Easing the Cultural Transition for Internationally Educated Nurses

As more foreign educated nurses are working in US hospitals, health care organizations and settings are going to need to address some of the barriers that are preventing these highly skilled nurses from making a smooth transition to their workplace.

Penny Pattalitan, EdD, MSN, ARNP, FNP,BC, RN, found the discrepancies to be so prevalent, she studied what might help foreign educated nurses (her study focused on Filipino nurses) become assimilated faster when they start working in the United States and how hospitals can support the transition. The need is as great in number as it is pressing in time. With an aging and increasingly diverse US population, internationally educated nurses will fill a projected staffing gap and will more closely reflect portions of the population, which can lead to better patient outcomes, especially among ethnically diverse populations. 

Pattalitan, an associate professor at the Chamberlain College of Nursing in the Miramar, Fla., campus, came to the US after graduating with a nursing degree in the Philippines. “It was a challenge,” she recalls, as she was treated as a new nurse, not one with the experience she actually had. “There were lots of challenges with how they perceived graduates from international schools,” she says.

So when Pattalitan set out to study the root of the issue, she first compared the educational systems in the Philippines and the US. “There is not much difference,” she says, noting that in the Philippines some of the work, especially related to community health, was even more intense than in the US. But US nurses had more autonomy and were used to making more patient care decisions.

But the cultural differences that make practicing as a nurse in the US challenging can be rectified.

Pattalitan found five major factors that impact the acculturation of foreign educated nurses. By doing so, she identified ways that hospitals can begin to recognize how those factors influence the ways nurses assimilate to a new working environment.

Staff support ranks high for a successful acculturation to the working environment. Placing even above things like language, how nurses were accepted into a unit and how they were treated was a big influence on their successful acculturation.

In addition, language, including both the language difference and accents, can present barriers to clear communication.

There is also a difference in clinical settings and clinical orientation that make a big impact, specifically the prevalent use of computers in the US and the paper-based system in some areas of the Philippines. In addition, the US has protocols for different units where in the Philippines, it is often one unit. “It takes a while for nurses to adjust to that,” says Pattalitan.

Nurses also found operating machinery or technology they had not used before took some getting used to and some practice.

But Pattalitan also identified certain areas where medical settings can help ease the transition. Training in machinery and technology is vital, as is a cultural orientation. Nurses also wanted to have more training on physical assessments, management of diseases, especially the acute cases that are more common in the US, and a review of medication administration and technology. Nurses in the US have much more autonomy than do nurses in the Philippines, who often wait for a doctor to give the final word on treatment.

For now, Pattalitan says this is an important step. “It will benefit the Filipino nursing graduates who will work in the settings and it will benefit the hospitals that are employing the nurses,” says Pattalitan. “[Awareness] will facilitate the process.”

Pattalitan is excited to see her research produce identifiable barriers and potential solutions. Further studies will explore the acculturation of other international nursing populations as well.

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