Integrating internationally qualified nurses: a qualitative exploration of nurse managers' influence from nurses'...

Healthcare systems globally are confronted with a shortage of nurses. Various strategies to address this have been applied, including active recruitment of internationally qualified nurses. Nurse managers may have a central role in supporting workplace integration. This study aimed to explore how domestically qualified nurses and internationally qualified nurses viewed the role of nursing management and its impact on workplace integration.

Semi-structured interviews with 21 domestically and 14 internationally qualified nurses were conducted. Nurses were selected using purposive sampling. Snowball sampling was applied to reach a sufficient sample size. Interviews were pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and subthemes.

Five key themes related to impact of nursing management on workplace integration were identified: (a) Appropriate Placement, (b) Recruitment Process, (c) Leadership Support, (d) Workforce Shortage, and (e) Additional Burden/ Increased Workload. Active support by nursing leadership and the opportunity for shared-decision making was seen as a key factor. Increased workload, additional time and resources requirements associated with orientation of internationally qualified nurses and pressures from staff shortages were highlighted as hindrances. Inappropriate placement of internationally qualified nurses was perceived as key hindrance that could be addressed by nursing management. An imbalanced ratio between domestically and internationally qualified nurses was perceived as challenging by domestically qualified nurses.

Integration of internationally qualified nurses to clinical practice brings several challenges that may be positively impacted by nursing management through appropriate placement of internationally qualified nurses, supportive nurse managers and adequate preparation of domestically qualified nurse mentors/preceptor.

Nurse managers should ensure that internationally qualified nurses' work experience matches local clinical unit vacancies before hiring them. Peer support is a supportive factor for internationally qualified nurses. Nurse managers should find a balanced ratio between internationally and domestically qualified nurses in the roster. Introducing mentors or preceptors at ward level may be a strategy decrease work-related stress in both nursing groups.

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (DRKS00017465).