Having more nurses trained outside of the United States working on a hospital unit does not hurt collaboration among healthcare professionals and may result in a more educated and stable nursing workforce, finds a new study by researchers at NYU Rory Meyers College of Nursing published in the journal Nursing Economic$.
Internationally educated nurses -- who receive their primary nursing education outside of the country where they currently work -- have become an important part of the nursing workforce in many countries. In the U.S., recruiting internationally educated nurses has been used to address nursing shortages. While the true number of internationally educated nurses in the U.S. is difficult to capture, it is estimated that 5.6 to 16% -- or 168,000 to 480,000 -- of the country's more than 3 million nurses were educated in another country.
Internationally educated nurses often face challenges when transitioning to practice in the U.S. because of cultural, language, and healthcare system differences. While internationally educated nurses can help mitigate nursing workforce shortages, there is little research on their impact on quality of care and patient outcomes, and the findings have been mixed.
WHAT'S THE IMPACT
In this study, the researchers looked at the proportion of internationally educated nurses on hospital units and evaluated whether this affects collaboration among health professionals and other factors of hospital units. They used 2013 survey data from the National Database of Nursing Quality Indicators, analyzing responses from 24,045 nurses (2,156 of whom were trained outside the U.S.) working on 958 units across 160 U.S. acute care hospitals. Collaboration on a unit was measured using a nurse-nurse interaction scale and a nurse-physician interaction scale.
The researchers found having more internationally educated nurses did not lead to decreased collaboration among nurses and between nurses and physicians. This is important because collaboration among healthcare professionals is a fundamental aspect of quality work environments and can result in positive patient outcomes and satisfaction.
Interestingly, units with higher proportions of internationally educated nurses had notable differences, including factors that could both help and hurt patient care. For example, units with more internationally trained nurses had nurses with higher levels of education, which may be because internationally educated nurses are more likely to have a baccalaureate degree in order to qualify for and pass the U.S. nursing licensure exam.
Units with more internationally trained nurses also had less turnover, as these nurses are likely to stay in a job longer than their U.S.-educated peers.
By contrast, units with more internationally trained nurses had worse nurse staffing levels or higher patient-to-nurse ratios, despite these nurses being recruited to address shortages. Worse staffing levels have been shown to hurt collaboration and could potentially worsen patient outcomes.
The researchers note that hospitals and nurse recruitment agencies can play an important role in helping to integrate internationally educated nurses into the U.S. workforce--for instance, providing training on the basics of the healthcare system, creating peer mentoring programs, and running workshops on culture, communication, and teamwork.
THE LARGER TREND
Amid a nursing shortage, hospitals are struggling to hire and keep nurses, with burnout and workplace violence cited as contributing factors, a November survey found.
Flexibility and work-life balance had the most influence for 39% of nurses in whether they decided to stick with a job, though 31% say compensation and benefits were the biggest driving factors.
More than one in five nurses say they are working two nursing jobs. Seven percent said both jobs are full-time.