Table 5 Migrants’ journey and the barriers to and facilitators of integration of international nurses, doctors and dentists
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 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 | 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 | Self-awareness Opportunities for training in listed skill | |
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 | |
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 Entrepreneurship Focus on long-term goals Positive psychosocial well being |