Table 4 Characteristics of Included Studies
Authors, country | Study aim(s) | Study design | Sample characteristics | Key findings |
|---|---|---|---|---|
Adhikari and Melia (2013), United Kingdom | To examine migrant nurses’ professional life in the UK | A multi-sited ethnographic approach using in-depth interviews | 21 Nepal nurses | • Nepali nurses had aspirations to work in a technologically advanced and modern British hospital to further their career but eventually land in private sector nursing and care homes • Nepali nurses experienced downward professional mobility where valuable skills in acute-care nursing were gradually lost • Downward spiral of job dissatisfaction and lack of opportunity for career progression |
Almansour et al. (2021), Saudi Arabia | To gain an understanding of the impact of expatriate status on nurses’ perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries | A descriptive qualitative study using semi-structured interviews | 8 Saudi Arabian nurses 6 Filipino nurses 4 Indian nurses 4 South African nurses 2 Jordanian nurses 2 Malaysian nurses | • Being away from family and friends significantly affected their happiness. Married contracts providing family accommodation and air tickets for family members were found to mitigate turnover intention • Language barriers as a fundamental factor influencing job satisfaction • The lack of opportunities for career advancement and further education had a negative influence on retention |
Alshareef et al. (2020), Saudi Arabia | To identify and analyse the risk factors contributing to nursing turnover in Saudi Arabia and identifies practical solutions to decrease turnover and encourage nurses to stay in their jobs | A descriptive cross-sectional quantitative study using the 24-item Organizational Commitment Questionnaire | 502 Asian nurses | • Organisational commitment is negatively correlated with anticipated turnover • Social support from immediate supervisor is negatively correlated with anticipated turnover • Autonomy also had a significant negative effect on anticipated turnover among nurses • Floating of staff – understaffed, heavy workload, pressure in working environment is negatively correlated with anticipated turnover |
An et al. (2014), United States of America | To examine factors affecting the job satisfaction of immigrant Korean nurses | A descriptive cross-sectional quantitative study using a five-item Job Satisfaction Index (Brayfield and Rothe, 1951) | 105 Korean nurses | • Job satisfaction showed a significantly negative correlation with perceived stress • Job satisfaction was significantly positively correlated with perceived organisational support • Job satisfaction was significantly positive correlated with self-efficacy |
Connor (2016), United States | To understand culture’s influence on coping patterns and preferences among diverse populations | A cross-sectional qualitative descriptive design using semi-structured interviews | 20 Filipino nurses | • The themes that emerged reflected similar coping behaviours and strategies and were categorised as (a) familial, (b) intracultural, (c) fate and faith-based, (d) forbearance (patience and self-control) and contentment, (e) affirming the nursing profession and proving themselves, and (f) escape and avoidance • Understanding the role of culture and adaptation on stress and coping behaviours is important to retain quality nurses and promote a healthier workplace |
Coustas (2019), South Africa | To understand the obstacles and remediation required to retain the Registered Nurses recruited from India, and explore the hospital managements’ perceptions of these nurses’ contribution to their hospitals’ functioning | An instrumental case study | 30 Indian nurses | • Deteriorating exchange rate negatively correlated with retention • Adjustment and the support of the spouse were critical to retention, expressed hopes that spouses would join them in South Africa • Role of management (workload, work environment) in retention of nurses from India |
Dahl et al. (2021), Norway | To explore the educational experiences of Filipino nurses in the Philippines and expectations of their competence in Norway | An explorative design consisting using semi-structured interviews | 10 Filipino nurses | • Nurses experienced a mismatch of expected competence, devalued by nurse credential process in Norway and experienced deskilling as an auxiliary nurse |
Efendi et al. (2016), Japan | To develop a deeper understanding of the meaningful experiences of Indonesian nurses while working in Japanese hospitals | A phenomenological approach using semi-structured interviews | 5 Indonesian nurses | • Six key themes were identified: (i) seeking better than before; (ii) communication challenges; (iii) the nursing examination as a culmination; (iv) differences in nursing practice; (v) cultural differences; and (vi) the benefits of living in developed country |
Efendi et al. (2020), Kuwait | To explore the life experience of Indonesian nurses living and working in Kuwait | A phenomenological qualitative approach using semi-structured interviews | 21 Indonesian nurses | • Similar culture and religious practices had a positive influence on retention • Linguistic incompetence an occupational stressor due to inability to engage in professional and social communication with confidence • Maintaining a close relationship with their family in the home country, increasing their mental strength, and engaging in social life to deal with homesickness |
Efendi et al. (2022), Japan | To describe the narratives and experiences of Indonesian nurse migrants who worked as care workers in Japanese long-term care facilities | A descriptive qualitative study using semi-structured interviews | 18 Indonesian nurses | • Nurses misunderstood the job scope and experienced deskilling due to a limited scope of practice • Access to religious infrastructure • Communication barrier despite a year of Japanese language training • A supportive leadership, peer support, emotional bonding with colleagues had a positive impact on retention |
Geun et al. (2016), United States of America | To describe the gap between expected and perceived organisational experiences among Asian foreign-educated nurses (FENs) in the United States and to examine factors associated with turnover in their 1st year of employment | A descriptive cross-sectional quantitative study using Expectations and Experiences Measures as modified by Irving and Meyer | 148 Korean nurses 44 Filipino nurses 4 Indian nurses 3 Taiwanese nurses 2 Chinese nurses | • Gap between expectations and experienced responsibilities is positively correlated with turnover intention • Significant differences between expectations and experiences in all 3 subscales: reward, responsibility, and comfort • Demographics and career characteristics is significantly associated with turnover intention |
Geun et al. (2018), United States | To investigate factors affecting turnover of Asian foreign-educated nurses (FENs), which may lead to improvements in retention strategies | A descriptive cross-sectional quantitative study using the 24-item Organizational Commitment Questionnaire | 148 Korean nurses 144 Filipino nurses 9 China, Indian and Taiwan nurses | • Perceived quality of orientation and affective commitment were significant predictors of turnover at the organisation level • perceived quality of orientation has important practical implications for human resources managers in nurse retention and the successful transition of Asian FENs |
Goh & Lopez (2016), Singapore | To explore the job satisfaction level of migrant nurses working in a multicultural society and, more specifically, the relationship between their job satisfaction levels, work environment, their intentions to leave and the predictors of their intentions to leave | A descriptive correlational quantitative study using the 37-item Job Satisfaction Questionnaire | 202 Filipino nurses 113 Malaysian nurses 81 Chinese nurses 45 Indian nurses 23 Myanmar nurses 31 Others | • A negative correlation between job satisfaction and each of the domains of the practice environment scale: participation in hospital affairs, nurse manager ability, staffing adequacy, nurse–physician relationship and nursing information technology • The ability of nurse managers to lead a ward and the practice environment are predictors of turnover intention |
Healee (2016), New Zealand | To compare the differences experienced by Japanese nurses working in New Zealand from an organisational and personal perspective, using a qualitative approach | A descriptive qualitative study using semi-structured interviews | 9 Japanese nurses | • An overall theme: finding a voice • Moving from a monoculture society with a traditional sense of duty, and a hierarchical approach to authority and working style to a society with a diverse culture, a flattened approach to authority, and a more active engagement in nursing • Ensuring that migrant nurses understand and adapt to a new socio-cultural and organisational environment, but also maintain their own cultural identity within it, has significant implications for the retention in the healthcare sector |
Joseph et al. (2022), Australia | To explore the transition experiences of overseas-trained nurses from India currently working in mental health in Australia | A hermeneutic phenomenology approach using in-depth interviews | 16 Indian nurses | • Difficulty acculturating due to strong Indian cultural beliefs • Loneliness in the absence of family, unfamiliarity with country and workplace |
Lee et al. (2021), Malaysia | To examine the job satisfaction of the foreign-educated nurses in Malaysia, which includes the job satisfaction dimensions and the significant difference between sociodemographic status and job satisfaction | A descriptive cross-sectional quantitative study | 29 Indian nurses 69 Filipino nurses 4 Pakistani nurses | • Job satisfaction was positively correlated with positive relationships with colleagues and superiors |
Nortvedt et al. (2019), Norway | To explore how Philippine-educated nurses explain their choice of Norway as their migration destination and their experience with the credential assessment process in Norway | A hermeneutic design using qualitative research interviews | 10 Filipino nurses | • The experienced were not getting jobs in the Norwegian healthcare system because they lacked credential recognition and sufficient Norwegian language skills • The fight for credential recognition—long and exhausting struggle with regulatory authorities |
Nursalam et al. (2020), Taiwan | To elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan | A phenomenological qualitative approach using semi-structured interviews | 16 Indonesian nurses | • Feelings of being trapped, victimised by fraud, losing their professional identity and skills • Difficult journey, communication inadequacy, limited career pathway • Feeling of being supported, support from management, support from recruiting agent may mitigate turnover intention |
Philip et al. (2019), Australia | To explore the barriers and enablers of clinical communication experiences of OQNs from their perspective using a Communities of Practice framework | An exploratory qualitative study using semi-structured interviews | 8 Filipino nurses 7 Indian nurses 1 Singaporean nurse 1 African nurse | • Lack of cultural orientation into work environment and this manifested in language causing uncertainties and confusion • Workplace interactions were unsatisfactory due to foreign accents, mispronunciation, or rapid speech • Adjustment for smooth transition: developing self-awareness, getting acquainted with Western cultural practices applicable to clinical setting via use of Australian colloquialisms |
Primeau et al. (2021) Canada | To identify the main correlates of internationally educated nurses’ career satisfaction | A quantitative study using a self-developed questionnaire | 86 Arabian nurses 880 Asian nurses 181 Black nurses 30 Latino nurses 774 White nurses | • Individual characteristics, namely age, gender, ethnicity (visible minority), parenting responsibility, and education, were all found to be significantly correlated to career satisfaction • Internationally educated nurses who experience discrimination are less satisfied with their nursing career |
Salami et al. (2018), Canada | To explore the experience of baccalaureate-prepared, internationally educated nurses who work as licensed practical nurses in Canada | An exploratory transnational feminist qualitative study using semi-structured interviews | 9 Filipino nurses 3 Indian nurses 1 Nigerian nurse 1 Mauritian nurse | • Migrating to Canada with hope for a better personal and professional life • A lack of knowledge and support about the RN registration process; difficulty in credential recognition and assessment; barriers in accessing bridging programmes; difficulty in passing language and RN registration examinations • Feeling dissatisfied due to a lack of training and leadership opportunities |
Stievano et al. (2017), Italy | To investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration | A descriptive qualitative study using semi-structured interviews | 20 Indian nurses | • Experiencing difficult work situations and declining salary compared with higher incomes gained in more affluent countries (Australia, Canada, USA, UK) had a negative influence on retention • Lack of opportunity for career advancement, underemployed, organisational responsibilities, and restricted scope of practice had a negative influence on retention • Providing visas for families of nurses had a positive influence on retention |
Stubbs (2015), United Kingdom | To explore the transition experiences of nurses recruited from India to London to work in critical care settings | A descriptive qualitative study using semi-structured interviews | 16 Indian Nurses | • Differences in nurses’ role: autonomy and responsibility • Language: difficulty in understanding English accents • Pre-allocated mentors of similar culture aids their personal and professional integration into a new country |
Yusuf et al. (2021), Saudi Arabia | To identify and explore the social network communication tools used to facilitate the adjustment process of Malaysian female expatriate nurses working in the Kingdom of Saudi Arabia (hereafter “the Kingdom” or “SA”) who are accompanied by neither their spouses nor families | A descriptive qualitative study using semi-structured interviews | 16 Malaysian nurses | • Continuous engagement with family in country of origin may mitigate turnover intention • Social media communication tools being used by female expatriate nurses can help curb their loneliness and lessen the culture shock of living and working in a foreign country |
Zanjani et al. (2021) Australia | To examine factors associated with OQNs’ sociocultural adjustment to the Australian healthcare system. A secondary aim was to determine whether there was a correlation between OQNs’ sociocultural adjustment and their mental and physical health | A descriptive cross-sectional quantitative study using 21-item revised version of the Sociocultural Adaptation Scale (SCAS-R) | 84 Indian nurses 57 Filipino nurses 17 Chinese nurses 42 Others | • Sociocultural adaptation was positively associated with job satisfaction • Sociocultural adaptation was negatively correlated to perceived stress level • A supportive initial work environment, helpful responses to questions, robust orientation programme, respect for cultural differences, ability to demonstrate expertise, and effective communication channels were critical to successful long-term adaptation |
Zhou (2014), Australia | To explore the ways in which China-educated nurses construct meaning regarding the experience of working in Australia | A constructivist grounded theory method using in-depth interviews | 28 Chinese nurses | • Realising: difficult for participants to accept the washing, toileting, and feeding patients as there is moral obligation to look after sick family members in Chinese culture • Struggling: tension between the participants’ desire to hold on to their old selves and the need to conform to the new society • Reflecting: participants perceived that they were much unlikely to rise to managerial positions despite their relatively superior qualifications and greater seniority |
Zhou et al. (2016), Australia | To explore factors influencing China-educated nurses to emigrate to Australia | A grounded theory approach using semi-structured interview | 28 Chinese nurses | • (a) personal factors (to improve English, to see more of the world and cultures, to seek novelty and adventure); (b) work-related factors (better work environment and more career choices); (c) social factors (better living environment and lifestyle); (d) cultural factors (positive perceptions in China of those who emigrate or have overseas experiences), and (e) economic factors (higher salaries) |