Internationally Educated Nurses in U.S. Practice

Communication Barriers

Nursing is a deeply personal endeavor. Strong verbal and nonverbal communication skills are essential to truly understanding and meeting patient needs. Although internationally educated nurses must pass an English proficiency exam, subtle communication cues, slang, and acronyms can still create barriers to effective communication.

Culture

Starting a new job in a different country can be challenging. Many internationally educated nurses face feelings of loneliness and homesickness, as well as adjusting to unfamiliar foods, climates, and everyday tasks that we often take for granted. Almost every aspect of their work and home environments may be different.

CARE Systems

The U.S. healthcare system stands out compared to other countries' systems, creating a significant learning curve. Dr. Padilla illustrates this with the acronym “CARE,” which encompasses the following components:³

• Clients: Understanding client roles and rights
• Access: Identifying barriers to treatment
• Roles and Responsibilities: Clarifying the scope of practice
  for nurses
• Equipment: Utilizing tools and technology for clinical practice

Bias in the Workplace

Dr. Padilla does not address the issue of bias in the workplace. Bias can be overt or subtle, often stemming from preconceived notions about internationally educated nurses. A prevalent assumption is that IENs may be less educated than their U.S. counterparts, though this may not be true for everyone. By recognizing and acknowledging these preconceived attitudes, we can foster a workplace environment free of bias and inclusive of IENs.

Transition Programs for IENs

Various credential evaluation agencies, staffing firms, universities, and healthcare providers have enhanced their recruitment and training programs to facilitate the transition for IENs living and practicing in the U.S.

Staffing Firms

International staffing and recruiting agencies are vital in assisting IENs with their nursing practice in the U.S. They provide support in several key areas:

• Evaluation Services: Help with CGFNS International education and experience evaluation.
• Visa and Immigration Assistance: Guidance on obtaining visas (e.g., H-1B or permanent resident documentation) to work legally in the U.S.
• Licensing Exam Preparation: Resources and support for preparing for the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
• Job Placement: Matching employment opportunities based on skills, experience, visa sponsorship, location, and assistance in negotiating fair compensation and benefits.
• Orientation and Mentorship: Onboarding programs and mentorship to help IENs transition into U.S. culture.

IENs are encouraged to thoroughly research and compare agencies that align with their personal and professional goals.

Colleges and Universities

In addition to staffing agencies, nursing programs at colleges and universities provide significant support for IENs:

• Bridge Programs: Specifically designed for IENs, these programs bridge the gap between foreign education and U.S. nursing standards, often including coursework, clinical experiences, and NCLEX preparation.
• RN-to-BSN Programs: These programs aid in the transition from an associate degree to a bachelor's degree in nursing, enhancing career advancement and leadership opportunities.
• Scholarship and Financial Aid Programs: Financial assistance can help alleviate the costs associated with additional education and the licensure process.
• Collaboration with Local Healthcare Systems: Partnerships with healthcare institutions often create employment opportunities for IENs.

Nursing programs and healthcare institutions are important in supporting IENs through successful licensure and integration into the U.S. nursing workforce.

Healthcare Providers

Healthcare providers are instrumental in welcoming and supporting IENs post-licensure. They offer support through:

• Mentorship Programs: Pairing IENs with experienced nurses provides essential guidance as they adjust to cultural nuances and the U.S. healthcare system.
• Culturally Sensitive Onboarding and Orientation: It is crucial to address the specific needs of IENs, including cultural differences and language barriers. This may include offering translation services and cultural sensitivity training for staff.
• Ongoing Professional Development: Continuing education opportunities focused on U.S. healthcare regulations, specific specialties, and cultural competence help IENs stay informed and broaden their knowledge.
• Support Groups and Networking Opportunities: These events allow IENs to connect with colleagues, share experiences, and foster community.

Through effective onboarding and professional support programs, healthcare providers can smooth the transition for IENs into their new environment and strengthen their teams.

The Research on Transition Programs

Transition programs for internationally educated nurses have shown promising results. A 2022 study examined the effectiveness of these programs in helping IENs acclimate to the U.S. healthcare system.⁴ IENs who participated in a 5-week clinical and cultural transition program, which included logistical support for migration, were assessed by nurse leaders after their first 90 days of employment. The findings were encouraging, indicating that transition programs, combined with ongoing support, can enhance the development of IENs as competent care providers and streamline their path to licensure.

“Because we were nurses for over 10 years, we were required to be trained for 1 month only. I would say it really helped since our senior nurses were really accommodating, helpful, understanding, and patient with our learning adjustments.” — Leona O., an IEN from the Philippines

UWorld Nursing’s NCLEX Prep Resources

Limited research has been conducted on how international nursing students adapt to U.S. educational systems and how internationally educated nurses transition into U.S. practice. However, growing evidence suggests that resources such as UWorld can be highly beneficial.

• Our question banks (QBanks) include evolving case studies and practice questions designed to closely resemble the NCLEX format, which has been shown to improve student performance.⁶
• A cross-sectional survey of internationally educated nurses preparing for licensure in Canada noted a similar trend.⁷ This study indicated that a combination of professional experience and guided study resources significantly predicts success on first-attempt licensure exams.

Our QBanks specifically cater to this need by providing NCLEX-style questions and detailed answer explanations crafted by practicing nurse educators. Internal data suggests that this evidence-based approach, utilizing NCLEX-style content, enhances students' clinical understanding.

We attribute our enhanced performance to our item development process. While our primary goal is to prepare students from all backgrounds for their licensure exams, our greater focus is on fostering the clinical reasoning and judgment skills essential for providing quality patient care. We accomplish this through:

• Evidence-based, culturally sensitive content that aligns with national clinical standards
• Exam items created by practicing nurse educators from across the U.S. and Canada
• A thorough review process involving nurse and physician panels to ensure accuracy, clinical relevance, and lasting value
• An unbiased, entry-level focus that establishes a strong clinical foundation for nurses from diverse backgrounds and specialties
• Ongoing updates and enhancements to maintain item accuracy and usefulness