Magazine article Nursing Economics

Transition Programs for Internationally Educated Nurses: What Can the United States Learn from the United Kingdom, Australia, and Canada?

Magazine article Nursing Economics

Transition Programs for Internationally Educated Nurses: What Can the United States Learn from the United Kingdom, Australia, and Canada?

Article excerpt

EXECUTIVE SUMMARY

* It is critical to conduct competency assessments of internationally educated nurses (IENs) to ensure public safety, as well as uphold accountability to nursing as a regulated profession.

* Transition programs are needed because of the required proficiency of the working language, as well as differences in nursing education, national health care systems, nursing practice and culture, etc.

* Transition programs in the United States are grossly under-developed because of lack of recognition of their importance, lack of funding and standardization, and decentralized regulation in nursing.

* United States can learn from the United Kingdom, Australia, and Canada regarding how to best transition IENs.

* Its current hit-and-miss approach is inadequate and inconsistent with the emerging global trend to systematically deal with the transitional challenges of IENs at the national level.

AUSTRALIA, CANADA, UNITED Kingdom, and United States are leading host countries for internationally educated nurses (IENs). The proportions of IENs in the national nurse workforce range from 5.6% in the United States (Health Resources and Services Admini - stration, 2010) to 17.6% in Australia (Australian Institute of Health and Welfare [AIHW], 2009), with an average of 10.7% in Organisation for Economic Cooperation Countries in 2000 (Yeates, 2010). Moreover, IENs are providing vital direct care. For instance, a significantly higher proportion of IENs (71.1%) worked in direct patient care positions compared to their American counterparts (54%) (Xu, Zaikina-Montgomery, & Shen, 2010).

Challenges of IENs during their transition into foreign health care environments are well documented from systematic review studies (Alexis & Vydelingum, 2005; Konno, 2006; Likupe, 2006; Woodbridge & Bland, 2010; Xu, 2007), especially on those IENs from non-English backgrounds. These challenges present real and potential risks to patient safety and quality of care (Davis & Nichols, 2002; Edwards & Davis, 2006; Hearnden, 2007; Shen et al., 2012; Takeno, 2010; Tregunno, Peters, Campbell, & Gordon, 2009; Xu, 2007; Xu, Gutierrez, & Kim, 2008). Based on the emerging evidence, Xu (2010a) not only argues that transitioning IENs is a regulatory issue but also proposes an evidence-based transition program for the acute care setting (Xu, 2010b). Yet, there is scant literature on transition programs in both the United States and other countries as an intervention to address these formidable challenges (Zizzo & Xu, 2009).

Currently, only Australia, New Zealand, and the United Kingdom require IENs to participate in transition programs before official registration. The situation in Canada, however, is somewhat different. Because the majority of IENs are "landed immigrants" (permanent residents) (Blythe & Baumann, 2008) rather than contracted skilled workers sponsored by health care employers on work visas, Canadian efforts have been focused on developing pre-registration, pre-hire "bridging/upgrading programs" that are primarily designed to help IENs to "bridge" gaps in education and experiences for the national registration exam (Baumann & Blythe, 2009). In the United States, there is no required transition program for post-hire IENs, who must obtain either a U.S. nurse license or a Com - mission on Graduates of Foreign Nursing Schools certificate and secure a job offer before coming to the country. No government funding has been provided to develop such programs. Essentially, transitioning IENs is entirely leftto each health care employer, who frequently provides the same orientation or post-hire training to IENs that are no different from domestic hires. In fact, transition programs in the United States are grossly under-developed because of lack of recognition of their importance, lack of funding and standardization, and decentralized regulation in nursing.

There are many different terms used in various countries to refer to IENs: overseas qualified nurses (Australia), overseas nurses (United Kingdom), internationally educated or foreign-educated nurses (Canada, United States), internationally recruited nurses, foreign-born nurses, etc. …

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