Internationally Educated Nurses' Perceptions of Agency: Implications for Patient Care and Nurse Retention 公开

Wheeler, Rebecca M. (2012)

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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

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

Manuscript for Publication 1

Experiences of Internationally Educated Nurses in the Southeastern United States
Manuscript for Publication 2

Pursuit of Further Education in Nursing: Internationally Educated Nurses and US
RNs Compared
Manuscript for Publication 3

Governance and Professional Advancement: Issues of Empowerment among
Hospital Nurses
Manuscript for Publication 4

Discrimination Experienced by Internationally Educated Nurses and U.S. Nurses
in Hospitals


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