First generation immigrant and native nurses enacting good care in a nursing home

Abstract

Background: Several studies have investigated the experiences of first-generation immigrant nurses in new workplaces. Yet, little is known about how native nurses and newcomers collaborate in their care for aging residents in European nursing homes. Objective: To gain a deeper understanding of interactions between first-generation immigrant nurses and native nurses in their care for aging residents in a Dutch nursing home. Methods: Ethnography, including 105 h of shadowing immigrant and native nurses, 8 semi-structured interviews with 4 immigrant and 4 established nurses, and 2 focus group discussions with 8 immigrant and 6 established nurses in a Dutch nursing home. Data were analyzed by a post-positivist grounded theory coding approach. Ethical consideration: The Medical Ethical Review Committee of the Leiden University Medical Center approved this study. Results: The interactions between established staff and newcomers were influenced by norms, rules and regulations, policies and protocols. In daily practice and institutional structure, we observed both opportunities and challenges. The strict time schedules and the requisite standards of care were opportunities related to nurses’ expectations. Residents’ needs were sometimes challenging and inhibited newcomers’ active participation. However, sometimes new practices were developed where nurses created common ground, tinkered, and formed an inclusive playing field to enact good care. Conclusion/ discussion: This study shows that despite obstacles, there was room to make small changes in the rules of the game of nursing. These moments of tinkering may be sufficient to establish a stable, inclusive workforce for first-generation immigrants and give room to the evolvement of hybrid professional identities. Implications: The findings of this Dutch study are relevant for nursing ethics related to “good care” and nurses in other cultural contexts on how the integration of immigrant nurses in European countries in general could be facilitated.

“My Color Doesn’t Lie”: Race, Gender, and Nativism among Nurses in the Netherlands

“…Nursing scholars have examined the underrepresentation and experiences of racial/ethnic, or “visible minorities,” in Europe and North America ( Berdes & Eckert, 2001 ; Ham, 2020 ; Institute of Medicine, 2011 ; Jefferies et al, 2019 ; Premji & Etowa, 2014 ; Tuttas, 2015 ). Ulrich et al (2007) found that nurses of color in the U.S. reported more stress and were three times more likely to say they wanted to leave the profession than white nurses.…”

“…Black nurses in the U.S. experience both overt forms of racism such as receiving derogatory racial slurs from patients, as well as more subtle forms of racism, including patient non-compliance and questioning of authority ( Cottingham et al, 2018 ). Ham (2020) , looking specifically at the Netherlands, notes that first-generation immigrants from East Africa experience refusal and noncompliance from elders in the nursing home where they work. In focusing on the dynamics between first-generation immigrants and native nurses, Ham’s findings clarify how immigrant’s caring practices are adapted to expectations in a Dutch context.…”

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

“…They described being regarded as second class citizens (Aboderin, 2007 ) and not being respected (Berdes & Eckert, 2001 ). Some experienced that residents refused their care, not wanting to receive care from a ‘foreigner’ (Ham, 2021 ).…”

The reported experiences of internationally qualified nurses in aged care: A scoping review

“…While all 14 papers included IQN participants from CALD backgrounds, only 4 papers focused exclusively on IQN from a specific country or region: East African countries, India, Indonesia and Nepal (Adhikari & Melia, 2015;Ham, 2021;Nursalam et al, 2020;Yong & Manthorpe, 2016) with 5 papers including a mix of CALD participants from diverse backgrounds, for example, Africa, Asia (Adebayo et al, 2021(Adebayo et al, , 2023Angus et al, 2021;Jenkins & Huntington, 2016;Pung et al, 2017). Three papers included a mix of IQN with CALD backgrounds and IQN with European backgrounds as a part of a broad cultural mix (Baluyot, 2019;Munkejord & Tingvold, 2019;Nichols et al, 2015).…”