How Divergent Views of Specialist Nurse Status Affect IQNs' Skill Utilisation in Australia

To examine how internationally qualified nurses (IQNs) and Australian nurse managers conceptualise specialist nurse status within speciality nursing and how definitional divergence may contribute to the underutilisation of IQNs' specialist skills.

A sequential, explanatory mixed-methods study grounded in pragmatism.

Phase 1 used a descriptive cross-sectional survey (July-September 2022) distributed via social media, professional organisations and snowball sampling. Phase 2 involved qualitative data collection (December 2022-March 2023) through three focus groups with seven IQNs and eight individual interviews with nurse managers. Participants were asked to define specialist nurse status (survey prompt: 'specialty nurse or clinical nurse specialist'), and data were analysed using content analysis (Phase 1 open text) and reflexive thematic analysis (Phase 2).

A total of 115 participants (71 IQNs; 44 nurse managers) provided definitional statements. Both groups drew on experience, education and advanced skills, but with different emphases. IQNs were significantly more likely than nurse managers to prioritise clinical experience as central to specialist nurse status (χ ² (1, N = 115) = 7.94, p = 0.005, Cramér's V = 0.26). No statistically significant difference was observed in references to education (p = 0.44). References to advanced skills and expanded scope were infrequent and differed in emphasis, with nurse managers more commonly highlighting leadership, mentoring and quality improvement functions, while IQNs more often emphasised clinical autonomy. These divergences indicate a recognition mismatch that may delay or limit deployment of IQNs into specialist roles.