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Written By

Bianca de Loryn


College of Healthcare Sciences

Publish Date

3 December 2021

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Adapting to Australia

Adjusting to life Down Under is not easy for everyone, as Dr Ylona Chun Tie discovered while doing her PhD on international nurses who are working in Australia.

Imagine you have just arrived in a foreign country. You have a work visa, and you landed a fantastic job with a big company. You have trained for years for this job. You know you are good at it. But life is different here: the people don’t speak your language, and the way they deal with each other is completely different from what you are used to at home. That can come as quite a shock.

This is the situation thousands of international nurses face in hospitals and healthcare settings around Australia. The newcomers might originate in the Philippines, India or China, and work in hospitals in Cairns, Townsville or Toowoomba.  Some will quickly adjust to the new life, while others will find it harder to adapt.

Multicultural nursing teams in Australian hospitals

Dr Ylona Chun Tie has dedicated her PhD thesis to understanding how local and international nurses can work together to provide safe and appropriate health care. Ylona knows what she is talking about, coming from a multicultural background herself. “In our extended family, we speak six languages amongst us, and we come from seven countries,” she says. This has made her naturally sensitive to issues that other people might not even notice.

Australia has over 400,000 registered and enrolled nurses. Around 30 per cent, that is around 118,000 of registered nurses, have at some point migrated to Australia. Almost every single hospital or healthcare service in Australia will have nurses with a non-Australian background.

Nurse holding a hand
Tired nurse

Culturally diverse nurses

“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

The doctor is always right?

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.”

An easier transition for international nurses

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.

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Dr Ylona Chun Tie

Deputy Academic Head of Nursing & Midwifery Townsville

Dr Ylona Chun Tie is a Senior Lecturer and the Deputy Academic Head of Nursing & Midwifery Townsville in the JCU College of Healthcare Sciences. She is also a member of the RN OSCE Examination Committee of the Nursing and Midwifery Accreditation Committee.

For the past decade, Ylona has influenced the education of undergraduate and postgraduate registered nurses both here and overseas. Ylona’s outstanding PhD was recognised and awarded the Dean’s Award for Research Higher Degree Excellence.  Ylona represents the nursing profession at the state and national level. She is National Secretary and a Fellow of the Australian College of Critical Care Nurses (ACCCN) and the Secretariat for the Australian College of Nursing (ACN) Community of Interest: International Nursing.