title: Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study.
abstract: BACKGROUND
  Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse.
  
  
  OBJECTIVE
  The aim of this study was to examine interplaying relationships between social structures and nurses' actions that either enabled or inhibited workforce integration in hospital settings.
  
  
  METHODS
  Giddens' Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses' perceptions of factors affecting workforce integration.
  
  
  RESULTS
  Four themes were identified from the data. These were: (1) employer-sponsored visa as a constraint on adaptation, (2) two-way learning and adaptation in multicultural teams, (3) unacknowledged experiences and expertise as barriers to integration, and (4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses' performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations.
  
  
  CONCLUSIONS
  Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host country. Learning from each other in multicultural teams and positive intergroup interaction in promoting intercultural understanding are enablers contributing to immigrant nurses' adaptation and workforce integration.
authors.affiliation: School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Electronic address: lily.xiao@flinders.edu.au.
authors.forename: Lily Dongxia
authors.initials: LD
authors.lastname: Xiao
authors.affiliation: School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Electronic address: eileen.willis@flinders.edu.au.
authors.forename: Eileen
authors.initials: E
authors.lastname: Willis
authors.affiliation: Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia. Electronic address: lesley.jeffers@health.sa.gov.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Jeffers
mesh_terms: D001315:Australia; D004641:Emigration and Immigration; D009740:Nursing Staff
keywords: Cultural diversity; Double hermeneutic; Health care organizations; Hospital nursing staff; Immigrant nurses; Nursing administration research