F e a t u r e
International nurse migration:
U-turn for safe workplace transition
Deborah Tregunno,a Suzanne Peters,a Heather Campbellb and Sandra Gordonc
aYork University, Toronto, ON, Canada, b College of Nurses of Ontario, Toronto, ON, Canada, cMt Royal College,
Calgary, AB, Canada
Accepted for publication 14 January 2009
TREGUNNO D, PETERS S, CAMPBELL H and GORDON S. Nursing Inquiry 2009; 16: 182–190
International nurse migration: U-turn for safe workplace transition
Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country
is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they
seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated
nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country.
In this article, the authors report findings from an empirically grounded study that examines the experience of IENs who
entered Ontario’s workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as ‘different’
from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice
and the role of patients and families in decision-making. In addition, problems with English language fluency cause workrelated
stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides
important insights as policy and management decision-makers balance the tension between increasing the IEN workforce and
the delivery of safe patient care.
Key words: internationally educated nurses, patient safety, qualitative methods, workplace transition.
This paper examines the experiences of newly registered
internationally educated nurses (IENs) as they transition
into clinical practice in the Canadian province of Ontario.
By registration, we are referring to the point at which the
IEN has written and passed the national registration examination.
IENs make an important contribution to the nursing
workforce in Ontario. In 2005, IENs represented 11.5%
Ontario’s nurses and 34% of the new supply of Registered
Nurses (Blythe et al. 2006). With projections that IENs will
increasingly be significant contributors to the nursing supply
(e.g. Kingma 2007), and within the political context of
heightened accountability and attention to issues of fair,
open and timely access to licensing practices for foreign
trained professionals (e.g. Fair Access to Regulated Professions
Act 20061), and responsibility for insuring successful
integration into their new community (McIntosh, Torgerson,
and Klassen 2007), the College of Nurses of Ontario (CNO)
undertook this study to gain greater insights into the degree
to which IENs are competent to practice safely upon registration,
and to begin to explore whether CNO entry to practice
requirements have kept pace with the rapidly changing
health human resource environment. While there is a wide
Correspondence: Deborah Tregunno, School of Nursing, Faculty of Health, York
University, Toronto, Canada.
E-mail: <[email protected]>
1 The Fair Access to Regulated Professions Act 2006 (FARPA), the first of its kind
in Canada, was passed on 12 Dec in the Ontario Legislature. The purpose of Act
is to help ensure that regulated professions are governed by registration practices
that are transparent, objective, impartial and fair. The Act requires 34 regulated
professions in Ontario to have a licensing process that has fair, open and timely
assessment of credentials of foreign trained professionals; established the Office
of the Fairness Commissioner who would be responsible for assessing registration
and licensing practices and ensure compliance; and create an ‘access center’ for
internationally trained individuals, a new one-stop resource center to help people
navigate through the complex systems when seeking to enter regulated professions,
and promote internships and mentoring programs.
2009 Blackwell Publishing Ltd
Nursing Inquiry 2009;16(3):182–190
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