Internationally Educated Nurses’ Emotional, Behavioural, and Cognitive Responses to Workplace Integration in High-Income Countries’ Healthcare Environments: A Scoping Review

Abstract

Nursing shortages are a growing global concern, with workforce migration flows predominantly from low- and middle-income countries to high-income countries. Following the recruitment of internationally educated nurses (IENs), workplace integration becomes a crucial phase that although necessary, can provoke negative and/or positive responses, affecting both individual well-being and healthcare system outcomes. Improving positive integration experiences, enhancing workforce retention, and preserving healthcare delivery requires a thorough understanding of these responses. Nevertheless, existing evidence on IENs integration has not been systematically mapped. The purpose of this scoping review was to identify and chart current evidence on emotional, behavioural, and cognitive responses of IENs from low- and middle-income countries during workplace integration in high-income countries’ healthcare environments. This review utilized the JBI scoping review methodology. A comprehensive search was conducted across MEDLINE, CINAHL, Embase, PsycINFO, Cochrane CENTRAL, JBI Evidence Synthesis, ProQuest Dissertations and Theses Global, and grey literature. Inclusion criteria were applied by two independent reviewers to identify and select appropriate sources. A total of 13,178 records were retrieved through the search. Of these, 37 sources were included, comprising of 30 qualitative studies, four quantitative studies, two mixed-methods studies, and one literature review. Results revealed three distinct domains of responses: emotional (ranging from initial optimism to distress, frustration, and isolation), cognitive (including reality shock, perceptions of professional devaluation, and inequality), and behavioural (encompassing avoidance, overcompensation, and adaptation strategies). Integration followed a temporal pattern progressing from initial optimism through crisis phases to either successful adaptation or departure from the healthcare system.