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Facilitators and barriers to adjustment of international nurses: an integrative review


Jennifer Kawi, School of Nursing, University of Nevada, Las Vegas, 4505 Maryland Parkway, Las Vegas, NV 89154-3018, USA; Tel: (702) 895-5935; Fax: (702) 895-1543; E-mail:


Background:  There is a scarcity of research focusing on issues encountered by international nurses (INs) in their adjustment to foreign health-care environments. Increasingly, INs are relied upon to address staffing shortages in many Western countries. As such, it is vital to identify what facilitates and what the barriers are to the successful adjustment in order to assist their integration into new workplace environments.

Aim:  This integrative review identifies facilitators and barriers encountered by INs as they adjust to foreign health-care environments.

Method:  Based on Cooper's Five Stages of Integrative Research Review, a systematic search of eight electronic databases was conducted, combined with hand and ancestral searches. Two authors independently reviewed each qualified study for relevance and significance. Subsequently, facilitators and barriers were identified and categorized into themes and subthemes.

Findings:  Twenty-nine studies conducted in Australia, Canada, Iceland, UK and the USA were included in this review. Findings indicated that positive work ethic, persistence, psychosocial and logistical support, learning to be assertive and continuous learning facilitated the adjustment of INs to their new workplace environments. In contrast, language and communication difficulties, differences in culture-based lifeways, lack of support, inadequate orientation, differences in nursing practice and inequality were barriers.

Conclusion:  The review findings provide the basis for the development and testing of an evidence-informed programme to facilitate the successful adjustment of INs to their new work environments.