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196 Pages·2010·0.94 MB·English
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The Lived Experience of Non English Speaking Background Overseas Qualified Nurses Working in the Western Australian Metropolitan Hospital Workforce: A Transcendental Phenomenological Study Christine Denise Andree Smith This thesis is presented for the Masters of Health Professional Education at the University of Western Australia Education Centre, Faculty of Medicine, Dentistry and Health Sciences May 2010 ii ABSTRACT The purpose of this research study was to explore the lived experiences of 13 female Non English Speaking Background (NESB) Overseas Qualified Nurses (OQNs) as they integrate into the Western Australian (WA) metropolitan hospital workplace. The current shortage of nurses worldwide has taken its toll on the Australian health care system. In fact nurses are at present at the top of the ten occupations in most demand. As a result there is an increased and ongoing migration of OQNs, some of them coming from non English speaking countries. Studies of migrant nurses working abroad have been conducted in countries such as the United Kingdom, Canada and the United States of America each of which have a long history in employing OQNs. Similar studies have also been carried out in the eastern states of Australia. However while NESB migrant nurses are employed in the WA health care setting and are still encouraged to come and work here, there is very little research on their employment experiences in WA. This study was a first step in addressing this gap in knowledge. A qualitative design based on Husserlian transcendental phenomenology was used to explore the lived experience of working in the WA metropolitan hospital system of 13 female NESB OQNs from five different WA metropolitan hospitals. Four main themes emerged from the data analysis; “the initial feelings of professional loss”, “feelings of otherness”, “rediscovering nursing” and “it all works out in the end”. The findings from this research highlighted the personal and professional journey of the participants as they integrated into the WA workforce. A feature of the outcomes of this study was the participants’ resilience and agency in terms of their willingness and determination not only to iii adapt and to learn from the new country and work practice, but also to maintain their integrity as unique professional individuals practising nursing. iv ACKNOWLEDGEMENTS Now that I have completed the thesis I admit that while the journey has been long and tumultuous, I have thoroughly enjoyed it and learnt immensely. However the successful completion of this research would not have been possible without the interest and support of the following individuals to whom I wish to express my appreciation. I am very grateful and would like to thank the 15 NESB OQNs who volunteered to participate in this study. I feel very privileged that they offered to share their experiences with me so that this project could take place. This thesis is the result of their valuable contribution. Special thanks go also to my two supervisors. Dr Annette Mercer’s patience and encouragement assisted me to persevere on what I recall being a difficult journey. Dr Colleen Fisher who came on board in the middle of last year provided the guidance to undertake Husserl’s transcendental phenomenology to this project. Her high competence in qualitative research and genuine supportive approach gave me the confidence to carry out this project. Finally I would like to express my above all appreciation of the support and understanding provided to me by my husband Kim and my two children Jeremie and Melanie. v DECLARATION In accordance with the regulations for presenting theses and other works for higher degrees, I hereby declare that this thesis is entirely my own work and that it has not been submitted as an exercise for a degree in any other university. Christine Denise Andree Smith Date: / / vi ABBREVIATIONS ABC Australian Bureau of Statistics ANMC Australian Nursing and Midwifery Council APNMF Australian Peak Nursing and Midwifery Forum CGFNS Commission on Graduates of Foreign Nursing Schools CN Clinical Nurse DIAC Department of Immigration and Citizenship EN Enrolled Nurse ESB English Speaking Background HPH Hollywood Private Hospital IELTS International English Language Testing System INC International Nursing Council IV Intravenous MDGs Millennium Development Goals MODL Migration Occupation in Demand List NESB Non English Speaking Background NHS National Health Services NMBWA Nurses and Midwifery Board of Western Australia NMRAs Nursing and Midwifery Regulatory Authorities OECD Organisation for Economic Corporation and Development OET Occupational English Test OQN Overseas Qualified Nurse PCA Patient Care Assistant QNU Queensland Nurse Unions REOH Researching Equal Opportunities for Overseas-trained nurses and other Healthcare professionals RN Registered Nurse SCGH Sir Charles Gardner Hospital UK United Kingdom USA United States of America WA Western Australia vii TABLE OF CONTENTS Abstract.............................................................................................................. iii Acknowledgements............................................................................................. v Declaration......................................................................................................... vi Abbreviations .................................................................................................... vii Table of Contents .............................................................................................viii 1 Chapter One – Introduction .........................................................................1 1.1 Background ..........................................................................................1 1.2 Aim of the Study ...................................................................................3 1.3 Structure of the Thesis .........................................................................3 1.4 Summary ..............................................................................................5 2 Chapter Two – Nursing in Australia .............................................................7 2.1 Introduction...........................................................................................7 2.2 The nursing profession in Australia ......................................................8 2.2.1 Foundation of nursing....................................................................8 2.2.2 The national regulatory body.........................................................9 2.2.3 Nursing education .......................................................................10 2.2.4 Regulations on OQNs coming to Australia ..................................11 2.2.5 Nurses and midwifery board of Western Australia.......................12 2.3 The mobility of nurses ........................................................................13 2.3.1 Shortage of nurses worldwide .....................................................14 2.3.2 Shortage of nurses in Australia ...................................................15 2.3.3 Strategies to alleviate the shortage .............................................17 2.3.4 Migrating to Australia...................................................................17 2.3.5 Australian migration history .........................................................18 2.3.6 Recruiting OQNs .........................................................................19 viii 2.4 Summary ............................................................................................20 3 Chapter three – Methodology ....................................................................22 3.1 Introduction.........................................................................................22 3.2 Overview of the methodology .............................................................22 3.2.1 Qualitative research.....................................................................22 3.2.2 Phenomenology - overall perspective..........................................25 3.2.3 Transcendental phenomenology .................................................26 3.2.4 Hermeneutical phenomenology...................................................28 3.2.5 Phenomenology in nursing research ...........................................30 3.2.6 Summary .....................................................................................33 3.3 Research methods..............................................................................33 3.3.1 Rationale for choosing a phenomenological approach................34 3.3.2 Moustakas’ approach to phenomenological research..................35 a Methods and procedural guidelines ................................................36 3.3.3 Personal and social foundation in the research topic ..................37 3.3.4 Research aims and questions .....................................................39 3.3.5 The author’s standpoint ...............................................................39 3.3.6 Ethical considerations..................................................................41 3.3.7 The data collection process.........................................................42 a Identifying the participants ..............................................................42 b Recruitment of participants .............................................................44 c The study sample............................................................................45 d The interview process .....................................................................46 3.3.8 Managing the data.......................................................................48 a The interviews.................................................................................48 b The transcriptions............................................................................48 ix c The analysis of the data..................................................................49 3.3.9 Rigour and trustworthiness..........................................................51 a Credibility ........................................................................................52 b Dependability ..................................................................................53 c Transferability .................................................................................53 d Confirmability ..................................................................................53 3.4 Summary ............................................................................................53 4 CHAPTER FOUR – THE INITIAL FEELINGS OF PROFESSIONAL LOSS 55 4.1 Introduction.........................................................................................55 4.2 The overwhelming differences experienced in the work environment 56 4.2.1 So many things are different........................................................56 4.2.2 Feeling a lack of trust ..................................................................59 4.2.3 Feeling self doubt ........................................................................61 4.2.4 Relationship and discussion of findings to existing literature.......62 4.3 Being like a learner again ...................................................................66 4.3.1 Acting as a learner ......................................................................66 4.3.2 Being treated like a junior/ novice nurse......................................67 4.3.3 Relationship and discussion of findings to existing literature.......68 4.4 Phenomenological explanation of the participants’ experiences.........73 5 CHAPTER FIVE – FEELING OF OTHERNESS ........................................75 5.1 Introduction.........................................................................................75 5.2 I have to speak English ......................................................................75 5.2.1 English is not my native language ...............................................76 5.2.2 What’s wrong with my English?...................................................78 5.2.3 I don’t understand their English ...................................................80 x

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