Exploring the Integration Experiences of Internationally Educated Nurses (IENs) within the Canadian Health Care System

The number of internationally educated nurses (IENs) in Ontario is growing. Given the predicted nursing shortage due to an aging nursing workforce and a short supply of nursing graduates, this trend will probably continue as international recruitment to meet nursing demands in Canada continues. Current Canadian research that examines IENs’ experience as they integrate into their workplaces is scarce. With an increasingly diverse Canadian and patient population due to rising immigration trends, a workforce that addresses the needs of the diverse patient population is valuable. Therefore an in-depth understanding of IENs’ experience, their contribution to nursing practice, and their distinct role in promoting health care access to Canada’s diverse population is necessary. A qualitative study using descriptive phenomenology was used to explore the integration experiences of eleven IENs within the Ontario, Canada health care system. Interviews were conducted to examine their experience of integrating into Canadian work settings. Thematic analysis informed by a descriptive phenomenological lens was used to uncover the essence of the IEN’s integration experience. The findings are categorized into five major themes including: Relationship with colleagues; Professional knowledge and experience; Organizational practices and work environment; Cross-cultural and linguistic competence; and IENs as an asset to nursing and patient care. These findings were nested within an overarching theme of resilience and an intrinsic motivation to establish their credibility as competent nurses. These findings highlight IENs’ unique integration experiences, and contribute to Canadian literature in the field, especially in terms of an understanding of IENs’ unique contribution to nursing in Canada. Implications and recommendations for nursing with regards to practice, education, research, and administration are presented. IENs’ INTEGRATION EXPERIENCES IN CANADA iii Acknowledgements First, and most important, I wish to acknowledge my heavenly Father and best friend, in whom I live, in whom I move, and in whom I have my being. I love you, Jesus, thank you for bringing me to this end. I wish to acknowledge the support of my thesis supervisor and committee members: Dr. Josephine Etowa, Dr. Isabelle St. Pierre, and Salma Debs-Ivall. I am truly grateful for your expert advice, your support, and your encouragement to me during this academic journey. To my thesis supervisor, Josephine, your expert guidance, inspiration, and continual support has been greatly appreciated. To my external examiners, thank you for your valuable feedback. To all the eleven nurses who have shared their stories with me, for your willingness to meet with me and to share your experiences, without which this work would have been impossible to attain, I share this joy with you. I sincerely thank each and every one of you. To my unit manager, Eileen Frattini, thank you for your immeasurable support. To my husband, Fritz, my son, François, and my daughters, Nathania and Vivienne, you all have walked down this road with me. Thank you for your unending love, support, patience, and prayers. IENs’ INTEGRATION EXPERIENCES IN CANADA iv