Perceptions of Indian IQNs transitioning into a bachelor of nursing programme in New Zealand

About the author:

Kathy Corner, RN, MN, PGDip adult learning and teaching, ESOL teacher, is a nursing lecturer at the Universal College of Learning (UCol), Palmerston North, New Zealand.
Her correspondence address is: [email protected]

Key words

IQN, bachelor of nursing, cultural safety, cross-cultural communication, transition, resilience

Aim

The aim of this pilot study was to gain a deeper understanding of Indian internationally qualified nurses’ (IQNs) experiences of transitioning into a bachelor of nursing (BN) programme in New Zealand.

Background

IQNs transitioning into the BN are exempted from the first 18 months of the programme, through recognition of prior learning, so they enter the BN in the second year. Twenty seven percent of the New Zealand nursing workforce are IQNs (Nursing Council of New Zealand, 2017) so these nurses make an important contribution to the nursing workforce. International research has highlighted an array of issues that have a negative impact on IQNs’ learning and clinical experiences, as well as the positives that have enabled them to succeed, for example resilience and good support networks (Philip et al., 2015). The experience of IQNs transitioning in New Zealand is under-researched and requires further investigation, including those IQNs who are not able to register immediately as their overseas qualification is not sufficient. The tertiary institution where this research was conducted offers IQN students an 18-month bridging course to registration. The students undertake an initial four-week programme which, on completion, enables them to transition into the BN programme part way through the second year.

Methods

A qualitative descriptive method (Braun & Clarke, 2006) was used to gain insight into the experiences of three male and one female Indian IQN student nurses who consented to participate in the research. Focus groups are useful when the researcher wishes to discover the opinions and experiences of participants from a different cultural background to their own (Liamputtong, 2010). Data was collected via a focus group, using semi-structured questions, following ethical approval to conduct the research. The digital recording of the focus group session was transcribed and data analysed using Braun and Clark’s six-stage thematic analysis process. This process involved reading, browsing, reflecting, coding, searching for themes, and defining and naming themes.

Findings

Four main themes were identified in the data analysis: adapting to a new way of learning; cultural differences in adapting to living and working in New Zealand; adapting to a different clinical environment; and cultural safety.

Significant challenges faced the participants as they adapted to new ways of learning in the BN programme. They experienced significant culture shock when adjusting to the Western pedagogy. Throughout the focus group, phrases commonly used were “everything is new to us”, “we struggled”, “we were under immense stress”, “we had to make lots of effort”. Key areas where they faced difficulties as students were in critical analysis, academic writing, and becoming accustomed to accessing and citing scholarly sources to support their discussion. Another challenge was adapting to living and working in New Zealand. Hurdles arose due to language difficulties, cultural differences and the financial pressures of having to work part-time and study. Participants were aware of living in two different worlds. They had their world of work and study which they were adapting to with increasing ease. However, socially they remained significantly separate. Despite these challenges, their overall experience of living and working in New Zealand was increasingly positive over time.

The participants were aware before they came to New Zealand that there would be clinical adaptations to be made. They explained that they wanted to change and adapt as they knew that the working environment would be better, and they wanted to work in a developed country. The participants were inexperienced in working autonomously and assessing patients. In addition, they had to learn how to think critically and make decisions, as in India they had been accustomed to working under the complete control of doctors with no expectation that they would think for themselves. A supportive clinical environment and learning critical thinking skills in simulation scenarios enabled the participants to adapt successfully.

Finally, the concept of cultural safety (Nursing Council of New Zealand, 2011) is an integral part of nursing education and clinical practice. The unique aspects of cultural safety were new concepts for the participants to grasp and apply in their clinical practice. The participants reflected on how crucial cultural safety was for safe care in New Zealand. One student commented, “it is the best thing the New Zealand health system has”. Once they were in their final clinical placement, they were able to apply the concepts they had learnt and deliver safe nursing care.

Discussion

The findings of this study revealed the participants’ resilience and determination. Many reasons were given for this persistence and resilience. Firstly, financially they and their family had made a significant investment in their education. To fail would have a significantly adverse impact economically but there was also the issue of bringing shame on their family and community. A further impetus to succeed was the participants’ perception that the New Zealand BN was an internationally recognised qualification leading to better employment opportunities, working conditions and pay rates, compared with those in India. The participants struggled initially with the change to learner-centred education; however they indicated that over time they came to enjoy this approach and the greater depth of knowledge that came with it. It was evident from this study that if the participants received sufficient guidance and support right at the beginning, the shift in learning approach was manageable. Another educational adaptation was the notion of reflection on practice. Reflection was a new concept for the participants, which raises questions for educators on how best to facilitate reflective practice with a diverse student group, including IQNs. The differences in learning styles can present challenges for nursing lecturers, who need to ensure they encourage an inclusive and culturally responsive pedagogy.

International literature reveals that it takes time to adapt to a new culture, and a new way of nursing, and to learn to nurse in a culturally safe manner (O’Callaghan et al., 2016; Pung & Goh, 2016). The participants in this study spoke about how they gradually learnt and adapted over the time they had been in New Zealand, and were able to reflect on how they were delivering safe care. Despite the difficulties adapting to person-centred, culturally safe care, this study and research in New Zealand by Jenkins and Huntington (2016) show IQNs acknowledge that they value the holistic way of nursing.

Conclusions

Much of the research, both internationally and in New Zealand, identifies the many challenges IQNs face when transitioning to nursing in a new culture, as well as some positives of the experience. The qualitative nature of this study means that issues have been explored in depth. However, due to the small sample size, the generalisability and transferability of the findings need to be interpreted carefully. It is vital that IQN nursing students receive adequate support and guidance right from the beginning, so they can successfully adapt to a new academic and clinical environment. In the clinical environment, it would be valuable if employers supported preceptorship training to enhance cultural awareness. Cross-cultural awareness also needs to be improved in the academic environment. The responsibility for creating a supportive learning environment lies not only with educators and leaders, but with other registered nurses in the host country (Brunton et al., 2017). IQNs may need extra support adjusting to the New Zealand health environment, to critical thinking and decision-making, as well as managing different expectations about power relations between nurses and medical colleagues (Woodbridge & Bland, 2010). Nurse educators have the potential to have a positive impact on students, by making them aware of strategies to foster resilience.

This study highlights several issues relating to the transition of IQNs into a BN programme. Given the scant research applicable to the New Zealand context, this study has highlighted the need for larger qualitative studies to be undertaken. Further research could examine and evaluate the impact of an academic English-language support programme for IQNs and whether this could alleviate some difficulties and stress.

References

Braun, V., & Clark, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 27-101.

Brunton M., Cook, C., Walker, L., & Clendon, J. (2017). Where are we? Workplace communication between RNs in culturally diverse healthcare organisations: Analysis of a 2-phase, mixed-method study. Compiled for the New Zealand Nurses Organisation and the Nursing Education and Research Foundation McCutchan Trust Grant 2015-2017. Massey University.

Jenkins, B. L., & Huntington, A. (2015). A missing piece of the workforce puzzle. The experiences of internationally qualified nurses in New Zealand: A literature review. Contemporary Nurse, 51(2-3), 220-231.

Liamputtong, P. (2010). Performing qualitative cross-cultural research. Cambridge University Press.

Nursing Council of New Zealand. (2017). Nursing Council of New Zealand Annual Report.

Nursing Council of New Zealand. (2011). Guidelines for Cultural Safety, the Treaty of Waitangi and Māori Health.

O’Callaghan, C., Loukas, P., Brady, M., & Perry, A. (2019). Exploring the experiences of internationally and locally qualified nurses working in a culturally diverse environment. Australian Journal of Advanced Nursing, 36(2), 23-34.

Philip, S., Manias, E., & Woodward-Kron, R. (2015). Nursing educator perspectives of overseas qualified nurses’ intercultural clinical communication; Barriers, enablers and engagement strategies. Journal of Clinical Nursing, 24(17-18), 2628-2637.

Pung, L. Y., & Goh, Y. S. (2016). Challenges faced by international nurses when migrating: An integrative literature review. International Nursing Review, 64(1), 146-165.

Woodbridge, M., & Bland, M. (2010). Supporting Indian nurses migrating to New Zealand: A literature review. International Nursing Review, 57(1), 40-48.

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