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Thinking globally to beat staff shortages

Overseas nurses and students want to come to Australia but our educational institutions need to cater for their needs, writes Ruth Terwijn

Australia has always needed to supplement its workforce and population by embracing people from other countries. This young country has depended on overseas labour to build it, shape it and make it a nation. The nursing workforce is no different.

At present, one in seven nurses working in Australia has received their qualification overseas.

Of real concern is the ageing of the nursing workforce. Registered nurses over the age of 55 currently account for 36 per cent of the workforce; therefore the retirement of this group is considered a major factor in workforce sustainability.

However, the 2007 global financial crisis and now the Eurozone woes, have directly impacted on the value of superannuation funds and assets since this time, which has led many intended retirees to postpone or return to the workforce for stability and an assured income.

The 2012 Health Workforce Australia report, Health Workforce 2025, established a model to project the shortfall of nurses. It is clear throughout this report that without recruitment and retention of international nursing students and registered nurses, Australia’s health sector will not be able to meet the demand for services in both the short and long term.

The increased numbers of nursing students and registered nurses working outside of their homeland has meant that the nursing community has progressively become more globalised. In addition, there are large numbers of students with English as an additional language (EAL) and culturally and linguistically diverse (CALD) backgrounds entering nursing programs at universities of industrialised nations.

Reasons for working overseas

International nursing students in English-speaking countries usually have economic, social or political reasons for studying nursing in a developed country.

Economic reasons are usually centred on quality of life, such as improved wages, working conditions and a higher standard of living, which are made possible when an international student completes his or her program of study and is able to work as a registered nurse. This often allows the graduate to provide support for family and extended family within their homeland.

Secondly, a move from country or rural living to city dwelling for many international students has opened up more opportunities for student nurses, especially in acquiring varied nursing skills.

Finally, a move to a developed country offers the opportunity of a safer life due to improved political and social circumstances.

Students from developing nations who are able to study outside of their home country have increased opportunities for career enhancement, exposure to a different lifestyle and culture, and the potential for an increased income that is disproportionate to that in their homeland. These incentives may well impact on the decision of prospective nurses to consider nursing education outside of their homeland.

Factors around living arrangements, studying at tertiary institutions, making friends and applying for permanent residency were highly valued by international students when applying for a university placement. However, positive experiences for this group of students in relation to these factors were not easily identified.

Barriers to newcomers

Despite these reasons for engaging in international study, international nursing students also experience a number of well-documented barriers. These can be identified as communication, exclusion, personal and academic challenges, and value and race judgments. There is also a risk of social exclusion and feelings of isolation and loneliness, coupled with the stress of familial expectations.

While nursing programs in Australian universities are well-established in relation to educating domestic students, there are substantial challenges in response to meeting the educational and non-academic needs of international pre-registration nursing students.

These challenges range from English language competency and assessment, through to different learning styles and approaches, cultural differences, social exclusion and feelings of isolation and loneliness.

International nursing students face many hurdles, but some students persist in their desire to achieve a Western nursing qualification. Academic, cultural and social barriers exist for nursing students establishing themselves in a foreign country. These barriers are challenging and stressful and can influence the study success for this cohort of students.

The challenge is that many of these education programs may not be geared to respond effectively to the needs of this cohort. The growth in international nursing students requires providers of nursing education to understand better the students' particular learning needs, as well as health and cultural expectations, whilst studying abroad.

Language is a barrier for many international students. English may be learnt in their homeland but conversational “Australian English” is gained here. International nursing students have reported that they think many Australians speak quickly and use colloquialisms, making understanding and communicating very challenging.

In addition, the international nursing student then faces a new language, medical terminology.

Thirdly the “language” of therapeutic communication is essential for safe and competent nursing practice, yet this is an area where international nursing students often struggle within the clinical area. In essence, they have three new languages to learn, not just one.

However, despite well-documented perceived barriers, international students display resilience by keeping their long-term goal as a focus with a willingness to adjust to meet outcomes. This requires a new range of skills that may range from developing English language competency, acquiring different learning styles and demonstrating academic competency. Transitioning to living outside the homeland is an important skill that is underpinned by university support, family and culturally similar friends and personal goals.

It has been found that a culturally diverse educational environment and cultural awareness are the keys to successful recruitment and retention of student nurses from EAL and CALD backgrounds.

Culturally competent education remains a key to inclusiveness of international students where educational leaders are required to promote an educationally conducive learning environment.

Nurses are fundamental to healthcare delivery worldwide, and hence a potential worldwide shortage of nurses is cause for alarm. There is well-documented evidence that the international nursing shortage is creating substantial momentum for nurses from primarily developing countries to consider education outside of their homeland as a pathway to greater career opportunities in their own countries, or in Western nations.

The rapid rise in the number of international students from non-English speaking backgrounds means that immediate attention needs to be directed to their academic and non-academic needs to ensure their personal welfare as well as good academic and professional outcomes.

Ruth Terwijn is a lecturer with the department of nursing and midwifery at the University of Southern Queensland. This article is based on a systematic review of research studies on the experience of international nursing students conducted in the past 20 years.

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