level, the IENs with familial and social support systems can
morale in the workplace which was a motivating factor aiding their impact their experiences positively or negatively as seen in the
decision to migrate to Australia (Smith, 2010; Walters, 2008). divergent interests of the nurses in Zhou’s (2014) study. Migrant
nurses that are established persevere by providing for their families
9. Discussion by sending remittances back to their country of origin to support
their extended families (Kline, 2003) and to take advantage of better
This integrative review reveals that there are various factors that currency exchange rates (Buchan et al., 2005). Professionally, IENs
impact on the personal and professional lives of IENs migrating to find that recruitment and work conditions can challenge and facil-
Australia. Most skilled migrants travel to other countries to bet- itate the professional experiences of IENs, for instance, workplace
ter the circumstances of themselves and their families (Hardill and environments that were not encouraging or supportive of IENs led
MacDonald, 2000Hardill & MacDonald, 2000), and there are many to professional negation, deskilling, poor morale and nurse reten-
other motivating factors that ‘push’ and ‘pull’ skilled migrant nurses tion when placed in unfamiliar clinical areas and roles (Omeri &
to travel to other countries (Blythe & Baumann, 2009; Dywili et al., Atkins, 2002; Sidebotham, 2010). Conversely, improved workplace
2013; Kingma, 2007) as evident in migration studies on undergrad- conditions that positively facilitate professional growth and greater
uate nursing students and IENs seeking to live and work in Australia autonomy proved to be beneficial for nurse satisfaction and profes-
(Ohr et al., 2010; Shakya & Horsfall, 2000). sional development (Konno, 2008; Takeno, 2010; Zhou et al., 2010).
Prior to commencing their journey to Australia, IENs make Overall, these IENs were able to overcome their struggles and suc-
considerably difficult decisions that are stressful, complex and mul- cessfully establish their identity and find a comfortable sanctuary
tifaceted at every stage of their migration (Smith et al., 2011; Zhou for themselves (Brunero et al., 2008; Jackson, 1996; Konno, 2008;
et al., 2010). These important pre-migration decisions depend on Walters, 2008).
gathering information to understand the entirety of what it takes to
move to Australia, finding the right location and length of stay for 10. Limitations of the study
resettlement, paying agency services, visas and nurse registration,
submitting evidence of nurse qualifications and past experience Every attempt was made to identify all the possible articles
documents to employers, checking English language and compe- regarding the topic of IENs migrating to Australia, however, there
tency standards set by the Nursing and Midwifery Board of Australia is no guarantee that all articles may be included. This review was
(NMBA) (Australian Nursing & Midwifery Accreditation Council limited in a sense that only English language articles were used.
[ANMAC], 2017; Nursing and Midwifery Board of Australia [NMBA],
2016), deciding when to leave their original job and coming to
11. Conclusion
terms with being apart from family and friends (Brunero et al.,
2008; Hawthorne, 2001; Stankiewicz and O’Connor, 2014; Vafeas,
This integrative review explored the personal and professional
2013; Walters, 2008).
experiences of IENs who migrate to Australia. The review identified
Once in Australia, it was reported that IENs face a ‘cultural shock’
a number of challenging and facilitating factors that impact on their
based on various differences in expectation, society and culture
experience. In the main, challenging factors were often described,
(Vafeas, 2013; Zhou, 2014). Some nurses recognise the differences
in particular the IENs adapting to a new country and English lan-
in their new environment and adapt accordingly, like in Smith
guage difficulties. Overall, it is important for decision makers of
et al.’s (2011) study of UK nurses who had to rediscover nursing by
policies and programs that manage the migration and successful
tackling the nuances of the Australian language. While others, for
settlement of IENs to Australia, to understand and develop strate-
example, Zhou et al. (2010) found nurses had great difficulty resolv-
gies that mitigate the challenges, while maximising the facilitating
ing differences and felt ambivalent to working in Australia and
impacts identified in this review.
feeling homesick wanting to return back to China. The transitions
are difficult and sharing in a new world, as noted in Limpangog’s
(2016) study, requires adopting the value systems of Australia and Acknowledgements
dropping preconceived notions by setting up a new personal and
professional identity (Konno, 2008; Zhou et al., 2010), this is diffi- The authors would like to thank the technical support from Dr
cult particularly for those who arrive to no familial or social support Irene Chen for her assistance. There was no financial assistance with
(Vafeas, 2013; Zhou, 2014). this project.
H. Ng Chok et al. / Collegian 25 (2018) 247–253 253

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