Table 2.

Characteristics of twenty seven selected studies.

Author, year & country	Study design or methodology & data collection	Method of Analysis	Study aim/objectives	Sample and participant country of origin	Relevant findings to the current study	Study Quality
Adhikari and Melia (2015) United Kingdom	A multi-sited ethnographic approach In-depth interviews	Analytical memos, themes & insights (Silverman, 2012)	… to examine Nepali migrant nurses’ professional life in the UK	Snowball sample of 21 Nepali Nurses	Professional aspirations Mismatched skills and expectations Deskilling and ‘brain waste’	High
Alexis and Shillingford (2015) United Kingdom	Husserl's phenomenological approach Semi-structured face-to-face interviews	Colaizzi's (1978) analytical framework	… to explore the perceptions and work experiences of internationally recruited neonatal nurses	Purposeful sample of 13 nurses from Jamaica and the Philippines	Support mechanisms Unfamiliarity with family centred care Feelings of being treated like a child Coping strategies	Moderate
Al-Hamdan et al. (2015) United Kingdom	Qualitative Face to face & phone interviews	Content analysis	… how Jordanian nurses experienced the transition from home to host country to illuminate the elements of transformation	Snowball sample of 18 Jordanian nurses and 7 from other countries	Professional transformation Personal transformation Socio-cultural experiences.	High
Allen (2018) United States	Qualitative, phenomenological study Demographic questionnaire and Open-ended interviews	Colaizzi's (1978) seven-step phenomenological process	… to explore the experiences of internationally educated nurses in management positions in United States health care organisations.	Internal invitation for 7 IEN managers originally from Philippines (2), India (3), Jamaica (1) and China (1)	The role of supervisors in acceptance of management positions Challenges regarding job responsibilities Diversity and culture Language and communication Work relationships and support Opportunities for education and professional growth	Moderate
Brunton and Cook (2018) New Zealand	Qualitative Interviews using a questionnaire schedule	Thematic analysis	…to examine the viewpoints and experience of both NZ qualified nurses and internationally qualified nurses in managing communication within teams and the clinical practice context	Call through national nursing journal of 53 participants (17 New Zealand registered nurses and 36 internationally qualified nurses)	Interpersonal challenges Organizational challenges Value-based conflict and learning	Moderate
Brunton et al., (2019) New Zealand	Qualitative Face to face interviews	Thematic analysis and sensemaking theory	…the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts	Call through journal of 36 nurses practising in NZ and 20 nurses practising in the UAE The NZ sample were from UK (8), China (5), the Philippines (11), India (9) and S Africa (3) UAE: 9 participants of Asian origin (Indian and Filipino), 7 Western (US, UK, Canada, S Africa and Romanian), 4 of Arab origin	Lost in translation Who's in charge? “But I know best” Challenges to professionalism Who makes the decisions?	High
Choi et al (2019) New Zealand	Qualitative: Interpretative Phenomenology Semi structured interviews	Coded for common threads and meaning	… to explore the experiences of eight migrant nurses drawing on the concept of acculturation	Purposive sample of 8 nurses from India (5) and the Philippines (3)	Un/learning and the ‘hidden curriculum’ Destabilisation of expertise Preceptors and leaders as navigators Finding one's voice	Moderate
Connor (2016) United States	Cross-sectional qualitative descriptive design Semi-structured interviews.	Auerbach and Silverstein's (2003) qualitative analysis	… to explore the strategies that Filipino IENs use to cope effectively with their work-related and non-work-related stress. (Part of a larger study Connor et al 2014).	Purposive sample of 20 nurses from the Philippines	Coping behaviours and strategies: (a) familial, (b) intracultural, (c) fate and faith-based, (d) forbearance (patience and self-control) and contentment, (e) affirming the nursing profession and proving themselves, and (f) escape and avoidance	Moderate
Connor et al. (2014) United States	Qualitative: descriptive cross sectional Semi structured interviews	Auerbach and Silverstein's (2003) qualitative analysis	…to explore the stresses and work experiences of Filipino immigrant nurses.	Purposive sample of 20 nurses from the Philippines	Specific stressors experienced: Immigration and resettlement challenges related to unexpected social and living environments. Immigration stressors interact with and intensify work-related stressors. Challenges arise from encountering cultural differences.	Moderate
Higginbottom (2011) Canada	Ethnography Semi-structured interviews	Roper & Shapira's framework for Ethnography	… to understand the transitioning experiences of IENs upon relocation to Canada and creating recommendations for improving the quality of their transition and their retention.	Purposive sample of 23 nurses from the Philippines (12), the Caribbean (2), UK (6) & NZ (3)	Motivation and decision to relocate Expectations versus actual experiences of recruitment, reception, salary & support on arrival The health care system nursing work environment Discrimination in the professional lives Life beyond the nursing setting Learning to overcome challenges	High
Jose (2011) United States	Qualitative, phenomenology Guided interviews	Giorgi's principles.	…to elicit and describe the lived experiences of internationally educated nurses who work in a multi-hospital medical centre in the urban USA.	Purposive sample of 20 nurses from the Philippines (8), Nigeria (5) and India (7)	Dreams of a better life, A difficult journey A shocking reality Rising above the challenges Feeling and doing better Ready to help others	High
Kishi et al. (2014) Australia	Qualitative Semi structured interviews	Thematic Analysis (Braun and Clarke 2006).	… to investigate the experiences of Japanese nurses and their adaptation to their work environment in Australia	Purposive and snowball sample of 14 Japanese nurses	Seeking: new/different experiences, stressful working environment, unsatisfactory working conditions, unhappy relationships in the workplace, Acclimatizing: struggles, languages, unfairness, active approaches, passive approaches, social support Settling: aspects subject to change, stepping away from the Japanese health work environment, future prospects, reaffirmation of sense of self-worth	Moderate
Likupe (2015) United Kingdom	Qualitative (part of a larger study) Focus Group & individual interviews,	van Manen's (1990) selective analysis.	…to explore experiences of racism, discrimination and equality of opportunity among black African nurses and their managers’ perspective on these issues.	Purposive sample of 36 nurses from sub-Saharan Africa (Malawi, Kenya, Ghana, Nigeria, South Africa, Zambia, Zimbabwe and Cameroon)	Perceptions of discrimination and racism from managers, colleagues and patients Lack of equal opportunities. Stereotyping	Moderate
Lin (2014) United States	Qualitative In-depth interviews	Strauss and Corbin (2008) comparing codes to develop categories, connections, and sequences.	… to increase understanding of perceptions of role transitioning into the US healthcare system by providing new information about their unique experience, and ways to help ease their transitions	Purposive sample of 31 nurses from the Philippines	Stages of adaptation: (1) pre-arrival, (2) early adaptation, and (3) late adaptation. Strategies for FNs, recruiting agencies, and recruiting facilities are also shown for each stage.	Moderate
Mapedzahama et al. (2012) Australia	Qualitative; Conceptual framework: Filomena Essed's (1991) theory of ‘everyday racism’. Individual interviews	Interpretative approach, utilising thematic manual coding	… to examine how skilled African migrant nurses working in Australia forge social and professional identities within their transnational, cross-cultural existences	Snowballing sample of 14 black African nurses	The salience of skin colour: becoming the black nurse How black nurses experience everyday racism The white gaze and surveillance of the black nursing body Contesting racial stereotypes	Moderate
Neiterman and Bourgeault (2013) Canada	Qualitative Semi-structured interviews	Thematic analysis	… to explore how and why cultural competence of IENs becomes a challenge in their professional integration.	Snowballing sample of 71 international nurses and 70 key stakeholders 29 different countries	Cultural differences as a challenge to professional integration and lack of fit Language proficiency Nursing licensure examinations Local model of nursing practice Policy Solutions: facilitating integration Cultural competence	High
O'Brien and Ackroyd (2012) United Kingdom	Comparative case study Multiple methods of data collection, including observations, semi structured interviews	Assimilation model	… to gain an understanding of the processes underlying successful (or failing) assimilation of nurses into the long-term nursing labour force.	Overall, seven cohorts of international nurses from India (3 cohorts), the Philippines (2 cohorts) and Spain (2 cohorts). Convenience sample for 40 nurses for the interviews	A comparative model of the key processes involved in the overseas nurse's assimilation process. Culture shock Home nurse attitudes and ‘everyday racism’ Informal occupational closure and occupational segmentation Formal occupational closure (or credentialism) Explaining patterns of variation in outcome for cohorts	Moderate
O'Neill (2011) Australia	Qualitative Semi-structured interviews	Thematic Analysis	… how IENs for whom English is a second language engage with language and culture during their journey from the language classroom to the clinical context	Convenience sample of 10 nurses from India (5), Chinese (4) and Nepal (1)	Cultural and professional identity and belonging Competence & safety Adapting to new roles and ways of communicating are revealed	Moderate
Philip, Woodward-Kron, Manias and Noronha (2019) Australia	Qualitative Interview & Participant observation	Discourse Analysis	… to understand the interprofessional and intra-professional communication patterns of overseas qualified nurses as they coordinate care for patients in Australian hospitals	Convenience sample of 13 nurses from India (6), Philippines (6) and Nigeria (1)	Clinical communication: Coordinating care Communication strategies Discourse patterns Peer communication with peers Positive interpersonal interactions	High
Salma, Hegadoren and Ogilvie (2012) Canada	Qualitative: Interpretive descriptive study Semi-structured interviews	Thematic analysis (Green, 2007)	… to look at the perceptions of IENs regarding career advancement and educational opportunities in Alberta, Canada	Convenience and purposive sample of 11 nurses from Iran, Guyana, Britain, India, China and the Philippines.	Motherhood as a priority, communication and cultural challenges, Skill recognition, Perceptions of opportunity Mentorship.	Moderate
Salami, Meherali and Covell (2018) United States	Exploratory transnational feminist qualitative research Interviews	Thematic analysis	… to explore the experience of baccalaureate prepared IEN who work as licensed practical nurses in Canada.	Purposive & snowballing sample of 14 nurses from the Philippines (9), India (3), Nigeria (1) and Mauritius (1).	Migrating with hope for a better personal and professional life Experiencing barriers to RN workforce integration Deskilling and ambivalent skill recognition Feeling dissatisfied as an LPN in Canada	Moderate
Smith, Fisher and Mercer (2011) Australia	Transcendental Phenomenology Individual interviews	Moustakas's (1994) method of analysis	… to explore how overseas qualified nurses experienced the practice of nursing in WA, Australia.	Snowball sample of 13 Nurses from China, S Africa, Japan, Taiwan, Zimbabwe, Hong Kong, the Philippines, Sweden and Nepal.	Preparedness to work: it's the same… but it's different Working with patients: patient-centred approach Working with doctors: team approach, doctor–nurse hierarchy Feeling valued? etiquette and professionalism	Moderate
Thekdi et al. (2011) United States	Qualitative Open ended interviews	Thematic analysis	…to examine the transitional/ adaptation challenges of IENs in the U.S. healthcare system from multiple stakeholders: clinical educators, preceptors, and the IENs themselves	Recruitment of 6 nurses from India, Haiti, the Philippines, and the UK 4 clinical educators, and four preceptors	FENs’ point of view Communication, Attitude of peers. Preceptors’ point of view Learning the “American way” of nursing. Clinical educators’ point of view Lack of initiative and autonomy. Communication challenges. Nursing practice knowledge. Cultural understanding between FENs and preceptors.	Moderate
Vafeas and Hendricks (2018) Australia	Heuristic enquiry Focus group, individualised interviews & journal	Coding and Thematic Analysis (Moustakas 1990)	… to understand the experience of migration for RNs moving from the UK to WA	Purposive and Snowball sample of 21 nurses from the UK	Making the move; finding a way New life; fitting in Here to stay	Low
Wolcott, Llamado and Mace (2013) United States	Qualitative pilot study Interviews	Constant comparison, thematic analysis	…to explore the experiences of IEN and the nurse managers and educators working with them, to understand the issues, and to highlight potential solutions for addressing integration challenges.	Purposive and snowballing sampling for 5 IEN from Denmark, Germany, India, Philippines and Portugal, their managers, and educators -	Communication difficulties Financial challenges Social support Educational orientations focused on culture, Nurse role Communication techniques.	High
Zhou et al. (2011) Australia	Symbolic interactionist approach In-depth interviews	Initial and focused coding and constant comparison of data	… to explore the social construction of difference and the related intersection of difference and racialisation	Snowball sample of 28 Chinese nurses	Difference in: - You are you and I am I - We cannot live a life like that - We are among but not in… Difference as: - ‘incompetence’ - ‘not knowing’ - ‘deviance’	Moderate
Zhou (2014) Australia	Grounded theory In-depth interviews	GT analysis methods (Glazer 2005).	… to explore experiences of China-educated nurses working in Australia.	Purposive sample of 28 Chinese nurses	Reconciling different realities. Three phases of reconciling were conceptualised: realising, struggling, and reflecting. (Second publication of same study – Zhou et al 2011)	High