Preparation for Practice: Internationally Qualified Nurses’ Perceptions of Clinical and Cultural Practice Learnings Gained Through a New Zealand Competence Assessment Programme
Authors: Clubb Anne , Saravanakumar Priya , Holroyd Eleanor 
Published: December 2024

The past two years has seen a rapid influx of internationally qualified nurses (IQNs) to Aotearoa New Zealand to address a long-term shortage of nurses. In 2023, the Nursing Council of New Zealand changed the process by which IQNs registered as nurses. Prior to this date, IQNs, whose professional culture were assessed as not being equivalent to New Zealand trained nurses, were required to complete a Competence Assessment Programme with a Nursing Council accredited programme. These programmes (8-12 weeks duration) were intended to prepare IQNs for practice in the Aotearoa New Zealand health system. This article reports on a study undertaken in 2020 which informed the changes to Nursing Council’s registration process for IQNs. The aim of this qualitative study was to understand how IQNs perceived the Competence Assessment Programme’s relevance and usefulness to their clinical and cultural transition into the Aotearoa New Zealand’s nursing profession to inform future registration processes. Using a focused ethnography methodology, participants were purposively recruited who were IQNs and who had participated in a Competence Assessment Programme between 2001 and 2016. Twelve nurses participated in individual semi-structured interviews. A thematic analysis framework was used to interpret the data. Two primary themes emerged: 1) social interaction, which encompassed sub-themes of communication barriers and the need for supportive preceptors; and 2) navigating new professional practice, with sub-themes of feeling deskilled in unfamiliar roles, and misconceptions about cultural safety and Te Tiriti o Waitangi. Novel insights included participants’ newfound understanding of the balanced power dynamics within the Aotearoa New Zealand healthcare system and the recognition of the vital support received from engaged and knowledgeable clinical preceptors. However, participants did not perceive the programme as having significantly influenced their acquisition of new professional knowledge nor their understanding of cultural practices necessary for achieving equitable health outcomes for Māori. The study found that it is imperative that IQNs are supported into the health workforce with orientation programmes delivered by the employing organisations, access to ongoing professional development, and the provision of professional supervision. IQNs are a critical and substantial part of the nursing workforce who must be supported, educated, and protected to ensure they thrive in the workplace. ##Te reo Māori translation Te Takatū mō te Mahi Tūturu: Ngā Kitenga o ngā Tapuhi Whai Tohu Mātauranga ā-Ao mō ngā Akoranga Tiaki Tūroro, Mahi Ahurea hoki i riro i a rātou mai i tētahi Hōtaka Aromatawai Matawai o Aotearoa Ngā Ariā Matua I ēnei tau e rua ka hipa ake nei kua tino piki ake te maha o ngā tapuhi kua whai tohu ā-ao (IQN) ki Aotearoa hei whakatika i te korenga tapuhi wā roa. I te tau 2023, i panonitia e Te Kaunihera Tapuhi o Aotearoa te hātepe mō te ara rēhita mō ngā IQN hei tapuhi. I mua atu i taua wā, i runga i te momo aromatawai i kī, kāore i taurite te ahurea ngaio o ngā IQN ki ngā tapuhi o Aotearoa, i herea ngā IQN kia whakaoti i tētahi Hōtaka Aromatawai Matatau i raro i tētahi hōtaka whai tiwhikete nā te Kaunihera Tapuhi. Ko te whakaaro, ko ēnei hōtaka (12 wiki te roa) hei whakangungu i ngā IQN mō ngā mahi i roto i te pūnaha hauora o Aotearoa. Ka whakapūrongo tēnei tuhinga i tētahi mātainga i kawea i te tau 2020, i noho ai hei tūāpapa mō ngā panonitanga ki te hātepe rēhita o te Kaunihera Tapuhi mō ngā IQN. Ko te whāinga o tēnei mātainga inekounga kia mārama he pēhea te titiro a ngā IQN mō te hāngai me te whāinga take o te Hōtaka Aromatawai Matatau ki tō rāto whakawhiti tiaki tūroro, ahurea hoki ki te umanga tapuhi o Aotearoa, me kore e kitea he māramatanga mō ngā hātepe rēhita o Aotearoa mō ngā rā kei te tū mai. Nā te whakamahi i ētahi tikanga mātai mātauranga momo tangata arotahi, i āta rapu mariretia ētahi tāngata whai wāhi, he IQN hoki rātou, kua whai wāhanga hoki ki tētahi Hōtaka Aromatawai Matatau i waenga i 2001 me 2016. Tekau mā rua ngā tapuhi i whai wāhi ki ētahi uiuinga māhorahora nei. I whakamahia tetahi tātaritanga tāhuhu toro-whānui hei tātari i ngā raraunga. E rua ngā tāhuhu matua i puta: 1) ko te whakahoa atu ki te tangata; i uru ki roto ko ngā tāhuhu whāiti o ngā maioro whakawhiti kōrero me te hiahia kia noho mai he kaiako atawhai, me 2) ko te whakatere haere a te tangata i a ia anō i te ao mahi ngaio hou, tae atu ki ngā tāhuhu whāiti o te whakaaro he pūkenga-kore te tangata i ōna tūranga hou, ngā pōhēhētanga hoki mō te haumaru ahurea me Te Tiriti o Waitangi I uru ki ngā kitenga hou rawa tētahi māramatanga hou mō te tūtika o te taha mana i roto i te pūnaha hauora o Aotearoa, me te whakaae ki te tautoko takenui i whiwhi rātou, i ngā kaiako mataara, matatau hoki mō te tiaki tūroro. Ahakoa tērā, kāore te hunga whai wāhi i whakaae i tino pāngia tō rātou hopu akoranga ngaio hou e te hōtaka, tō rātou māramatanga rānei ki ngā tikanga ahurea taketake mō te whakapiki i ngā putanga hauora kia tairite mō ngāi Māori. I kitea e te rangahau he mea hira kia tautokona ngā tapuhi whai tohu ā-ao kia urutomo nei ki te kāhui tapuhi o Aotearoa, mā ngā hōtaka whakangungu mā ngā kaiwhakawhiwhi mahi e hora, me te whakawātea i te whakapakari ngaiotanga mau roa, me te tirohanga ngaio pūputu i muri i te rēhitatanga. He rōpū taketake ngā tapuhi whai tohu ā-ao nō te kāhui kaimahi tapuhi, me mātua tautoko, me mātua whakaako, tautiaki i a rātou kia tino ora ai rātou i te wāhi mahi. Ngā kupu matua Aromatawai matatau; haumaru ahurea; whakawhitinga ahurea ki te ao mahi; ngā tapuhi whiwhi tohu ā-ao; whakangungu; ngā tapuhi i whakangungua i tāwāhi; inekounga