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Table 5 Migrants’ journey and the barriers to and facilitators of integration of international nurses, doctors and dentists

From: Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis

Main theme based on migrants’ journey Sub-themes [References] Barriers to integration Facilitators of integration
Adaptation Motivation for migration [16, 20, 26, 28, 30,31,32, 34, 35, 37, 39, 40, 43, 44, 48, 49, 53] Motivations for migration not met Motivations for migration met
Professional challenges [17, 20, 26, 29, 32, 33, 35, 39,40,41, 44, 45, 49,50,51,52,53] Registration barriers
Employment barriers
Lack of professional mentors or networks
Recognition and transferability of qualifications and training
Less duration of time for registration and employment
Support from professional mentor or network
Social and political challenges [20, 26, 35, 37, 40, 41, 43, 48,49,50, 52] Lack of social and family network
Immigration barriers
Pre-existing social and family networks
Right to remain or British citizenship
Mismatched expectations [30, 32, 35, 39, 40, 49,50,51, 53] Mismatched expectations between migrants, managers and organisations Prior knowledge of destination country and systems
Ability to communicate and accept diverse views balance of autonomy and scrutiny
Career progression Mismatch of education [26, 32, 33, 37, 41, 42, 49] Non-recognition of training received in source country
Gaps in education caused by migration
Variation in education between countries
Adaptation or transitional courses improved education
Translation of source country training into UK workplace and its acceptance by employers
Mismatch of skills [17, 24, 26, 32, 33, 35, 37, 40,41,42, 45, 46, 49,50,51,52] Good verbal and non-verbal communication skills
Good English language skills
Good technology-related skills
Good interpersonal skills
Opportunities for training in listed skill
NHS training pathways [26, 28, 34, 39, 40, 47, 48, 55] Lack of access to NHS training and NHS jobs
National and regional variation reducing career choice
Equal opportunities based on merit
Experiences of integration Multi-level discrimination [20, 28,29,30,31,32, 34, 35, 39, 42,43,44,45, 47, 48, 50, 55] Discrimination from patients, colleagues, managers and organisations
Exploitation in care homes across EU
Discrimination in pay
Discrimination in progression
Equality and diversity training for all
Organisational policy and frameworks to promote equal opportunities
Self- actualisation, resilience, focus on long-term goal
Moving away from ethnocentric views
Support networks [24, 30, 32, 34, 37, 41, 42, 45, 47,48,49,50,51,52] Lack of personal, professional, social and organisational support networks
Lack of mentors and ability to mentor
Insensitivity to interpersonal dynamics
Access to formal or informal, professional or social, individual or organisational networks for support
Ability to mentor and be mentored
Positive feedback loops from patients, colleagues, managers
Sensitivity to interpersonal dynamics
Cultural health awareness [24, 32, 34, 35, 37, 41, 43, 45, 48, 49] Social isolation and lack of international exposure
Unwillingness to exchange of knowledge and skills
Struggle between self, social and professional identity
Knowledge of behaviours and ability to adapt
Interactional styles
Health literacy related to the country, population and beliefs
Personal attributes [17, 30, 32, 47, 48, 50] Lack of flexibility
Low self-esteem
Lack of self-awareness
Lack of emotional maturity
Insensitivity to interpersonal dynamics
Lack of insight and reflection
Self-blame and negative psychosocial wellbeing
Personal traits of adaptability, resilience, lateral thinking
Sensitivity to interpersonal dynamics
Focus on long-term goals
Positive psychosocial well being