Optimising the Utilisation of Internationally Qualified Nurses' Specialty Skills: Insights From Recruiting Managers' Perspectives

ABSTRACT

Aim

To explore recruiting managers' perception of the facilitators and barriers to specialty skill transfer of internationally qualified nurses in Australia.

Design

A qualitative descriptive study using a cross‐sectional online survey with open‐ended questions. Data were collected from July to September 2022.

Methods

A self‐designed survey was distributed through social media, snowballing, and nursing professional organisations. Nine open‐ended questions generated text responses that were analysed using qualitative content analysis. Descriptive statistics (counts/percentages) were used to summarise participant characteristics and the frequency of codes/categories; no inferential statistical tests were undertaken because the study did not aim to estimate population parameters or test group differences.

Results

Participants defined a specialty nurse as encompassing formal education, clinical experience, and advanced practical skills, including mentoring and leadership capabilities. Key challenges to IQN specialty skill transfer included uncertainty about overseas training quality, lack of formal transfer models, fragmented recruitment processes, insufficient managerial support, and bias or mistrust regarding international qualifications. Facilitators included structured support systems, positive workplace culture, informal mentorship, contextualised training, and access to continuing professional development. Managers emphasised that recognition and utilisation of IQNs' skills influenced retention, with personal circumstances, visa issues, and perceived lack of recognition contributing to attrition. Most participants (34/37; 91.9%) believed that IQNs' specialty skills can be effectively transferred to the Australian healthcare context with appropriate support and time (95% CI 78.7%–97.2%).

Patient or Public Contribution

A total of 37 recruiting managers contributed their perceptions.

1. Introduction

The global nurse shortage is a complex and severe issue with significant consequences for healthcare systems worldwide. Numerous factors contribute to this shortage: population ageing, the rise in chronic diseases, the retirement of skilled nurses, and the demanding nature of the profession (Doleman et al. 2022; Smith et al. 2022). To meet the ambitious healthcare targets set by the United Nations for 2030, an additional 9 million nurses globally are required (United Nations 2022). The COVID‐19 pandemic has worsened nursing shortfalls by increasing the demand for healthcare services and causing burnout among existing nurses (Litton et al. 2021).

Nurse managers are essential in healthcare organisations, as they oversee nursing staff, ensure the quality of patient care, and manage budgets (Cave et al. 2023). However, the nurse shortage heavily burdens nurse managers in Australia, who are also responsible for recruiting nurses (Agency for Healthcare Research and Quality 2012; Boort District Health 2017). The nursing skill shortage in Australia is expected to cost the economy $7 billion by 2026, leading universities to restructure their programs to meet the increasing demand (Lansdown 2023, August 9). This restructuring includes an expansion of international student enrollment. Notably, international student enrollment is the third‐largest export for Australia, behind iron ore and coal, contributing $29 billion to the economy (Universities Australia 2023). However, there is a high attrition rate among students in pre‐registration nursing programs in Australia (Australian Government 2020). To address the immediate shortage, Australia heavily relies on recruiting Internationally Qualified Nurses (IQNs), with almost one‐third of the current healthcare workforce comprising IQNs, mainly from non‐English speaking countries (Kurup et al. 2022, 2026).

Australia's reliance on IQNs reflects a broader global trend, as many countries face similar workforce challenges (Kurup et al. 2024a, 2024b, 2024c). Research in Canada reveals that IQNs face difficulties with work contracts, communication breakdowns during recruitment, perceived discrimination, and discrepancies between expected and actual professional roles (Higginbottom 2011). Similarly, in the United Kingdom, international nurses and midwives often require tailored support to transition successfully and to pass mandatory examinations such as the Objective Structured Clinical Examination (OSCE) (Afriyie 2022). In the United States, evidence points to the need for structured, evidence‐based transition programs, particularly in acute care settings, that address the unique needs of international nurses in new healthcare environments, with regulatory implications suggesting that such programs may eventually become mandatory (Yu 2010). Simulation‐based learning has also been identified as an effective strategy for familiarising IQNs with the clinical standards (Ryan et al. 2023), communication expectations, and professional norms of their host countries, thereby bridging gaps between prior training and new regulatory requirements. Together, these international experiences illustrate the complexity of global nurse migration and the importance of structured, supportive pathways for IQNs.

2. Background

Integration of IQNs into the Australian healthcare system comes with challenges. Recognition of overseas qualifications and experience remains a significant barrier to integration, leading to the underutilisation of IQNs' skills (Donald et al. 2010). There is widespread underutilisation of skills among IQNs, with many working below their educational and specialisation levels despite possessing valuable expertise (An et al. 2016; Stankiewicz and O'Connor 2014). These circumstances contribute to personal job dissatisfaction and have wider ramifications for patient care, exacerbating shortages of nurses in specialty nursing areas (Ressia et al. 2017). The lack of familiarity among nurse managers regarding the assessment of IQNs' skills and qualifications further compounds this issue (Kurup et al. 2024a, 2024b, 2024c, 2025).

Underutilisation of skills carries both opportunity and direct financial costs. The Committee for Economic Development of Australia (CEDA) estimated that reduced productivity due to skill underutilisation costs the Australian economy approximately $1.25 billion annually (CEDA 2021). Roche et al. (2015) note that underutilising nurses' skills drives attrition, increasing turnover rates and necessitating agency staffing, which raises overtime expenses and further strains budgets. Job satisfaction among IQNs is closely linked to the effective use of their specialised skills, and a lack of utilisation often results in dissatisfaction and resignation (Timilsina Bhandari et al. 2015). The departure of experienced staff can disrupt team dynamics and workflow, compounding organisational costs and potentially compromising patient care continuity (Albougami et al. 2020; Nuffieldtrust 2021).

The effect of skill underutilisation on patient care cannot be overstated. When healthcare professionals cannot fully apply their specialised skills and knowledge in their roles, it can result in suboptimal patient outcomes (Kurup et al. 2023). For example, a nurse with specialised training in a particular area may be unable to provide the best possible care if assigned tasks outside their expertise (Kurup et al. 2023). This malalignment of skills can lead to errors, delays in treatment, and a lower quality of patient care (Randa and Phale 2023). Additionally, when the right skills are not available for patient care, healthcare organisations may struggle to meet the complex needs of their patient population, leading to dissatisfaction among patients and their families (Alibrandi et al. 2023).

Despite a long history of nurses migrating from developing to developed countries, there is limited literature on recognising the specialised skills of IQNs. This underutilisation of skills contributes to staff turnover and associated costs and compromises patient care quality. The lack of information related to this topic in the literature highlights the need for further research. The high demand for nurses worldwide, especially in the context of COVID‐19, underscores the relevance and seriousness of the problem. Therefore, this study aims to explore recruiting managers' perceptions of the facilitators and barriers to specialty skill transfer of IQNs in Australia.

3. The Study

3.1. Aim(s)

To explore recruiting managers' perceptions of the facilitators and barriers to specialty skill transfer of IQNs in Australia.

3.2. Objective

To gather perspectives from recruiting managers regarding the utilisation of IQN's specialty skills in Australia post‐immigration.

3.3. Research Question

How can the specialty skills of IQNs be effectively utilised in the healthcare system of a developed country following immigration?

4. Methods

4.1. Research Design

A cross‐sectional online survey was employed to investigate the facilitators and barriers linked to transferring and using IQNs' specialised skills into Australia's healthcare system following immigration. A qualitative descriptive approach was selected because it is well‐suited to capturing practice‐based perspectives in participants' own words and to generating actionable insights for workforce and recruitment contexts.

4.2. Study Setting and Sampling

The recruitment of participants employed a purposive sampling technique. A specifically designed survey was disseminated through various channels, including social media groups, snowballing, and professional institutions such as the Australian College of Nursing. Additionally, survey distribution utilised public email addresses and web inquiry pages. Those interested in participating were guided to the survey through an advertisement link. To ensure eligibility, screening questions were incorporated on the first page of the survey.

Additionally, the Participant Information Letter was accessible via a link on the survey landing page. The recruitment advertisement text was refreshed every two weeks on various social media platforms and professional organisation discussion forums to maintain visibility. Participation in the study was voluntary, and a formal a priori sample size calculation was not undertaken because the study did not involve hypothesis testing or inferential statistics; instead, sampling continued over the recruitment window to maximise the diversity of recruiting‐manager perspectives across jurisdictions and settings, with adequacy judged by the richness and redundancy of responses across the nine questions. Because recruitment occurred through open online distribution and snowballing, a response rate could not be calculated.

Purposive sampling was used to ensure respondents had direct, role‐based experience in recruiting and supporting IQNs, which is the specific knowledge required to address the research question. This approach was considered appropriate for exploratory qualitative work focused on understanding barriers/facilitators within recruitment decision‐making and workplace integration.

4.2.1. Inclusion and Exclusion Criteria

The study included participants who were nursing managers and had firsthand experience in recruitment and working with IQNs, including decisions about role allocation and support that may influence the utilisation of specialty skills in Australia's health system. Inclusion criteria required all participants to be registered nurses who hold current registration with the Australian Health Practitioner Regulation Agency (Ahpra) and are responsible for recruiting new nurses. Participation in the study was voluntary. Registered nurses who were not currently occupying management roles were excluded from participation.

4.2.2. Instrument Development and Validation

A self‐designed survey was developed to collect data to address the research question. The formulation of survey questions was guided by a comprehensive literature review on utilising specialty skills among IQNs (Kurup 2025). The survey comprised nine open‐ended questions designed to elicit detailed responses from participants. To enhance credibility and comprehensiveness, the instrument underwent expert review through a pilot study involving academics with extensive experience in recruitment‐related nursing management roles. Their feedback was instrumental in refining both the survey questions and the participant recruitment advertisement before the main study was conducted.

The advertisement was disseminated through professional networks and social media platforms such as Facebook and LinkedIn. It clearly outlined the study purpose, eligibility criteria, ethical approval details, and contact information, ensuring transparency and informed consent. The final version of the survey instrument and the corresponding recruitment advertisement are presented in Table 1.

TABLE 1.

Survey.

Survey recruitment advertisement text

Survey questions

Hi everyone, Are you an Australian Nurse in a leadership capacity responsible for recruiting nurses? Have you recruited internationally qualified nurses (IQNs) to your workplace? If you would like to share your knowledge and experiences about the specialty skills transfer of your IQN workforce, please take the time to complete a survey via the link below. (https://rdcap.acu.edu.au/surveys/?s=LPKXK4P9CA&fbclid=IwY2xjawQW9D1leHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeEhiVk1extZfJ9NZOpPWUtNEbz0rraitWBFutVb6EzznLQUVfPoN‐pKddtEs_aem_e6d8Fdqe5DzYj8NVKeckXw) has approved this study. We plan to use the results to modify future specialty skill transition models for IQNs. Eligibility criteria: 1. Age 18 years or above. 2. An Australian nurse in a leadership role responsible for recruiting nurses. If you wish to participate, simply click the link below, and you will be directed to a survey page. The survey will take 10–15 min to complete and includes questions about IQN specialty skill transition knowledge and experience. You may withdraw at any time. Click here to participate. For further information, please contact: (https://rdcap.acu.edu.au/surveys/?s=J9CTEADXDF&fbclid=IwY2xjawQW9GFleHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeyX82mRufOntCCMcJokD‐Z‐UoIgmBClXS7zLHvk69tOXhVdpJYs5TeRQYH0c_aem_UYJlBFHwIEsn8xC5QclTsQ)

In your understanding, what is the definition of a specialty nurse or clinical nurse specialist? What difference do you think exists between your nursing training and that of registered nurses educated in Australia? Explain the specialty skill transfer model used in your hospital. In your opinion, can IQNs' specialty skills be safely transferred to Australian settings? In your view, are there other facilitators for specialty skill transition among IQNs? Do you have any further comments on the facilitators in the skill transition? In your view, are there other barriers to specialty skill transition among IQNs? Do you have any further comments on the barriers to skill transition? Do you have any further comments about the retention of specialty‐trained IQNs?

4.2.3. Data Collection

The survey was developed and distributed using the REDCap platform; it was accessible to participants for two months, from July to September 2022.

4.2.4. Data Analysis

Content analysis, as explained by Kuckartz and Rädiker (2023), was used to examine the data from the open‐ended questions. Participant responses were transferred to an Excel spreadsheet, where they were divided into meaning units or smaller sections, condensed and colour‐coded. Two research team members independently coded each comment before comparing them to ensure consistency; a third investigator then reviewed the codes. Any disagreements in coding were addressed through collaborative discussions aimed at reaching a consensus among the researchers. Codes were then divided into categories and subcategories, which were further sorted and quantified by highest frequency to indicate the emphasis the participants gave to each category. Common themes among the categories were determined and reported to discover the patterns arising from the data.

Qualitative content analysis was chosen because it supports systematic coding of short‐to‐medium length text responses and enables transparent movement from meaning units to codes, categories, and themes. Frequency counts were used descriptively (not inferentially) to indicate which ideas were most commonly raised by participants. No statistical hypothesis tests were conducted because the dataset was not designed for group comparisons, the sample was purposive/self‐selected, and the study aim was exploratory. Where proportions are reported (e.g., perceived transferability), they are presented as descriptive ‘effect size’ equivalents with 95% confidence intervals to support interpretation without overstating generalisability.

4.2.5. Ethical Considerations

Ethical approval was obtained from the Australian Catholic University Human Research Ethics Committee (approval number 2022‐2524E) prior to commencement of data collection. Participation was voluntary, and informed consent was implied when participants confirmed they wished to proceed beyond the initial information and eligibility screen and then completed the survey.

4.2.6. Data Trustworthiness

Trustworthiness was addressed through credibility, dependability, confirmability, and transferability strategies. Credibility was strengthened via literature‐informed question development, expert review in piloting, and the use of verbatim excerpts to demonstrate alignment between the data and interpretations. Two researchers independently coded all responses and resolved differences through discussion, with a third investigator reviewing the coding framework and theme structure. Dependability and confirmability were supported by a documented coding pathway (meaning units to codes, categories, themes), iterative codebook refinement, investigator triangulation, and reflexive consideration of researcher positioning. Transferability was supported by reporting participant and context characteristics and by recruiting across jurisdictions to capture a range of recruiting‐manager perspectives.

5. Findings

5.1. Sample Characteristics

Thirty‐seven participants completed the open‐ended questions in the survey. Most responders (68.1%, n = 24) were females, averaging 53.7 years (see Table 2). Managers who classified themselves as IQNs accounted for 35% (n = 13) of the participants. Among these participants, 24 managers (65%) received their initial nurse training in Australia, while others obtained their qualifications from various countries (Table 3). The survey's geographical coverage included every state and territory, with Victoria (VIC) leading the way with 22 (n = 8) responses (Figure 1).

TABLE 2.

Demographics.

Gender			Age
Females	Males	Prefer not to say	Mean	53.7
N = 24 (65%)	N = 11 (30%)	N = 2 (5%)	Range	35‐over 65

TABLE 3.

Countries of initial nursing qualification.

Countries of initial nursing qualification	N
Australia	24 (65%)
United Kingdom	4 (11%)
New Zealand	3 (8%)
India	3 (8%)

FIGURE 1.

State and territory distribution.

5.2. The Meaning of the Term ‘Specialty Nurse’

Nurse managers described a ‘specialty nurse’ through three interconnected dimensions: education and training, experience, and specialised skills (Table 4).

TABLE 4.

Defining the term ‘Specialty Nurse’.

Category	Code count (n = 34)	Theme
Training	14 (41%)	Education & Training
Experience	13 (38%)	Clinical Experience
Specialised	13 (38%)	Specialised Skills & Leadership

5.2.1. Theme 1: Education and Training

Many participants believed a ‘specialty nurse’ is, or should be, a nurse whose education is specifically aligned with a particular clinical field. Their comments reinforced this notion, which highlighted the expectation for nurses in specialised roles to have undergone targeted training. One manager emphasised, ‘A nurse who has completed a specialist training, preferably post‐grad, in cardiac care nursing or something similar’ (Manager 3). Another echoed this sentiment, underscoring that ‘these skills should be supported by an appropriate postgraduate qualification in the respective area’ (Manager 12). Similarly, a third participant expanded on this idea, explaining that a ‘nurse with specialty training, either hospital‐based or tertiary institution‐based,’ best fits the definition of a specialty nurse (Manager 21). These perspectives underscore the consensus that formalised education, mainly through postgraduate training, is essential to defining and supporting specialty nursing practice.

5.2.2. Theme 2: Clinical Experience

Several participants linked the concept of a ‘specialty nurse’ to formal education and practical work experience in a specific clinical field. Their comments reflected this interpretation, highlighting the importance of hands‐on experience in defining specialty nursing. As one manager noted, ‘A nurse with experience in departments which handle specialty cases’ (Manager 7) embodies this role. Another participant echoed this view, emphasising the value of ‘clinical experience in the nursing specialty’ (Manager 23). Similarly, another manager reinforced the idea, stating that a ‘nurse with [experience] in specialised clinical wards or [departments]’ (Manager 25) truly fits the definition. These perspectives emphasise that real‐world experience within specialty areas is critical in shaping and identifying specialty nurses.

5.2.3. Theme 3: Specialised Skills & Leadership

Several participants associated the term ‘specialty nurse’ with specialised skills within a specific field, reflecting a broader understanding of expertise beyond education and experience. Their comments highlighted the significance of advanced competencies in defining specialty nursing. One manager noted, ‘A nurse with work expertise in specialty areas of nursing’ (Manager 28), emphasising the practical skillset. Another manager expanded on this, describing a specialty nurse as a registered nurse with advanced practical skills and competency in teaching, mentoring, supervising, and delivering evidence‐based care in a particular specialty (Manager 12), suggesting that these nurses are not only experts in their field but also crucial educators and mentors. Further reinforcing this, a third participant added that a specialty nurse is ‘someone who has clinical expertise within a specialty and supports other RNs in their training, assists in research or quality improvement, and acts as a leader/role model’ (Manager 5). These views collectively underscore the idea that specialised skills, combined with leadership and mentorship abilities, are central to the identity of a specialty nurse.

5.3. Difference in Nursing Training

Participants' views on the differences between nursing training for IQNs and registered nurses in Australia were sought. Nurse managers' understanding of the term revealed four key themes: Uncertainty, Practice Preparation, Similarity, and Varying Scope (Table 5).

TABLE 5.

Difference in nurse training.

Category	Code count (n = 42)	Theme
Unsure of overseas training	14 (33%)	Uncertainty
Different components/length	13 (31%)	Practice Preparation & Scope
Variance in scope/no patient ratio	20 (47%)	Practice Preparation & Scope
Similar	11 (26%)	Similarity

5.3.1. Theme 1 Uncertainty

The theme of ‘Uncertainty’ underscores a significant challenge in integrating IQNs into the Australian healthcare system. This uncertainty primarily reflects a lack of confidence and trust in the quality and validity of these nurses' training overseas. Nurse managers often express concerns regarding the authenticity and credibility of the certificates and nursing education programs from various countries, creating an atmosphere of scepticism that complicates their ability to assess and evaluate the skills and competence of IQNs accurately.

One manager articulated this concern vividly: ‘I cannot trust the training received from overseas, as there are a lot of dodgy providers just issuing certificates. So, we don't know if the nurse is a nurse or not’ (Manager 4). This statement captures the essence of the apprehensions shared by many within the managerial ranks, who feel the weight of uncertainty regarding the legitimacy of the qualifications presented to them.

Another participant echoed similar doubts, stating, ‘I am unsure of the nursing training in other countries to have a valid assessment’ (Manager 8). This sentiment reveals a pervasive unease that permeates the managerial perspective, where the ability to make informed judgements about IQNs' qualifications is hindered by the diverse and often opaque training systems from which these nurses emerge.

Furthermore, the geographical diversity of IQNs adds another layer of complexity to this uncertainty. A manager explained, ‘The countries they come from are all around the world. Hence, what preparation they received in their country is a guessing game’ (Manager 20). This remark emphasises nurse managers' challenges as they navigate the intricacies of varying educational standards and training methodologies across different nations.

These statements highlight a fundamental issue: the pervasive uncertainty surrounding the preparation and qualifications of IQNs complicates the evaluation process for nurse managers. This uncertainty affects the integration of IQNs into the workforce and poses a risk to patient care quality. As healthcare systems strive to harness the skills and experiences of IQNs, addressing this uncertainty through enhanced transparency and standardised assessment frameworks becomes paramount.

5.3.2. Theme 2: Practice Preparation & Scope

The theme of Practice Preparation and Scope highlights the interplay between differences in educational pathways and the varying scope of nursing practice across countries. Together, these factors shape how effectively internationally qualified nurses (IQNs) can utilise their specialty skills in Australia.

Managers noted that in many countries, specialty training after registration is limited or absent, leaving IQNs without certificates to formally validate their expertise. This gap is often compounded by limited leadership education, which can prevent IQNs from confidently asserting their knowledge or challenging authority when their skills are overlooked. As one manager explained, ‘The leadership qualities are not covered in the overseas curriculum, I believe. The new nurses may be quiet, but they have immense knowledge that the right kind of manager can utilise’ (Manager 23).

These educational differences also extend into how nurses are prepared for practice. One participant observed, ‘Australian nursing students have fewer clinical hours to complete than nursing school in the Philippines. Learning starts after completing the course there. Here, nurses don't do personal learning to excel in an area unless the role gives more money. Hence, there is usually no specialty training; it's all the work experience in the area’ (Manager 1). Such contrasts reflect differing balances between structured training and experiential learning across contexts.

Alongside preparation, managers emphasised stark differences in the scope of practice. IQNs often come from environments with heavier patient loads and broader responsibilities. ‘The patient ratio that they are exposed to, the conditions are much worse there’ (Manager 24), one manager noted. Others highlighted differences in clinical roles: ‘I have skilled nurses who do intubations, but Australia restricts the scope… I wouldn't have known it if I never asked’ (Manager 25). The technology and resources available in different countries also shape what nurses are trained and expected to do, with some arriving from systems where the breadth of practice is much wider than in Australia (Manager 26).

Despite these challenges, managers recognised that IQNs' clinical training provides a strong foundation. ‘IQNs have skills that are very well supported by clinical training. They better understand the theories, which is very supported by their clinical experience’ (Manager 11). This reinforces the idea that while educational gaps and differences in scope may complicate initial integration, the depth of IQNs' clinical experience remains an untapped strength. Addressing gaps in leadership training, clarifying scope differences, and recognising experiential learning could unlock this potential more effectively within the Australian healthcare system.

5.3.3. Theme 3: Similarity

The theme of ‘Similarity’ reflects the perception that there are significant parallels between nursing training in Australia and the home countries of IQNs. Many participants believed that the educational backgrounds and qualifications of IQNs closely resemble those of Australian‐trained nurses, suggesting that IQNs are well‐prepared to adapt to the Australian healthcare system.

For instance, one manager observed, ‘Education seems pretty similar’ (Manager 7), indicating confidence in the equivalency of training standards. Another manager echoed this sentiment, stating, ‘I have a great bunch of nurses, so the course should all be good’ (Manager 10), suggesting that the training IQNs receive is comparable to that in Australia. Similarly, another participant noted, ‘Nurses are pretty skilled coming from overseas; hence, the courses could be very similar’ (Manager 17). These comments highlight the shared perception that, despite geographical and cultural differences, nursing education for IQNs and Australian nurses shares a strong foundation in both knowledge and practical skills.

5.4. Hospital Specialty Transfer Support

Recruiting managers were asked to share their perceptions of the facilitators and barriers to specialty skill transfer of IQNs in Australia. Analysis of responses revealed two main themes: ‘No transfer model’ and ‘Informal bespoke support’ (Table 6).

TABLE 6.

Hospital specialty transfer support.

Category	Code count (n = 26)	Theme
No transfer model	21 (81%)	Lack of Formal Transfer Models
Informal/ad hoc support	13 (50%)	Informal Bespoke Support

5.4.1. Theme 1: Lack of Formal Transfer Models

Participants consistently emphasised that IQNs enter the workforce without dedicated transition programs or tailored induction. Most organisations relied on standard orientation for all staff, with no recognition of the additional needs of internationally qualified nurses. One manager explained, ‘General induction is provided to all employees. There is no special international support plan, but it would be good if we had one’ (Manager 1).

Resource constraints were frequently cited as a barrier to change. As one participant put it, ‘There is not enough staff or funding for supplies, who cares about skill model’ (Manager 22). Others highlighted that the absence of funding and structured planning made it difficult for IQNs to adapt their skills effectively to the Australian healthcare system. Collectively, these views suggest that the lack of formal programs represents a systemic gap in supporting IQNs' transition and skill utilisation.

5.4.2. Theme 2: Informal and Ad Hoc Support

In the absence of structured models, managers reported that support often relied on informal arrangements within teams. Colleagues and managers would provide guidance as needed, but this assistance was inconsistent and dependent on individual goodwill rather than institutional policy. As one participant remarked, ‘Not a well‐designed transition plan, but support by nurses and managers exists’ (Manager 12).

Examples of these informal practices included easing IQNs into their roles by temporarily shielding them from complex tasks or rostering challenges. One manager described, ‘We don't issue them night shifts for three months… as the night shift has a minimum number of staff, and there is no one to ask for help or take advice’ (Manager 23). While helpful, these ad hoc strategies were not sufficient substitutes for structured transition support, leaving gaps in consistency and long‐term integration.

5.5. Skill Underutilisation & IQN Attrition

Most nurse managers shared data on the underutilisation of speciality skills and their link to IQN attrition in Australia, indicating a significant issue. Nurse managers' insights revealed two themes: Reasons for Attrition and Addressing Employee Utilisation to Reduce Attrition (Table 7).

TABLE 7.

Attrition of IQNs.

Category	Code count (n = 26)	Theme
Personal/family/visa/location	16 (61%)	Personal and Circumstantial Factors
Lack of recognition	6 (23%)	Lack of Recognition & Skill Underutilisation
Support & utilisation	6 (23%)	Structured Support for Retention

5.5.1. Theme 1: Personal and Circumstantial Factors

Many participants attributed attrition to external circumstances such as family needs, geographic preferences, or visa‐related issues. As one manager explained, ‘Nurses usually take the first job offered in strange locations. Then, based on climate and family surroundings, they might move to metros or any other states’ (Manager 19). Visa instability was also significant: ‘Visa‐related reasons make them move’ (Manager 28). These challenges created uncertainty and mobility, with IQNs often leaving in search of more stable or suitable conditions for themselves and their families.

5.5.2. Theme 2: Lack of Recognition & Skill Underutilisation

Attrition was also strongly linked to a lack of recognition for IQNs' specialised skills. Some participants noted that IQNs, despite being highly trained, were not given opportunities aligned with their expertise. One manager observed, ‘Immigrants are here for a better job opportunity; if they cannot find it in a workplace, there is a high chance they will not stay’ (Manager 10). Underutilisation left many IQNs feeling undervalued, reinforcing decisions to move on.

5.5.3. Theme 3: Structured Support for Retention

Managers emphasised that retention could be improved by creating supportive environments and systematic utilisation of IQNs' skills. One participant, an international recruiter, explained, ‘Our recruits will phone me, and if necessary, I'll have a chat with their CNC to try and solve any issues before they become a reason for the IQN to leave. Usually, they don't feel valued. Support networks are crucial’ (Manager 9). Others suggested institutional plans: ‘Every hospital should develop an individual plan to assess, train, and retain internationally qualified nurses’ (Manager 4). These perspectives highlight that proactive support, mentorship, and structured retention strategies can mitigate attrition and unlock the full value of IQNs within the workforce.

5.6. Transferability of Specialty Skills

Most participants (92%) believed IQNs' specialty skills can be effectively transferred into the Australian healthcare system with time and support. Managers highlighted the value of contextual training to adapt practice, describing IQNs as ‘absolute assets… the best strategy is not rushing and waiting’ (Manager 7).

Recent changes, such as COVID‐era eligibility for graduate programs, were seen as creating new opportunities: ‘Now, overseas nurses can apply for grad positions… they are skilled clinicians’ (Manager 6).

Beyond training, social factors were also critical. As one manager noted, ‘It is the intangibles, such as isolation from their previous support network, that have a greater impact on their staying’ (Manager 1).

Overall, participants expressed strong confidence in IQNs' ability to contribute meaningfully, provided their transition is supported both professionally and socially.

5.7. Facilitators

Nurse managers identified two main facilitators of IQNs' specialty skill transfer: support systems and strategic approaches to skill development (Table 8).

TABLE 8.

Facilitators.

Category	Code count (n = 53)	Theme
Managerial/workplace support	30 (57%)	Role of Support Systems
IQN community/agency	14 (26%)	Role of Support Systems
Transition programs/CPD/mentorship	9 (17%)	Skill Transfer Strategies

5.7.1. Theme 1: Role of Support Systems

Managers emphasised that strong support systems are central to successful integration. Effective leadership, team support, and a positive workplace culture were seen as critical for IQNs to feel valued and confident in applying their skills. One participant explained, ‘Support, especially managerial support, training, and education mechanisms, needs to be planned and implemented… a manager is the central key there’ (Manager 34). Similarly, another noted, ‘Retention is greatly affected by the work culture; if staff feel valued and their skills are utilised, you are half winning’ (Manager 20). These insights show that supportive environments not only enhance skill transfer but also improve retention.

5.7.2. Theme 2: Skill Transfer Strategies

Participants highlighted targeted strategies such as continuous professional development, mentorship, and career planning as essential to maximising IQNs' contributions. Offering structured learning opportunities was recommended: ‘Recommend free CPD courses as part of their package, which also ensures any upskilling if required’ (Manager 12). Mentorship was seen as equally important, particularly for navigating local terminology and practice expectations. As one manager explained, ‘It takes a fair discussion to see which area they are more interested in and maybe develop a career plan’ (Manager 23). Others stressed that retention depends on valuing IQNs' skills: ‘Not feeling valued for their skills is a big reason why they leave’ (Manager 18).

5.8. Barriers

The study gathered recruiting managers' opinions on the barriers to IQNs' specialty skill transfer. Nurse managers' understanding of the term revealed two themes: Specialty Skill Identification Challenges in Recruitment and Bias and Trust Issues with Overseas Qualifications, as presented in Table 9.

TABLE 9.

Barriers.

Category	Code count (n = 60)	Theme
Fragmented recruitment/limited resources/managerial capacity	41 (68%)	Skill Identification Challenges
Bias, trust, discrimination	19 (32%)	Bias and Trust Issues

5.8.1. Theme 1: Skill Identification Challenges

Managers described fragmented recruitment systems, limited resources, and insufficient training for managers as barriers to effectively recognising IQNs' skills. Departments often worked in silos, with one noting, ‘The wards and departments did international recruitment differently. If there were shared communication, it would be smarter work than hard work’ (Manager 18).

The focus on filling vacancies rather than retaining skilled staff was a recurring issue: ‘Hospitals aren't truly invested in retention… the lack of support to assess and employ nurses causes skill use issues’ (Manager 6). Managers also highlighted that they themselves lacked formal training and resources to support IQNs, leaving gaps in skill assessment and integration. Collectively, these challenges reveal systemic inefficiencies that prevent IQNs' expertise from being fully utilised.

5.8.2. Theme 2: Bias and Trust Issues

Entrenched bias and mistrust of overseas qualifications further constrained IQNs' contributions. Some managers described discriminatory behaviours from both colleagues and patients: ‘Patients who have refused a nurse who is different in colour are also common’ (Manager 20). Even nurses from English‐speaking countries faced scepticism: ‘The UK nurses also face the confidence issue… that nursing is not up to Australian standards’ (Manager 14).

Others pointed to deep‐seated prejudice: ‘Discrimination, racism, and lack of trust in overseas qualifications were always there and will be there. Unless Australians are open… we will be stuck with the nurse scarcity forever’ (Manager 28). These comments illustrate how bias undermines confidence, hinders teamwork, and perpetuates the underutilisation of IQNs' skills.

Together, these themes highlight that barriers are both structural and cultural: fragmented systems fail to identify IQNs' strengths, while bias and mistrust diminish their opportunities. Addressing both dimensions is essential for creating a healthcare environment where IQNs' specialty skills are fully recognised and effectively applied.

6. Discussion

This study explored recruiting managers' perceptions of the facilitators and barriers to specialty skill transfer of IQNs in Australia. Rich data was gathered through nine open‐ended questions. Detailed demographic data were collected from all Australian states and territories. Participants were mainly trained in Australia, with some from India, the UK, New Zealand, and the Philippines, reflecting recent population trends (ABS 2021). Participants' ages aligned with global IQN studies (Hewko et al. 2015; Membrive‐Jiménez et al. 2020; Naranjo‐Gil 2009), and there was a predominance of female nurse managers similar to the nursing workforce in Australia, where 85.6% of registered nurses are women (NMBA 2022). Most participants held nurse unit manager roles, consistent with their global role description (Agency for Healthcare Research and Quality 2012), with support from other higher‐role RNs.

6.1. Exploring the Concept of Specialty and Nursing Training

Managers conceptualised ‘specialty nurse’ as requiring advanced education, clinical expertise, and leadership, an understanding shaped by local regulation, culture, and workforce needs. For instance, while the US recognises the Clinical Nurse Specialist (CNS), Australia uses titles such as Clinical Nurse Consultant (CNC), with state‐based variations in postgraduate requirements (Gordon et al. 2012). In many developing countries, career progression relies more on years of service and internal assessments than formal postgraduate pathways (Kerala Public Service Commission 2021; Shang et al. 2014; Stephen and Vijay 2019).

In this study, specialty nurses were seen as RNs with advanced clinical knowledge, supported by postgraduate or specialist qualifications, who provide direct care, supervise colleagues, and contribute to research and quality improvement. Yet managers highlighted discrepancies between Australian and overseas training, particularly in clinical hours and scope of practice (Deng 2015). IQNs from countries such as the UK and Canada, despite comparable systems, have reported difficulty transferring specialised skills in Australia due to registration and recognition barriers (Gillespie et al. 2012; Vafeas 2013). Concerns about fraudulent or inconsistent overseas training further complicate perceptions of competence (Attewell and Domina 2011; Johnson 2006). Cultural differences also influence adaptation, shaping workplace communication and patient care practices (Balante et al. 2021; O'Callaghan et al. 2018). Gradual, supported opportunities to apply skills were seen as crucial for successful integration (Mitchell et al. 2017).

6.2. Facilitators and Barriers to Utilising Specialty Skills Among IQNs

Managers identified supportive leadership and a positive workplace culture as key enablers of specialty skill utilisation among internationally qualified nurses. Programs such as buddy or mentor systems, employer‐sponsored education, and structured cultural orientation were viewed as beneficial in supporting transition and confidence‐building (Allen 2017; Ryan et al. 2025). However, participants noted that these initiatives frequently focus on general workforce integration rather than specialty‐specific practice, leaving many IQNs underprepared to apply their advanced skills and consequently feeling undervalued (Kurup et al. 2023). Limited funding for specialty‐focused transition programs and the inequitable distribution of professional development opportunities, particularly in rural and regional settings, further compound these challenges (Khatri et al. 2021).

Importantly, these findings suggest that underutilisation of specialty skills is not primarily a function of individual capability but instead reflects implementation and system design gaps. Evidence from broader healthcare implementation research indicates that professional knowledge and competence alone rarely translate into sustained practice change without enabling organisational structures, leadership support, and trusted systems to guide implementation (Ford et al. 2023). In parallel, nursing education and workforce literature demonstrate that structured, context‐specific training interventions, particularly those incorporating simulation and supported transition, can facilitate the safe adaptation of existing expertise to new clinical environments (Ryan et al. 2025).

Visa and work permit complexities were cited as major barriers, with inconsistent processes discouraging managers from hiring overseas applicants (Liou and Cheng 2011; Safari et al. 2022; Salami and Nelson 2014). These uncertainties can lock IQNs into insecure positions, vulnerable to underpayment and exploitation (Boese et al. 2013). Addressing such issues requires advocacy services, clearer guidance, and peer support to empower IQNs and ensure their rights are protected (Kurup et al. 2024a, 2024b, 2024c). By actively reducing these structural barriers, healthcare organisations are better positioned to leverage IQNs' specialised expertise, enhance workforce stability, and ultimately improve the quality and safety of patient care.

6.3. Utilisation of Specialty Skills

By identifying the facilitators and barriers to specialty skill utilisation post‐immigration, this study highlights the need for structured pathways to help IQNs transition into their specialties. Such initiatives can strengthen nurses' confidence, improve workforce efficacy, and ultimately enhance patient safety and outcomes. Achieving this requires coordinated efforts from healthcare organisations, nurse managers, regulators, and government agencies to provide targeted support during transition.

A consistent theme among participants was the absence of a standardised pathway for IQNs, with current processes remaining informal and inconsistent. Hospital‐based transition programs, mentorship, and residency models are crucial but unevenly available (Boyer et al. 2017; Kurup 2025). Nurse managers also require ongoing training and clear guidelines to overcome barriers and strengthen trust in overseas qualifications. Although Ahpra ensures compliance with national standards (Australian Health Practitioner Regulation Agency 2023), doubts persist among employers, underscoring the need for better communication and alignment across the sector.

Mentorship and orientation programs were recognised as essential supports, offering clarity on IQNs' roles and capabilities. Examples such as the Transitioning Internationally Educated Nurses for Success (TIENS) program (Adeniran et al. 2008) illustrate the benefits of phased, structured transition. Workshops and targeted seminars can also bridge knowledge gaps and ensure safe practice (Aggar et al. 2021; Xiao et al. 2014). Importantly, support should extend beyond recruitment, focusing equally on retention and addressing attrition drivers (Smith et al. 2006).

Global standardisation of nursing education could further ease skill transfer. Initiatives such as the Bologna Accord and WHO frameworks promote consistency in evidence‐based, patient‐centred learning and can be expanded to postgraduate and specialist levels (Baker et al. 2021; WHO 2020). While national adaptation is essential, aligning international education around critical thinking and clinical reasoning would strengthen professional mobility. Continuous opportunities for specialisation remain vital for safe, contemporary practice (Ahpra 2023).

In addition, collaboration between government agencies and registering bodies is key to supporting IQNs through both registration and workplace integration. Tailored mentorship, guidance on immigration and culture, and comprehensive transition plans can reduce barriers and foster confidence (Deegan and Simkin 2010). Validating IQNs' prior expertise through competency frameworks, even for those lacking formal documentation (Cassar 2020), would further enhance utilisation. Legislative amendments may be required to accommodate such recognition under Australia's National Law (Ahpra 2023). With sustained collaboration, IQNs' specialty skills can be fully leveraged to strengthen Australia's healthcare system.

6.4. Future Directions

Building on the findings of this study, future work should prioritise the development of structured and standardised pathways for IQNs, ensuring that their diverse skills are fully recognised and utilised across healthcare systems. Particular attention should be given to strategies that strengthen workforce resilience and sustainability by valuing the varied contributions IQNs bring to specialised practice.

In addition, there is merit in exploring these issues on a global scale. A coordinated international survey, facilitated through the WHO platform, would enable the collection of comparative data across countries. Such an approach could provide a broader understanding of IQNs' experiences, identify common barriers and facilitators to specialty skill utilisation, and guide the development of globally relevant frameworks for supporting internationally qualified nurses in their transition to specialised roles.

6.5. Strengths and Limitations of the Work

Employing a qualitative methodology to examine firsthand experiences and viewpoints from the community of recruiting managers proved instrumental in attaining the study's anticipated outcomes. Reflexivity played a pivotal role in ensuring the study's credibility and validity. The lead researcher, an IQN, actively engaged in self‐awareness and self‐examination to mitigate personal biases, fostering objectivity and reducing undue influence on research outcomes (Skukauskaite et al. 2022). Furthermore, to enhance the quality of data collected, the survey was refined through expert review and pilot feedback prior to dissemination, strengthening the clarity and relevance of questions (Jacob et al. 2021). Additionally, the research incorporated triangulation by involving multiple researchers in the content analysis, ensuring diverse viewpoints and minimising potential biases. Data collection extended to nurse managers from various age groups across Australia, offering a more comprehensive and inclusive understanding of the topic.

Similar to other online studies, this study had some limitations. One of these limitations was related to the recruitment process, which relied on internet access and connectivity. This dependence on technology sometimes results in technical issues, such as poor or lost connectivity (Ochieng et al. 2018; Yayeh 2021). The survey's distribution via clickable links in social media ads might have contributed to a lower response rate. Concerns about online financial crimes, data leaks, and warnings from the Australian Government about scam prevention might have deterred potential participants from clicking on unapproved links. Despite contacting all publicly accessible hospitals and residential aged care facilities, the initial survey dissemination request may not have reached some hospitals' educational or research centres, resulting in lower overall participation. Since the study was disseminated through publicly accessible platforms, eligible participants with negative experiences might have been more inclined to share their grievances. Conversely, recruiting managers from hospitals with successful transition pathways might have been less motivated to participate.

Because recruitment was limited to online platforms and relied on a self‐selected sample, the findings may not fully reflect the experiences of all recruiting managers across Australia. This limits the generalisability and transferability of the results, particularly beyond the Australian context.

7. Conclusion

Despite the presence of many IQNs in Australia's healthcare system and the likelihood of continued international recruitment, research on the transfer and utilisation of IQNs' specialty skills from the perspective of recruiting managers remains limited. This research highlights the variations in nursing education and training, the importance of cultural context in adaptation, and the critical role of facilitating and hindering factors in IQNs' skill transition. It reveals a gap in tailored transition support programs for IQNs, emphasising the need for initiatives that recognise their unique expertise and improve their integration into the healthcare workforce. Furthermore, the study underscores the need to address visa‐related complexities and enhance the role of nurse managers and registering bodies in providing essential support and guidance. Standardising nursing education and fostering ongoing professional development are critical to achieving a cohesive and globally recognised framework for nursing professionals. In light of these findings, a collaborative effort among healthcare organisations, registering bodies, and policymakers is essential to harness the full potential of IQNs, ensuring a more robust and inclusive healthcare system for Australia and resulting in safer patient outcomes.

Author Contributions

Chanchal Kurup: conceptualisation, methodology, formal analysis, investigation, writing – original draft preparation, writing – review and editing. Adam Scott Burston: conceptualisation, methodology, writing – review and editing, supervision. Vasiliki Betihavas: conceptualisation, methodology, writing – review and editing, supervision. Elisabeth Ruth Jacob: conceptualisation, methodology, writing – review and editing, supervision.

Funding

The authors have nothing to report.

Ethics Statement

Permission from the ACU's HREC (Human Research Ethics Committee) was obtained (2022‐2524E) prior to the research.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.