Empowering Nursing Newcomers
Conditions: Education, Professional, Refugees, Nursing, Migrants, Cultural Diversity
Sponsor: University Medical Center Groningen

 
 
Dear Dr. Wijsmuller, 
 
At the request of the Board of Directors of the University Medical Centre Groningen (UMCG), the  
Central ethics Review Board non-WMO studies (CTc UMCG), in its capacity to review studies that fall  
outside the scope of the Medical Research Involving Human Subjects Act (WMO), has discussed 
whether this study (see ‘Project title’) meets the UMCG’s non-WMO Framework Regulations as part 
of the nWMO system as adopted by the Board of Directors. The UMCG’s non-WMO Framework takes 
into account the ‘Toetsingskader medisch-wetenschappelijk niet-WMO-plichtig onderzoek 2023’ 
from the VWS program Regeldruk in Onderzoek as well as other relevant legislation and regulations. 
 
On 21 November 2025, the CTc UMCG has approved the conduct of the study mentioned above, 
based on the documents submitted before this date including, if applicable, the written responses 
provided by the applicant. 
 
With this assessment letter, the 'ethical review' component of your study has been successfully  
completed. 
The CTc would like to point out that you may need other forms of permission before you can begin 
your studies (e.g. department permission, signed contracts). Please note that other legal acts and/or 
guidelines, such as for medical device, may apply to the scientific research. Contact your 
department's research coordinator if you have any questions about this. 
 
In addition, the CTc UMCG informs you that this approval only applies to the research activities 
carried out at the UMCG. If research activities will also be conducted elsewhere, the CTc UMCG 
advises you to check whether other local assessment procedures must be followed at these sites. 
University Medical Centre Groningen 
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen 
Central ethics Review Board 
non-WMO studies 
Phone: 050 - 3613564  
Email: nwmoloket@umcg.nl 
To 
Mr.Dr. A. Wijsmuller 
Kenmerk: 22944 
Surgery department 
Internal zipcode: BA11 
Date: 26/11/2025 
Subject: Decision CTc UMCG, amendment 
Project title: Empowering nursing newcomers, The EMPOWER study 
Research Register number: 22944 

 
Any amendment to the currently approved study must be submitted to the CTc UMCG for review. 
Please note that the main applicant (Principal Investigator) remains responsible for complying with 
the relevant legislation, the UMCG regulations, and for the overall scientific quality of the study.  
 
If you have questions regarding the assessment by the CTc, please contact the non-WMO Office. You 
can find the telephone number and the e-mail address at the top of this letter. 
 
The CTc UMCG wishes you a lot of success with this project. 
 
Sincerely,  
on behalf of the CTc UMCG, 
 
Prof. dr. D. de Zeeuw 
 
 
 
 
M.T. Dreves 
Chair 
 
 
 
 
 
 
Secretary 
 
 
 
 

 
 
 
P.O. Box 30 001, 9700 rb Groningen, The Netherlands 
 
 
Medical Ethics Review Board 
 
 
 
 
 
To 
A.R. Wijsmuller, MD Ph.D. 
Department of Surgery 
a.r.wijsmuller@umcg.nl  
 
  
 
Phone   (050) 361 4204 
Fax   (050) 361 4351 
Email metc@umcg.nl 
Website http://metcgroningen.nl 
 
Enclosure(s) -- 
Ref   M25.363484 
 
 
 
 
 
Date   
21 November 2025 
METc number 
METc 2025/606 
Title  
Empowering nursing newcomers, The EMPOWER study. 
UMCG RR number  22944  
 
 
The Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG) has 
discussed the above mentioned protocol and considered whether or not the research falls within 
the scope of the Medical Research Involving Human Subjects Act (WMO). 
 
Based on the submitted documents the METc UMCG concludes that the above mentioned 
protocol is not a clinical research with human subjects as meant in the Medical Research Involving 
Human Subjects Act (WMO).  
 
Furthermore, the committee has concluded that the proposed research does not fall within the 
scope of the Medical Device Regulation (MDR, EU 2017/745) or Clinical Trial Regulation (CTR, 
EU 536/2014). 
 
Therefore the METc UMCG has no task in reviewing the protocol and you do not need a full 
review or approval before you can start the research. 
 
Please note that other legal Acts and/or guidelines, such as the Medical Treatment Agreement 
(WGBO), Dutch Personal Data Protection Act (Wpb) and codes of conduct of the FEDERA 
(Federation of Medical Scientific Institutions) may apply to the scientific research. 
 
Before you can start your study/study activities, you must await the favourable opinion 
of the CTc. 
 
 
 
 
 
 
 
 

 
 
 
 
 
2
 
Kind regards, 
on behalf of the Medical Ethics Review Board 
 
 
prof. H.P.H. Kremer, MD Ph.D. 
 
 
 
 
J. Davids, MSc 
chairman 
 
 
 
 
 
 
official secretary 
 
 

1 
EMPOWER nWMO studie protocol, V1 
 
 
 
 
 
 
 
 
 
Empowering nursing newcomers 
THE EMPOWER STUDY; 22944 
 
(non-WMO study protocol) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Date of document: 
 
15 -9-2025 
Protocol version number: 
1 
 
 

2 
EMPOWER nWMO studie protocol, V1 
CONTENTC
 
1. 
Study organization ......................................................................................................................... 3 
2. 
Protocol Signature Sheet ................................................................................................................ 6 
3. 
Study summary .............................................................................................................................. 7 
4. 
Study design ................................................................................................................................... 7 
5. 
Population ...................................................................................................................................... 9 
6. 
Study data, and analysis ............................................................................................................... 10 
7. 
Recruitment and informed consent/objection ............................................................................... 14 
8. 
Third parties ................................................................................................................................. 16 
9. 
Data Management Plan (DMP) .................................................................................................... 17 
10. 
FAIR Data and Data Sharing ................................................................................................... 19 
11. 
Management of Biomaterials (either newly collected or from an existing biobank) ............... 19 
12. 
Burden, Risks & Benefits ........................................................................................................ 20 
13. 
Incidental findings ................................................................................................................... 20 
14. 
References ............................................................................................................................... 21 
15. 
Appendices .............................................................................................................................. 21 
 
 
 

3 
EMPOWER nWMO studie protocol, V1 
1. Study1organization1
Study title: 
Empowering nursing newcomers 
Planned start date and estimated completion date 
1-10-2025 – 1-3-2031 
Members of the UMCG 
study team. 
Information 
Role in study 
1 
Dr. F. Loonstra, research 
assocociate, Human 
Resources, UMCG 
Researcher  
2 
P.M.V.Veltman, 
projectcoordinator, Human 
Resources, UMCG 
Coordinating investigator 
3 
Dr. A.R.Wijsmuller, surgeon, 
Department of Surgery, 
UMCG 
Principal Investigator 
If applicable:  
Senior members of the 
non-UMCG study team(s). 
Information 
Role in study 
1 
Marjon Tijl, research 
associate, regioplan 
Laura Brouwer, associate 
director, Social Finance NL 
Coordinating investigator 
Coordinating investigator 
Principal investigator , 
contact information 
Name 
A.R.Wijsmuller 
E-mail 
a.r.wijsmuller@umcg.nl 
Corresponding 
researcher UMCG, 
contact information 
Name 
A.R.Wijsmuller 
E-mail 
a.r.wijsmuller@umcg.nl 
Telephone 
18643/ 06-25646662 
Sponsor (Dutch: 
verrichter/opdrachtgever) 
UMCG:      ☐ 
Other:     ☒ 
Financial support / 
subsidy provider 
 
☒ 
Organisation name 
Goldschmeding Foundation 
Stichting op Klompen Begonnen 
Collaboration with non-
profit Laboratory /   
research sites  
(in- and outside UMCG) 
NA  
☐ 
Organisation name 
NA 
Contact person 
NA 
Email 
NA 
Telephone 
NA 
Collaboration with for-
profit / commercial 
parties / companies  
(in- and outside UMCG) 
 
☒ 
Organisation name 
Regioplan 
Social Finance NL 
Contact person 
Marjon Tijl (regioplan) 
Laura Brouwer (Social Finance NL) 
Email  
Marjon.tijl@regioplan.nl 
Laura.brouwer@socfin.nl 
Telephone 
020 - 5315334 (Marjon) 
 06 - 83508192 (Laura) 

4 
EMPOWER nWMO studie protocol, V1 
Is this study connected to 
a previous nWMO or 
WMO application 
Yes 
☐ 
No 
☒ 
If yes, please provide the 
following information 
and/or documentation 
regarding the previous 
application 
Please add the name 
of the previous study 
NA 
Please add the 
panama number of 
the previous study 
NA 
Has the ethical 
approval of the 
previous application 
been added to the 
current application 
NA 
☒ 
 
Yes 
☐ 
No 
☐ 
Has the study 
protocol of the 
previous application 
been added to the 
current application 
NA 
☒ 
 
Yes 
☐ 
No 
☐ 
Has the patient 
information (DIF) of 
the previous 
application been 
added to the current 
application 
NA 
☒ 
 
Yes 
☐ 
No 
☐ 
Has the Informed 
Consent form (IC) of 
the previous 
application been 
added to the current 
application 
NA 
☒ 
 
Yes 
☐ 
No 
☐ 

5 
EMPOWER nWMO studie protocol, V1 
2. Protocol1Signature1Sheet1
The undersigned principal investigator (NL: hoofdonderzoeker) UMCG and head of department 
UMCG confirm that the study protocol is compliant with the UMCG researchcode, the nWMO 
Kaderreglement UMCG and other legislation (such as the (U)AVG and WGBO).  
 
Name 
Signature 
Date 
Principal Investigator UMCG: A.R. 
Wijsmuller 
 
12/10/25 
Head of the department UMCG: J.P.P.M. 
de Vries 
13/10/25 
Departmental Scientific review board 
(if applicable) 
 
 
 
If tissues are requested from a biobank 
or data from a databank, please add a 
signature from the biobank 
administrator (NL: beheerder)  here. 
NA 
 
Klik of tik om 
tekst in te 
voeren. 
 
If tissues are requested from the UMCG 
biobank pathology, please add a 
signature from the tissue review board 
pathology here. 
NA 
Klik of tik om 
tekst in te 
voeren. 
 
 
 
 
 

6 
EMPOWER nWMO studie protocol, V1 
3. Study1summary1
 
3.1 Introduction and rationale 
The increasing shortage of nurses in the Netherlands significantly impacts healthcare 
capacity1. Currently, half of all job vacancies in the Netherlands are in healthcare, trade, and 
business services2. Reports indicate that nursing faces the largest labor market shortages 
among the healthcare professions, with 10,500 vacancies in 2021 and an expected 24,900 by 
20313,4. Enhancing personnel inflow is one of the solutions. In that regard, the Dutch system 
does not appear to be well-equipped to support the integration of refugees and migrants 
certified as nurses in their country of origin, into healthcare positions. Recognition of 
qualifications is characterized by long delays and there is a lack of guidance5,6. In practice, it 
also takes a considerable amount of time to reach a sufficient level of language proficiency, 
especially if individuals are unable to work and have limited exposure to the Dutch language. 
This slows down the speed at which the tests for obtaining a declaration of professional 
competence, required for Dutch healthcare licensure, are completed. Consequently, many 
qualified newcomers in healthcare are either underemployed or unemployed5. In 2022, the 
UMCG assessed the interest among nursing newcomer in the Northern region to participate in 
a fast-track integration programme (Appendix 1). As sufficient interest was confirmed, such a 
programme was developed that includes a vocational language and intercultural 
communication course, after which participants begin working as assistant nurses, salaried 
as care assistants, while receiving guidance toward BIG registration before taking the 
examinations required for BIG registration (appendix 2). In this process, data were 
prospectively collected on whether the participating newcomers successfully completed the 
different phases of the program, the duration of these phases, and the stage of integration 
and employment situation from which they entered, and consent was obtained from 
participants to store these data (appendix 3). The programme was initially developed at the 
UMCG and grew into a multicentre initiative. In collaboration with Healthcare of the North 
(‘Zorg voor het Noorden’, ZvhN), a regional network across the three northern provinces, it has 
expanded to four non-academic hospitals. As this improvement process, which was not 
initially conceived as a research project, appeared to be successful, it was subsequently 
decided to analyze the outcomes in a scientific manner. The primary objective is to determine 
the proportion of participants who are either progressing as planned or successfully 
completed the program. In addition, a qualitative analysis and a societal business case is 
conducted to identify where the benefits lie, thereby providing guidance for sustainable 
implementation once philanthropic funding is phased out. Additionally, the study aims to 
analyze potential racial microaggression in the workplace. 
 
3.2 Design (including population, method, confounders and outcomes) 
In March 2022, the first version of the survey was sent to 22 language schools in the Northern 
provinces and shared via various social media channels, such as the municipality of 
Groningen and the Foundation for Refugee Students (UAF). The survey included a digital 
questionnaire available in 17 languages (appendix 1), designed to collect data on professional 
background, curriculum vitae, credential evaluation, legal status, years of education and 
work experience, type of clinical experience, entrustable professional activities, and 
proficiency in Dutch, and English. The entrustable professional activities offer additional 
insights beyond traditional diploma evaluation. 
Since December 2023, the REDCap recruitment process has been optimized (appendix 4) so 
that, in addition to skills, competencies are more broadly assessed to gain the best possible 
insight into the various domains identified by the World Economic Forum (WEF) as the most 
in-demand skills by organizations7. These include cognitive skills, self-efficacy, collaboration, 
ethics, physical skills, management skills, and technological skills. Based on the submitted 

7 
EMPOWER nWMO studie protocol, V1 
data, potential participants have been identified and invited for an application interview with 
the core team of the programme. Eligibility criteria include being a refugee or migrant residing 
in one of the three northern provinces with a nursing background, holding at least a diploma 
equivalent to the Dutch MBO-4 level, and having practical experience, preferably in a hospital 
setting. Additionally, candidates were required to demonstrate sufficient learning capacity to 
participate in a language course at the University of Groningen’s Language Centre (LC). An 
intake at the LC is conducted before or shortly after the application interview to assess the 
candidate’s developmental potential, considering factors such as motivation, initiative, 
intelligence, and communication skills. Throughout the course of the project, this intake was 
expanded to include a study skills test (appendix 5), a brief assessment designed to measure 
the speed at which an individual can learn a language. Candidate have been invited to 
participate if the LC deems the candidate’s learning ability sufficient (based on the intake 
and, if available, a study skills test), and the application interview is successful. 
 
The primary outcome:  the proportion of participants who either progressed as planned, 
successfully completed the program by obtaining a (conditional) certificate of professional 
competence, or transitioned to employment as care assistants.  
Secondary outcomes include: 
- a societal business case and a qualitative analysis to assess the impact of the program on 
participants and departments 
- the influence of competencies on the need for additional guidance 
- potential unconscious and conscious racial microaggression in the workplace 
 
Factors considered as potential confounders are: 
-  sociodemographic characteristics: age, gender, time since arrival in the Netherlands, and 
family situation 
- educational and professional background: level and type of nursing qualification, years of 
work experience, and previous additional training 
- language and cognitive capacity: baseline Dutch and English proficiency, learning capacity 
as assessed by the study skills test, and motivation and initiative 
- programme-related/contextual factors: hospital/department, differences in 
mentorship/guidance during integration, regional labor market demand, adaptations or 
optimizations implemented within the program over time 
 
3.3 Research questions 
What is the proportion of participants who progressed as planned or successfully complete 
the program at 3, 6, and 10 years after start of the programme? What is the societal business 
case of the programme and what opportunities for improvement can be identified to optimize 
its sustainability through a qualitative analysis of the impact on both participants and hospital 
departments? To what extent do competencies across different domains provide insight into 
when a participant may require additional support? To what extent do conscious or 
unconscious racial microaggressions occurs in the workplace and what opportunities exist to 
address and mitigate the unconscious form? 
 
 
4. Study1design1
4.1 Mono- or multicenter study. 
Monocenter study 
☐ 
Multicenter study 
☒ 

8 
EMPOWER nWMO studie protocol, V1 
4.2 Retrospective study or prospective study 
Retrospective study 
☒ 
Prospective study 
☒ 
4.3 Cross-sectional or follow-up study 
Cross-sectional 
study 
☐ 
Follow-up study 
☒ 
4.4 Quantitative or qualitative study 
Quantitative study 
☒ 
Qualitative study 
☒ 
4.5 Pilot or explorative study? 
Not applicable 
☐ 
Pilot study 
☒ 
Explorative study 
☒ 
Explain why it is a pilot or explorative study. 
This study can be considered both a pilot and an exploratory study for several reasons. First, the 
program under investigation was not originally conceived as a research project but as an 
improvement initiative, meaning that the data were collected prospectively in a real-world 
setting without predefined hypotheses. Second, the number of participants is still limited, and 
the program is in an early stage of implementation across centers, which makes the findings 
preliminary by nature. Third, the primary aim is descriptive, examining proportions of 
participants who progress through or complete different phases of the program, rather than 
testing causal relationships. In addition, secondary analyses, such as the societal business 
case and the qualitative assessment of program impact, are exploratory in character, intended 
to generate insights and hypotheses for future, more definitive evaluations. Taken together, 
these features justify the classification of the study as a pilot and exploratory investigation, 
providing essential groundwork for larger-scale, hypothesis-driven research. 
In case of a pilot study, what are the concrete follow-up plans. 
The concrete follow-up plan is to expand the program to hospitals at the national level and to 
integrate data from these additional sites into the analysis. This will allow for larger-scale 
evaluation, validation of findings across different contexts, and the development of more robust 
evidence on program effectiveness. Ultimately, the pilot provides the foundation for a 
nationwide multicenter study aimed at informing sustainable policy and implementation. 
5. Population11
5.1  Research participants 
Healthy volunteers 
Patients 
☒ 
☐ 
5.2  Participant classification 
 
Participants  16 years 
☒ 
Children between 12 and 16 years 
☐ 
Children < 12 years 
☒ 
Explain purpose limitation (‘doelbinding’ in Dutch) if you plan to include minors below 16 of age. 
This means that this data may only be gathered if participation of that age group is utterly 
essential  (Dutch: persoonsgegevens alleen verzamelen met een gerechtvaardigd doel waarvoor 
die leeftijdsgroep noodzakelijk is). 
NA 
5.3 Incapacitated adults 
 
Participants can be incapacitated/decisionally impaired adults 
Yes 
☐ 
No 
☒ 

9 
EMPOWER nWMO studie protocol, V1 
If yes, explain purpose limitation (‘doelbinding’ in Dutch). This means that this data may only be 
gathered if participation of this group is utterly essential (persoonsgegevens alleen verzamelen 
met een gerechtvaardigd doel waarvoor deze groep noodzakelijk is). 
NA 
5.4 Inclusion and exclusion criteria  
• Inclusion criteria:  
- refugee or migrant with a nursing background or other paramedical background and sufficient 
indications that the relevant hospital department is prepared to cooperate in a fast-track 
integration trajectory 
- holding at least a diploma equivalent to the Dutch MBO-4 level 
- having practical experience, preferably in a hospital setting 
- residence in one of the three northern provinces 
- sufficient learning capacity to participate in a language course at the University of Groningen’s 
Language Centre (LC) based on the intake and, if available, a study skills test 
- a successful application interview  
• Exclusion criteria:  
- diploma lower than Dutch MBO-4 level 
- refugee or migrant with a background as medical doctor 
6. Study1data,1and1analysis11
6.1 Data collected 
For primary outcomes: 
- Background: nurse, nursing assistant, other 
- Start date of medical vocational language program 
- Start date as assistant nurse 
- End date as assistant nurse 
- Start date as care assistant 
- Early dropout/ withdrawal 
- In case of premature exit: 1 during (vocational) language training (months 3-6); 2 during early 
stages of the employment trajectory (months 7-12); 3 later in the employment trajectory (months 
12-18/24) 
- Date dropout/ withdrawal 
- Date of decision on the application for a statement of professional competence and whether one 
may begin practicing under conditions 
- CBGV decision on the application for a statement of professional competence: 1 decision 
granting a statement of professional competence allowing conditional registration in the BIG 
register ("Work in your profession in the Netherlands for three months under the supervision of a 
healthcare professional with the same profession who is fully registered in the BIG register, to 
become familiar with the Dutch healthcare system, related laws and regulations, and medical 
ethics.") Diploma is nearly equivalent. 2 additional internships: X months of internship in a 
hospital, VVT (nursing and care facilities), and/or GGZ (mental health care). 3 diploma not 
equivalent: Not allowed to practice as a nurse in the Netherlands. 
- Conditional BIG registration date (above profession) with BIG number 
- Date of possible meeting with the CIBG committee in case of a failing oral exam result, while 
results for the knowledge and practical tests are sufficient 
- Start date of supervised practice 
- End date of supervised practice 
- Supervised practice: full-time, parttime 
- In case of internships, what type of internships? 
- Start date of internships 

10 
EMPOWER nWMO studie protocol, V1 
- End date of internships 
- Internships: full-time, parttime 
- Theoretical modules 
- Knowledge test result: insufficient, sufficient, good 
- Knowledge test score 
- Profession-specific test result: insufficient, sufficient, good, excellent 
- Oral examination result: insufficient, sufficient, good, excellent 
- Date of issuance of the statement of professional competence, enabling the colleague to qualify 
for (unconditional) registration in the BIG register 
- Date on which the participant is officially registered in the BIG register after submission and 
approval of CCPS and CGC, etc. 
- Exit position: premature exit, exit as healthcare assistant, exit as BIG-registrered nurse (or 
achievement of a comparable qualification at the paramedical level with a similar background) 
- At exit: healthcare assistant or nurse – type of contract and number of hours: 1 Temporary (eg 1 year); 
2 Permanent 
- Start date as fully qualified nurse (possibly including onboarding period) 
- Program underway and on track? program successfully completed; program still in progress and 
proceeding as planned; dropped out during the medical language program phase; dropped out 
during the assistant nurse phase due to insufficient background to continue; decided to stop BIG 
trajectory during assistant nurse phase and continue/start working as a care assistant; Other 
 
For secondary outcomes and other outcomes: 
Data to be completed by newcomer 
- Years of education completed 
- Country of training 
- Attempts to have diploma recognized in the Netherlands 
- Level achieved according to the diploma evaluation: A level that corresponds in Dutch terms to: 
diploma from senior secondary vocational education (MBO), qualification level 4, in nursing and 
care; 2 years of a nominal 4-year bachelor’s program in higher professional education (HBO) in 
nursing; degree of bachelor in higher professional education (HBO) in nursing; degree of master in 
higher professional education (HBO) in nursing; other level 
- Place of work experience: hospital, nursing home or care home, home care, other 
- Years of work experience 
- Last country you worked in before arriving in the Netherlands? 
- Experience in the following types of hospital departments (multiple answers possible) 
- Nursing tasks for which you are qualified: measuring blood pressure, wound care, removing 
stitches/sutures, preparing medication, venous puncture, inserting IV (intravenous) line, inserting 
urinary catheter, inserting nasogastric tube, resuscitation / CPR (cardiopulmonary resuscitation) 
- As a nurse in the hospital, you have day, evening, and night shifts. Each shift lasts 8 hours. What 
is your attitude towards evening and night shifts? No problem, I am used to working these shifts; It 
will take some getting used to, but I think I can manage this with my private life; It is difficult to 
reconcile with my private life 
- Years living in the Netherlands at time of entry 
- Socioeconomic status at the time of entry 
- Income level (if employed): 1 Less than or equal to minimum wage; 2 Comparable to a healthcare 
assistant’s income; 3 Higher than a healthcare assistant’s income 
- Receiving healthcare allowance: 1 Yes; 2 No 
- At entry EuroQol EQ-5D-5L questionnaire 
- At exit EuroQol EQ-5D-5L questionnaire 
- Residence and work permit for the Netherlands 
- Basis for a residence permit? asylum; residence with partner; study (temporary residence 
permit); other 

11 
EMPOWER nWMO studie protocol, V1 
- Have you already had a 'Further Hearing' with the IND? 
- Completed language/integration course? 
- English/ Dutch language proficiency level: 1 A2 to B1; 2 B1 to B2; 3 B2 
- Initials, surname, age, email address, phonenumber, current address or name of the shelter 
- Domains: self-efficacy (resilience, flexibility, and adaptability; motivation and self-awareness; 
curiosity and lifelong learning; reliability and attention to detail); working with others (empathy and 
active listening; leadership and social influence); Ethics (cultural competence); physical skills 
(manual dexterity, endurance, and precision in the professional field); management skills (quality 
control); technological literacy (Appendix 4) 
- Modified Racial Microaggresions Scale (RMAS) including 6 subscales: invisibility, criminality, 
dysfunctional culture, sexualization, foreigner/not belonging and environmental microaggressions. 
This questionnaire was developed by Torres-Harding et al8 and modified by King et al9 and appears 
to be an appropriate tool to assess this on the workplace10 (appendix 6). 
 
Data to be completed by language center: 
- Suitable candidate for ‘Newcomers in Their Strength 2.0’ program (based on intake)? No, the 
candidate is definitely unsuitable; yes, this is a suitable candidate; there is doubt about the 
candidate’s suitability 
- Score Study Skills Test 
- Optional 2nd Score Study Skills Test 
- Reason for taking 2nd Study Skills Test? 
 
Data to be completed by study coordinator: 
- Is the candidate a refugee or asylum seeker? 
- Date of introductory meeting 
- Candidate enrolled in newcomers program? no; yes; no, but may be considered in the future if the 
candidate develops appropriately 
- Reason for rejection? different background than nursing; background as midwife/nurse where 
previous cases show insufficient experience in the nursing domain to participate in the newcomers 
program; has a nursing/caregiving background but does not have at least an MBO4 diploma 
equivalence; not sufficiently learnable according to language center / Study Skills Test; too little 
practical experience; practical experience too long ago; no status yet; residing outside regions 
participating in the newcomers program; language development not yet sufficient; may be 
considered later if appropriate language development is shown; too busy to participate in the 
program due to integration activities, searching for housing, etc.; other reason 
- Living situation during the program? already own housing; medical vocational language program 
started from COA location, moved during the program to linked municipality; not residing at COA 
location or own housing, other 
- Unlinked from previous municipality, linked to the municipality of Groningen? after obtaining 
status, linked to the municipality of Groningen within the program; unlinking from previously linked 
municipality, and linking to the municipality of Groningen within the program; already linked to a 
municipality near the hospital where the participant will start, within the newcomers program; not 
applicable 
- reason for starting as a care assistant instead of assistant nurse (optionally indicate in which 
hospital as care assistant and where the participant may have worked as assistant nurse) 
- Hospital name 
- Type of department 
- Extra guidance needed 
- Type of additional support 
- Cause of early dropout/ withdrawal 
- Date of application received for a statement of professional competence for the nursing 
profession 

12 
EMPOWER nWMO studie protocol, V1 
- Date of General Knowledge and Skills test 
- Date of profession-specific test 
 
Various durations are automatically calculated, including: 
- Working as an assistant nurse 
- From start as assistant nurse to date of profession-specific test 
- From date of profession-specific test to conditional BIG registration 
- Work under supervision 
- Internships 
- From start as assistant nurse to unconditional BIG registration 
- From start of medical vocational language program to date of early dropout 
- From start of medical vocational language program to start as assistant nurse 
 
Have all the data for the primary and secondary 
outcomes been described or the alternatives? 
Yes 
☒ 
No 
☐ 
6.2 Number of participants: 
Target total number of participants is estimated to fall within the range: 159-227 
Target number of UMCG participants is estimated to fall within the range: 118-147 
6.3 Justification of sample size 
Based on the observed enrolment rates in the Northern region (3.3 participants per hospital per 
year) an additional 98 participants are expected to enrol between March 2025 and March 2031 if 
the 5 hospitals in this region continue to participate. Assuming a similar rate of enrolment in the 
Randstad, an additional 80 participants are expected in this period across the 4 hospitals located 
there. This results in a maximum of 227 participants across all hospitals during the entire study 
period. However, given potential risks such as hospitals discontinuing their participation due to 
lack of financial resources to cover 4–6 months of above-budget salary costs, a more conservative 
projection of approximately 30% fewer participants should be considered resulting in an estimated 
range of 159–227 participants. 
The sample size is therefore not based on a formal power analysis but on realistic projections of 
expected enrolment, as no official national data on the number of nursing newcomers are 
available. As such, the study follows a pragmatic design in which all eligible participants can 
enroll, depending on the availability of places in the hospitals involved in their region. This ensures 
that the sample is sufficiently large to answer the research questions regarding integration 
success, retention, and professional registration outcomes, while at the same time adhering to 
GDPR requirements to not include more participants than necessary. 
 
Has the sample size justification been described? 
NA 
☐ 
Yes 
☒ 
No 
☐ 
6.4 Data minimisation 
  
Only the essential baseline characteristics and data, that are required to 
answer the research question, will be collected: 
 
Yes 
☒ 
No 
☐ 
6.5 Statistical and/or qualitative analysis 
Please specify Statistical Analysis Plan (SAP): 
a. 
Description of study population: 
The study population consists of nursing newcomers who are already enrolled or will enrol in 
the fast-track integration trajectory at UMCG and participating partner hospitals. This includes 
both asylum seekers and migrants. Demographic and baseline characteristics include age, 

13 
EMPOWER nWMO studie protocol, V1 
gender, language proficiency, participant status (asylum seeker or migrant), and socioeconomic 
and employment background. Participants who provide consent for research purposes will be 
included in the analysis. 
 
b. 
Description of preparation of the data for analyses: 
Collected data will be pseudonymized and direct identifiers removed. Data cleaning will involve 
checking for completeness, consistency, and plausibility. Variables will be coded according to 
pre-specified categories (e.g. employment history, language level). Missing data will be handled 
using appropriate methods such as multiple imputation or sensitivity analyses, depending on 
the extent and pattern of missingness. For qualitative data from surveys or interviews, 
responses will be anonymized and transcribed for coding and thematic analysis. 
 
c. 
Specify all applicable statistical and/ or qualitative methods. This usually requires an extensive 
description of the planned analyses and covariates: 
Primary outcome analysis: Descriptive statistics and inferential analyses (e.g. proportions, 
means, standard deviations) will be calculated for successful trajectory completion, BIG 
registration achievement. Associations with baseline characteristics will be explored using 
logistic regression or other appropriate multivariable models. 
Secondary outcome analysis: Qualitative data from the Regioplan survey will be analyzed using 
thematic analysis to identify patterns, facilitators, and barriers in the trajectory. Quantitative 
secondary measures (e.g. language progress, employment outcomes) will be summarized using 
descriptive statistics and, where appropriate, tested with regression models to explore 
predictors of success. 
Subgroup analyses will consider variables such as asylum seeker vs. migrant status, age groups, 
gender, and baseline language proficiency. 
 
d. 
Clarify how this analysis plan, study setup, sample size and design will answer the study 
questions: 
This analysis plan ensures that both primary and secondary outcomes are systematically 
evaluated. The prospective cohort design, together with a projected sample size of 
approximately 300 participants nationwide (80 in the Northern region), allows for sufficient 
statistical power to explore patterns of trajectory completion and integration success. 
Qualitative analyses complement the quantitative results by providing in-depth understanding 
of barriers, facilitators, and contextual factors affecting trajectory outcomes. Together, these 
analyses will answer the research questions regarding the effectiveness, scalability, and 
potential optimization of the integration trajectory for nursing newcomers. 
 
Has the statistical analysis section (6.5) been completed? 
Yes 
☒ 
No 
☐ 
7. Recruitment1and1informed1consent/objection11
7.1 Data collection  

14 
EMPOWER nWMO studie protocol, V1 
Please check the data source that is applicable to your study, more may apply: 
Data will be prospectively collected (data/ biomaterials from 
[some] participants will be collected) 
☒ 
Data will be collected from (electronic) patient records (e.g. ‘EPD 
UMCG’) 
☒ 
Data will be collected from an already existing bio- or databank  
☒ 
Data will be collected from a previous study (e.g. 'FAIR data' - 
internal/external).  
☐ 
 
7.2 Informed consent procedure 
7.2.1 Participants will be asked informed consent 
Yes 
☒ 
If yes: please 
complete 7.2.2 
and 7.3. 
No 
☐ 
If no: 
please 
complete 
7.2.3 and 
7.3. 
7.2.2 If consent is asked complete this section 
7.2.2.1 if the potential participant is a patient:  
 
 
First contact with potential participant is made by the 
treatment provider, either by accompanying letter or in 
person. 
Yes 
☐ 
No 
☒ 
 
Informed consent procedure, including signing the IC, will 
be carried out by the researcher/ research nurse (not the 
treatment provider). 
Yes 
☐ 
No 
☒ 
7.2.2.2 For participants that are either patients or non-patients: 
⦁  Recruitment:  
Potential participants can register via a custom public survey 
URL: https://redcap.link/trajectnieuwkomers. This link is shared by organizations such as UAF, 
COA, and municipalities with their clients. Until now, participants who signed up were asked to 
provide consent for the processing and storage of their personal data for a maximum of four 
years. In addition, they could consent to the processing and storage of other data they provided 
for up to six years (after four years anonymized) for research purposes to analyze how well the 
trajectory fits the participant and to identify areas where newcomers may need additional 
support (Appendix 4). 
With the start of this study, participants who register will: 
1 Be asked to provide consent for the processing and storage of personal data for up to four 
years to determine their eligibility for participation in the trajectory. 
2 Receive the attached participant information letter and be asked to digitally sign the consent 
form, granting permission to use their data for research purposes, the analyses as intended 
within this study. 
 
Although the 49 participants already enrolled have previously provided consent for the 
prospective storage of their data, they will be asked again to provide consent for the use of their 
data for research purposes. This seems justified by the societal and scientific value of these 
outcomes as analyzing these data may help optimize the trajectory for future participants in 
other hospitals and improve the chances of successful integration for nursing newcomers. 
Only the data of participants who provide this additional consent will be used to determine the 

15 
EMPOWER nWMO studie protocol, V1 
results for the primary outcome measure. The number of participants who do not provide 
consent will also be recorded. 
For the first analysis of the secondary outcome measures, the UMCG project coordinator 
invited 17 participants to contribute. These participants completed a survey, developed jointly 
by Regioplan and UMCG and were asked to participate anonymously (Appendix 7). 
⦁  Information provision: 
The participant will only be contacted via telephone if 
they have given prior permission for this: 
 
NA 
☒ 
 
Yes 
☐ 
 
No 
☐ 
Contact via telephone only serves to provide 
additional information, it cannot be used to ask 
informed consent: 
 
NA 
☒ 
 
Yes 
☐ 
 
No 
☐ 
If either of the above 2 items are answered with ‘no’ please elaborate on the reason for this:   
NA 
⦁ Time to consider:  
The participant will have at least 14 days to consider 
participation: 
Yes  
☒ 
 
No 
☐ 
If this is not the case please describe the reason for this and what time is allotted for the 
participant to consider participation. 
NA 
⦁ Informed consent recording:  
Informed consent will be recorded either on paper via 
signature or electronically:  
Yes 
☒ 
 
No 
☐ 
If no, please elaborate on how will the informed consent be recorded?  
NA 
⦁  Use of templates 
Have the UMCG templates been used for both DIF and IC-form: 
Yes 
☐ 
No 
☐ 
7.2.3 If consent cannot be asked please complete this section: 
Total number of participants who will not be asked informed consent: NA 
Total number of UMCG participants who will not be asked informed consent: NA 
Which WGBO argumentation applies to your study (see SOP Obtaining Informed Consent 
nWMO): 
⦁  Asking permission is reasonably impossible, because it would burden the 
patient to such an extent that it might cause psychological distress.  
 
☐ 
⦁  Asking permission is reasonably impossible, because a large part of the 
participant group is likely deceased or cannot be located.  
 
☐ 
⦁  Consent cannot be required because obtaining it would entail a 
disproportionate amount of time and effort, such as in the case of large numbers of 
patients or patients who were treated a long time ago 
 
☐ 
⦁  Consent cannot be required because requesting consent would lead to 
selective response, thereby potentially biasing the research results 
 
☐ 
⦁  Consent cannot be required, because:  
NA 
 
☐ 

16 
EMPOWER nWMO studie protocol, V1 
Required: In addition to the broad categories above, please clarify why these arguments apply 
to your specific study: 
NA 
The objection registry will be checked in case one or more UMCG 
patients will not be asked informed consent, the data from those 
who objected will be excluded from the analyses. 
NA 
☐ 
Yes 
☐ 
7.3 Linking with (other) bio-/databank 
 
In case the data will be linked with a /another bio-/databank, 
informed consent will be/has been obtained for this 
linkage(s) 
Yes, 
consent  
☐ 
No 
consent 
☐ 
Data will 
not be 
linked 
 ☐ 
8. Only1complete1in1case1of1collaboration1with1parties1outside1of1the1
UMCG1(also1called:1third1parties)1
8.1 Which party is in the lead? 
UMCG 
☒ 
 
Not the 
UMCG 
☐ 
 
8.2 Is the leading party a commercial party? 
Yes 
☐ 
No 
☒ 
8.3 Only complete if UMCG is not in the lead: Is the role of the UMCG 
limited to supplying data? 
Yes 
☐ 
No 
☐ 
8.4 Description of the cooperation 
This study involved collaboration with two external parties:Regioplan and Social Finance NL. The 
philanthropic organization Golsdschmeding Foundation commissioned Regioplan to perform a 
qualitative analysis and Social Finance NL to perform a cost-benefit analysis. For these purposes, 
UMCG provided anonymous participant data, including socioeconomic and employment 
background at the start of the trajectory, participant status (asylum seeker or migrant), age, 
gender, and language proficiency. 
Additionally, the UMCG project coordinator invited 17 participants to contribute to a qualitative 
analysis of the trajectory. These participants completed an anonymous developed jointly by 
Regioplan and UMCG (Appendix 7). All data collection and handling were performed in 
accordance with GDPR requirements and a code of conduct established by Regioplan as co-
founder and member of the Association for Policy Research (VBO) in collaboration with MOA and 
VSO for policy research compliance. Regioplan is also certified according to the latest ISO 
9001:2015 standard and conducts regular internal and external audits to ensure quality and 
identify improvements. 
For future analyses in addition to the existing contracts between the Goldschmeding Foundation 
and Regioplan and Social Finance NL, a research data transfer agreement will be established 
between UMCG and the external partners (Regioplan and Social Finance NL) to regulate the use, 
transfer and storage of study data. 
 
8.5 Data and/or biomaterial management in combination with the partners 
Please elaborate on the following aspects: 
• 
Which data (and/or biomaterials) will be shared with the partners  

17 
EMPOWER nWMO studie protocol, V1 
Only anonymized participant data will be shared with the partners including socioeconomic and 
employment background, participant status (asylum seeker or migrant), age, gender and language 
proficiency. No direct identifiers are shared. 
• 
How is the data (and/or biomaterials) saved and/or destroyed after study end. 
After the study ends, all shared data remain pseudonymized and are securely stored according to 
UMCG data management policies. Direct identifiers are either removed or securely destroyed. 
Access to the pseudonymized data is restricted to authorized study personnel. Any data shared 
with partners are either returned or securely deleted according to the research data transfer 
agreements 
8.6 With Informed consent 
Please complete only if patients are asked for Informed Consent: 
 
In case of collaboration with commercial/for-profit organizations. 
Has the research participant been informed in the DIF, or will they 
be informed, about the collaboration with commercial third 
parties. 
 
 
 
Yes  
☒ 
 
 
 
 
No 
☐ 
Has or will informed consent be(en) obtained for data sharing with 
the third party? 
Yes 
☒ 
 
No 
☐ 
8.7 Contracts 
For both with informed consent and without informed consent: will 
you contact the loket Contract Research to arrange the proper 
contracts? 
 
Yes 
☐ 
 
No 
☒ 
8.8 Data Protection Impact Assessment (DPIA) 
Will a DPIA be drawn up? 
 
Yes 
☐ 
No 
☒ 
If a DPIA will not be drawn up please elaborate on the reason for this: 
A DPIA will not be performed as the processing of personal data in this study does not involve a 
high risk to the rights and freedoms of participants. This is based on the measures already 
implemented including pseudonymization of data once all required information is collected, 
temporary and limited access to direct identifiers by the study coordinator and strict access 
control for the Principal Investigator and authorized study delegates. 
9. Data1Management1Plan1(DMP)1
In this study the data will be collected, processed, and archived in accordance with the General 
Data Protection Regulation (GDPR) and the FAIR (Findable, Accessible, Interoperable, Reusable) 
principles under the responsibility of the Principal Investigator, as is required by the GDPR law. 
Please note that completion of this section is required. A separate DMP will not be reviewed. 
9.1 Handling and storage of data 
The following are requirements with regards to handling and storage of data, please mark all that 
apply: 
• 
Digital data will be archived following a strict security and back-up policy (akin 
to UMCG security level). 
☒ 
• 
Paper source data and study files will be archived according the UMCG policy 
☒ 

18 
EMPOWER nWMO studie protocol, V1 
• 
Source data, study files and digital data will be archived 15 years after the study 
is completed. 
☒ 
• 
Tooling (eg. software and procedures) used for collecting, processing, 
analysing, and storing data will be compliant with the UMCG policy and 
Standard Operating Procedures in the UMCG Research Toolbox. 
☒ 
9.1.1 If applicable: Not all items in the above section 10.1 apply to my study. Please elaborate on 
the reason for this and the solutions. 
NA 
9.2 Anonymization and pseudonymization 
Data will be anonymized during data collection. 
Yes 
☐ 
No 
☒ 
If data is anonymized:  
• 
Please explain what procedure is used: 
               NA  
• 
Please reflect on the applicability of K1-anonimity on your dataset: 
NA  
If anonymized data please skip the rest of section 9. 
Data will be pseudonymized during data collection (i.e. data cannot 
directly be linked back to the participant). 
Yes 
☒ 
No 
☐ 
If data is pseudonymized, please explain what procedure is used. 
During data collection direct identifiers are temporarily accessible to the study coordinator to 
complete essential outcome data (e.g. BIG registration). Once all required data are collected, 
direct identifiers (e.g. names, contact details) are replaced with a unique study code and the 
code list linking identifiers to pseudonyms is stored separately and securely. From that point 
onward only pseudonymized data are used for analysis with access restricted to the Principal 
Investigator and authorized study delegates. 
9.3 Pseudonymization requirements 
9.3.1 The following are requirements when pseudonymized data is used, please mark all that 
apply:  
• 
Indirect and direct identifiable information collected will be minimized and only 
collected for the purpose of this study 
☒ 
• 
Direct identifiable information (e.g. contact details, code list, encryption key, 
participant identification log) will be stored separately from pseudonymized 
data 
☒ 
• 
Direct identifiable information can only be accessed by the Principal 
Investigator and study delegates after authorization by the Principal 
Investigator. 
☒ 
• 
Pseudonymized data can only be accessed by the Principal Investigator and 
study delegates after authorization by the Principal Investigator. 
☒ 

19 
EMPOWER nWMO studie protocol, V1 
• 
Data roles, responsibilities, access and authorization, during the study and after 
study completion, will be managed and documented (e.g. in the DMP or study 
delegation log). 
☒ 
9.3.2 If applicable: not all items in the above list of pseudonymization requirements apply to my 
study. Please elaborate on the reason for this and the alternative solutions. 
 
All pseudonymization requirements apply to this study. The only clarification is that during the 
data collection phase direct identifiers and research data are temporarily handled together by 
the study coordinator to complete essential outcome information. Once these data are 
recorded direct identifiers are removed and replaced by a study code with the code list stored 
separately and securely. From that point onward, all requirements are fully met: direct 
identifiers are stored separately, pseudonymized data are used for analysis only and access is 
restricted to the Principal Investigator and authorized study delegates. Data roles and 
responsibilities are documented in the delegation log 
10. 
FAIR1Data1and1Data1Sharing1
10.1 FAIR data 
The following statements concern FAIR data, which is the UMCG policy. Please note that FAIR is 
not the same as Open Access.  
Data will be made findable by including the description of the study 
(and type of data (i.e. metadata) in the UMCG FAIR data catalogue 
and other discipline specific catalogue(s). 
Yes 
☒ 
No 
☐ 
If ‘no’ is answered on the above question , please elaborate on the reason for this. 
NA 
10.2 Data Sharing 
In case data (and biomaterials) will leave or enter the UMCG, will 
you contact the loket Contract Research to arrange the proper 
contracts? (Loket_Contract_Research@umcg.nl) 
Yes 
☒ 
No 
☐ 
No data 
will leave 
or enter 
UMCG 
☐ 
11. 
Management1of1Biomaterials1(either1newly1collected1or1from1an1
existing1biobank)1
11.1 Will biomaterials be collected, processed, analyzed 
and/or stored for the purpose of this study? 
Yes 
☐ 
No 
☒ 
skip and delete rest of 
section 11 
11.2 Will the biomaterials be collected, specifically for this 
study, in a prospective manner?  
Yes 
☐ 
No 
☒ 
skip section 11.3 untill 
11.6. Continue with 
section 11.6 
11.3 What biomaterials will be collected: 
NA 

20 
EMPOWER nWMO studie protocol, V1 
11.4 How will the biomaterials be collected and processed: 
NA 
11.5 Where and how will the biomaterials be stored: 
NA 
11.6 What will be done with the remaining biomaterials after study completion (eg. destroyed, 
returned to biobank/previous study, stored)  
NA 
11.7 Biomaterials check-list 
11.7.1 The following are requirements for the use of biomaterials, please mark all that apply: 
• 
Only biomaterials required to answer the research question(s) will be 
collected (dataminimalisation) 
☐ 
• 
The biomaterials will be anonimized or pseudonimized according to laws, 
guidelines and (if applicable) SOPs 
☐ 
• 
Biomaterials can only be accessed by the Principal Investigator and study 
delegates, after authorization by the Principal Investigator 
☐ 
• 
Biomaterials will be stored 15 years after the study is completed 
☐ 
11.7.2 Not all items in the above section apply to my study. Please elaborate on the reason for 
this and the alternative solutions. 
NA 
12. 
Burden,1Risks1&1Benefits11
12.1 Burden 
Is there a (potential) burden for the participant as a 
result of participating in this study? 
For example: feeling tired after performing tests, 
reliving bad memories. 
Yes, minimal 
burden 
 
☒ 
Yes, more 
than minimal 
burden 
☐ 
No 
 
 
☐ 
 
If yes, please explain what the burden is/might be 
The potential burden for participants is minimal. Participation involves completing a short 
questionnaire of approximately 10 minutes aimed at assessing professional competencies. All 
other required information overlaps with data that participants are already asked to provide as 
part of the regular eligibility assessment for the program. 
Clarify what is done to alleviate the burden 
To alleviate the burden, data provided by participants for the regular program eligibility 
assessment (e.g. background information) are directly and secondarily used for research 
purposes as well. In this way, no duplicate data collection is required, and participation in the 
study does not add substantially to the effort already needed for program entry 
12.2 Risk 
Does the participant run a risk of injuries and/or 
other discomfort as a result of participating in this 
study? 
For example: risk of falling while doing exercises 
Yes, minimal 
risk 
 
☐ 
Yes, more 
than minimal 
risk 
☐ 
No 
 
 
☒ 

21 
EMPOWER nWMO studie protocol, V1 
13. 
Incidental1findings11
 
Is there a risk of incidental findings?  
yes, 
minimal 
risk 
☐ 
yes,  
substantial risk 
 
☐ 
No 
 
 
☒ 
If yes, please explain the nature of the incidental findings.  
NA  
Procedure to assess if a finding should be returned to the participant, or not 
NA 
Procedure to inform the participant 
NA 
14. 
References1
Klik of tik om tekst in te voeren. 
1. 
Landman I. Shortage of ICU nurses: Hospitals are no longer able to solve this issue 
independently. Dutch Broadcasting Foundation (NOS) 2021: https://nos.nl/artikel/2395093-tekort-ic-
verpleegkundigen-ziekenhuizen-kunnen-dit-niet-meer-zelf-oplossen (accessed May 12, 2025). 
2. 
Unfilled positions. Statistics Netherlands (CBS) 2022. 
3. 
Labor market shortage in healthcare professions. Prognosemodel Zorg en Welzijn 2022. 
4. 
Baartmans M, Keuper J, Schoten van S, Bosmans M, Wagner C, Batenburg R. Staffing Levels 
and Patient Safety in Specialist Hospital Care. Nivel – Netherlands Institute for Health Services 
Research 2021: https://www.nivel.nl/sites/default/files/bestanden/1003998_1.pdf (accessed May 
12, 2025). 
5. 
toe Laer E. Although the healthcare sector is in urgent need of personnel, refugees with a 
residence status are not being hired, ‘Al schreeuwt de zorg om mensen, statushouders worden niet 
aangenomen’. Het Financieel Dagblad 2021. 
6. 
Report: From Asylum Seeker to Healthcare Provider, Employment Participation of Asylum 
Migrants in the Healthcare Sector, submitted to the State Secretary for Justice and Security. The 
Advisory Committee on Migration Affairs 11/5/21. 
7. 
Future of Jobs 2023 Report. World Economic Forum May, 2023: 
https://www3.weforum.org/docs/WEF_Future_of_Jobs_2023.pdf (accessed May 12, 5). 
8. 
Torres-Harding SR, Andrade AL, Romero Diaz CE. The Racial Microaggressions Scale (RMAS): a 
new scale to measure experiences of racial microaggressions in people of color. Cultur Divers Ethnic 
Minor Psychol 2012; 18(2): 153-64. 
9. 
King DD, Fattoracci ESM, Hollingsworth DW, Stahr E, Nelson M. When thriving requires 
effortful surviving: Delineating manifestations and resource expenditure outcomes of 
microaggressions for Black employees. J Appl Psychol 2023; 108(2): 183-207. 
If yes, please explain what the risk entails.   
NA 
Clarify what is done to alleviate the risk. 
NA 
12.3 Benefits  
Does the participant receive benefits/reward/incentives for 
participating in this study: 
Yes 
☐ 
No 
☒ 
If yes, please explain what the benefits/reward/incentives entail. 
NA 

22 
EMPOWER nWMO studie protocol, V1 
10. 
Newman A, Chrispal S, Dunwoodie K, Macaulay L. Hidden bias, overt impact: a systematic 
review of the empirical literature on racial microaggressions at work. Journal of Business Ethics 2025: 
1-20. 
 
15. 
Appendices1
Appendix 1: 
To identify the number of nursing newcomers in the region interested in participating a questionnaire was 
developed in 2021 and processed using REDCap (Research Electronic Data Capture, Vanderbilt University). In 
addition to indicating whether someone was interested in participating, information could be provided on 
professional background, credential evaluation, legal status, years of education and work experience, type of 
clinical experience, entrustable professional activities, and proficiency in Dutch and English. The questionnaire 
was published in 16 different languages in addition to Dutch: English, French, Spanish, Persian, Farsi, Polish, 
Syrian Arabic, Kurdish, Ukrainian, Russian, Uzbek, Turkmen, Dari, Pashto, Bahasa Indonesia, and Turkish. It was 
disseminated online via a public survey link. In March 2022, the first version of the survey was sent to 22 
language schools in the Northern provinces and shared via various social media channels, such as the 
municipality of Groningen, the Foundation for Refugee Students (UAF) and a national platform that supports 
connections between refugees and local communities, businesses, and organizations (RefugeeStartForce) with 
the following text: ‘Possible job opportunity for asylum seekers or newcomers in the region of Groningen with 
a background as scrub nurse at an operating theater OR nurse at the nursing ward/ care unit. Are you 
interested to be guided to a job as a full team member at the operating theatre or nursing ward? In that case 
please click on the link below and fill in the form (3 minutes) on your smartphone or tablet: 
www.redcap.link/nieuwkomers. Questionnaire in Dutch, English, Français, Español, 
Ape
nd
 
ixp , 
Polski, 
1:
T
o
etf
 
1:y
hxuf
, Kurdî, mbrsgwcabs,rmccbqv, O'zbek, Türkmençe, 
|
}
lo
 
2
e
0
,
, Bahasa Indonesia, Türkçe.’  
The version available through this link is already an updated second version, after it became clear that there 
were enough potential participants to further shape the program. The questionnaire was updated a third time 
(December 2023) for scaling up to the other three Northern provinces and then a fourth time for scaling up to 
four hospitals in the Randstad which can be viewed via www.redcap.link/trajectnieuwkomers. 
 
Appendix 2: 
Ontworpen fasttrack integration trajectory: The language centre of the University of Groningen developed a 
vocational language course as part of this project: 
 
Vocational language course 
General Course Outline – Customized Program: The specialized language course for nurses focuses on the 
essential language skills needed in nursing practice. It is based on the book ‘De taal van de verpleging’, 
designed for foreign healthcare professionals at A2 level, with word lists in English, Polish, Lithuanian, and 
Spanish. The course also incorporates contemporary texts, videos, websites, and other relevant materials. 
Practical Information: The course consists of 24 lessons, held twice a week, each lasting 2 hours, for a total of 
48 contact hours. Additionally, at least 48 hours of self-study are required. The program runs for approximately 
3 to 3R5 months. 
 
Once participants reach the minimum Dutch language level (A2), they are required to successfully complete 
this 3.5 month course. Additionally, the UAF offers separate intercultural communication courses for both 
participants and their ward nurse mentors (‘buddies’): 
 
Intercultural communication training for newcomers and buddies 
For Newcomers 
Goal: Communication is essential in healthcare. Whether engaging in a conversation with a client, discussing 
matters with family members, or handing over information to colleagues, effective communication plays a key 
role. In any conversation, it is not only the words spoken that matter—facial expressions and body language 
(non-verbal communication) are equally important. During the intervision meetings, we address questions and 
challenges from daily work practice, particularly those related to cultural differences, language, and 
communication. Additionally, we cover the following topics:   

23 
EMPOWER nWMO studie protocol, V1 
- Perspectives on health, illness, birth, and death across different cultures   
- Various levels of cultural differences   
- Indirect and direct communication styles   
- Differences in time perception   
- Understanding personal space   
- Developing intercultural sensitivity 
The training focuses on Dutch workplace culture and provides insights into communication, cultural awareness, 
and the skills needed to function effectively. It explores written and unwritten rules, direct and indirect feedback, 
time management, and workplace behavior and attitudes.   
The initial training sessions were organized by the UAF in collaboration with the LC. Currently, the training is 
provided by Leerzorg in partnership with the LC. In principle, each group participates in five intervision sessions 
over the first eight months, with each session lasting two hours. 
 
For buddies 
A training on workplace skills and culture is also provided to buddies and other interested nurses. This interactive 
training combines knowledge sharing and information exchange with engaging, hands-on activities. The training 
is a one-time session lasting four hours and covers the following topics:   
- Diversity and inclusion   
- Cultural self-awareness and understanding of unwritten rules and dimensions   
- Employment of refugee professionals/newcomers in the Netherlands: challenges and opportunities   
- Guidance and translating knowledge into practice   
 
Those who attain B1-level Dutch and complete the vocational language course begin working as assistant 
nurses, salaried as care assistants (a hospital role created specifically for this programme). The programme 
follows a work-study model with task-differentiated development across three hospital-based phases while 
participants work as assistant nurse:  
- Phase 1 introduces the Dutch healthcare system, culture, and practical language use.  
- Phase 2 delivers procedural and professional training by the accredited provider Leerzorg preparing 
candidates for the nursing competence assessment.  
- Phase 3 focuses on developing professional nursing skills in practice.  
 
Procedural and professional training in preparation for the nursing professional competence assessment 
provided by an accredited training organization Leerzorg 
A training program to prepare for the professional competence assessment for internationally educated 
nurses. This assessment consists of three components: (1) a theoretical knowledge test, (2) a practical exam on 
nursing skills, and (3) an interview focused on clinical reasoning.  The preparatory training includes an online 
program, theoretical foundations based on the book "Niveau 4 onder de knie", the Vilans protocols for nursing 
procedures, 8 classroom teaching sessions, and individual coaching. Preparation for components: 
1 – the knowledge test – includes various elements such as practicing sample questions, completing 
assignments, attending lessons, becoming familiar with clinical conditions, and gaining understanding of 
different healthcare sectors, including psychiatry, hospital care, elderly care, home care, and care for 
individuals with intellectual disabilities.  
2 – nursing skills – includes, among others, dosage calculations and practice in the skills lab for procedures such 
as bladder catheterization, injections, feeding tubes, and peripheral IV insertion. As part of component 
3 – the clinical reasoning interview – participants practice with clinical case studies. 
 
The phases last approximately 4–6, 6–8, and 4–6 months, respectively. Participants are paired with one or two 
dedicated nurse buddies for onward support and to help set learning objectives. Additional support, such as 
extra language assistance or coaching by a medical content advisor, is available if needed.  
In addition to medical guidance, a key aspect of the programme is the tailored support provided in areas such 
as municipal contact, registration in the Dutch healthcare system, and, where needed, engagement with other 
relevant organisations. A project leader with expertise in supporting healthcare newcomers was appointed.  
 
Appendix 3: 

24 
EMPOWER nWMO studie protocol, V1 
The first questionnaire, issued in 17 different languages, requested consent to store the data in the following 
manner: ‘The personal data that you enter will be processed. Your data will be stored for a maximum period of 
1 year. Do you give permission?’ 
In the updated version in 2023, consent was requested in the following manner in seven different languages 
(Dutch, Turkish, English, Arabic, Ukrainian, Russian, and Spanish), because previously the questionnaire had 
only been completed in these languages and not in any of the other 10: ‘The personal data you provide will be 
processed and stored for a maximum period of 4 years. The other data you provide will be processed and 
stored for a period of 6 years (anonymized after 4 years). These data will be analyzed to assess how well this 
program fits your needs and to understand where newcomers may need additional support. Do you give 
consent for this?’ 
 
Appendix 4: 
 
During the first phase of the trajectory, experience was already gained with a skills-oriented recruitment 
procedure. The questionnaire specifically assessed certain authorized nursing activities in addition to the 
portfolio and credential evaluation. The aim of the development project is to further expand this approach to 
include multiple items that provide insight into competencies and attributes across various domains, thereby 
pursuing a more objective selection process. An additional advantage of an automated approach appears to be 
a substantial reduction in administrative workload. 
Prior to entry into the program, it may be valuable to obtain a more comprehensive assessment of candidates’ 
skills. These outcomes could provide insight into a candidate’s likelihood of successfully completing the 
program or indicate the need for additional support. Such insights could positively influence completion rates. 
According to the World Economic Forum (WEF), the skills listed in Figure 1 are among the most sought-after by 
organizations. Starting with the updated version in 2023, additional questions have been developed and 
included to obtain the most comprehensive understanding across multiple domains: cognitive skills, self-
efficacy, teamwork, ethics, physical abilities, management skills, and technological skills. 
 
 
Figure 1 
 
The skills/attributes related to the different domains: 
DOMAINS 
SKILLS / ATTRIBUTES 
Self-efficacy 
Resilience, flexibility, and adaptability 
 
Motivation and self-awareness 
 
Curiosity and lifelong learning 
 
Reliability and attention to detail 
Teamwork 
Empathy and active listening 
 
Leadership and social influence 

25 
EMPOWER nWMO studie protocol, V1 
Ethics 
Cultural competence 
Physical abilities 
Manual dexterity, endurance, and precision 
 
Professional field 
 
Recent practical experience 
Management skills 
Quality control 
Technological skills 
Technological literacy 
 
The questions related to the different skills/attributes: 
 
Self-efficacy 
Resilience, flexibility, and adaptability 
How do you feel about 
changes in the workplace?  
- I am open to changes 
- I assess whether this change presents opportunities for me or my 
surroundings, and if so, I am willing to adapt 
- I am not a fan of change 
How do you respond to 
stressful situations?  
- I avoid stressful situations 
- I remain calm and look for solutions 
- I try to cope with stress as best as I can 
How do you deal with 
mistakes you make? 
- I hide my mistakes from others 
- I ignore it and hope it goes unnoticed 
- I acknowledge the mistake, learn from it, and move on 
How do you experience 
dealing with unfamiliar 
situations? 
- I experience excitement and challenge 
- I don't feel entirely at ease 
- I feel very uncomfortable 
 
How do you respond to 
setbacks? 
- I tend to lose courage quickly 
- I actively seek new approaches and persevere 
- I experience frustration and feel discouraged 
 
Motivation and self-awareness 
How important do you 
consider having a positive 
impact on others? 
- It does have some significance for me 
- It doesn't hold much value for me 
- It is very important; I am eager to inspire others 
 
How aware are you of your 
strengths and weaknesses? 
- Reasonably well 
- I am not consciously engaged in that. 
- I am well aware; I know both my strengths and 
weaknesses well 
What does success mean to 
you?  
- Material prosperity and status 
- Recognition and respect from others 
- Personal growth and happiness 
How would you describe 
yourself when it comes to I 
set ambitious goals and do 
everything I can to 
setting goals? 
- I set ambitious goals and do everything I can to achieve them 
- I set achievable goals and fully commit to them 
- I set few goals and prefer to live in the present 
How do you handle criticism 
from a colleague?  
- I tend to ignore criticism and stick to my own approach 
- I listen to the criticism, consider it seriously, and am willing to adjust my 
approach if necessary 
- I often tend to defend my decisions and may not always be open to 
extensive discussion 
How do you deal with a lack 
of motivation?  
- I consider a lack of motivation as something normal 
- I wait for motivation to come naturally 
- I look for ways to motivate myself 
 

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EMPOWER nWMO studie protocol, V1 
Curiosity and lifelong learning 
How do you respond to new 
technological developments? 
- I experience confusion and prefer to avoid them 
- I don't have a strong opinion on this 
- I strive to understand them and apply them in a meaningful way 
What is your usual response 
when hearing about new 
ideas or concepts? 
- I am curious and would like to learn more about it 
- My interest varies depending on the topic 
- I am somewhat hesitant when it comes to change 
How often do you seek new 
information outside your 
field, assuming you have the 
time for it? 
- Occasionally 
- Rarely 
- Regularly 
What do you do when faced 
with something you know 
nothing about? 
- I research to learn more about it 
- I ask others for clarification 
- I prefer to avoid the subject 
What is your approach to 
learning new skills, assuming 
you have the time to learn? 
- I don't focus too much on picking up new things 
- I prefer familiar tasks but am occasionally willing to learn something new 
- I am enthusiastic and always open to new challenges 
What does the ongoing 
process of acquiring 
knowledge, skills, and 
competencies throughout life 
mean to you? 
- A cliché, I don't really believe in it 
- An essential principle for personal growth 
- It depends; it can be important in certain situations 
 
Reliability and attention to detail 
What does 'reliability' mean 
to you? 
- Essential, others should be able to rely on me 
- It is important but not crucial for me 
- It doesn't hold particularly high priority for me 
What is your response to 
repetitive tasks? 
- I find it annoying and get bored quickly 
- I complete them quickly to get rid of them quickly 
- I carry them out with care 
How good are you at 
organizing your work and 
tasks? 
- I am quite organised 
- I am not very organized 
- I am well organised 
How do you deal with 
deadlines in your work? 
- I am generally on time 
- I ensure that I complete tasks within time 
- I find it difficult to complete tasks within time 
 
Teamwork 
Empathy and active listening 
What do you think is 
important for good 
communication? 
- I often speak without waiting for a response 
- I try to actively listen and respond to the needs of others 
- I tend to emphasize my position clearly and repeatedly, regardless of what 
others say 
 
How important do you think 
good communication is in a 
hospital setting?  
- It is important; I believe that good communication is essential for efficient 
healthcare provision 
- It's quite important, but I think individual performance is more important 
than communication 
- It's not important; everyone should just do their own work 
 
What is your attitude during a 
team meeting? 
- My attitude is expectant and wait until I am asked a question 
- I prepare myself for what I want to say but I don't ask questions 
- I prepare myself for what I want to say and actively participate in the 
consultation by also asking questions. 
 

27 
EMPOWER nWMO studie protocol, V1 
How do you respond if you do 
not understand a question 
from your colleague? 
 
- I indicate that I do not understand and ask for an explanation 
- I say yes to the question and don't reveal anything 
- I ask my colleague to repeat the question again 
 
 
Leadership and social influence 
How do you describe your 
leadership style in a 
professional setting? 
- I usually let others make decisions 
- I emphasize the strengths of my team members and guide them to 
success 
- I like to give direct instructions and maintain control 
What do you think is the most 
important characteristic of a 
good leader? 
- Empathy and the ability to inspire others 
- Power and authority 
- Efficiency and results-oriented 
 
How do you deal with 
transferring tasks and 
responsibilities within your 
team? 
- I prefer to do everything myself because I'm 
afraid that others won't do it right 
- I know what my colleagues are good at and transfer tasks that suit a 
colleague who can do that well 
- If I am too busy, I transfer tasks to a colleague in my team who has time 
 
Ethics - Cultural competence 
How excited are you about 
exploring new cultures, ideas 
or perspectives? 
- Not very enthusiastic 
- Somewhat enthusiastic, depends on the situation 
- Very enthusiastic, I like diversity 
How do you respond to 
situations where cultural 
misunderstandings may arise? 
- I try to understand the cultural context, ask questions and look for a 
common understanding 
- I rely on my own cultural frame of reference and assume that others think 
the same 
- I prefer to avoid such situations to avoid conflict 
How do you adapt your 
communication style when 
working with people from 
different cultures? 
- I stick to my own communication style, regardless of the cultural 
background of others 
- I don't attach much importance to communication style differences 
- I try to adapt my communication style to the needs and expectations of 
the person I am talking to 
How do you deal with 
conflicts arising from cultural 
differences within a team?  
- I side with the cultural norms that best fit my own beliefs 
- I facilitate open communication and try to achieve understanding and 
compromise 
- I avoid conflicts and hope they go away on their own 
 
Physical abilities 
Manual dexterity, endurance, and precision, professional field 
How do you ensure hygiene 
and sterility when performing 
medical procedures? 
- I follow strict protocols to ensure all procedures are hygienic 
- I don't pay much attention to it; it is mainly about carrying out the task 
- I trust my own experience and intuition 
How do you maintain your 
physical and mental stamina 
during busy healthcare shifts? 
- I take regular short breaks to recharge, look after my own health and try 
to maintain a balanced 
approach 
- I ignore my own needs and work without breaks, aiming to complete my 
tasks quickly 
- I work constantly and pay little attention to my well-being, often ignoring 
the need for short rests 
How do you feel about 
wearing short sleeves at 
work? 
- I always wear long sleeves because this corresponds to the norms and 
values of my religion 
- According to my religion I cover as much skin as possible, but I realize that 
from a hygienic point of view it may be desirable to wear short sleeves 
- I always wear short sleeves for hygienic reasons 

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EMPOWER nWMO studie protocol, V1 
How do you train yourself to 
act both quickly and 
accurately in healthcare 
emergencies? 
- I practice specific emergency situations to improve speed and accuracy 
- I trust my natural reactions and move quickly without much attention to 
precision 
- I believe my experience is sufficient, and I am not actively engaged in 
specific training for 
emergency situations 
How do you stay informed of 
recent developments and 
trends in your field? 
- I rely on my existing knowledge; I don't have time for constant training 
- I don't think it's necessary to constantly stay informed 
- I regularly participate in training courses, webinars and read professional 
literature to keep my knowledge up to date 
 
 
Management skills 
Quality control 
What is your response to 
negative feedback from 
patients about the quality of 
care?  
- Usually there is little time to think about this 
- In the event of a real complaint, I take this up with my head nurse/team 
leader with the aim of 
analyzing the complaint, recognizing patterns and 
taking measures for continuous improvement 
- I indicate that it is annoying if we have fallen short in the quality of care, 
but I defend the care as it was provided 
As a team member, how 
would you like to be involved 
in maintaining quality 
standards? 
- The responsibility lies entirely with management 
- The team is responsible for quality, but nurses do not have to recognize 
quality issues themselves 
- I think it is important and would like to follow training in this and involve 
my team in this 
How would you go about 
implementing new quality I 
develop and implement a plan 
for improvement 
control measures? 
- I develop and implement a plan for improvement step by step 
- I will immediately implement new measures 
- I avoid changes so as not to disrupt existing processes 
 
Technological literacy 
What steps do I take to 
update and improve my 
technological 
technology skills? 
- I have no interest in updating technological knowledge 
- I proactively follow training and courses to stay informed of the latest 
developments 
- I'll wait until my employers offer training 
 
Appendix5:  Study Skills Test 
The appropriate developmental potential is assessed by the LC. All applicants have an intake with the LC, where 
an impression of their developmental potential is formed based on motivation, initiative, intelligence, and 
communication skills. During the first scaling-up phase, the Study Skills Test was added, a short test that 
provides information about the speed at which an individual is able to learn a language. 
The following information is available for individuals who take the test: The test will assess the skills that make 
learning a language easier. It will not test your Dutch language skills, so it does not matter whether you already 
speak Dutch or not. The test will be done on the computer. At the start of the test, you will receive instructions 
from one of our staff members in English and Dutch. You will have to do the test completely independently, of 
course, and without any resources. The explanation included in the test is available in many languages. The test 
is held roughly once every two weeks, in a group setting. 
The result: 
Within two business days after completing the test, you will receive an email with your test result. There are 
three options: 
• 
If you score 15 or more points out of the maximum 25, it is very likely that a Language Centre course is 
suitable for you. We will then invite you to do an online intake interview with a teacher. 

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EMPOWER nWMO studie protocol, V1 
• 
If you score somewhere between 11 to 14 points, our courses are probably too high-paced for you. 
We will still invite you to do an online intake interview with a teacher, because sometimes it is still 
possible to do a course with us. 
• 
If you score 10 points or less, a course at a lower pace at a different language institute is probably a 
better fit for you. We will still invite you to do an online intake interview with a teacher to make sure 
that your score truly reflects your learning ability and was not negatively influenced by external 
factors. 
https://language-centre.rug.nl/cursus-talencentrum/study-skills-test 
 
Appendix 6: Racial microaggresions scale, orginal questions 
1. Because of my race, other people assume that I am a foreigner 
2, Because of my race, people suggest that I am not a "true" American 
4, Other people ask me where I am from, suggesting that I don’t belong 
9, Other people make assumptions about my intelligence and abilities because of my race 
14, Other people treat me like a criminal because of my race 
15, People act like they are scared of me because of my race 
16, Others assume that I will behave aggressively because of my race 
18, I am singled out by police or security people because of my race 
20, Other people view me in an overly sexual way because of my race 
21, Other people hold sexual stereotypes about me because of my racial background 
22, Other people act as if they can fully understand my racial identity, even though they are not of my racial 
background 
23, Others act as if all of the people of my race are alike 
26. Other people assume that I am knowledgeable about multicultural issues, simply because I am a 
member of a racial minority group 
27, Others ask me to serve as a "spokesperson" for people in my racial group 
28, Others suggest that people of my racial background get unfair benefits 
29, Others assume that people of my racial background would succeed in life if they simply worked 
harder 
30, Other people deny that people of my race face extra obstacles when compared to Whites 
32, Other people assume that I am successful because of affirmative action, not because I earned my 
accomplishments 
33, Other racial group members expect me to behave in a way that is not consistent with my own racial or 
cultural values 
35, Others hint that I should work hard to prove that I am not like other people of my race 
36, Others suggest that my racial heritage is dysfunctional or undesirable 
37, Others focus only on the negative aspects of my racial background 
39, I am mistaken for being a service worker or lower-status worker simply because of my race 
40, I am treated like a second-class citizen because of my race 
41, I receive poorer treatment in restaurants and stores because of my race 
42, When I interact with authority figures, they are usually of a different racial background 
43, I notice that there are few role models of my racial background in my chosen career 
44, Sometimes I am the only person of my racial background in my class or workplace 
45, Where I work or go to school, I see few people of my racial background 
46, I notice that there are few people of my racial background on the TV, books, and magazines 
47, Sometimes I feel as if people look past me or don't see me as a real person because of my race 
49, I feel invisible because of my race 
51, I am ignored in school or work environments because of my race 
52, My contributions are dismissed or devalued because of my racial background 
The modified RMAS will be used. 
 
Appendix 7:  In the context of the qualitative analysis conducted by Regioplan, 17 participants were invited by 
the UMCG project coordinator to contribute. These participants completed a survey that was jointly developed 
by Regioplan and UMCG and were asked to participate anonymously. The following consent was requested: 
‘ Beste deelnemer van het UMCG traject 'Nieuwkomers in hun kracht', 
Onderzoeksbureau Regioplan is bezig met een evaluatieonderzoek over het traject dat je aan het volgen bent. 
Hierin willen we meer leren over wat er goed gaat in het traject, en hoe we het traject nog beter kunnen 

30 
EMPOWER nWMO studie protocol, V1 
maken. Om hierachter te komen is jouw mening belangrijk. Daarom vragen wij je om deze vragenlijst in te 
vullen. Het invullen duurt ongeveer 20 minuten en je antwoorden worden helemaal anoniem opgeslagen. Je 
kunt dus alles zeggen wat je wil, zonder dat wij weten wie het antwoord heeft gegeven. 
Het kan zijn dat je deze vragenlijst al eerder hebt ingevuld. As dat zo is, vragen we je om hem weer in te vullen 
en hebben we een aantal aanvullende vragen voor je. 
Veel dank voor het meedoen aan het onderzoek!’ 
 
Multiple choice questions used by Regioplan to survey the participants. 
Questionnumber 
3 
The program has – so far – met my expectations (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, 
Agree; 5, Strongly agree; 6, Don't know) 
5 
How satisfied are you with how the intake at the language center went? (1, Very dissatisfied; 2, 
Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
6 
How satisfied are you with the course of the interview to be able to participate in the program at the 
UMCG? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very 
satisfied; 6, I don't know) 
8 
How satisfied are you with the medical language program you have completed? (1, Very dissatisfied; 
2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
10 
How satisfied are you with the support you are receiving on the path to BIG registration? (1, Very 
dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't 
know) 
12 
Have you already started as a nursing assistant? (Yes/ No) 
13 
How satisfied are you with the level of support/guidance you receive from your buddy while working 
as a nursing assistant? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, 
Satisfied; 5, Very satisfied; 6, I don't know) 
14 
How satisfied are you with the level of support/guidance you receive from the other colleagues on 
the department while working as a nursing assistant? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither 
dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
15 
How satisfied are you with the level of support you receive from your head or lead nurse while 
working as a nursing assistant? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor 
satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
17 
By already working with Dutch-speaking colleagues and patients before I have my BIG registration, I 
get to know the language faster. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly 
agree; 6, Don't know) 
19 
The work as a nursing assistant gives me the opportunity to apply my nursing knowledge. (1, Strongly 
disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, Don't know) 
21 
The work as a nursing assistant gives me the opportunity to get to know the Dutch healthcare 
system. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, Don't know) 
23 
The newcomers program ensures that I can achieve my goal (working as a BIG-registered nurse) in an 
efficient way. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, Don't 
know) 
25 
As a nursing assistant, I am given the opportunity to perform tasks that match my level – currently 
still under supervision. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, 
Don't know) 
27 
I would recommend the program to newcomers with the same background as mine. (1, Strongly 
disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, Don't know) 
29 
Now that I have experience with the program and know what it is like, I would start this program 
again. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 5, Strongly agree; 6, Don't know) 
31 
During one of the lessons of the medical language program, the Newcomers team from the UMCG 
came to the language center to provide information about the program. This was the orientation 
meeting. Did you attend this 'orientation meeting'? (Yes/ No/ Don’t know) 
32 
How satisfied are you with this orientation meeting? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither 
dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
34 
At the start of your work as a nursing assistant, you took a workplace skills training. How satisfied are 
you with this training? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, 
Satisfied; 5, Very satisfied; 6, I don't know) 

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EMPOWER nWMO studie protocol, V1 
36 
How satisfied are you with the peer review sessions you attended as a follow-up to the workplace 
skills training? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, 
Very satisfied; 6, I don't know) 
38 
Are you currently taking the re-entry training, or have you already completed this training? (I am 
currently taking the training/ I have completed the training/  I have not started the training yet 
because.../ I don't know) 
39_1 
This training is in preparation for the Professional Content Exam. This exam consists of three parts: 
knowledge test, clinical reasoning, and nursing technical skills. How satisfied are you with the 
insights you gained during the training, specifically regarding the knowledge test? (1, Very 
dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't 
know) 
39_2 
This training is in preparation for the Professional Content Exam. This exam consists of three parts: 
knowledge test, clinical reasoning, and nursing technical skills. How satisfied are you with the 
insights you gained during the training, specifically regarding clinical reasoning? (1, Very dissatisfied; 
2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
39_3 
This training is in preparation for the Professional Content Exam. This exam consists of three parts: 
knowledge test, clinical reasoning, and nursing technical skills. How satisfied are you with the 
insights you gained during the training, specifically regarding nursing technical skills? (1, Very 
dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't 
know) 
40 
How satisfied are you with the training in general? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither 
dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know)4.7 (0.6) 
43 
To what extent can you apply the insights from the training in your work as a nursing assistant? (1, 
Not at all; 2, Not good; 3, Neither good nor bad; 4, Good; 5, Very good; 6, I don't know) 
46 
What do you think of the informal meetings that are occasionally organized to speak with other 
participants or stakeholders? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 
4, Satisfied; 5, Very satisfied; 6, I don't know) 
 
Open questions used by Regioplan to survey the participants. 
Questions 
2. What does the program 'Newcomers in their Strength' mean to you? 
4. In what ways does the program not meet your expectations? 
7. Can you indicate what aspects of the intake and/or the interview to be able to participate in the program 
you are not or less satisfied with? And how would you improve this? 
9. Can you indicate what aspects of the language program you are not/less satisfied with? Do you have a 
suggestion for improving this? 
11. Can you indicate what support you are missing on the path to BIG registration? 
16. Can you indicate what support you are missing in your work as a nursing assistant? 
18. Can you explain your answer to question 17? 
20. Can you explain your answer to question 19? 
22. Can you explain your answer to question 21? 
24. Can you explain why the program does not contribute to efficiently achieving your goal? 
26. Can you explain in what way the tasks are not suitable for your level? 
28. Can you explain why you would not recommend the program to other newcomers? 
30. Can you explain why you would not start the program again or what makes you hesitant? 
33. What could be improved about the orientation meeting? 
35. What could be improved about the workplace skills training? 
37. What could be improved about the peer review sessions? 
 
41. Can you explain your answer to question 40? 
42. What would you have liked to learn more about, or what would you like to learn more about, during the 
training? 
44. Can you explain why you are unable to apply the insights effectively? 
45. In what way can the re-entry training be improved? 
47. Can you explain why you are not satisfied as answered in question 46? 

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EMPOWER nWMO studie protocol, V1 
48. In what way can these informal meetings be improved? 
49. What would you like to share about the program, about things that are going well or things that could be 
improved? 
 
Open and multiple choice questions with which the buddies were surveyed by Regioplan 
Questions 
1. What does the program 'Newcomers in their Strength' mean to you? 
2. What motivates you to participate as a buddy in the program? 
3. How many months have you been a buddy? 
4. How many participants are you guiding as a buddy? 
5. Being a buddy has met – so far – my expectations. (1, Strongly disagree; 2, Disagree; 3, Neutral; 4, Agree; 
5, Strongly agree; 6, Don't know) 
6. In what ways does the program not meet your expectations? 
7. To what extent are you generally satisfied with the development of the participant(s) you are a buddy for? 
(1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I 
don't know) 
8. Can you explain why you are dissatisfied with the general development of these participant(s)? 
9. To what extent are you generally satisfied with the language development of the participant(s) you are a 
buddy for? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very 
satisfied; 6, I don't know) 
10. Can you explain why you are dissatisfied with the language development of these participant(s)? 
11. To what extent are you generally satisfied with the professional development of the participant(s) you 
are a buddy for? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very 
satisfied; 6, I don't know) 
12. Can you explain why you are dissatisfied with the professional development of this participant(s)? 
13. Where could the participant you are mentoring still grow? 
14. How satisfied are you with the communication about the progress of the program towards the buddies? 
(1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, Very satisfied; 6, I 
don't know) 
15. How satisfied are you with the communication regarding the development goals of the participants 
towards the buddies? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 5, 
Very satisfied; 6, I don't know) 
16. How satisfied are you with the guide that was created for nursing departments about the program and 
supporting participants? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor satisfied; 4, Satisfied; 
5, Very satisfied; 6, I don't know) 
17. How could the information provided to mentors be improved? 
18.  Have you attended any of the IC training sessions offered by the UAF? (Yes/ No) 
19. How satisfied are you with this training? (1, Very dissatisfied; 2, Dissatisfied; 3, Neither dissatisfied nor 
satisfied; 4, Satisfied; 5, Very satisfied; 6, I don't know) 
20. To what extent does this training help in supporting the newcomer on your department? 
(1, Does not help at all; 2, Helps a little; 3, Neither helps nor hinders; 4, Helps a lot;  5, Helps a great deal; 6, I 
don't know) 
21. Can you explain your answer? 
22. How would you assess the interaction between the participant and other colleagues on the nursing 
department? (1, Very good; 2, Good; 3, Neither good nor bad; 4, Bad; 5, Very bad; 6, I don't know) 
23. How would you assess the support within the nursing department to make the program and the 
guidance of participants a success? (1, Very good; 2, Good; 3, Neither good nor bad; 4, Bad; 5, Very bad; 6, I 
don't know) 
24. How would you assess the interaction between the participant and patients on the nursing ward? (1, 
Very good; 2, Good; 3, Neither good nor bad; 4, Bad; 5, Very bad; 6, I don't know) 
25. How would you describe the attitude of patients towards the participant on the nursing ward? (1, Very 
good; 2, Good; 3, Neither good nor bad; 4, Bad; 5, Very bad; 6, I don't know) 
26. How can the interactions between the participant and patients be improved? 
27. Would you be willing to mentor a participant again in the future? (Yes/ No/ Don’t know) 
28. Can you explain your answer? 

33 
EMPOWER nWMO studie protocol, V1 
29. How satisfied are you with the following statement: "The ‘Newcomers in their Strength’ program 
prepares participants well to work on a nursing ward in the future." (1, Strongly agree; 2, Agree; 3, Neither 
agree nor disagree; 4, Disagree; 5, Strongly disagree; 6, I don't know) 
30. Can you explain your answer? 
31. How satisfied are you with the following statement: "I see the participant I am mentoring working on a 
nursing ward after this program." (1, Strongly agree; 2, Agree; 3, Neither agree nor disagree; 4, Disagree; 5, 
Strongly disagree; 6, I don't know) 
32. Can you explain your answer? 
33. How satisfied are you with the following statement: "Mentoring a newcomer is educational and has 
broadened my perspective on my nursing profession." (1, Strongly agree; 2, Agree; 3, Neither agree nor 
disagree; 4, Disagree; 5, Strongly disagree; 6, I don't know) 
34. Can you explain your answer? 
35. What would you still like to share about the project, including things that are going well or things that 
could be improved?