Nurse Leaders’ Strategies and Tool Kit For Internationally Educated Filipino Nurses’ Transition to Practice in the United States

Nurse leaders and health care workers working with IEFNs in various health care settings have positive experiences with IEFNs’ work ethic. They are hardworking, dependable, and compassionate and caring to their patients. Filipino nurses are courageous to leave their native country and their families to help their families in the Philippines. They want to better themselves personally and professionally. My personal experience working with fellow IEFNs has been rich and rewarding. They want to participate in unit- and house-wide committees or councils. With nurse managers’ encouragement, they take leadership roles in committees, which results in positive patient outcomes. As in any successful unit- or house-wide committee, they need to be provided with time to either attend or conduct meetings and work on significant projects, and they learn to present positive outcomes in front of their fellow nurses and coworkers with confidence. These IEFNs are bachelor of science in nursing graduates in the Philippines and have been educated using US textbooks and nursing journals.

In an ethnographic study, Spangler investigated 26 nurses’ nursing care values and caregiving practices. The nurses in this group espoused a professional obligation to care. The nurses expressed seriousness and dedication to work, which was derived from a sense of duty, having a conscience to do right, and having a vocational commitment to work. The nurses articulated attentiveness to patients’ physical comfort and possessed a great deal of respect and patience for patients’ needs. Filipino-American nurses’ dedication and commitment to service are congruent and consistent with Filipino cultural traditions, which include respect for authority and social interests. I have experience working with IEFNs, and they are very respectful to their managers, educators, and coworkers. They are nonconfrontational and want to meet the preferences of their patients and families. As an IEFN myself, I believe that IEFNs came to the United States with the purpose, not only to better themselves and help their families in the PH, but more than ever, to also contribute significant outcomes to health care, society, and the communities they serve. They want to be successful in their transition to US practice. They have deep faith, positive attitudes, and a pursuit of lifelong learning by going back to school for higher education, attending nursing conferences, seeking membership in professional organizations, taking specialty nursing certifications, and participating in the hospital clinical ladder for professional development. They also like to have mentors to help them navigate their career paths in practice, leadership, management, and academia.

Literature has shown that regardless of gender, age, education level, or prior years of experience, IEFNs are faced with challenges in their transition to US nursing practice and work environments. Recognizing the barriers to IEFNs’ transition to nursing practice in the United States is valuable information for nurse leaders in developing strategies and a tool kit to facilitate IEFNs’ successful transition to the US health care system.

The author’s qualitative study showed that IEFNs had begun a difficult transition process. Regardless of the type of health care institution nurses were employed in, there were practice and cultural differences to face that were characterized as either intrinsic or extrinsic factors.

The author’s qualitative study showed intrinsic and extrinsic facilitators of IEFN participants’ transition to practice. Intrinsic facilitators are those factors innate in oneself, such as determination to learn and a quest for lifelong learning, personal goals, determination to succeed, and strong faith in God. All participants, regardless of any challenges, were determined to succeed in the US nursing practice and work environments. The IEFN study participants had a deep desire to learn about the US culture and health care systems and to utilize their nursing education and training, positive attitudes, and behaviors to meet the needs of patients. All participants expressed their strong faith in God, which kept them strong amidst the challenges they faced. They believed they had the purpose of making a difference in the lives of people and society as a whole.

The extrinsic facilitators were those environmental factors that supported and facilitated participants’ adaptation to US nursing practice and work environments. In the study findings, extrinsic factors include support systems from management, preceptors, educators, coworkers, families, and friends; thorough orientation and value of the preceptor; interdisciplinary teamwork and partnership; utilization of evidence-based practice; and the impact of National Council Licensure Examination–Registered Nurse (NCLEX-RN) on practice. In the study findings, participants stressed the importance of interdisciplinary teamwork and partnerships, which facilitated their adaptation to the US nursing practice and work environments. Participants appreciated the availability and assistance of the dietitian, physical therapist, respiratory therapist, case manager, social worker, chaplain, and physician in coordinating patients’ care plans. These IEFNs only learned the concept of the interdisciplinary team approach in the United States from textbooks and nursing journals. In the PH, due to a lack of resources, participants claimed that there was no such thing as an interdisciplinary team available to coordinate patients’ plan of care.

My experience working with IEFNs validated these extrinsic facilitators in their transition to practice. They expressed the importance and value of management support—for example, a brief but meaningful rounding to check on them, what is working well in their orientation or nursing practice, as well as areas of opportunities to improve. Another suggestion was to conduct a weekly meeting with IEFNs, educators, preceptors, and managers to ensure a thorough orientation of whether the IEFN is progressing well and if any resources are needed. The vital role of the preceptor in the IEFN transition-to-practice process has been emphasized both in the study and in my lived experiences. Preceptors are important to the successful transition of IEFNs to nursing practice. They are not only knowledgeable but have the clinical skills, patience, and positive attitude to teach IEFNs clinical skills and the use of equipment to make them feel secure and safe in their nursing practice.

Utilization of evidence-based practices in all health care institutions was an important part of institutional emphasis and expectations. The study participants claimed that core measures and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) were part of their orientation. These evidence-based practices were learned by IEFNs from US nursing journals and were now part of their daily practice, and they understood and valued their purpose and positive patient outcomes. A study by Sherman and Eggenberger identified the orientation needs of IEFNs regarding regulatory bodies and issues such as HIPAA (Health Insurance Portability and Accountability Act), JCAHO (Joint Commission on Accreditation of Healthcare Organizations), and EMTALA (Emergency Medical Treatment & Labor Act). For transition programs, the following should be included: cultural aspects of care, confidentiality, the importance of documentation, roles of interdisciplinary team members, core measures, legal aspects of care, and differences in English pronunciations.

Orientation was an important facet of transitioning to US practice. However, there was variability in orientation depending on the type of institution involved. Participants who worked in hospital settings expressed appreciation for their thorough orientation that incorporated both classroom and clinical training with a preceptor. The average orientation was 6 to 8 weeks. An educator or unit manager met weekly with participants and the preceptor to assess the orientation process and the participants’ progress. However, participants who worked in nursing homes and/or home health agencies had received minimal orientation due to staffing needs. They described their classroom orientation as watching a video and following their preceptors in a clinical setting or home. The average orientation lasted about 3 to 5 days before IEFNs became part of the health care institution’s staffing. In addition, the study findings showed that participants who had Filipino nurse preceptors learned faster and felt more confident after their orientation period. The participants claimed that they felt comfortable asking questions with Filipino nurse preceptors, which helped them feel confident and competent in their clinical skills. Studies have shown that a thorough orientation and continuing education cannot be overemphasized in order to ensure that IEFNs have a solid orientation program that is more than a routine hospital orientation.

In my study findings, participants confirmed that passing the NCLEX-RN helped them apply theories to actual US nursing practice. Most of the IEFN participants used different methods in preparing for the NCLEX-RN. Some participants attended 2 months of review classes offered by review centers or self-review using books and NCLEX-RN review manuals. All participants firmly believed that passing the NCLEX-RN improved their critical thinking, prioritization, delegation, culturally sensitive care, and safe medication administration. All participants acknowledged the value and importance of passing the NCLEX-RN in order to practice safely and effectively in the United States.

With the critical nursing shortage throughout the country, IEFNs will continue to fill the gaps to support the staffing needs of health care institutions. We know that regardless of gender, age, education level, prior experience, or type of health care institution, IEFNs face significant challenges when transitioning to US nursing practice. However, the transition to US nursing practice can be achieved through a combination of intrinsic strength of resolve on the part of IEFNs and institutional support. Although personal and professional advancement are motivators for IEFNs to engage in US nursing practice, IEFNs possess a strong aspiration to make a difference in the lives of patients and society as a whole. The IEFNs’ successful transition to US nursing practice needs facilitation on many levels.