Adaptation experiences of internationally educated Filipino nurses employed in the United States

The nursing shortage is a global issue and countries throughout world, the United States (U.S.) more than others, are consistently challenged to meet their nursing needs. Recruitment of internationally educated (IE) Filipino nurses is one strategy used to fill gaps in the U.S. nursing workforce. Filipino nurses constitute over half of IE nurses in the U.S. This study described the adaptation process of IE Filipino nurses employed in the U.S. Hermeneutic phenomenology as espoused by Heidegger provided the philosophical underpinnings. Using the Philippine Nurses Association of Metropolitan Houston, 17 IE registered nurses were recruited through purposeful and snowball sampling methods. A demographic form and a semi-structured interview guide were used for data collection. Demographic data were analyzed using descriptive statistics. Interview transcripts were analyzed using a hermeneutic phenomenological approach incorporating the concept of hermeneutic circle.

The three phases of adaptation were identified (a) Pre-arrival Dreams and Motivations, Followed by Reality; (b) the Transitional Phase, and (c) Adaptation. Pre-arrival Dreams and Motivations, Followed by Reality reflected aspirations prior to leaving the Philippines and the actualities of initiating U.S. practice. During the Transitional Phase nurses faced intrinsic and extrinsic barriers to adaptation as well as intrinsic and extrinsic factors facilitating adaptation. Intrinsic barriers consisted of being shy and timid, sensitive, and lonely. Extrinsic barriers included language and communication, variations in nursing practice and technology, cultural differences, fear of healthcare lawsuits, and facing discrimination. Intrinsic adaptation facilitators included quest for life-long learning, determination to succeed, strong faith in God, and love of family. Extrinsic adaptation factors related to support of management, preceptor, educator, co-workers, family, and friends; a thorough orientation and value of preceptor; interdisciplinary teamwork and partnership; utilization of evidence-based practice; and the impact of NCLEX-RN on practice. Adaptation strategies involved observing and listening to preceptors, educators, and co-workers; asking questions and hands-on practice; being a team player, and having a positive attitude, embracing the value of lifelong learning; building relationships and finding meaning in nursing practice; capitalizing on personality traits; and self-reflection. During the Adaptation phase nurses found a balance between overcoming barriers and positively contributing to U.S. nursing practice.