An inclusive workplace is where everyone is supported to thrive and succeed regardless of their background. Supportive working conditions and general self-efficacy have been found to be important for ...nurses' perceived competence and well-being at work, however, in the context of being a nurse in a new country, research is limited. Moreover, knowledge is lacking about whether different paths to a nursing license are related to nurses' perceived competence and well-being when working.
To examine determinants and experiences of nursing competence and well-being at work (thriving and stress) among internationally and domestically educated nurses.
A longitudinal descriptive and correlational design with a mixed-methods convergent approach was used.
A longitudinal study was conducted between January 2019 and June 2022 with two groups of internationally educated nurses who had completed a bridging program or validation to obtain a Swedish nursing license and one group of domestically newly educated nurses. Data were collected on three occasions: Time1 at the end of the nursing licensure process (n = 402), Time2 after three months (n = 188), and Time3 after 12 months (n = 195). At Time3, 14 internationally educated nurses were also interviewed. Data were analyzed separately and then interpreted together.
Multiple regression models showed that greater access to structural empowerment (B = 0.70, 95 % CI 0.31; 1.08), better cooperation (B = 3.76, 95 % CI 1.44; 6.08), and less criticism (B = 3.63, 95 % CI 1.29; 5.96) were associated with higher self-rated competence at Time3, whereas the variable path to a nursing license was non-significant (R2 = 49.2 %). For well-being, greater access to structural empowerment (B = 0.07, 95 % CI 0.02; 0.12), better cooperation (B = 0.36, 95 % CI 0.07; 0.66) and being domestically educated (B = 0.53, 95 % CI 0.14; 0.92) were associated with higher thriving at work (R2 = 25.8 %). For stress, greater access to structural empowerment (B = −0.06, 95 % CI −0.09; −0.02), better cooperation (B = −0.30, 95 % CI −0.51; −0.10), and less criticism (B = −0.28, 95 % CI −0.46; −0.05) were associated with having symptoms less frequently while being domestically educated was associated with having stress symptoms more often (B = 0.44, 95 % CI 0.07; 0.81) (R2 = 43.3 %). Higher general self-efficacy at Time1 was associated with higher self-rated competence at Time2 (B = 4.76, 95 % CI 1.94; 7.59). Quantitative findings concurred with findings from interviews with internationally educated nurses. However, qualitative findings also highlighted the importance of previous education, working experience, the new context, and communication abilities.
Both quantitative and qualitative data showed that working conditions were important for nurses' self-rated competence and well-being at work. Although communication difficulties, previous education, and working experience were not statistically significant in the multiple regression models, in the interviews these factors emerged as important for internationally educated nurses' competence and well-being.
Aim
To examine internationally educated nurses’ (IENs’) experiences of the recertification process when undergoing a series of examinations to test their nursing knowledge and skills and, thereby, ...obtain a Swedish nursing license.
Design
A qualitative study with a descriptive design.
Methods
A convenience sample of 15 IENs at the end of the recertification process was included. Data were collected using semi‐structured telephone interviews between September 2019 and January 2021 and analysed using qualitative content analysis.
Results
Conducting the recertification process to obtain a Swedish nursing license was challenging in many ways, and the nurses described a rollercoaster of emotions during the process: frustration, loneliness, stress and anxiety, but also happiness, pride and relief. The process was, for some, so demanding they almost gave up, and support was, therefore crucial for the nurses. However, many times, they had to struggle to find out where they could turn for help or guidance.
Conclusion
The nurses found the formal support during the recertification process to be inadequate and inaccessible. For this reason, and to decrease the risk of nurses dropping out and instead taking unlicensed jobs, there is a need to develop and introduce more supportive structures and to make the existing support and information more accessible for the nurses.
Impact
This study highlights the importance of offering accessible support during a demanding and challenging recertification process. These findings can help policymakers develop and introduce supportive structures in the process of recertification for IENs.
Internationally educated nurses attending a bridging program must demonstrate clinical competence and meet requirements to apply for a nursing license in Sweden.
To describe preceptors' experiences ...of supervising internationally educated nurses undergoing clinical practice education during a bridging program.
A qualitative descriptive study.
Two universities offering the 1-year bridging program for nurses with a nursing degree from outside European Union/European Economic Area and Switzerland.
Fifteen preceptors, all registered nurses, who supervised internationally educated nurses were included.
Semi-structured interviews were performed, and data were analyzed using qualitative content analysis.
Supervising internationally educated nurses was not the same as supervising nursing students and raised feelings of both joy and frustration. Preceptors had to adapt supervision to the student's nursing knowledge and skills. They had to help students communicate in Swedish and form good relationships with other students, patients, and other professionals. Most preceptors requested more information about the student's nurse education, country of education/cultural background, and previous work experiences. Mixed experiences of support from the university, first-line managers, and colleagues were reported.
Being a preceptor for internationally educated nurses is a challenge, and supervision training is important for managing preceptorship. To supervise students based on their level of knowledge and skills, more information must be shared with the preceptor. Encounters with others are of importance in the training, where teamwork and person-centered care must be in focus, both in prior theoretical education and in clinical practice education.
•Preceptors need information on students' previous knowledge and experiences.•Support from preceptors in specific nursing language is important.•Teamwork and person-centered care can be challenging areas for IENs.•Previous experience and supervision training are beneficial when supervising IENs.
Bridging programs have been created to facilitate internationally educated nurses' integration process. Thus far, studies on bridging programs have been few and have only been conducted in ...English-speaking countries. Due to language barriers, it may be a greater challenge to attend a bridging program in a non-English-speaking country.
The aim was to examine internationally educated nurses' experience of attending a one-year bridging program to obtain a Swedish nursing license.
A qualitative study with a descriptive design was applied.
The study setting was the five universities offering the one-year, full-time Swedish bridging program.
Purposive sampling was used. Eighteen nurses participated in the study at the end of the program.
Semi-structured interviews were conducted and analyzed using qualitative content analysis.
Studying in a new environment and language was challenging and intensive, as were adapting to a new healthcare system and relearning some nursing practices. However, attending the bridging program was also rewarding and gave feelings of happiness and pride; the nurses developed their nursing skills as well as their language and academic skills. Moreover, they became familiar with Sweden's nursing practices, healthcare system, and culture. Good support was important, but not always enough.
By attending a bridging program, nurses can become familiar with the country's healthcare system and nursing practices. Moreover, develop their language skills and attain skills important to lifelong learning. Although the program may not eliminate all difficulties nurses often experience in a new country, it can offer the support nurses need to handle the challenges. However, for some nurses, due to different backgrounds and prerequisites, the support offered may need to be more individualized.
•Migrated nurses' view of a bridging program in a non-English-speaking country.•Attending the bridging program was described as both challenging and rewarding.•Results have relevance to developing supportive structures in bridging programs.•Results have relevance to sustainable inclusion of migrated nurses.
Bridging programs are offered to support migrated nurses, but in some countries, nurses can also choose to validate their nursing competence. Thus far, little is known about how migrated nurses ...estimate their competence when they are about to enter working life in a new country and how this differs from regular nursing students.
To compare two groups of internationally educated nurses' – those from bridging programs and those who chose validation – and one group of regular nursing students' self-rated professional competence when they are about to start working as registered nurses. The hypotheses were: 1) internationally educated nurses rate their competence higher than regular nursing students and 2) those from bridging programs rate their competence higher than those who chose validation. In addition, the aim was to compare the groups' self-efficacy and thriving.
A cross-sectional, comparative design.
Five universities in Sweden.
Nurses educated in non-European countries from a bridging program (n = 128, response rate 79.0 %) or validation process (n = 61, response rate 59.2 %) and students graduating from the regular nursing program (n = 213, response rate 68.3 %).
Data were collected with coded questionnaires (paper or online) between 2019 and 2021 and analyzed using non-parametric tests, e.g., Kruskal-Wallis.
Both groups of internationally educated nurses had higher median scores on total nursing competence (both groups p < 0.001), general self-efficacy (bridging programs p < 0.001, validation p = 0.020), and total thriving (bridging programs p < 0.001, validation p = 0.012) than regular nursing students did. However, comparing the groups of internationally educated nurses showed no significant differences.
Internationally educated nurses rated their competence high but with differences within the groups for different competence areas. More research is needed to investigate whether the different paths are important for nurses' competence later in working life, and some of the competence areas might need extra attention when nurses start working.
•Migrated nurses rated overall high levels of professional competence•Lowest median scores were found for the competence factor Development, leadership and organization of nursing care•No differences between migrated nurses from bridging programs and from validation in competence, self-efficacy and thriving•Results generate knowledge important to those working with bridging programs and validation
PDF
