Support for overseas qualified nurses in adjusting to Australian nursing practice: a systematic review

OBJECTIVES: The objective of the review was to summarise the best available evidence supporting overseas nurses' adjustment to Australian nursing practice. The specific review question was: what supportive interventions assist overseas nurses to adjust to Australian nursing practice? INCLUSION CRITERIA: The review considered qualitative and quantitative papers that addressed adjustment issues of overseas qualified nurses coming and working in Australia. The types of participants were nurses who have received basic nursing education outside Australian, and either nurses who already registered and were working as nurses in Australia or nurses who were undertaking courses required for registration in Australia. Interventions of interest included creating positive work and educational environments that support overseas qualified overseas nurses' adjustment to nursing practice in Australia. SEARCH STRATEGY: The search strategy sought to find both published and unpublished papers in English language. The search was performed using the following databases: Medline, CINAHL, ERIC, AUSTRUM, APAIS, Sociological Abstract, ProQuest, Dissertation Abstract. In addition, the reference lists and bibliographies of the articles were also hand-searched to identify other studies. Relevant worldwide websites were also searched. METHODOLOGICAL QUALITY: Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument from Qualitative Assessment and Review Instrument (QARI) software developed by the Joanna Briggs Institute (JBI). RESULTS: A total of 12 papers, qualitative, quantitative and textual in nature, were included in the review. Sixty-four papers were identified and 52 papers were excluded as they did not meet the inclusion criteria. There were: three papers utilising qualitative methodology (two phenomenology, one grounded theory), three program evaluation reports, two descriptive studies, and four expert opinions being included. Findings from two qualitative studies utilising a phenomenological approach were extracted and meta-synthesised using JBI-QARI. Two syntheses were derived: (i) overseas nurses find entry into Australian culture very difficult; and (ii) overseas nurses who feel lonely, isolated or 'outsiders' experience difficulty in settling in to nursing in Australia. Findings from other papers were discussed in narrative form. CONCLUSION: The clash of cultures between overseas nurses and the dominant Australian culture should be addressed in a transition program. If strategies to assist overseas nurses to establish informal networks of friends and professional colleagues are in place, the transition to becoming effective practitioners could be greatly enhanced.