International nurses struggling to fit in

“Historically, nurses who migrated to Australia came from England, New Zealand, and Canada – more English-speaking countries really”, Ylona says. This has changed in recent years, and nurses are now coming from countries where English might be their second or even their third language.

According to Ylona, some countries intentionally educate nurses so they can migrate to Australia.  Often, the nurses will send money back home to support their families. “This is actually a multi-billion-dollar industry,” she says. However, international nurses do not only migrate to Australia for the money. “Quite often, it is the lifestyle, work and professional opportunities, but sometimes it is also to escape war or poverty.”

Many cultures, many languages, one hospital

Language is often seen as a challenge for international nurses in Australia. Even if they are originally from English speaking countries like Canada, some of them struggle with the Aussie vernacular, which even differs between states like Victoria or Queensland. And, of course, the colloquialisms – the true-blue Aussie slang. Think esky and thongs, a bickie for brekkie, and downing a stubby by the barbie.

Internationally qualified nurses can sometimes find it difficult to understand what some patients are trying to say. There are many local indigenous languages and lots of foreign accents with patients from over 150 different countries represented in Australia’s multicultural society. “Patients would speak their normal language, of course, and they would use colloquialisms all the time. That was quite challenging,” Ylona says. However, there are also advantages when a nurse spoke the same native language as the patient or client.

“But it is more about the difference in healthcare systems. A lot of nurses come from countries with a patriarchal model. Whereas here in Australia, we have a much more collaborative approach. We work as a team. We work with the patients. We don't tell them, we ask them. We speak with them, and we collaborate.”

Dr Ylona Chun Tie

As an example, a nurse from the Philippines would wait to be told what to do, because that was how she was trained. “The research found some participants stated it was also very difficult for them to stand up and question the doctor, for example, or anyone who was perceived  higher in rank than them, such as doctor or a senior nurse. It wasn't culturally appropriate to do that, in the system they came from,” Ylona says. This can turn out to be a problem if a nurse sees a doctor make an error, but isn’t confident enough to raise questions.

The undervalued nurse

On the other hand, in some cases highly qualified international nurses found themselves undervalued. “Some nurses said they had a higher skill set that they weren't allowed to use. For example, they were used to taking blood samples or cannulating [inserting an intravenous line into someone’s vein]. When they first came to Australia, they had to redo all these competencies that they had already been doing for years somewhere else, and that wasn't always recognised.”

What nurses from all countries struggled with were the unwritten rules. “You look at a policy, look at a guideline or a protocol, but you also need to stand back and look, to observe first and then see how things work. And then seeing how they as a nurse fit into the culture of that work unit,” Ylona says.

Success stories – nurses finding a home in rural communities

“The other big thing that international nurses found challenging was that a lot of nurses didn't comprehend how big Australia is. How geographically vast it is. They didn’t understand that when they agreed to work in a rural or remote region, how rural and remote that was. That was hard for some of them.”

However, Ylona says that if the nurses got along with locals who embraced them, many would stay and integrate into the rural community. “If they had friends and family in the rural town, they tended to stay.”

Working in a multicultural and multi-language environment can not only be problematic for the newcomers, but also for the Australian staff who often knows very little about the cultural background of the newcomers.

In her outstanding PhD thesis, Ylona made several recommendations that will help international and local nurses to work together in the Australian healthcare system.  “Many of the recommendations have been taken up by the NMBA [Nursing and Midwifery Board of Australia] and by AHPRA Australian Health Practitioner Regulation Agency,” Ylona says.

One of Ylona’s main recommendations is a specific orientation program that will teach practical knowledge about life and work in Australia. “The local context is explained to them. It makes life so much easier when you understand the local context. After all, being a registered nurse in Australia is not only about the work, but even more so about the people.”

Dean's Award for Excellence 2020

Dr Chun Tie received the Dean's Award for Excellence 2020 for her PhD thesis Playing the game: a grounded theory study of the integration of internationally qualified nurses in the Australian healthcare system.