Internationally Qualified Nurses’ Perceptions of How the New Zealand Registered Nurse Competency Assessment Programme Enabled Transition to Clinical and Culturally Safe Nursing Practice in Aotearoa New Zealand
Aotearoa New Zealand faces a workforce shortage of nurses nationally. One current approach to address the labour deficit is recruiting internationally qualified nurses (IQNs) into the workforce. Undertaking a competency assessment programme (CAP), entailing targeted study and clinical assessment, supports IQNs to meet Nursing Council of New Zealand requirements for nursing registration in Aotearoa. However, CAP providers offer the course with diverse approaches and there are no standardised curricula. Furthermore, to date, there is no empirical evidence on the utility of the CAP for IQNs regarding how well the programme meets its intended objectives from the perspective of the IQNs. This research aimed to identify the elements of the CAP that a specific cohort of IQNs found relevant and useful in their first two years of working as a registered nurse (RN) in Aotearoa. A secondary aim was to ascertain if, and how, the course was perceived to enhance their acculturation into the Aotearoa nursing profession.
A qualitative research method of focused ethnography framed the methodological approach. Semi-structured interviews occurred with purposive sampling of CAP graduated IQNs from the Philippines and India, representing the largest practising IQN groups nationally. Twelve participants—eight from the Philippines and four from India—with between 3 and 17 years working as RNs in Aotearoa, were recruited from the upper North Island of Aotearoa. Thematic analysis of the data resulted in two main themes describing the participants’ experiences on the CAP: 1. navigating new professional practice and 2. the need for language proficiency and positive social support. Sub-themes arising were unfamiliarity with new clinical areas and nursing roles, feeling deskilled, and misunderstanding the healthcare concepts of cultural safety and te Tiriti O Waitangi. In addition, communication barriers, with English not being a native language, Aotearoa accents and new professional terminology, significantly influenced their experiences. Finally, novel research findings were the participants’ new understandings of the symmetrical power balances between healthcare professionals in Aotearoa and recognition of the importance of the support gained from engaged and knowledgeable clinical preceptors. This research found that the participants did not view their CAP experience as having a significant impact on learning new clinical skills, knowledge, or experience of their host country’s nursing workplace. Additionally, the curricula were not seen to have provided substantial educational and clinical experience benefits regarding the Aotearoa cultural context with the exception of specific cultural practices (Tikanga) and their application to nursing service provision for Māori. Recommendations from the research are for a comprehensive multiple stakeholder review of the current CAP curriculum, specifically regarding the clinical practice model used for recontextualising nursing practice and transitioning IQNs into the Aotearoa workforce, and the provision of targeted te Tiriti O Waitangi healthcare education: and the potential for new registration pathways in-keeping with recent global trends with a focus on key nursing knowledge examinations, and mandatory modules on Aotearoa cultural context. A further recommendation is – the inclusion of extended orientation periods and mandating a period of professional supervision for IQNs in post-registration employment period.