Shining a light on refugee nurses

Conflict and war in countries across the world has driven the worst migration crises since WWII, with the number of refugees exceeding 25 million (Rother et al., 2016; United Nations High Commissioner for Refugees, 2016). Unlike “migrants” who are able to freely travel and return home, “refugees” are people who have “a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group” (UNHCR, 2017). Designation as a refugee is granted by the United Nations High Commissioner for Refugees (UNHCR) and some government authorities to individuals who meet certain assessment criteria. Internationally, under the UNHCR resettlement programme, only a few countries have agreed to resettle refugees worldwide (UNHCR, 2017). The reception, repatriation and adaptation of refugees to new host countries have led to ongoing widespread sociopolitical contention and discussion (Dumper, 2007; Geddes & Scholten, 2016). There is recognition in the literature of the health needs of refugees (Agbemenu, Volpe, & Dyer, 2018; Newbold & McKeary, 2017; Willey, Cant, Williams, & McIntyre, 2018). However, there is little literature on the nurses with a refugee background and how they re-establish themselves professionally in a new country. The data on the number of skilled health professionals with nursing qualifications arriving to a new country are seldom collected or often reliable (Australian Bureau of Statistics, 2017; Kingma, 2018). Nurses with refugee backgrounds (“refugee nurses”), as part of their premigration journey, experience significant adversity. They have lost everything, including all control of their livelihood, and many are forcibly removed from their homes and unable to return, fleeing from persecution, trauma and torture. Then, despite having past traumatic experiences, these refugees travel to a new host country for safety, commence resettlement processes and work extremely hard for qualifications in their new home country. This pathway is typical of refugee nurses who live and work among us. There is an abundance of literature on the challenges of engaging and collecting data from refugees (Baird et al., 2017; Clark-Kazak, 2017). However, the number of studies on refugee nurses is limited in comparison with studies on “migrant nurses” or “internationally educated nurses” (IENs). This may be due to the fact that there are proportionately less refugees in the nursing population of many countries. It may also point to a relative invisibility of this group of nursing colleagues in research studies. Methodological issues exist in studies of IENs that pool refugee nurses together with other IENs in sample populations (Newton, Pillay, & Higginbottom, 2012). This is despite the categorical differences between migrants and refugees (UNHCR, 2016). This is also a consequence of a lack of recognition of preresettlement qualifications which further pushes refugee nurses into non-nursing occupations, additional study or securing employment in nursing roles that do not reflect adequately their professional nursing credentials (Brandt, 2010; Dumper, 2002; Smit & Rugunanan, 2014). Historically, the earliest depictions of refugee nurses in the academic literature are in retrospective discussion papers that depict oral histories and sociopolitical accounts of Austrian, German and Soviet Union refugee nurses fleeing Nazi occupation during the 1930s to the end of WWII (Brooks, 2018; Grant, 2014; Stewart, 2003). The findings from these studies of refugee nurses during WWII are not too dissimilar to the experiences of contemporary refugee nurses, as found in a scoping review of international literature (reported in four research studies from 2005–2015). The scoping review explored the factors that impact refugee nurses as they journey to nurse registration in a new host country (Ng Chok, Mannix, Dickson, & Wilkes, 2018). From the review, there were three challenging impact factors: loss of control, shock in a new environmentand bleak employment prospects. In addition, there were three positive impact factors: reconciling a new reality, establishing a new identityand hope for the future. These findings provide some insight into the challenges faced by refugee nurses. Amidst nursing shortages, IENs abroad are commonly encouraged to seek employment to address nursing workforce gaps in various countries (Blythe & Baumann, 2009; Little, 2007). Refugee nurses are potentially another available source to overcome nursing workforce shortages. As nurses with refugee backgrounds themselves, they can bring unique perspectives to their practice. Their overall life experiences position refugee nurses well to provide culturally sensitive and appropriate care to vulnerable populations of refugees that are increasing in numbers globally. Refugee nurses have unique insights as they too have experienced being a newly arrived refugee and understand the nuances of what it is like for a refugee experiencing and navigating a new country and healthcare system for the first time. Barriers to employment do exist for refugee nurses, and there is evidence of refugee nurses experiencing discrimination and feeling demeaned and degraded in the workplace (Casimiro, Hancock, & Northcote, 2007; Winkelmann-Gleed & Seeley, 2005). Strategies to support the professional and personal development of refugee nurses are essential and will help provide the confidence and self-assurance to allow them to thrive as health professionals in their new home country. Promoting a welcoming workplace environment among healthcare staff for newly employed refugee nurses will support positive experiences. Providing opportunities at appropriate nursing forums for refugee nurses to volunteer to share and showcase their untold stories of resettlement and re-establishing their professional identities could provide greater insight and understanding among the profession. In addition, recognising the contributions of refugee nurses in health care during national weeks that celebrate and recognise refugees would also be beneficial to the wider community. These types of awareness-raising activities among the community and the healthcare system may encourage greater understanding of the journey taken by the refugee nurses and highlight barriers and provide insight into overcoming these obstacles. In the age of heroes and heroines, refugee nurses are truly remarkable individuals who embody hope, survival and resilience. Their inherent strength and commitment to providing compassionate care towards strangers despite their traumatic pasts and in environments that may be xenophobic cannot be overlooked. With the inevitable rise of refugees arriving with nursing qualifications, it may well be in the best interests of various governments and associated entities to support refugee nurses to reach their full potential in an ever-growing culturally diverse and complex healthcare system.