What are the experiences of Internationally Qualified Nurses transitioning into aged residential care in the New Zealand health care system?

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Authors
Walter, Anna
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Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2017
Supervisors
Marshall, Bob
Jacobs, Susan
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
internationally qualified nurses (IQNs)
aged residential care
barriers
ANZSRC Field of Research Code (2020)
Citation
Walter, A. (2017). What are the experiences of Internationally Qualified Nurses transitioning into aged residential care in the New Zealand health care system? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
BACKGROUND New Zealand has an aging population with increasingly complex comorbidities, and a nursing shortage. The New Zealand health care system is heavily reliant on internationally qualified nurses (IQNs), who predominantly work in aged residential care, where the demand for IQNs has been predicted to grow. Literature has shown IQNs have been confronted by challenges during their transition into aged residential care that have affected the level of delivery of care to residents. IQNs for whom English is an Additional Language (EAL) appear to face further challenges in New Zealand, including discrimination, frustration, and disappointment in their constrained role, scope of practice and limited career opportunities. IQN migration and recruitment impact not only the New Zealand health care system but the individual nurse and potentially on the quality of resident care. AIM The aim of this research was to provide an insight into the experience of IQNs with EAL transitioning into aged residential care in the New Zealand health care system and to identify the barriers and aids to a successful transition. METHODOLOGY This research used a descriptive exploratory approach to collect rich narrative data from focus group interviews. The researcher facilitated five focus groups, with 12 IQN participants, using a series of open-ended questions to collect in-depth explanations of their experiences transitioning into aged residential care in New Zealand. RESULTS The results of this research indicate that IQNs face a multitude of challenges when transitioning into aged residential care. One of the findings revealed that while most IQNs working in aged residential care have clinical skills, knowledge and experience in acute care settings, many have had little or no exposure to nursing the elderly. Furthermore, aged residential care was frequently not their first choice of employment, but with time constraints to securing a work visa, work in aged residential care was often the quickest and easiest employment option. Additionally, the IQNs reported challenging clinical experiences combined with an increased level of managerial responsibilities and accountability, for themselves, the residents and the caregivers, beyond their previous experience. Furthermore, during their transition, IQNs experienced challenges in understanding and providing effective palliative and mental health care in the aged residential care context. IQNs also experienced communication challenges related to terminology and colloquialisms used in the clinical setting, which could be exacerbated by the stress of communicating by telephone or with residents and families. Another theme identified by the participants was cultural challenges, and for some participants this affected the effectiveness of their nursing care. Racial discrimination from some caregivers and residents was noted as a contributing factor leading to reduced job satisfaction, and personal and professional isolation. However, the participants identified that most clinical nurse leaders and senior nurses supported IQNs during their transition. Generally, the IQNs have a deep-seated drive to be successful, appear to have positive dispositions, and demonstrate resilience while working in aged residential care in New Zealand. This research also identified that the IQNs’ challenges are not new, as shown by national and international literature. Evidently some of these issues are not being addressed, and based upon the findings of this research, recommendations have been made to improve IQNs’ transition. This research has furthered our knowledge into the barriers and aids IQNs experience when they transition into aged residential care. However, the consequences of the IQN’s challenges not being rectified could jeopardise the recruitment and retention of IQNs into aged residential care. IQNs make a considerable contribution to aged residential care and if they feel valued and supported, they will stay; if not, they will leave. The reality is the quality and standard of much of the care for one of the most vulnerable populations in New Zealand is in the hands of the IQNs.
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