Internationally Educated Nurses' Experiences of Working in U.S. Long-Term Care Settings

Increasing reliance on Internationally Educated Nurses (IENs) in the U.S. healthcare system, particularly in Long-Term Care (LTC) settings, necessitates an in-depth exploration of their transition experiences. The primary purpose of this qualitative study was to understand how IENs describe their experiences transitioning to work with older adults in LTC settings in the United States and the policies and practices that contribute to the successful integration of IENs. A qualitative descriptive design was used, including one-time individual interviews with 22 IENs working in various LTC settings across the United States via Zoom using a semi-structured interview guide. Demographic data were analyzed using descriptive statistics, while NVivo 14 software was utilized to organize the data; verified verbatim transcripts were subjected to thematic analysis. Three key themes were identified: Systemic and Practice-Based Barriers to IEN Integration, Structural and Social Enablers of IEN Integration, and Role of Structured Support Systems in the IENs' Transition. This study highlighted the critical challenges and facilitators that influence IENs during their integration into LTC settings in the United States. Participants reported concerns, specifically noting experiences of racial discrimination and xenophobia perpetrated by co-workers, patients, and patients' families. These experiences highlight the complex interpersonal dynamics faced by IENs, underscoring the need for proactive strategies to mitigate discriminatory practices and provide culturally sensitive orientation and mentorship programs to support the smooth integration of IENs into LTC settings. Addressing these challenges can have profound implications for strengthening inclusivity and enhancing the overall resilience of the U.S. nursing workforce, particularly within LTC environments.