Migrant nurses’ experiences in the workplace — what support do they need to thrive?

June 27, 2024

To thrive in the workplace, internationally qualified nurses need professional development, protection from bullying and good communication skills, a New Zealand researcher has found.

The global nursing shortage has been a catalyst for the international migration of nurses. The shortfall in the New Zealand health service has seen numbers of internationally qualified nurses (IQNs) rise to more than 40 per cent of the workforce.


Dana Taylor

NZNO seeks to help migrant nurses adjust to working in the New Zealand health-care sector by encouraging employers to support them.1 For my doctoral research, I sought to find out what support IQNs need by asking them to tell their stories about their positive and negative interactions with work colleagues.


I aimed to shed light on how IQNs see themselves as professionals working in the New Zealand health service and to provide insights that would be useful to both migrant nurses and their health service employers.

The eight IQNs I interviewed were recruited via interpersonal networks, online media (including an article I wrote for Kaitiaki in November 2020), and social media networking. They came from Southeast Asian, African and European countries; some had English as their first language, while for others it was an additional language. All had been nursing in towns and cities around New Zealand for at least three years.

I invited them to tell me their stories of both challenging and positive workplace interactions with their colleagues, ie with doctors, administrators, and fellow nurses — both New Zealand nurses and other IQNs. I use pseudonyms here to protect their privacy.


These are my study’s key findings:

  • IQNs need to be able to develop their nursing skills.
  • They need protection from bullying and exploitation.
  • They need to develop their interpersonal communication skills.
  • They need help with stress management.
  • Teamwork needs to be promoted by health-care employers and managers.

Firstly, participants recommended that IQNs be encouraged to help their colleagues follow nursing protocols correctly to avoid repeating clinical errors. Lilly and Carmel spoke of their difficulties confronting nursing colleagues when their organisation’s medication administration policy was not followed and an error made, potentially risking patient safety.

Rose wanted to see professional development for IQNs to “keep nursing skills up [so they can] be an example to all the other nurses”. She also felt this would enhance teamwork and help IQNs develop strong communication skills.

Research shows IQNs benefit from having a positive relationship with an encouraging manager who responds to their professional development needs.2

 IQNs are negatively affected by bullying, exclusion, and exploitation in New Zealand health-care workplaces.

Secondly, IQNs are negatively affected by bullying, exclusion, and exploitation in New Zealand health-care workplaces. Their experience of harassment is an individual burden resulting from a systemic problem.3 Ricky described “being set up for failure” by a bullying colleague from the same region in Ricky’s home country.

Workplace exploitation of IQNs, where they are given higher patient acuity or caseloads, has the potential to harm patient and worker safety.4

Ability to respond assertively

However, IQNs who feel empowered in their nursing role may respond assertively to counter any bullying, racism, or exploitation.5, 6 Ricky, for instance, stood up for her IQN colleagues who were concerned about being given unfair case numbers but did not want to speak up for fear of putting their job at risk.

Thirdly, IQNs had positive experiences of their work relationships where they were able to resolve disagreements and communicate clearly with colleagues. According to Rose, “The best thing is communication skills […] And working within the nursing boundaries, which is very, very crucial.”

IQNs had positive experiences of their work relationships where they were able to resolve disagreements and communicate clearly with colleagues.

By giving IQNs training in soft communication skills — both interpersonal and cross-cultural communication — educators may help them develop the confidence to respond professionally to workplace issues.7 This is in line with the Nursing Council of New Zealand’s expectation for IQNs to communicate effectively with patients and colleagues.8

Finally, health-care employers need to understand the pressures IQNs face. Mons said, “If you add emotion to your workload, you’re just increasing your time […] after hours. The thinking. The going over and over it again.”

What kind of managers they valued

IQN participants valued managers who focused on “working alongside people, rather than above them” (Mons) and who prioritised delegation and collaboration for effective teamwork (Lilly, Nightingale, Ricky).

The New Zealand nursing sector is struggling to train and retain nurses amid a global nursing shortage.9 My research findings are consistent with NZNO’s recommendations for employers to enhance IQNs’ workplace wellbeing.10

Insights from this research may provide the impetus for health-care providers and policymakers to make IQNs feel more empowered to build a successful long-term nursing career in New Zealand.

Dana Taylor is a former international English language testing system (IELTS) examiner, who has been teaching migrant health-care professionals to prepare them for the IELTS and occupational English test (OET) for over 15 years. She has a masters of teaching English to speakers of other languages (TESOL) leadership and will graduate with a PhD in applied linguistics later this year. To find out more about her research, visit www.tinyurl.com/danataylorphdproject.

  1. New Zealand Nurses Organisation. (2018). New Zealand Nurses Organisation strategy for nursing: Advancing the health of the nation. Hei oranga motuhake mō ngā whānau, hapū, iwi 2018–2023. 
  2. Aloisio, L. D., Coughlin, M., & Squires, J. E. (2021). Individual and organizational factors of nurses’ job satisfaction in long-term care: A systematic review. International Journal of Nursing Studies, 123, 104073.
  3. Jenkins, B., & Huntington, A. (2016). “We are the international nurses”: An exploration of internationally qualified nurses’ experiences of transitioning to New Zealand and working in aged care. Nursing Praxis in New Zealand, 32(2), 9–20.
  4. Schilgen, B., Handtke, O., Nienhaus, A., & Mösko, M. (2019). Work-related barriers and resources of migrant and autochthonous homecare nurses in Germany: A qualitative comparative study. Applied Nursing Research, 46, 57–66.
  5. Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly, 43(3), 274–279.
  6. Eriksson, E., & Engström, M. (2018). Internationally educated nurses’ descriptions of their access to structural empowerment while working in another country’s health care context. Journal of Nursing Management, 26(7), 866–873.
  7. Aggar, C., Shinners, L., Penman, O., Mainey, L., Kurup, C., Hallett, J., Doran, F., & Raddi, S. (2021). Evaluation of a digital application to support internationally qualified nurses’ communication and leadership skills. Nurse Education Today, 104, 104982.
  8. Nursing Council of New Zealand. (2022). Tuhinga whai tohutohu/Consultation document: Proposed changes to the internationally qualified nurse (IQN) competence assessment process and English language standard.
  9. Weston, K., & Longmore, M. (2020). Summit brings nursing leaders together. Kai Tiaki Nursing New Zealand, 26(9), 38.
  10. New Zealand Nurses Organisation. (2017). NZNO discussion document on internationally qualified nurses: Immigration and other issues.