Expectations and Plans of Internationally Recruited Nurses: A Case Study in a NHS London Hospital Tr

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Expectations and Plans of Internationally
Recruited Nurses A Case Study in a NHS London
Hospital Trust

• Researcher
• Alvaro Alonso-Garbayo RN, MSc, DrPH (Candidate)
• Supervision
• Prof. Gill Walt and Dr Jill Maben

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Outline

• Background
• Aim and objectives
• Methodology
• Strengths and limitations
• Ethical issues
• Issues arising

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Background

• There is a shortage of nurses in the UK
• Policies to address the shortage of nurses
  include INTERNATIONAL RECRUITMENT
• High proportion of nursing workforce from
  overseas
• Low retention of internationally recruited nurses
  (IRNs)

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Aims and Objectives

• To explore
• The experiences of overseas nurses
• Their expectations
• Their intention to stay or to leave
• Their plans for career development
• The experiences, expectations and attitudes of
  mentors and managers
• To provide recommendations

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Methodology Methods Design

• Methods
• Qualitative approach
• Ethnographic methods
• Data generation
• Research design
• Exploratory case study
• Two components
• Longitudinal study
• Cross-sectional study

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Methodology Sampling Site

• Purposive sample
• Total 29 nurses (41 interviews)
• Longitudinal study one group of Indian nurses
  (6)
• Cross-sectional study two groups of Filipino
  nurses
• One group with one year experience in UK (6)
• One group with more than three years experience
  (9)
• A group of mentors (4) and nurse managers (4)
• Sampling site selected opportunistically
• London selected for its high proportion of IRNs

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Methodology Data Analysis

• Interviews audio-recorded and transcribed
• Data coded by empirical themes
• Validation of coding by supervisors and peer
  research students
• Intra-case and cross case analysis

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Methodology Data Analysis (2)

• Mapping and interpretation
• Preliminary findings validated by participants
• NUDIST-V6 used for data management

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Strengths Limitations

• It gives voice to IRNs
• Longitudinal data
• Rapport with IRNs
• Managers and mentors included

• Small sample
• One Trust
• Possibility of lack of analytical distance

Timeframe June 2004 to May 2006
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Ethical Issues

• NHS and LSHTM RECs approval
• Coercion avoidance
• Intra-interview counseling
• Confidentiality and anonymity
• Information appropriateness

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Some Issues Arising From a Preliminary Analysis

• Unmet expectations
• Technology and infrastructure
• most often we would see like hospital settings
  in the television, or in films, I mean American
  settings in TV and in films and they are kind of
  modern and hi-tech, I thought London is also like
  that thats one of the expectations I got, which
  is surprising when I got here (IRN with more
  than 3 years in UK)

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Some Issues Arising From a Preliminary Analysis

• Unmet expectations
• Standards of care
• what we can see here is that after surgery one
  or two weeks, all patients come with an infection
  or some other thing... we were back home more
  strict to infection control when we thought of
  London, we were expecting very good standards but
  we are not finding anything like that (IRN
  newly arrived in UK)

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Some Issues Arising From a Preliminary Analysis

• Discrimination and negative attitudes from
  patients
• I think they patients treat British nurses
  differently, I think they have more respect to
  British nurses rather than for overseas nurses,
  I dont mean that they are racist but there is a
  difference (IRN with more than 3 years in UK)

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Some Issues Arising From a Preliminary Analysis

• Discrimination and negative attitudes from
  patients
• if you are not very careful, you could get
  like bullied from other relatives as well,
  perhaps, I really dont know whats the reason
  for that (IRN with more than 3 years in UK)

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Some Issues Arising From a Preliminary Analysis

• Discrimination and negative attitudes from
  patients
• patients and relatives treat you differently,
  as if , you have to give service to them, as if,
  we were doing this job because we are being paid
  to do so they dont seem to give us respect, as
  you know, we are responsible for their life and
  its not just the money that we are here for
  (IRN with more than 3 years experience in the UK)

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Some Issues Arising From a Preliminary Analysis
(3)

• Professional autonomy
• he the doctor is ready to consider us and
  our knowledge but back home they just tell us
  what to do and we just do that (IRNs newly
  recruited)

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Some Issues Arising From a Preliminary Analysis
(3)

• Professional autonomy
• you have this notion back home that doctors
  are really very superior to nurses, you are there
  to assist the doctors at all times, you dont get
  much autonomy which is different from here,
  because here you really have the autonomy (IRN
  with more than 3 years in the UK)

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Some Issues Arising From a Preliminary Analysis
(4)

• Economic targets as an influence over their plans
  to stay or to leave
• I would say that most of us are aiming to build
  our own house, and to buy a car and a small
  business And as soon as they have these three, I
  think most of us are going to go back home (IRN
  with more than 3 years in the UK).

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Some Issues Arising From a Preliminary Analysis
(4)

• Economic targets as an influence over their plans
  to stay or to leave
• and indirectly their plans for career development
• they dont want any managerial
  responsibility because at some point they are
  going to go back home. (IRN with more than 3
  years in UK)

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Thank you!