http://www.nursing.health.wa.gov.au/overseas/index.cfm
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The Author of this blog is working as a Nurse in WA since 2006 after immigrating from Switzerland and is happy to share infos and work experience with you. Just contact me Email: marianne@success-coaching.org

   WA Health has launched a new nursing and midwifery advertising campaign

WA Health has launched a new nursing and midwifery advertising campaign to target university and school-aged students, and nurses and midwives who have left the workforce.  (But also to attract overseas nurses to make the move and provide easy accessable information : http://www.nursing.health.wa.gov.au/overseas/index.cfm

The campaign, ‘Nursing. It can take you anywhere’, will run on TV, in the cinema and on radio over the coming months, as well as being featured in a range of press. You can view the television commercial at www.nursing.health.wa.gov.au

The campaign aims to:

1. increase the desirability of nursing and midwifery as a career, and
2. encourage nurses and midwives to re-enter the public health system

This campaign supports a range of initiatives being developed by WA Health, including increased post graduate scholarships, graduate transition funding and the establishment of a Hospital Nurses Support Fund to value and support nurses and midwives.

The Nursing and Midwifery in Western Australia website has also been redeveloped and now contains information for the whole community; especially those thinking about becoming a nurse or midwife, wanting to get back into the workforce, moving to WA Heath from overseas or those currently employed by WA Heath. Please visit the website at www.nursing.health.wa.gov.au

Associate Professor Di Twigg
Acting Chief Nursing and Midwifery Officer

Source: official email to me (Author of this Blog) Jan. 09 as a  WA Governm Employee

Aim of literature analysis

(Part of research proposal Marianne Rentsch, Perth, Australia, 2007)

The author of this literature review found it is important to explore and understand the phenomena of lived experience of the so called culturally linguistically diverse (CALD) or non-English speaking background (NESB) nurses,  and  addresses to rise awareness and that support can be established to enable CALD nurses to contribute their unique competences within the Australian nursing work force.

4. Literature review

The aim of this literature review was to identify issues and challenges of NESB nurses in their transition to the Australian work place based on past research findings. Five qualitative phenomenological studies were found, two were not available as full text and one did not match to the topic under investigation. Thus, the findings of two qualitative-phenomenological studies (Jackson, 1996, Omeri & Atkins, 2002) conducted in NSW in 1996 and 2001) are analysed and discussed. The first chapter outlines the literature search strategies and provides an introduction to the found qualitative studies as well as the critical analysis of its design and reliability. The following chapters then present research findings complemented with expert statements grouped into the umbrella themes: Language barrier / silencing, loneliness, lack of support, differences in nursing practice, otherness / discrimination, context issue culture shock / adjustment and finding comfort / support.

The literature search was conducted by using the databases CINAL Plus, Pro Quest 5000 International, Australian Bureau of Statistic, APAIS-Health, AGIS Plus Text, ECU Library catalogue and databases, Medscape, Google Advanced Scholar Search, Google. Furthermore to identify other studies citation tracing using the reference lists of retrieved articles was conducted. The search terms and key words used were: overseas nurses, immigrating nurses, health professionals, skilled migration, immigration, immigrants, nursing recruitment, overseas recruitment, transition, cultural adaptation, culture shock, language, language barrier, to Australia, Australia.

4.1 Language barrier / silencing

“The language is a fabric of a culture or social environment, that may convey meanings known only to those who live in that culture.” (Josipovic, 2000 cited in Jeon & Chenoweth, 2007, p. 18). Leiniger (1970) applies this to nursing practise and postulates that the knowledge of language will enable nurses to apply interactions and care in its diverse settings and lead to “cultural understanding hence better care” (cited in Omeri, 2006, p. 57). Various research findings point out that a language barrier was a major cause of CALD nurses work dissatisfaction (Jeon & Chenoweth 2007, p. 19, referring to Lee, 2004 and NSW Health, 2001). Language and communication difficulties is judged to be a core problem contributing to transitional stress (Chiswick, Lee & Miller 2006; DEST, 2007, Chapter 7.1.4; Hawthorne, 2001, p.227; Jackson, 1996, p.123; Leiniger 1970, cited in Omeri, 2006 p. 56;Narchal, 2007, p. 60; Omeri & Atkins, 2002, p. 502) and is described as silencing. Despite the OET and IELTS requirements for nursing registration many CALD nurses struggle with ineffective communication, abbreviations, professional terminology, jargon, ability to communicate with staff and patients and the style of Australian nursing notes (Hawthorne, 1997, cited in Konno, 2006, p. 96). In addition, Palmer (1989) emphasised that pronunciation is a crucial factor in both understanding and being understood at work. Nurses found local accents extremely difficult to understand and that nurses in Australia used a “highly complex language in clinical settings” (cited in Omeri & Atkins, 2002, p. 502). Omeri and Atkins described this as “being silent” and view this as a core factor in hindering transition. To sum it up, the core issue for NESB nurse’s transition is described to be “their command of English and the general lack of communication support programs available in the health system” (Jeon & Chenoweth, 2007, p.18). Evidence for this is drawn from the following quotes of study subjects:

“It was stressful, language was a problem, have to concentrate very hard… to understand, so very often I did have a stress headache from concentrating…trying to understand what people were saying. People speck so quickly and some people get annoyed when you ask them to repeat what they have said, some they just mutter and walk away from you and then you follow that person and try to understand but they angry and you feel it or should you just forget the whole thing? But it could be important for the patient, so it is all very stressful.” (Jackson, 1996, p. 123)

“It is not knowledge that is the problem, it is things like how to deal with the jargon and the slang and abbreviations…”(Jackson, 1996, p.123)

“I need a lot of concentration. When I am writing a report I like to go to a quiet room. I can’t write when it is crowded and every body is chatting.” (Omeri & Atkins, 2002, p.503)

4.2 Loneliness

Loneliness is understood to be a “manifestation of adjustment difficulties” with the potential of serious consequences induced by distress and “aversive valuing” (DiTommaso, Brannern-McNutly & Best, 2004, cited in Narchal, 2007, p. 56). Narchal adds by citing Hughes, Waite, Hawkley et al. (2004) that the core experience of loneliness is defined as “being isolated socially and absent from relation of collective connectedness” (p. 56). He further presents that silencing due to language barriers was reported to be a very isolating factor (p. 60). Omeri and Atkins demonstrate that their subjects experienced loneliness in several dimensions. It first accounted for the “settling down period” after immigrating to and being cut off from family and friends. This was intensified by lack of support from “main-stream services and other cultural specific groups” (2002, p. 501). This is demonstrated in the following quotes:

“…I got withdrawn [at work] and I think that this was because I had nobody to share it with, much of the day I was totally alone and I was nervous to approach people…” (Jackson, 1996, p. 123)

“You feel you can’t really relate to other people so it can make you lonely, you can’t depend on other people, you’re sort of on your own and you’re not understood by other people.” (Narchal, 2007, p. 59)

4. 3 Lack of support

Adjustment to the new workplace usually happens “through various trial and error techniques” in positive and negative ways (Jeon & Chenoweth, 2007, p.18). They introduce the support guide supplied by Alexis and Chamberts (2003) for overseas nurses which aims to empower them by introducing them to the Australian health care services structure, policies, nursing practise and so on as well as to outline effective learning strategies and ways for practical, social and financial aspects of living in a foreign country (p.20). Lack of support, lack of direction and loneliness in professional settings is one of CALD nurses’ core statements (Omeri & Atkins, 2002, p. 55) and is defined as professional negation. Such a view is expressed in the following quote:

“I don’t have people to ask how to do these things and they make me feel much more outside and much more isolated because if I can’t get these things right…” (Narchal, 2007, p. 59)

4. 4 Differences in nursing practice

Overseas nurses need to adapt to the new and different work environment to become able to successfully integrate. Australia has an expansive health system and unique staff rights/responsibilities, policies, nursing medical procedures, interaction modus with colleagues and interdisciplinary teams as well as the range of agencies (Jeon & Chenoweth, 2007, p. 18). “Health and illness care practise are shaped by cultural values, and beliefs” (Leiniger, 1970, cited in Omeri, 2006, p. 56). There are significant differences in the performance of nursing duties and work ethics around the world. Depending on the cultural framework nursing care may address mainly daily living activities and patients are highly dependant on the caring nurse whereas in other countries those tasks are seen as a family responsibility. Nursing in Australia is based on the mono-cultural Anglo-Saxon concept of nursing and is performed in quite a technical- instrumental way and is orientated on the medical model.(DEST, n.d., Chapter 7.7). Thus, according to CALD nurses origin and cultural model it will be more or less challenging to adapt to the Australian way of nursing, with its heightened extent of patient self-care and western nursing culture (Omeri, 2006, p. 56). DEST advanced arguments that CALD nurses are best able to offer the urgently needed competent culturally sensitive care but ironically often “encounter[s] barriers when trying to meet current Australian competency standards.” (n.d., Chapter 7.7). A subject expressed this as:

“It is not the knowledge that is the problem, it is things like…new equipment and technology, you just need someone at your elbow to give you advice and to also give you confidence. You see it is the fear, it is crippling after a while. You are so scared…(Jackson, 1996, p. 123)

4. 5 Otherness / discrimination

Cultural barriers are described to be a major factor influencing the scope of psychological distress and therefore transition (DEST, n.d., Chapter 7.1.4). On the other hand, “lack of cultural awareness and respect for cultural differences” towards immigrant nurses is deemed to contribute towards misunderstandings (Jeon & Chenoweth, 2007, p.19). High levels of inter-collegial bullying, separateness, lack of equal opportunities, aggression and discrimination was found in many studies in Australia (Hawthorne, 2001; Omeri & Atkins, 2002, Jackson, 1996). Hence, to be an immigrant CALD nurse includes being in a vulnerable situation, particularly if belonging to a ethnic minority (Omeri, 2006, p. 54). This is caused either by interpersonal distress or discrimination. Hawthorne (2001, p. 227) highlights his  findings that especially NESB nurses from Commonwealth Asia “spontaneously reported a serious and discomforting level of Australian nurse peer rejection”, as observed in the following excerpts.

“I still remember one hospital… They told me the best way is to go back to where you come from. I wept all the way home.” (Omeri & Atkins, 2002, 502)

“Well, after a while I realized that even if we are a very egalitarian society, I am a second class citizen. I still feel like that and this is because of the fact that I come form a different culture. With different ideas and language. And regardless of how well I speak I am still treated as stranger” (Omeri & Atkins, 2002, 502)

4. 6 Culture shock / adjusting

The uncomfortable role of being a stranger is described as a separate dimension besides the stress of being a nurse challenged to deal with a different culture in a new country. Its origin is regarded to be grounded in the phenomenon, culture shock (Jackson, 1996, p. 123). Transition to the work environment is rather seen as one aspect of the phenomenon of culture shock than vice versa and is therefore explored to set the context of CALD nurses transition.. The phenomenon of culture shock was first described by Oberg (1954 cited by Wikipedia) and describes experiencing anxiety and feelings of surprise, disorientation, and confusion if individuals are confronted to deal with an “entirely different culture or social environment.” It proceeds in phases such as vacation-honeymoon, denial, anger, escape, depression and adjustment (Oberg (1954) or anxiety, elation, culture shock, superficial adjustment, depression-frustration, acceptance of new culture (Rhinesmisth, cited by ECU). Various degrees of homesickness, longing for one’s old job, desire to avoid unpleasant interactions, physical complaints and sleep disturbance, depression, feeling of helplessness, vulnerability, powerlessness, loss of identity, difficulties to concentrate, inability to solve problems, lack of confidence, developing obsessions, loss of sense of humour, boredom or fatigue, and hostility (Travaglia, 2000, p. 5). Yi and Jezewski (2000, cited in Leon & Vhenoweth, 2007, p. 18-19) describe CALD nurses adjustment to proceed in two chronological phases. The initial stage is described to deal with coping stress, language problems and accepting the new style of nursing practice and this lasts for the first two to three years. This is followed by the second phase where adoption to the new style of problem solving and developing interpersonal relationships occurs, which may last for five to ten years. Pilette (1989) accounts the first 12 months to be the process of “making acquaintances, dealing with indignation, conflict resolution and integration” (cited in Leon & Vhenoweth, 2007, p. 18-19). Excerpts taken from Narchal’s (2007) study demonstrate this:

“I think it felt alien, I think we weren’t expecting it to be such a culture shock. And I think that it was that shock of, the rules are different, the way that people make friends is different, that way that , how do you use public transport, everything was…I felt like I knew nothing and I think that was the most difficult in terms of loneliness because I felt like, I don’t know how I’m going to …(Narchal, 2007, p. 60)

“Everything that was happening during my first year here was completely unlike me before an unlike me now so that was a new experience. Feeling lonely, desperate, very frequently I felt kike going back home also…that is unlike me and I knew if I went home at that time that would be giving up but I did think about that”. (Narchal, 2007, p. 60)

4.7 Finding comfort / support

Migrants are challenged to rediscover themselves and seem to have the choice to “assimilate or alienate” (Narchal, 2007 p. 62). He further stresses that assimilation demands coping with loss and establishment of new relationships. Jackson (1996, p. 124) explained that comfort was found if informal networks among CALD nurses were found. Especially, empathy based on shared experiences provided support and comfort, unfortunately some missed that simply because they did not encounter any other CALD nurse. Some nurses developed over time a “sense of belonging and ownership” and began to witness, understand and rationalise that local nurses were also encountering unfriendliness and aggression from colleagues. This realisation helped CALD nurses to make meaning of some lived experiences and enabled them to become more supportive and warm towards new (CALD) staff. The excerpts below demonstrate resolution of the need for comfort and support.

“I know some nurses from X [country of origin]. They’re here working in this hospital…I can come home from work and talk so someone and they can understand my feelings. Most of the had the similar experiences to me…” Jackson, 1996, p. 124)

“Yes, I don’t feel offended anymore. I used to feel offended if someone just asked where are you coming from? That is so innocent and simply a question…(Narchal, 2007, p. 61)

The review of literature presents that CALD nurses were more or less challenged by their transition to the Australian work place. This may also apply to the contextual phenomenon of culture shock in which adjustment to work is embedded. Experiences of transition difficulties seemed to have its origin and scope mainly according the participant’s English language ability, scope of differences in work practise, distance from own to Australian culture and their place of origin. The triggered reactions were experienced as distress, loneliness, otherness and discrimination. Lack of support, peer rejection, inequality and discrimination was judged to be caused by lack of cultural awareness and acceptance among the Australian health work force. However, some NESB nurses found comfort by sharing their experience with CALD peers.

Please leave a comment or contact me if you have any questions or want to share your experience by making a comment on this Blog or Email me: Marianne@success-coaching.org

I have a dream…

I have a dream that all children growing up in a safe and loving environment where their unique gifts are acknowledged and developed as they grow mentally and physically into their greater mission

I have a dream that human beings, animals, flowers, and all of nature are going to be our main focus and materialism is used to save our environment instead of destroy it.

I have a dream that more people seek to access their full potential and start living their divine mission. That a wave of love, generosity, goodness, kindness, happiness, support and deep inner joy overflows amongst humans throughout the world.

I have a dream for a world basking in deep inner peace, happiness and love.

Are you living your true potential? What gifts lie dormant in you?

Many people feel overwhelmed, restless, depressed and even scared, because of the current world economic crisis.

Others who have achieved great success when the economy was booming are now beginning to worry about their job and career.

Some might have had wonderful dreams of how they were going to contribute to the world or live in luxury. But adversity struck or life just happened in another direction, and the dreams faded away…

I believe it is a tragedy. The world is full of people with hidden gifts, talent, skills and exiting dreams who are settling for less.

The world needs illumination! People need to reawaken their dreamer to create an outstanding, and joy filled future.

Illumination can change the mindset of humankind and with it the world. A mental reawakening can and new solutions to threatening problems such as global warming, loss of love and support in families and society…

Illumination will touch hearts, awaken the ‘possibility’ in people, enable them to access the genius within, and create a new way of living in abundance full of love, happiness, joy, vibrant health.  This will be the breakthrough to get a glimpse of heaven here on earth.

Every one of us is born with a divine potential and a unique life purpose.

Everybody is meant to be here and has a unique mission to fulfil.

However, most people feel a vacuum in the place of these gifts. People are aware that there is ‘something’ missing and they feel the pain of this. They search for pain relief in the form of TV, over work, alcohol, drugs, food…  

As a result, divine talents are wasted. Instead of flourishing they are stagnating… 

I believe that everybody, that YOU, are here to fulfil a divine mission which only you can accomplish.

Are you living your true potential? What gifts lie dormant in you?

Would you like to start dreaming again? Do you long to access your true potential?

We are here for you, we are looking forward to hearing from you.

Helping People to Discover Their Full Potential & get True and Lasting Momentum.

www.success-coaching.org/

Immigration is a critical event in a person’s life and may include experiences such as culture shock and difficulties in transition to the new work place in Australia. Up until now, there has been little done to support CALD nurses in their transition, although Jackson (1996, p. 124) highlighted that comfort and support was found if sharing of the lived experience was possible with other CALD nurses.

Immigrant nurses with culturally and linguistically diverse backgrounds commonly experience a range of difficulties in their transition to their new workplaces in Australia. Studies in NSW explored this phenomenon and found that the core issues were language barriers, feeling lonely and experiencing otherness, discrimination, lack of support, and unfamiliarity with local nursing practise.

On the other hand comfort was found if sharing of their lived experiences with other non-English speaking background nurses was possible. Some of the experiences may be partly due to culture shock, other are linked to individual and environmental stressors in adapting to the new life and work environment in Australia. Adjustment was mainly mastered by overcoming the first difficult year and becoming able to rationalise the experiences as there are no specific support programs so far.

Moreover, since the nursing shortage is a current and future topic of concern, it is crucial to enable immigrant nurses to join the Australian nursing work force, as their cultural and linguistic competencies will be beneficial in caring for Australia’s multicultural population.

Bio Marianne

Marianne grew up in a small country village in the Swiss Emmenthal. In 2006 she put her dream of moving to Australia into reality and emigrated to Perth. This move to leave her comfort-zone in Switzerland, her desire for continuous self-development, as well as her excitement and determination toward reaching her goals reflects the challenges that Marianne readily embraces.

Marianne is an open hearted person who is interested in people, cultures and in making the world a better place. She lives out her dreams such as spending time at the beach, discovering Australia’s native environment but more than anything she enjoys supporting motivated individuals on their journey of healing and success.

Marianne has over 20 years experience as a nurse, working approximately 12 years in mental health/drug addiction. In 2007 Marianne graduated as a Post Graduate Mental Health Nurse at ECU, Western Australia. She loves her vocation as a nurse as it provides a great opportunity to empower people by using her coaching skills. These can contribute to better self-esteem, improved relationships with family and friends, finding visions and assisting in achieving a dream life.

At present she is benefiting greatly from the education and mentor-coaching with Beyond Success and is embracing the opportunity to find the freedom to live to her full potential and meeting like-minded people .

If you have any questions or comments, please feel free to contact me by making a comment on this blog or email me: marianne@success-coaching.org

The Department of Health was today releasing their annual nurses count and feedback in order to understand the current and future nursing and midwifery workforce. In their information they referred to numbers of the 2007 WA Nursing and Midwifery Labour Force Census and state that there were 30 000 plus nurses and midwives registered with the Nurses and Midwifery Board of WA. 

They highlight that WA is experiencing a nursing shortage and that the demand is set to increase particularly due to the ageing nursing workforce.

It also demonstrated that in the permanent employed workforce nurses worked approximately 24 hours per week (100% equals 38 hours a week with 6 weeks annual leave/”paid holiday”) and that 25% of the WA nursing and midwifery workforce were trained overseas (Letter from the Department of Health, Oct. 08).

 Introduction (Research proposal Marianne Rentsch, 2007)

In 2007 a newspaper headline  “Western Australia faces skills crises for another 10 years” aptly captured the present and future concern about a nursing shortage (Banks, 2007). In this article, Banks, argued that given the current economic growth, chronic shortages of teachers and nurse are likely to continue until 2016. Further, he cites that the West Australian government predicts that at least 180 000 skilled workers will be needed within the next decade. The Mental Health Division at a recent Service Provider Forum in Perth stated that the Department of Health is attempting to recruit overseas nurses to fill the gaps and increasing demand for more nurses (Trish Sullivan, Personal Communication, September 7. 2007). The Department of Immigration and Citizenship identify on their immigration web-page, nurses and doctors as the most needed professionals and provides a faster visa processing procedure for potential migrants in these categories. A shortfall of 40 000 nurses is projected by 2010 (Department of Education, Science and Training (DEST), 2002 cited by Jeon & Chenoweth, 2007, p. 21). Jeon and Chenoweth (2007, p. 17) further present unpublished data (DIMIA, 2004)  that up to 30% of the Australian nursing workforce was born overseas and about 7.4% of them were from culturally and linguistically diverse backgrounds. Importantly, overseas trained nurses are considered “valuable assets” within the labour market and are regarded as highly motivated and educated (Hawthorn, 2001, cited in Omeri, 2006, p. 56). Omeri, (2006) further adds that the majority of overseas nurses pass seamlessly into employment, with the exception of non English speaking background nurses. But, culturally and linguistically diverse nurses are reported to experience significant difficulties in their transition to the new work environment (Jackson, 1996; Omeri & Atkins, 2002) or even become lost to the workforce. Hence, it is important to explore and understand the phenomena of lived experience of the so called culturally linguistically diverse (CALD) or non-English speaking background (NESB) nurses so that awareness and support can be established to enable them to contribute their unique competences within the Australian nursing work force. (The terms culturally and linguistically diverse (CALD) and non English speaking background (NESB) are used to describe nurses who are working in a foreign country where a language other than their mother tongue is dominant).

Immigration situation in Australia / Nurses

According to unpublished data from the Department of Immigration and Multicultural and Indigenous Affairs (2004) the number of immigrant overseas trained nurses nearly tripled between 2000 and 2004 (cited in Jeon & Chenoweth, 2007, p. 17). In 1996 the Australian Institute of Health and Welfare (1999, cited in Omeri & Atkins 2002, p. 496) reported that 23.6 % of all qualified nurses were born outside Australia, including 7.4% from a non-English speaking background. Statistics from 1982 to 1994 indicate that the sources of immigrant nurses were as follows: 48% from the UK/Ireland, 25% from Asia, 12% NZ/Oceania and various countries all over the world (Hawthorne, 2000, cited in Hawthorne, 2001, p. 217). The phenomenon of a growing CALD workforce within this group is seen to be a result of the global nursing shortage (Jeon & Chenoweth, 2007, p. 17). The dilemma is that the CALD nurses were found to experience difficulties in transition that seemed to be caused mainly by language and cultural barriers (DEST, 2007, Chapter 7.1.4). However, the situation might have changed over time due to increased cultural awareness and acceptance as well as rise in numbers of skilled migration (Australian Bureau of Statistic, 2006). Nowadays, nurses are required to prove a high level of English language ability in by passing the International English Language Test System (IELTS) with a score of seven or Occupational English Test (OET) grade B for the professional licence to practise with the Australian Nursing & Midwifery Council (ANMC) (n.d.) and the state nursing board’s registration, before applying for a skilled visa DIAC (n.d.). In the past the English language test was judged to have prevented 67% of CALD nurses % from outside Australia and 41% of those in Australia from applying for nursing registration (Hawthorne & Toth, cited in Hawthorne, 2001, p. 222). They further report that only 29% of CALD nurses gained nursing registration immediately without attending a bridging program, and of those required to complete competency-based bridging programs 90-95% had passed in Victoria whereas only 55-71% passed in NSW. Despite having passed the hurdles of the English language test, professional recognition and visa conditions that determine successful transition to the new Australian work place, is sill experienced as a huge challenge. Therefore, some NESB nurses end up working as Nursing Assistants or are even lost to the nursing work force (DEST, Chapter 7.1.4; authors observation). DEST therefore postulates that bilingual/cultural skills should be better integrated and more valued and that support and encouragement is needed, “rather than perceiving their other language as an impediment or embarrassment to be denied or ignored”(Chapter 7.1.3).  (Background of research proposal, Marianne Rentsch, Nov. 2007)