The Influences on the Practice of Overseas Registered Nurses Working as Health Care Assistants in Aged Residential Care in New Zealand; Analysed Through the Lens of Pierre Bourdieu

Coates, Debra
Jones, Marion
Wright St-Clair , Valerie
Shannon, Kay
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Doctor of Health Science
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Auckland University of Technology

New Zealand relies on migrant nurses to undertake roles in aged residential care, which appear unattractive to New Zealanders. These roles include registered nurses and health care assistants. Many health care assistants in New Zealand aged residential care are qualified nurses in their countries of origin. This research aims to understand what influences overseas registered nurses' practice when working as healthcare assistants to better support their transition to being registered nurses in New Zealand.

Eleven participants who were overseas registered nurses working as health care assistants in aged residential care in New Zealand, were purposively recruited for this study. Eight participants were from India, and three were from the Philippines. All participants had worked as health care assistants for over six months at the time of the interviews. The interviews were recorded and transcribed verbatim using a professional transcriber. Data analysis involved repeatedly listening to recordings and reading the transcripts. Using the thematic analysis framework by Braun and Clark (2006) and Braun et al. (2019), the transcripts were systematically analysed to code data and cluster these codes into themes.

Bourdieu's theory of practice supported the interpretation of overseas registered nurses' characteristics, dispositions, and attributes developed over time and how these influenced their practice as health care assistants. The knowledge and skills acquired through nurse education and experience also influenced their practice as health care assistants.

Three main themes in the data were: a struggle for power, personal and professional habitus, and a game worth playing. The research revealed a downward trajectory that disempowered the overseas registered nurses, to a position where they felt they did not belong. Some participants explained how fitting in was difficult as they tried to understand the health care assistant role and build relationships with staff and residents.

In conclusion, the findings show that overseas registered nurses are valuable in providing good quality care; they bring many skills and attributes not recognised and valued in aged residential care. The research concurs with previous literature that more support should be available to help transition overseas registered nurses into the workforce in New Zealand. A suggestion is that overseas registered nurses have a pathway similar to the new graduate program in New Zealand. This pathway would provide orientation and integration into the workforce. For those overseas registered nurses who wish to migrate before being eligible to register as a nurse, a program of study or internship which leads to registration would reduce the downward trajectory and loss of cultural capital. An improvement for staff at all levels to have education regarding working with people from other cultures, is also recommended. In particular, it is the responsibility of education providers to ensure this is incorporated into undergraduate degree curricula. The research implies that government agencies such as Immigration New Zealand, the Nursing Council of New Zealand, the tertiary education, and the aged residential care sectors, collaborate to improve the transition experience for overseas registered nurses. This collaboration is particularly significant to ensure the appropriate use of nursing skills in the global nursing shortage and to enhance the upward development of care for older people in New Zealand.

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