Title : Supporting the journey: Helping immigrant nurses thrive in a new healthcare culture
Abstract:
The global nursing workforce deficit reached an estimated 5.9 million in 2020, according to the World Health Organization, and the United States is projected to experience a shortage of at least one million nurses by 2030. In response to this escalating crisis, international nurse migration has increased substantially. Foreign-educated nurses are often drawn to developed countries by economic opportunities, prospects for career advancement, improved working conditions, and overall social stability. While the recruitment of internationally educated nurses offers a valuable solution to workforce shortages, their transition to a new healthcare environment is often complex and challenging. These challenges can significantly influence both the individual nurse’s experience and the quality of patient care delivered. Foreign-educated nurses frequently encounter cultural differences, unfamiliar communication styles, variations in clinical practice, and difficulties adjusting to new social norms and workplace expectations. Despite meeting English proficiency requirements, many nurses report communication barriers related to accents, tone, idiomatic language, and nonverbal cues. These issues can affect teamwork, patient interactions, and confidence in clinical decision-making. Cultural differences and differing beliefs may also influence how nurses interpret clinical situations, approach patients, and interact with colleagues. As a result, immigrant nurses experience stress, low job satisfaction, burnout, and increased turnover. These outcomes highlight the need for structured onboarding support to ensure successful integration into the U.S. workforce. Healthcare organizations, therefore, play a critical role in promoting a smooth transition for foreigneducated nurses. A literature review of scholarly articles published between 2020 and 2025 using PubMed, Cochrane, and Google Scholar identified 10 relevant studies, of which three were selected for detailed analysis. Across these studies, pre-departure preparation emerged as a key factor in facilitating transition. Providing nurses with information about the U.S. healthcare system, licensing requirements, workplace expectations, cultural norms, and social dynamics can help them anticipate challenges and reduce early adjustment difficulties. Once in the host country, individualized orientation, structured skill-building sessions, competency-based training, and exposure to organizational policies and procedures further enhance their ability to adapt. Mentorship programs were consistently identified as essential components of successful transition. Support from experienced colleagues improves clinical confidence, fosters teamwork, and provides emotional reassurance. Access to linguistic specialists and ongoing language support can also help nurses refine communication skills necessary for safe practice. In addition, culturally competent training equips nurses to deliver safe, respectful care aligned with diverse patient values. The literature also highlighted the prevalence of discrimination and racism, emphasizing the need for healthcare organizations to promote equity, psychological safety, and fair treatment. Overall, the transition of foreign-educated nurses requires comprehensive organizational preparation, cultural awareness, and sustained support. When healthcare institutions prioritize these strategies, internationally educated nurses can integrate successfully, strengthen the U.S. nursing workforce, and contribute to improved patient outcomes and quality of care.
