Internationally Educated Nurse (IEN) Integration into the Workforce and Community: A Realist Evaluation in Nova Scotia, Canada

Background: Globally, the COVID-19 pandemic has amplified healthcare provider shortages. In Canada, multipronged strategies have been implemented to strengthen the nursing workforce; one widely implemented approach includes the expedited integration of internationally educated nurses (IENs). In 2022, the province of Nova Scotia (NS) collaborated with intersectoral partners to support the recruitment and retention of internationally educated nurses (IENs) who wish to relocate to NS. The Nova Scotia’s International Community of Healthcare Workers Engagement (NICHE) program was developed to facilitate the integration of IENs, by connecting key partners and decision-makers across the government (e.g., immigration services), nursing regulation, healthcare organizations and community supports, all with a shared vision for successful IEN integration into NS. A unique feature of the NICHE program was the intention to provide wraparound supports for the IEN workforce, by facilitating integration into the workplace (e.g., healthcare system), while connecting them with social services to support their integration into NS communities.

Approach: We conducted a provincial realist evaluation (Pawson & Tilley, 1997) of the integration of IENs into Nova Scotia. We collected data via program documents and 24 interviews with: program leadership [macro-level]; organizational leaders, managers and administrators [meso-level]; and IENs from staggered cohorts [micro-level]. All interviews were audio-recorded and transcribed verbatim. Using a content analysis approach, narrative data from the interviews and documents were constructed into themes, which informed a knowledge user summary report.

Results: The themes described (1) the IEN experiences of transition – inclusive of workplace integration and community integration, (2) the macro- and meso-level contextual factors and mechanisms which supported “successful” IEN integration, and (3) recommendations for desired long-term outcomes, such as IEN retention and program sustainability. This evaluation illustrates the high degree of intersectoral collaboration and commitment required by partners across healthcare, government, immigration, and community/housing support to facilitate IEN integration into the healthcare workforce and local communities. Areas for development pertain to the needs for: (1) equity-informed approaches to improve psychological safety for IENs in the workplace, and (2) enhanced community supports for IENs, particularly in relation to housing and childcare needs.

Implications: Our findings will inform the provincial Nursing Workforce Strategy and provide strategies to better facilitate IEN integration into the Canadian healthcare system and communities. This research highlights that health and social care integration are necessary to support shifting workforce demographics, particularly in areas integrating internationally educated health professionals.