Recruitment agency-mediated onboarding, acculturation, and contract completion among internationally educated nurses...

Internationally educated nurses play a vital role in addressing global nursing workforce shortages and supporting healthcare systems across many high-income countries. As international nurse migration continues to increase worldwide, effective transition, onboarding, and acculturation practices have become important determinants of workforce integration and retention. In the United States, internationally educated nurses comprise a growing segment of the nursing workforce; however, variability in onboarding practices may affect successful integration and retention.

To examine recruitment agency-mediated onboarding and acculturation practices and their association with contract completion among internationally educated nurses in the United States.

Cross-sectional descriptive correlational study.

A 30-item survey was administered using snowball sampling (N = 76). Descriptive statistics and Pearson correlations were used to examine relationships between onboarding practices, professional characteristics, and contract completion.

Thirty-six percent of respondents reported no pre-arrival onboarding. Key gaps included legal orientation, communication training, and mentorship. No statistically significant associations were found between contract completion and years of experience (r = -.13, p = .24) or contract length (r = .02, p = .86). Modest, non-significant associations were observed between contract completion and ongoing agency engagement (r = .18, p = .11).

Recruitment agency practices vary substantially and may influence internationally educated nurses' transition experiences. Standardized onboarding and sustained support mechanisms warrant further investigation as potential strategies to enhance workforce integration and retention.

Findings highlight recruitment agencies as underexamined actors in workforce integration and suggest opportunities for standardizing policy and practice.