Internationally Educated Nurses' Perceptions of Agency: Implications for Patient Care and Nurse Retention Público
Wheeler, Rebecca M. (2012)
Abstract
Abstract
The purpose of this study was to explore the perspectives of
internationally
educated nurses (IENs) in comparison to those of U.S. nurses about
their ability to
exercise agency in the context of health care in U.S. hospitals.
Specifically, the aims were
to explore the relationship between agency and retention and
quality of care with regard
to pursuit of nursing education and participation in
governance.
The nursing workforce in urban hospitals may consist of a
significant
percentage of IENs. Nurse migration to the United States increased
as hospitals sought
IENs to maintain staffing levels in the face of a national nursing
shortage. It is important
to understand how the perspectives of these nurses regarding their
agency may influence
patient care.
This exploratory, qualitative study framed by structuration theory
consisted of
two phases of semi-structured interviews. In the first, 82 nurses
were recruited from two
urban hospitals in the Southeastern United States: 21 IENs from
each hospital and 20
U.S. RNs. In the second, 40 nurses, 11 IENs from each hospital and
9 U.S. RNs, were re-
interviewed about themes discovered during the first phase. Data
were collected and
analyzed in an iterative process.
Most IENs plan to remain in nursing in the United States until they
retire. Most
initially received associate degrees in nursing, and many obtained
bachelor degrees in the
United States. Few obtained graduate degrees. Like U.S. RNs, most
do not perceive work
on hospital governance committees to be relevant to their roles as
nurses, nor do they
tend to seek promotions. Both IENs and U.S. RNs experienced
discrimination in the
workplace.
IENs may share perspectives similar to those of U.S. RNs because
they have
adapted to the U.S. hospital environment, reproducing what they
observe in the U.S.
RNs. In general, nurses may not pursue further nursing education or
participate in
hospital governance because they value the individual empowerment
they have providing
direct patient care. They may not see the value of collective
empowerment and/or may
not feel they have the knowledge, training and support for roles
that do not involve direct
patient care.
Table of Contents
Table of Contents
Introductory Chapter
1
Manuscript for Publication 1
76
Experiences of Internationally Educated Nurses in the Southeastern
United States
Manuscript for Publication 2
99
Pursuit of Further Education in Nursing: Internationally Educated
Nurses and US
RNs Compared
Manuscript for Publication 3
123
Governance and Professional Advancement: Issues of Empowerment
among
Hospital Nurses
Manuscript for Publication 4
140
Discrimination Experienced by Internationally Educated Nurses and
U.S. Nurses
in Hospitals
Conclusion
165
About this Dissertation
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