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Migrant Nurses, Motivation, Integration, Contribution

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Andrea Winkelmann-Gleed at SALING 2012 Ltd.
Andrea Winkelmann-Gleed
  • SALING 2012 Ltd.
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Abstract

The NHS and independent health care sector depend on the contributions of the migrant workforce to make up for serious shortfalls in staff numbers. Based on current debates of equality, ethnicity and integration, the book analyses the motivation for nurses to migrate, their own experiences of integration into an existing work team and the contribution they are making to organisational capacity. The book is based on qualitative and quantitative research conducted among migrant and refugee nurses and includes many personal accounts. It covers areas such as diversity, work-related relationships, cultural understanding and social exclusion, as well as taking an overall look at migration, ethnicity and employment.
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Migrant Nurses
motivation, integration, contribution
Andrea Winkelmann-Gleed
foreword by
Roswyn Hakesley-Brown

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book cover WINKELMANN-GLEED[1]
Data
December 2013
Andrea Winkelmann-Gleed
... Nurses seek employment abroad when they have enough motivation to leave the home country (Winkelmann-Gleed, 2006;Larsen et al., 2005). Empirical studies mention push factors, such as poor working conditions, the lack of promotion opportunities, poor living conditions, poor wages, unemployment, and the fact that some countries adopt a policy of exporting nurses to gain remittances (Munro, 1999;Larsen et al., 2005). ...
... International nurse studies reported that the factors of push and pull explain nurses tendency to migrate (Hardill and MacDonald, 2000;Kline, 2003;Aiken et al., 2004;Buchan and Sochalski, 2004;Vujicic et al., 2004;Winkelmann-Gleed, 2006). ...
... Thirty-six respondents to the survey said that the pay and income, is a reason for their migration to the UK. Research has shown that migrants in the host countries have diverse backgrounds and slightly different reasons to migrate from the source countries (George, 2005;Buchan et al., 2006;Winkelmann-Gleed, 2006 (Sami,30,Male,Telephone) With this pay amount, many nurses would probably choose to depend on other sources, such as, borrowing money and finding an access to the banks for loans to cover some of their primary needs. ...
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... The ILO's indicators mean that forced labourers are operating on the margins of or in illegality. Detailed information about the scope of forced labour in the UK remains extremely difficult to come by, often anecdotal (Dench et al, 2006;Winkelmann-Gleed, 2006;Gupta, 2007), small-scale or journalistic (Pai, 2008), its existence often extrapolated from evidence of extreme exploitation or workers reporting their conationals' experience. Evidence suggests that there is a growing problem, requiring stronger intervention by policy makers and those delivering services. ...
... Other main sectors for migrant worker employment unregulated by the GLA include construction, catering, leisure, hotels, cleaning, textiles and social care and healthcare. For example, 5,500 Filipino agency nurses were brought to the UK in 2003 under false pretences (Winkelmann-Gleed, 2006), and are now working excessive hours -often in publicly funded healthcare agencies -paying off large sums (£5,000) as contract fees. Many migrants -apparently working legally -do so under levels of exploitation that meet the ILO definition of 'forced labour'. ...
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... The healthcare sector in the UK depends heavily on foreign nurses. This peaked in the early 2000s when 13% of all nurses in the UK were foreign trained (Winkelmann-Gleed, 2006). However, in 2006, general nursing was removed from the "shortage occupation list." ...
‘I Can Only Do My Best and Leave the Rest to God”: Religious/Spiritual Coping Strategies of African Nurses in the UK
Article
Full-text available
  • Jul 2024
  • J BUS ETHICS
Research on racism in the workplace has long focused on organizational remedies for this moral problem. Given the acknowledged inadequacies of organizational solutions such as anti-racism training, attention is now turning to how immigrants manage their individual experiences of racism in a western context. Employing an agentic lens, this article describes a qualitative study of 43 African nurses in the UK in which their capacity for withstanding workplace racism is examined. It investigates how participants draw upon a range of religious coping strategies to make sense of and respond to racism. The data indicate that African nurses rely on specific coping strategies at different points in time and across various contexts, adapting their coping approaches to accommodate their personal growth and individual experiences. This underscores the versatility, context-dependency, and temporal aspects of religious coping among immigrants. The study’s findings are particularly interesting given the limited role that religion plays in western organizations.
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... Culturally and linguistically diverse (CALD) nurses have been referred to in previous research using various titles which show collective aspects that include the movement of nurses across borders, possession of a nursing qualification from a different nation other than the practice context and a different nationality or ethnicity from the host country. The adopted terms that define CALD nurses internationally include: immigrant nurses (Al-Nusair & Alnjadat, 2022;Buttigieg et al., 2018;Covell & Rolle Sands, 2021;Stievano et al., 2017;Xiao et al., 2014), internationally recruited nurses (Alexis, 2015), overseas-qualified nurses (Bhandari et al., 2015;Ohr et al., 2014;Philip et al., 2015;Zanjani et al., 2018), foreign-born nurses (Calenda et al., 2019;Wesołowska et al., 2020), migrant nurses (Al-Hamdan 24 et al., Brunton et al., 2020;Brunton & Cook, 2018;Buttigieg et al., 2018;Can et al., 2022;Choi et al., 2019;Chok et al., 2018;McBrien et al., 2022;Smith et al., 2022;Villamin et al., 2023;Winkelmann-Gleed, 2022), expatriate nurses (González et al., 2021), agency nurses (Knutsen et al., 2020), internationally qualified nurses (Brunton & Cook, 2018;Chun Tie et al., 2019;Kurup et al., 2023;O'Callaghan et al., 2018;Roth et al., 2023) and mobile nursing workforce (Leone et al., 2020). However, the use of CALD nurse as a term encompassing all the nurses whether locally or internationally educated, whose culture, language, professional experience, and practice context are different from the host healthcare system and society has recently gained popularity . ...
Organisational integration of culturally and linguistically diverse nurses : a hypothetical model
Thesis
Full-text available
  • May 2024
This study was aimed at developing a hypothetical model for identifying concepts to explain the integration of culturally and linguistically diverse (CALD) nurses into healthcare organisations. The study consisted of three phases. In Phase I, an umbrella review was conducted to establish evidence from a wide range of existing systematic reviews related to integration strategies and models that support transition and adaptation of culturally and linguistically diverse nurses into healthcare organisations. The JBI guidelines were used to conduct the review. A total of 27 scientific articles were selected. Based on inductive content analysis three main categories were developed namely, intra-organisational strategies and models, sociocultural integration strategies and models, professional development strategies and models. In Phase II, three qualitative descriptive studies were conducted. In all the studies, data were collected using individual semi-structured interviews and analysed using inductive content analysis. Culturally and linguistically diverse nurses (n=24) were recruited from primary and tertiary healthcare organisations. Nurse educators (n=20) were recruited from three universities of applied sciences. Nurse leaders (n=13) were recruited from four primary and specialised healthcare organisations. In Phase III, a hypothetical model describing culturally and linguistically diverse nurse integration into healthcare environments was built based on study Phase I and II. Eleven concepts were proposed described as: Effective transition to nursing practice, Institutional support, Leadership involvement, Competence recognition and support, Understanding of nurses’ roles through integration practices, Safe working environment, Growth within the organisation, Relationships, Collegiality, and Cultural diversity in healthcare and Linguistic diversity. This study provides a hypothetical model which can be utilised when supporting the organisational integration process of culturally and linguistically diverse nurses. Moreover, future studies on culturally and linguistically diverse nurse organisational integration could put emphasis on improving institutional support, nurse leadership, co-worker support and the structuring of integrational practices within the formal structure of healthcare organisations.
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... The UK's National Health Service (NHS) has been employing overseas healthcare professionals, including qualified nurses, since it was established in 1948. In the early years of the NHS, both trained and trainee nurses, particularly from Ireland and Caribbean countries, were targeted for recruitment (Winkelmann-Gleed & Hakesley-Brown, 2006). However, patterns of overseas nurse migration to the UK have fluctuated over time. ...
Nurse Migration in Australia, Germany, and the UK: A Rapid Evidence Assessment of Empirical Research Involving Migrant Nurses
Article
Full-text available
  • Jun 2022
  • Pol Polit Nurs Pract
Forecasts predict a growing shortage of skilled nursing staff in countries worldwide. Nurse migration is already a common strategy used to address nursing workforce needs. Germany, the UK, and Australia are reviewed here as examples of destination countries for nurse migrants. Agreements exist between countries to facilitate nurse migration; however, it is not evident how nurse migrants have contributed to data on which these arrangements are based. We examined existing primary research on nurse migration, including educational needs and initiatives to support policymakers’, stakeholders’, and health professions educators’ decisions on measures for ethical and sustainable nurse migration. We conducted a rapid evidence assessment to review available empirical research data which involved, was developed with, or considered migrant nurses to address the research question: what are the findings of research that directly involves migrant nurses in producing primary research data? A total of 56 papers were included. Four main themes were identified in this research data: Research does not clearly define what is meant by the term migrant nurses; discrimination is often reported by migrant nurses; language and communication competencies are important; and structured integration programs are highly valued by migrant nurses and destination healthcare employers. Migrant nurses continue to experience discrimination and reduced career opportunities and therefore should be included in research about them to better inform policy. Structured integration programs can improve the experience of migrant nurses by providing language support (if necessary), a country-specific bridging program and help with organizational hurdles. Not only researching migrant nurses but making them active partners in research is of great importance for successful, ethical, and sustainable migration policies. A broader evidence base, especially with regard to the views and experiences of migrant nurses and their educational support needs, should be promoted to make future immigration policy more needs-based, sustainable and ethically acceptable.
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... chief nurses, 'leads of education' nurses, managers) can have on the career progression, well-being and overall retention of newly arrived foreign professionals is consistent with the literature. 24,26,27 Finally, the findings also demonstrated the importance of the networks that nurses are able to access before and after they come to a foreign country. Social media communities, nurses of the same nationality in the recruiting hospital, 28 communities of people from similar nationalities nearby, and even the experience of being part of a cohort, were found to provide various resources as well as an identity that made newly recruited nurses feel less isolated. ...
Experience of mobile nursing workforce from Portugal to the NHS in UK: Influence of institutions and actors at the system, organization and individual levels
Article
Full-text available
  • Sep 2020
  • EUR J PUBLIC HEALTH
In UK, since 2010 shortages of nurses and policy changes led many health service providers to become more active in recruiting nurses from the European Union Member States. This article analyses the experience of Portuguese nurses working in the English NHS considering the individual and organizational factors that affect the quality and duration of nurses' migration experience, future career plans and expectations. Twenty-seven semi-structured interviews were conducted at the individual, organizational and policy levels in UK with Portuguese nurses and NHS healthcare staff in 2015-16. The results demonstrate that organizational settings, conditions, actors' attitudes and level of support influence nurses' level of commitment to their employer and their overall mobility experience. Professional achievements, professional and personal sources of support made these nurses evaluate their overall mobility experience as positive, even overcoming personal challenges such as homesickness. The results reveal that migration is accomplished through constant interaction between institutions and individual actors at different levels. Understanding the influencing factors as well as the complex and dynamic nature of a professional's decision-making can design more effective retention responses.
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... Likewise, a 2011 census found that 52.3% HCWs in Australia were born and educated in other countries. And also, out of 15,168 additional HCWs in Australia between the 2006 and 2011 censuses, 68.9% were foreign-born, which saved the Australian government US$1.7 billion in medical education costs [16,17]. In fact, the United States (US) health care system also, relies very heavily on HCWs from other countries with one in four doctors in the US being born and educated in another country [14]. ...
Exploring the risk of Middle East Respiratory Syndrome- coronavirus among expatriate healthcare workers. A comparative epidemiological study of Saudi Arabian and South Korean healthcare workers
Preprint
Full-text available
  • Dec 2019
Background In comparison to South Korea, which was able to contain the outbreak of Middle East respiratory syndrome corona virus (MERS-CoV) in 2015, new cases are still emerging in the Kingdom of Saudi Arabia. The Saudi Arabian healthcare sector, which is dependent on the expatriate workforce to cater to its growing local healthcare demands, has been reporting multiple healthcare-associated MERS-CoV outbreaks since 2012. In this paper, we compare the epidemiology of MERS-CoV among healthcare workers (HCWs) in Saudi Arabia and South Korea and to ascertain the risks of MERS-CoV among expatriate HCWs. Methods Data were collected from publicly available resources such as World Health Organization and health department websites. A line list of all reported cases of MERS-CoV among HCWs in Saudi Arabia and South Korea was prepared and analysed. Results Among the total infected HCWs in Saudi Arabia, 84.6% (n=192/227) were expatriates. The mean age of infected HCWs in both settings was similar (Saudi Arabia 38 years, South Korea 39 years). Female HCWs were more likely to be infected, while male HCWs were more likely to die. In Saudi Arabia, 36.5% (n= 68/186) of HCWs with MERS-CoV were asymptomatic, compared to 7% (n=2/28) HCWs in South Korea. Most of the expatriate HCWs in Saudi Arabia were asymptomatic (78%, n=53/68) to MERS-CoV. Unlike South Korea, in Saudi Arabia, a diversity of HCWs other than doctors, and nurses were also infected with MERS-CoV. Conclusions A high proportion of expatriate HCWs were infected with MERS-CoV in Saudi Arabia which highlights the need for adequate training and education in this group about emerging infectious diseases and the appropriate strategies to prevent acquisition. Also, we did not find any policy statements restricting the contact of HCWs, vulnerable to MERS-CoV like pregnant HCW, HCWs over the age 60, HCWs with underlying comorbidity etc, from getting in proximity with a suspected or potential MERS-CoV infected patient. Policy development in this regard should be a priority, to contain healthcare-associated transmission of emerging and remerging infectious diseases like MERS-CoV. Further studies should be conducted to determine social, cultural and other factors contributing to high infection rate among expatriate HCWs.
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Preparation for Practice: Internationally Qualified Nurses’ Perceptions of Clinical and Cultural Practice Learnings Gained Through a New Zealand Competence Assessment Programme
Article
Full-text available
  • Dec 2024
The past two years has seen a rapid influx of internationally qualified nurses (IQNs) to Aotearoa New Zealand to address a long-term shortage of nurses. In 2023, the Nursing Council of New Zealand changed the process by which IQNs registered as nurses. Prior to this date, IQNs, whose professional culture were assessed as not being equivalent to New Zealand trained nurses, were required to complete a Competence Assessment Programme with a Nursing Council accredited programme. These programmes (8-12 weeks duration) were intended to prepare IQNs for practice in the Aotearoa New Zealand health system. This article reports on a study undertaken in 2020 which informed the changes to Nursing Council’s registration process for IQNs. The aim of this qualitative study was to understand how IQNs perceived the Competence Assessment Programme’s relevance and usefulness to their clinical and cultural transition into the Aotearoa New Zealand’s nursing profession to inform future registration processes. Using a focused ethnography methodology, participants were purposively recruited who were IQNs and who had participated in a Competence Assessment Programme between 2001 and 2016. Twelve nurses participated in individual semi-structured interviews. A thematic analysis framework was used to interpret the data. Two primary themes emerged: 1) social interaction, which encompassed sub-themes of communication barriers and the need for supportive preceptors; and 2) navigating new professional practice, with sub-themes of feeling deskilled in unfamiliar roles, and misconceptions about cultural safety and Te Tiriti o Waitangi. Novel insights included participants’ newfound understanding of the balanced power dynamics within the Aotearoa New Zealand healthcare system and the recognition of the vital support received from engaged and knowledgeable clinical preceptors. However, participants did not perceive the programme as having significantly influenced their acquisition of new professional knowledge nor their understanding of cultural practices necessary for achieving equitable health outcomes for Māori. The study found that it is imperative that IQNs are supported into the health workforce with orientation programmes delivered by the employing organisations, access to ongoing professional development, and the provision of professional supervision. IQNs are a critical and substantial part of the nursing workforce who must be supported, educated, and protected to ensure they thrive in the workplace. ##Te reo Māori translation Te Takatū mō te Mahi Tūturu: Ngā Kitenga o ngā Tapuhi Whai Tohu Mātauranga ā-Ao mō ngā Akoranga Tiaki Tūroro, Mahi Ahurea hoki i riro i a rātou mai i tētahi Hōtaka Aromatawai Matawai o Aotearoa Ngā Ariā Matua I ēnei tau e rua ka hipa ake nei kua tino piki ake te maha o ngā tapuhi kua whai tohu ā-ao (IQN) ki Aotearoa hei whakatika i te korenga tapuhi wā roa. I te tau 2023, i panonitia e Te Kaunihera Tapuhi o Aotearoa te hātepe mō te ara rēhita mō ngā IQN hei tapuhi. I mua atu i taua wā, i runga i te momo aromatawai i kī, kāore i taurite te ahurea ngaio o ngā IQN ki ngā tapuhi o Aotearoa, i herea ngā IQN kia whakaoti i tētahi Hōtaka Aromatawai Matatau i raro i tētahi hōtaka whai tiwhikete nā te Kaunihera Tapuhi. Ko te whakaaro, ko ēnei hōtaka (12 wiki te roa) hei whakangungu i ngā IQN mō ngā mahi i roto i te pūnaha hauora o Aotearoa. Ka whakapūrongo tēnei tuhinga i tētahi mātainga i kawea i te tau 2020, i noho ai hei tūāpapa mō ngā panonitanga ki te hātepe rēhita o te Kaunihera Tapuhi mō ngā IQN. Ko te whāinga o tēnei mātainga inekounga kia mārama he pēhea te titiro a ngā IQN mō te hāngai me te whāinga take o te Hōtaka Aromatawai Matatau ki tō rāto whakawhiti tiaki tūroro, ahurea hoki ki te umanga tapuhi o Aotearoa, me kore e kitea he māramatanga mō ngā hātepe rēhita o Aotearoa mō ngā rā kei te tū mai. Nā te whakamahi i ētahi tikanga mātai mātauranga momo tangata arotahi, i āta rapu mariretia ētahi tāngata whai wāhi, he IQN hoki rātou, kua whai wāhanga hoki ki tētahi Hōtaka Aromatawai Matatau i waenga i 2001 me 2016. Tekau mā rua ngā tapuhi i whai wāhi ki ētahi uiuinga māhorahora nei. I whakamahia tetahi tātaritanga tāhuhu toro-whānui hei tātari i ngā raraunga. E rua ngā tāhuhu matua i puta: 1) ko te whakahoa atu ki te tangata; i uru ki roto ko ngā tāhuhu whāiti o ngā maioro whakawhiti kōrero me te hiahia kia noho mai he kaiako atawhai, me 2) ko te whakatere haere a te tangata i a ia anō i te ao mahi ngaio hou, tae atu ki ngā tāhuhu whāiti o te whakaaro he pūkenga-kore te tangata i ōna tūranga hou, ngā pōhēhētanga hoki mō te haumaru ahurea me Te Tiriti o Waitangi I uru ki ngā kitenga hou rawa tētahi māramatanga hou mō te tūtika o te taha mana i roto i te pūnaha hauora o Aotearoa, me te whakaae ki te tautoko takenui i whiwhi rātou, i ngā kaiako mataara, matatau hoki mō te tiaki tūroro. Ahakoa tērā, kāore te hunga whai wāhi i whakaae i tino pāngia tō rātou hopu akoranga ngaio hou e te hōtaka, tō rātou māramatanga rānei ki ngā tikanga ahurea taketake mō te whakapiki i ngā putanga hauora kia tairite mō ngāi Māori. I kitea e te rangahau he mea hira kia tautokona ngā tapuhi whai tohu ā-ao kia urutomo nei ki te kāhui tapuhi o Aotearoa, mā ngā hōtaka whakangungu mā ngā kaiwhakawhiwhi mahi e hora, me te whakawātea i te whakapakari ngaiotanga mau roa, me te tirohanga ngaio pūputu i muri i te rēhitatanga. He rōpū taketake ngā tapuhi whai tohu ā-ao nō te kāhui kaimahi tapuhi, me mātua tautoko, me mātua whakaako, tautiaki i a rātou kia tino ora ai rātou i te wāhi mahi. Ngā kupu matua Aromatawai matatau; haumaru ahurea; whakawhitinga ahurea ki te ao mahi; ngā tapuhi whiwhi tohu ā-ao; whakangungu; ngā tapuhi i whakangungua i tāwāhi; inekounga
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It’s OK to be different: supporting Black and Minority Ethnic nurses and midwives in their professional development in the UK
Article
  • Nov 2022
  • Nurse Educ Pract
Background A significant proportion of the United Kingdom’s (UK’s) healthcare workforce comprises people from Black and Minority Ethnic (BME) backgrounds. Evidence shows that this population is under-represented at senior management levels. A collaborative leadership development initiative for BME nurses and midwives, by involving their line managers and mentors, was designed and implemented in a Scottish Health Board. Aim This paper affirms the importance of a collaborative initiative that is targeted to support BME nurses and midwives for leadership development and career progression, and the promotion of an inclusive organisational culture to improve team work, and service standards. Method This initiative adopted an Action Research approach. The programme began with collectively exploring participants’ understanding of BME workforce development challenges, then planning and delivering a targeted leadership development training, and then evaluating it, in a cyclical way. Findings With support from the project facilitators, line managers and mentors, a significant number of BME participants have gone on to achieve career progression. Participating line-managers and mentors have gained an in-depth and nuance understanding of workforce diversity, individuals’ potentials, unconscious biases, and the importance of an inclusive organisational culture. All participants reported that they have learned to become more reflective in their professional practice, and more able to explore, embrace, and promote inclusive workplace culture. BME participants reported feeling that they were valued members of staff, and that this had led to a positive impact on team work and better patientcare outcome. Conclusion The project has opened a new window into the world of the BME workforce. Findings highlight the value of a diverse workforce, and of an inclusive organisational culture being crucial for effective team work, and of overall benefit to workforce management. Finally, a collaborative initiative like this can successfully improve team work to deliver better patient care.
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