IEN Transition and Integration into the Alberta Workforce Partners in Education and Integration of IENs Montreal 2018 Holly Crowe & Heather Kerr Mount Royal University, Calgary AB
Mount Royal University Calgary, Alberta
Bridge to Canadian Nursing Program Philosophy The BCN Program is designed to facilitate the knowledge and skill acquisition necessary to help IENs transition to professional nursing practice in Canada.
Transition Shock Model- Boychuck Duchscher 2007
Methodology & Questions asked Literature review of 11 articles dated between 2009-2017 using keywords integration and transition, Canadian workforce and Internationally educated nurse Definition search for terms Transition and Integration Question sets designed from themes identified in the literature and tailored specifically to the role of nurse interviewed
Questions for Program Graduate 1. What workplace supports were available to you when you were hired as a new grad? Were any of these targeted specifically to the IEN? (did you get an extended orientation?) 2. What supports would you have liked to have had available to you? 3. How would you describe your integration experience into the Canadian workforce? 4. Prioritize/identify the top 3 issues you faced as a new employee? 5. How were these issues addressed by your employer? 6. How have you been supported in your career and/or career advancement? 7. Do you feel your experience as an IEN is different than for other nurses within your unit? 8. Is there anything else you would like to add regarding your transition and integration experience?
Questions for the manager/administrator 1. Do you have a formal orientation tailored specifically for the IEN? Why?/Why not? 2. Are orientations flexible in order to provide extra training if needed? 3. Do you formally introduce new hires to the staff of which they will be working? 4. How would you describe the supports provided to a new staff member? 5. Can you please prioritize the top 3 issues for IEN s entering the workforce? How do you address these? 6. Does your facility utilize the strengths of its ethnic diversity? How? (what are the strengths IENs bring to your agency/) 7. Do you have any retention strategies directed towards IENs? 8. Anything else you d like to add regarding transition and integration? 9. Do your staff participate in cultural competence or have opportunities to attend workshops on reducing stigma? (cultural competence of all employees/ unit specific)
Definitions Transition: passage from one state, stage, subject, or place to another a movement, development, or evolution from one form, stage, or style to another (https://www.merriam-webster.com/dictionary/transition) Integrate: Integrated; integrating form, coordinate, or blend into a functioning or unified whole to unite with something else: to incorporate into a larger unit (https://www.merriam-webster.com/dictionary/integrating)
Literature Review: Transition issues & solutions Transition Issue Themes: 1. Determining specific learning needs of the IEN without stigmatization. 2. Cost of orientation and mentorship. 3. Gaps between the roles of regulation, education and practice. 4. Pre-immigration issues. Transition Solution Themes: 1. Improved communication and policies between levels of government, regulatory bodies, bridging programs and employers. 2. Voices need to be heard from grassroots to decision-makers in order to get funding. 3. Engage bridging programs and regulatory bodies to work together. 4. Transitional programs to include language, communication and Canadian HC system. 5. Better communication regarding expectations and requirements (immigration, registration and integration).
Interview Perspectives: Transition issues & solutions Orientation: All new hires welcomed and introduced, don t differentiate between IEN and CEN General Nursing Orientation 1-2 days Unit specific skills training (variable depending on unit) focuses on transition to specific unit not transition to nursing profession Inconsistent required content 5-9 buddy shifts on most acute care units Flexible and dependant on learning needs within the union contract Mentors vary depending on agency/unit (managers, clinical educators, or experienced RN) No formal mentorship programs though some units are exploring them
Gaps Between Levels of Authority: (CARNA, BCN, AHS) Total number of IENs with Practice permits as of January 2018 3,546 (Source: CARNA, 2018)
IENs By Employment Status Source: CARNA, 2018
IENs by Area of Responsibility CARNA, 2018
Literature Review: Integration issues and solutions Integration Issue Themes: 1. Language 2. Communication 3. Difficulty with use of technology 4. Stigma, discrimination & cultural competence (by leaders and team members) 5. Lack of recognition of previous skills and experience by managers. Integration Solution Themes: 1. Extended or flexible orientation length. 2. Comprehensive training on Cultural competence for both the IEN and leaders/team members. 3. Language training, support and practice in context (Bridging programs) 4. Mentoring within both the professional and social networks.
Interview perspectives: Integration Issues & Solutions Stigma and Cultural Competence don t differentiate between IEN and CENs no overt institutional stigma but frequent perceived and enacted stigma regarding hiring and rural acceptance cultural competence & diversity workshops available but staff & managers not aware and/or accessing them - focus now on Indigenous inconsistent views on requirements of staff regarding cultural competence Centralized scheduling according to union rules
Administrator: Kathy In my area there are two sites that border on First Nations Reserves, and we have done some cultural training but we are actively engaging in more training and awareness. This is targeted towards the Indigenous population, but certainly will benefit all staff who are from different cultures
Interview perspectives: Integration Issues & Solutions Technology trouble with technology is not specific to IENs it takes time to get comfortable, so clinical exposure is an asset
Manager & BCN Graduate: Raymond The BCN program is substantive, and in orientation we tend to focus more on processes than skills
Interview perspectives: Integration Issues & Solutions Professional Communication/Collaboration Establish roles and build trust IENs report that they are often apprehensive to ask for help or identify gaps, yet staff expect new hires to be able to identify their own learning needs and ask for help Standardize language and communication tools
Clinical Educator: Tara Our common language is English, so sometimes we need to slow things down and be sure to close the communication loop with verbal cues rather than non-verbal ones. We have unwritten rules to speak English on the unit and encourage using SBAR and professional language.
Summary of Successes: Clinical exposure (188 hours) to make contacts/build trust & relationships learn technology provide exposure to Canadian Health Care System Flexible & Individualized learning plans/orientation to meet the diverse needs of new hires without stigmatizing IEN
Summary of Successes cont. Language and Communication standards within CARNA, Bridging Program as well communication workshops within AHS SBAR tools utilized in both BCN and AHS Interprofessional education opportunities Collaboration between BCN, CARNA and AHS Advisory Committee and regular communication meetings
BCN Graduate: Ila the clinical practicum played a key role in smooth transition. Without that I can t imagine to work in an acute care setting
Unit Manager: Anthony I can t tell the difference between IEN and Canadian grads. The ones I hired were excited, eager to learn, had experience on the unit, were prepared for the interview, go getters, confident in their responses, and recognize what they don t know
Opportunities for future learning: Further research to further understand the funnel of application to registration ( why < half applicants enter practice) Formalize mentorship programs within BCN, AHS and immigration agencies Standardize some components of organization s orientation to include cultural competence/diversity & inclusion Curriculum development and clinical exposure to Long Term Care to meet workforce demands
Questions and/or Comments?
References Blythe, J., Baumann, A., Rhéaume, A. & McIntosh, K. (2009). Nurse Migration to Canada, Pathways and Pitfalls of Workplace Integration. Journal of Transcultural Nursing. 20(2), 202-210. Baumann, A., Blythe, J. & Ross, D. (2010). Internationally Educated Health Professionals: Workforce Integration and Retention. HealthcarePapers. 10(2), 8-20. Covell, C., Neiterman, E. & Bourgeault, L. (2016). Scoping review about the professional integration of internationally educated health professionals. Human Resources for Health. 14(38), 1-12. http://dx.doi.org/10.1186/s12960-016-0135-6 Covell, C., Primeau, M-D., Kilpatrick, K. & St-Pierre, I. (2017). Internationally educated nurses in Canada: predictors of workforce integration. Human Resources for Health. 15(26), 1-16. http://dx.doi.org/10.1186/s12960-017-0201-8 Higginbottom, G. (2011). The transitioning experiences of internationally-educated nurses into a Canadian health care system: A focused ethnography. BMC Nursing. 10(14), 1-13. Retrieved from http://www.biomedcentral.com/1472-6955/10/14 Khalili, H., Ramji, Z., Mitchell, J. & Raymond, G. (2015). Transition Supports for IENs in Workplace: Perspectives of IENs in Ontario. GSTF Journal of Nursing and Health Care. 2(2), 66-70. Lum, L., Bradley, P. & Valeo, A. (2015). Challenges in Oral Communicationfor Internationally Educated Nurses. Journal of Transcultural Nursing. 26(1), 83-91. http://dx.doi.org/10.1177/1043659614524792
References cont d Njie-Mokonya, N. (2014). Exploring the Integration Experiences of Internationally Educated Nurses (IENs) within the Canadian Health Care System. Retrieved March 2018 from https://ruor.uottawa.ca/bitstream/10393/30727/1/njie- Mokonya_Ndolo_2014_thesis.pdf Primeau, M-D., Champagne, F. & Lavoie-Tremblay, M. (2014). Foreign-Trained Nurses Experiences and Socioprofessional Integration Best Practices. The Health Care Manager. 33(3), 245-253. Rush, K., Adamack, M. & Gordon, J. (2013). Expanding the Evidence For New Graduate Nurse Transition Best Practices. Michael Smith Foundation for Health Research. Retrieved from https://www.msfhr.org/sites/default/files/expanding_the_evidence_for_new_graduate_nurse_transition_best_practices_0.pdf Yu, X. (2010). Is Transition of Internationally Educated Nurses a Regulatory Issue? Policy, Politics, & Nursing Practice. 11(1), 62-70. http://dx.doi.org/10.1177/1527154410371382