The Lived Experience of Non English Speaking Background Overseas Qualified Nurses Working in

196 Pages·2010·0.94 MB·English

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
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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

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adapt and to learn from the new country and work practice, but also to maintain
their integrity as unique professional individuals practising nursing.

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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.

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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: / /

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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

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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

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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

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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

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