Workplace Outcomes and Experiences of Internationally Educated Nurses: A Scoping Review

Abstract

Nursing shortages in the United States (U.S.) have increased reliance on internationally educated nurses (IENs), yet their workplace outcomes remain poorly understood. This scoping review synthesized peer-reviewed empirical studies examining IEN workplace outcomes and associated individual characteristics and work conditions. Findings from 34 studies published between 2004 and 2025 showed that IENs generally reported moderate to high job satisfaction, while burnout findings suggested moderate to high occupational strain. Evidence on intention to leave was limited by inconsistent measurement and insufficient reporting. Workplace outcomes were most consistently associated with organizational conditions, particularly workload, discrimination, leadership support, orientation, and organizational commitment. Individual characteristics, including age, host-country tenure, and sociocultural adaptation, showed less consistent associations. Interpretation was limited by heterogeneity in study designs, outcome measures, and international settings. Future research using standardized measures and longitudinal or mixed-methods designs is needed to inform organizational practice and workforce policy supporting IEN well-being and retention.

Introduction

Nursing shortages in the United States (U.S.) are a persistent and growing challenge (Haddad et al., 2023; McKinsey & Company, 2023). Between March 1, 2020, and December 31, 2021, 195,282 registered nurses (RNs), representing approximately 5% of the workforce, exited employment (National Center for Health Workforce Analysis, 2024). Furthermore, an estimated 600,000 RNs expressed the intention to leave their current roles by 2027 (Martin et al., 2023; Smiley et al., 2023), and the number of states facing RN shortages will rise from 5 in 2009 to 30 by 2030, leading to a cumulative national shortfall of over 900,000 RNs (Juraschek et al., 2019). These data underscore the importance of addressing the U.S. nursing workforce shortage.

The nursing shortage is an important policy issue because demand for health care services continues to increase as the U.S. population ages and more patients live with chronic and complex health needs (Agency for Healthcare Research and Quality, 2024; National Academies of Sciences, Engineering, and Medicine, 2021). At the same time, large numbers of experienced nurses are approaching retirement, while domestic nursing education programs have not kept pace with workforce demand (American Association of Colleges of Nursing, 2022; Smiley et al., 2023). Together, these trends intensify the need for effective strategies to recruit and retain a stable nursing workforce.

To mitigate the nursing shortage, health care institutions rely on internationally educated nurses (IENs), defined as individuals who completed their initial nursing education outside the U.S. and later obtained licensure to practice in the U.S. (Kawi & Xu, 2009; Wagner et al., 2020). IEN comprise 3.98% of the U.S. nursing workforce, or approximately 208,340 RNs (Smiley et al., 2023). Notably, the U.S. is home to approximately 36% of all IENs worldwide (Buchan & Catton, 2020). Evidence suggests that IENs provide quality of care comparable to non-IENs, and their diverse backgrounds support the growing need for cultural competence in a shifting U.S. demographic landscape (Hohn, 2016; Ma et al., 2020; Rovito et al., 2022; Wagner et al., 2020).

Despite their critical contributions, IENs are a uniquely vulnerable subgroup within the nursing workforce. Unlike immigrant nurses who were born outside the U.S. but received their nursing education in the U.S., IENs must navigate complex licensure and credential verification processes, adjust to new clinical standards, and adapt to differences in language, communication styles, and workplace hierarchies (Bae, 2012; Balante et al., 2021; Batalova et al., 2021; Korzeniewska & Erdal, 2019; Xu & Kwak, 2007). Many also experience underemployment (de-skilling), limited opportunities for professional advancement, and discrimination based on race, accent, or foreign credentials (Schilgen et al., 2017; Viken et al., 2018). These factors place IENs at increased risk for job dissatisfaction and burnout, potentially resulting in IENs leaving their positions or seeking employment in other countries. Understanding the workplace conditions that influence IEN well-being and retention is therefore critical to strengthening and sustaining the U.S. nursing workforce.

Research Questions

To address gaps in evidence about IEN workplace outcomes and factors that influence IEN workplace outcomes, this scoping review was guided by the following research questions:

• Research Question 1 (RQ1): What IEN workplace outcomes have been studied?

• Research Question 2 (RQ2): How are IEN workplace outcomes measured?

• Research Question 3 (RQ3): What factors influence IEN workplace outcomes?

• Research Question 4 (RQ4): What aspects of study characteristics (e.g., research designs, study populations) influence the generalizability of findings?

New Contribution

To our knowledge, this is the first review to synthesize evidence on IEN workplace outcomes, study characteristics, measurement approaches, and factors that potentially influence IEN characteristics, work conditions, and workplace outcomes. This review provides a comprehensive overview of the existing literature and identifies critical gaps that limit the generalizability and applicability of findings across diverse health care settings. Furthermore, by identifying methodological limitations related to study design, sample diversity, and research settings, this review offers valuable insights for future studies aiming to improve the reliability of evidence on IEN workplace experiences.

Conceptual Framework

The “Conceptual Model for Integrated Approaches to the Protection and Promotion of Worker Health and Safety” (Sorensen et al., 2021) was adapted to guide this scoping review (Figure 1). This adaptation of Sorensen’s model focuses on workplace outcomes and the multilevel factors—such as individual nurse characteristics and work conditions—that influence these outcomes. The key outcomes are job satisfaction, burnout, and intention to leave among IENs.

Figure 1.

Adapted model of internationally educated nurse workplace outcomes (Sorensen et al., 2021).

Note. IEN, Internationally Educated Nurse.

IEN characteristics include attributes of IENs such as gender, education, and job title, whereas IEN work conditions include attributes of the places where IENs are employed, such as the physical conditions of work, job design, and organizational practices. Guided by our adaptation of Sorensen’s model (2021), the purpose of this scoping review was to map out empirical, peer-reviewed studies that examined workplace outcomes of IENs and the individual nurse and work condition factors influencing them.

Methods

Design

A scoping review was undertaken to ascertain the extent or comprehensiveness of the body of empirical, peer-reviewed studies pertaining to IENs (Munn et al., 2018). While scoping reviews do not require formal quality appraisal, this review included a structured methodological appraisal to characterize limitations in the evidence base that may affect interpretation and generalizability (Tricco et al., 2018). This structured appraisal focused on features such as clarity of sample inclusion criteria, description of study settings and participants, measurement validity and reliability, handling of confounding factors, and appropriateness of statistical analysis. The scoping review was conducted following Arksey and O’Malley’s five-step framework: (1) identify research questions, (2) develop a search strategy, (3) select relevant literature, (4) chart relevant findings, and (5) collate the final results (Arksey & O’Malley, 2005). To report findings, this study adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews; Figure 2).

Figure 2.

PRISMA-ScR flow diagram for the study selection process.

Data Source and Searches

A health sciences librarian supported the systematic search to identify studies reporting the characteristics and factors that influence workplace outcomes among IENs. A comprehensive search was conducted on CINAHL, PubMed, and Scopus databases to identify publications written in English and published up to June 12, 2025. The full PubMed search strategy is provided in Supplement 1.

Selection Criteria

Two reviewers (Nayeon Lee and Naae Lee) independently screened the titles and abstracts of articles, using Covidence (2025). Discrepancies in screening were addressed through a process of secondary examination and subsequent discussion. Articles were included if they were empirical studies reporting on workplace outcomes and experiences of IENs. Inclusion criteria were (1) peer-reviewed articles published in the English language; (2) examined nurses who obtained their initial nursing education outside the country of current employment—referred to as internationally educated, foreign-educated, or overseas-qualified nurses; (3) included IENs as the primary study population or as a comparison group with host-country (domestically educated) nurses, with results reported separately for IENs; (4) reported at least one IEN workplace outcomes (e.g., job satisfaction, burnout, intention to leave), IEN characteristics, and work conditions; (5) used quantitative or mixed-methods designs with extractable quantitative findings relevant to the review questions; and (6) were published between 2004 and 2025. Exclusion criteria include (1) publications such as abstracts, brief, commentaries, dissertations, and editorials; (2) studies of nursing students and nursing faculty; and (3) qualitative studies.

Data Charting Process

Two reviewers (Nayeon Lee and Naae Lee) independently extracted data from each included article using a standardized template, then met to review and reconcile any discrepancies. The research team used literature on workplace outcomes and experiences of IENs, along with the adapted framework (Figure 1), to develop the terminology and definitions for data extracted. Data extracted included (1) study design, setting, and population, (2) IEN characteristics, (3) IEN work conditions, (4) IEN workplace outcomes, (5) the relationship between workplace outcomes and IEN characteristics and IEN work conditions, and (6) methodological appraisal (Joanna Briggs Institute, 2020). For mixed-methods studies, only the quantitative findings relevant to the review questions were extracted and synthesized.

Synthesis of Results

Abstracted data were entered into a data matrix using Microsoft Excel, with individual study features configured as columns. Using the data matrix, the reviewers conducted narrative synthesis and vote counting to summarize the frequency of reported findings related to IEN characteristics, IEN work conditions, and IEN workplace outcomes across the included studies. First, workplace outcomes were classified and reported in three groups: job satisfaction, burnout, and intention to leave. Owing to the diversity of measures of job satisfaction, burnout, and intention to leave, a direct comparison of outcome findings across studies was not possible; thus, for the purpose of describing trends across the reviewed studies, mean outcome scores for job satisfaction, burnout, and intention to leave were converted to a 100-point scale, and scores in each group were categorized into four quartiles: Group 1 with scores in the lowest quartile (1–25), Group 2 with scores in a middle quartile (26–50), Group 3 with scores in a middle quartile (51–75), and Group 4 with scores in the highest quartile (76–100). Then, to facilitate a summary of outcome findings, the number of studies in each quartile was counted. Finally, studies of IEN characteristics and work conditions that were associated with workplace outcomes were counted. Owing to the heterogeneity of the IEN characteristics and work conditions examined across studies, the narrative findings focused only on associations reported in two or more studies. Table 1 presents the terminology and definitions for data extracted across various domains, including IEN characteristics, IEN work conditions, IEN workplace outcomes, and factors associated with IEN workplace outcomes.

Table 1.

Terminology and Definitions for Data Extracted.

Domain	Variable	Definition
IEN Characteristics	Education attainment	Characteristics of those who are employed and unemployed with demographic attributes (U.S. Bureau of Labor Statistics, 2023a, 2023b)
	Race/ethnicity
	Gender
	Age
	Nationality/nativity
	Immigration/citizen status
	Families/marital status
	Multiple job holders
	Tenure
	Job titles/type of setting of principal nursing positions
	Annual income
IEN Work Conditions	Physical conditions of work	Include a range of possible hazards (chemical, physical, and biological) that pose a danger to occupational safety and health within the physical work environment (Sorensen et al., 2021). In this study, employment in hospitals is included under this category.
	The organization of work	Include the pace of work, workload, benefits, pay, and protection of workers (Sorensen et al., 2021).
	Job design	Encompass tasks, work procedures, job demands, work hours/shifts (work schedules), and the degree to which physical, cognitive, and emotional exertions are necessary for the given job (Sorensen et al., 2021).
	The psychosocial work environment	Indicate occupational strain, psychological demands/control, social support, exposure to harassment/discrimination, safety/health climate, and job security (Sorensen et al., 2021). In this study, work-related stress, perceived discrimination, perceptions of achieving career goals, IENs composition in staffing, job insecurity, quality of care, communication issues, and relationships with others are included under this category.
	Organizational policies, programs, and practices	Supportive policies, programs, and practices by strong leadership commitment (e.g., stable scheduling, staffing practices), engaging in participatory practices, adopting collaborative/comprehensive methods, and utilizing data-driven strategies (Sorensen et al., 2021). In this study, orientation, organizational support, hospital affairs, manager ability, and job resources are included under this category.
IEN Workplace Outcomes	Job satisfaction with overall nursing profession	The positive emotional response that nurses experience value or equity in their work experience (Busby & Banik, 1991; Liu et al., 2016).
	Job satisfaction with overall principal nursing position	An individual’s affective disposition toward their present employment position is associated with their conduct inside the workplace, hence manifesting sentiments of contentment or discontentment related to their employment (Fernández-Macias & Muñoz de Bustillo Llorente, 2014; Oktaviani, 2022; Spector, 1985).
	Burnout	A condition arising from prolonged occupational stress that has not been effectively managed, characterized by three distinct symptoms: feelings of energy depletion or tiredness; an increased mental distance from one’s job, or the presence of negativism or cynicism toward one’s work; and decreased professional efficacy (Sullivan et al., 2022). This study addresses burnout, encompassing job strain, stress, and other forms of distress.
	Intention to leave	An indication that an employee is psychologically disengaged from both the organization and their job, serving as a proxy for staff intention to leave (Nancarrow et al., 2014; Omar et al., 2015). This study explores intention to leave, considering intention to leave implications.

Results

As indicated in Figure 2, 3,412 studies were identified, duplicates were removed (n = 763), and the reviewers screened 2,649 studies. A total of 787 studies were eligible for full-text review, and 753 studies were excluded after the review, most frequently because they used qualitative designs, focused solely on work conditions or IEN characteristics without reporting workplace outcomes, or otherwise did not meet the inclusion criteria. A total of 34 studies were included in this review.

Characteristics of Included Studies

Of the 34 studies, 33 used cross-sectional designs and 1 used a longitudinal design (Table 2). Thirty-one studies used primary data, and three used secondary data. In terms of methodological approach, 32 studies used quantitative designs, and two used mixed-methods designs with extractable quantitative findings relevant to the review questions. Study samples included IENs and nurses from host countries. Of 34 studies, 28 included only IENs, while six studies included both IENs and nurses from host countries (Table 2 and Appendix 1). The sample size of studies varied considerably: 26 studies included fewer than 500 nurses, six studies included 501 to 1,000 nurses, and two studies included more than 1,000 nurses (Table 2).

Table 2.

Characteristics of Included Studies, Settings, and Sample (N = 34).

Characteristics of included studies
Study design, n (%)
Cross-sectional	33 (97.1)
Longitudinal	1 (2.9)
Data source, n (%)
Primary data	31 (91.2)
Secondary data	3 (8.8)
Methodological approach, n (%)
Quantitative	32 (94.1)
Mixed methods with extractable quantitative findings	2 (5.9)
Included sample, n (%)
Internationally educated nurses	28 (82.4)
Internationally educated nurses and nurses from host countries	6 (17.6)
Sample size, n (%)
0 to 500	26 (76.5)
501 to 1,000	6 (17.6)
>1,000	2 (5.9)
Methodological appraisal, 1 n (%)
Strong	0
Moderate	13 (38.2)
Low	21 (61.8)
Characteristics of settings in included studies
Country, n (%)
The United States (U.S.)	12 (35.3)
Saudi Arabia	6 (17.6)
Japan	4 (11.8)
Australia	2 (5.9)
Germany	2 (5.9)
Singapore	2 (5.9)
Others 2	6 (17.6)
Setting, n (%)
Hospitals	16 (47.1)
Long-term care facility/nursing home/homecare	3 (8.8)
Not reported	15 (44.1)
Characteristics of sample in included studies
Sample age, M (SD)
≤30 years	4 (11.8)
31–50 years	20 (58.8)
>50 years	2 (5.9)
Not reported	8 (23.5)
Race, n (%)
Non-Hispanic White or Black	1 (2.9)
Asian	10 (29.4)
Others 3	2 (5.9)
Not reported	21 (61.8)
Nationality, n (%)
Europe	2 (5.9)
Middle East and Asia	16 (47.1)
Mixed 4	6 (17.6)
Nor reported	10 (29.4)
Annual Income, n (%)
$50,000–$100,000	6 (17.6)
Not reported	28 (82.4)
Years worked in host country, n (%)
≤10 years	9 (26.5)
>10 years	6 (17.6)
Not reported	19 (55.9)

Note. (1) Range of 1 to 3: High level of methodological concern; range of 4 to 6: Moderate level of methodological concern; range of 7 to 8: Low level of methodological concern; (2) others include Canada, Finland, Qatar, Ireland, Sweden, and Italy; (3) others include non-Hispanic white, non-Hispanic black, Asian, and other races; and (4) mixed includes studies with multiple nationalities, including North America, Europe, the Middle East, Asia, Latin America, Africa, Australia, and New Zealand.

Characteristics of Settings in Included Studies

Of the 34 studies, 12 were conducted in the U.S., six in Saudi Arabia, four in Japan, two each in Australia, Germany, and Singapore, and six in other countries, including Canada, Finland, and Qatar (Table 2). Of the 34 studies, 19 reported a health care setting, whereas 15 did not report setting information. Among the 19 studies that reported a setting, 16 were conducted in hospitals and 3 were conducted in long-term care facilities, nursing homes, or home health care.

Characteristics of Sample in Included Studies

Out of the 34 studies, 26 studies reported sample age. Of these, 20 studies reported a mean sample age of 31 to 50 years, four reported a mean age of 30 years or younger, and two reported a mean age of over 50 years. IEN race was reported in 13 studies (Table 2). In ten studies, all IENs were Asian; in two studies, they were of mixed racial backgrounds; and in one study, they were either non-Hispanic White or Black.

IEN nationality was reported in 24 studies (Table 2). Of these studies, 16 included IENs with Middle Eastern and Asian nationalities, six studies included IENs with mixed nationalities, and two studies reported IENs with European nationality. The annual income of IENs was reported in six studies, ranging between $50,000 and $100,000 (Table 2). The mean number of years IENs worked in the host country was reported in 15 studies (Table 2). Of these studies, nine reported a mean of 10 years or less in the host country and six reported more than 10 years.

In the methodological appraisal, 21 studies were rated as having a low level of methodological concern (e.g., few design limitations), 13 were rated as having a moderate level of methodological concern, and none were rated as having high methodological concern (Tables 2 and 3). The most common limitations were unclear sample inclusion criteria, insufficient description of study participants and settings, limitations in the validity or reliability of exposure and outcome measures, and weaknesses in statistical analysis. These findings were used to characterize the overall strengths and limitations of the evidence base rather than to exclude studies or make causal judgments. Detailed appraisal results are presented in Table 3.

Table 3.

Methodological Appraisal of Included Studies (N = 34).

Study (year)	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Score	Level of methodological concern
Cheng & Liou (2011)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Bae (2012)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Hurtado et al. (2012)	Y	Y	U	Y	Y	Y	Y	Y	7/8	Low
Itzhaki et al. (2013)	Y	N	U	Y	Y	Y	Y	Y	6/8	Moderate
Neff & Harman (2013)	N	Y	U	Y	Y	Y	Y	Y	6/8	Moderate
Pittman et al. (2014)	N	N	U	Y	Y	Y	Y	Y	5/8	Moderate
Timilsina Bhandari et al. (2015)	Y	Y	Y	Y	Y	Y	U	Y	7/8	Low
An et al. (2016)	Y	N	Y	Y	Y	Y	Y	Y	7/8	Low
Geun et al. (2016)	Y	N	Y	Y	Y	Y	Y	U	6/8	Moderate
Goh & Lopez (2016)	N	Y	Y	Y	Y	Y	Y	Y	7/8	Low
Pung et al. (2017)	N	Y	Y	Y	Y	Y	Y	Y	7/8	Low
Geun et al. (2018)	N	N	Y	Y	Y	Y	U	Y	5/8	Moderate
N. Saquib et al. (2019)	N	N	Y	Y	Y	Y	Y	Y	7/8	Low
Zaghloul et al. (2019)	N	Y	Y	Y	Y	Y	Y	Y	7/8	Low
Almansour et al. (2020)	N	Y	N	Y	Y	Y	N	Y	5/8	Moderate
J. Saquib et al. (2020)	N	Y	Y	Y	Y	Y	Y	Y	7/8	Low
Schilgen et al. (2020)	N	Y	Y	Y	Y	Y	Y	Y	7/8	Low
Wesołowska et al. (2020)	N	N	Y	Y	Y	Y	Y	Y	6/8	Moderate
Billah et al. (2021)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Primeau et al. (2021)	Y	N	Y	Y	Y	Y	Y	U	6/8	Moderate
Roth et al. (2021)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Zanjani et al. (2021)	Y	N	Y	Y	Y	Y	Y	Y	7/8	Low
Hua et al. (2023)	Y	N	Y	Y	Y	Y	Y	Y	7/8	Low
Shatnawi et al. (2023)	N	N	Y	Y	Y	N	Y	Y	5/8	Moderate
Yasin et al. (2024)	Y	N	Y	Y	Y	Y	Y	Y	7/8	Low
Shoki et al. (2023)	Y	N	N	N	U	N	U	Y	4/8	Moderate
Högstedt et al. (2024)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Hua et al. (2024)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Robinson et al. (2024)	Y	Y	N	Y	Y	Y	N	Y	6/8	Moderate
Chang & Gu (2025)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Gazineo et al. (2025)	Y	Y	U	Y	Y	N	Y	N	5/8	Moderate
Ignacio et al. (2025)	Y	Y	Y	Y	N	N	N	Y	5/8	Moderate
Jun et al. (2025)	Y	Y	Y	Y	Y	Y	Y	Y	8/8	Low
Thankachen et al. (2025)	Y	Y	Y	Y	N	Y	Y	Y	7/8	Low
Total Yes	22	21	26	33	31	30	28	31
Total No	12	13	3	1	2	4	3	1
Total Uncertain	0	0	5	0	1	0	3	2

Note. Y, Yes; U, Uncertain; N, No; Screening questions: 1. Were the criteria for inclusion in the sample clearly defined? 2. Were the study subjects and the setting described in detail? 3. Was the exposure measured in a valid and reliable way? 4. Were objective, standard criteria used for measurement of the condition? 5. Were confounding factors identified? 6. Were strategies to deal with confounding factors stated? 7. Were the outcomes measured in a valid and reliable way? 8. Was an appropriate statistical analysis used? Range of 1 to 3: High level of methodological concern; range of 4 to 6: Moderate level of methodological concern; range of 7 to 8: Low level of methodological concern.

IEN Workplace Outcomes

The studies included in this review examined three workplace outcomes: job satisfaction, burnout, and intention to leave (Table 4). More details about these outcomes, including the measures used and patterns observed across studies with similar results, are provided in Appendix 2.

Table 4.

Summary of Findings From the Included 34 Studies.

Study	Design	Sample	Workplace outcome	IEN characteristics with significant associations with IEN workplace outcomes	IEN work conditions with significant associations with IEN workplace outcomes
Cheng & Liou (2011)	Cross-sectional, quantitative, primary data	U.S., 1 hospital, N = 195 Asian nurses	Intention to leave	Higher intention to leave was associated with younger age (r = −.24), fewer years lived in the United States (r = −.23), fewer years worked in current position (r = −.24), and poorer adaptation to cultural norms (r = −.24).	Higher intention to leave was associated with poorer evaluation of workplace conditions (r = −.34), and lower organizational commitment (r = −.52).
Bae (2012)	Cross-sectional, quantitative, secondary data (2008) 1	U.S., 100 hospitals, N = 245 International RNs and 507 American RNs	Intention to leave	Lower intention to leave their current position within 3 years was associated with older nurses (OR = 0.96, 95% CI [0.94, 0.98]), those who were divorced, separated, and widowed (OR = 0.45, 95% CI [0.22, 0.92]), and those with dependent child (OR = 0.57, 95% CI [0.37, 0.86]).	Lower intention to leave their current position within 3 years was with higher levels of integration into workplace culture (OR = 0.46, 95% CI [0.36, 0.58]), better treatment as colleagues by peers (OR = 0.77, 95% CI [0.60, 0.98]), and better support from supervisors at work (OR = 0.69, 95% CI [0.57, 0.84]).
Hurtado et al. (2012)	Cross-sectional, quantitative, primary data	U.S., 4 Nursing homes, N = 237 immigrant healthcare workers	Burnout (Measured as level of job strain)	None	None
Itzhaki et al. (2013)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 71 Former Soviet Union (FSU) RNs and 96 Filipino RNs	Job satisfaction	Higher job satisfaction components including professional status (r = −.250), task requirements (r = −.227), and organizational policies (r = −.294) were associated with shorter durations spent in the United States for Filipino nurses. Higher job satisfaction components, including pay (r = .269), autonomy (r = .290), and task requirements (r = .244) were associated with older FSU nurses.	None
Neff & Harman (2013)	Cross-sectional, quantitative, secondary data (2008) 2	U.S., 176 hospitals, N = 1,072 FENs and 7,781 U.S. nurses	Burnout (Measured as level of exhaustion)	None	Higher level of exhaustion was associated with higher levels of perceived unfavorable nurse work environment (OR = 1.7) and hospitals where FENs constituted 25% or less of the nursing workforce (OR = 1.5).
				Job satisfaction	Lower job satisfaction was associated with higher levels of perceived unfavorable nurse work environment (OR = 0.35) and hospitals where FENs constituted 25% or less of the nursing workforce (OR = 0.60).
				Intention to leave	Higher intention to leave was associated with higher levels of perceived unfavorable nurse work environment (OR = 2.42) and hospitals where FENs constituted 25% or less of the nursing workforce (OR = 1.9).
Pittman et al. (2014)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 502 FENs	Job satisfaction	Higher job satisfaction was associated with a lower proportion of nurses educated in Canada (OR = 0.910).	Lower job satisfaction was associated with FENs who reported insufficient orientation (OR = 0.122) and FENs who reported discrimination (OR = 0.107).
Timilsina Bhandari et al. (2015)	Cross-sectional, quantitative, primary data	Australia, five hospitals, N = 151 OQNs	Job satisfaction	Lower job satisfaction was negatively associated with the duration that OQNs stayed in Australia (r = −.196).	None
An et al. (2016)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 105 immigrant Korean nurses	Job satisfaction	Higher job satisfaction was associated with higher self-efficacy (r = .342), higher life satisfaction (β = 0.476), and greater self-esteem (β = 0.381).	Higher job satisfaction was associated with lower perceived stress (β = −0.328) and higher perceived organizational support (r = .281).
			Burnout (measured as level of perceived stress)	Higher perceived stress was associated with lower life satisfaction (r = –.251) and lower self-esteem (r = –.217).	Higher perceived stress was associated with lower job satisfaction (r = −.328)
Geun et al. (2016)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 201 Asian FENs	Intention to leave (measured as level of turnover)	None	Higher turnover at both the unit level (OR = 1.06, 95% CI [1.01, 1.12]) and organizational level (OR = 1.07, 95% CI [1.01, 1.13]) was associated with greater discrepancies in role expectations versus reality for FENs.
Goh & Lopez (2016)	Cross-sectional, quantitative, primary data	Singapore, 1 hospital, N = 495 migrant nurses	Job satisfaction	None	Lower job satisfaction was associated with lower levels of nurse participation in hospital affairs (r = −.539), lower quality of care (r = −.472), lower nurse manager ability (r = −.525), lower staffing adequacy (r = −.538), poorer nurse-physician relationship (r = −.372), and lower implementation of nursing information technology (r = −.329).
			Intention to leave	None	Lower intention to leave was associated with a better condition for nursing practice (OR = 0.876, 95% CI [0.791, 0.970]). Higher turnover intention was associated with better nurse manager quality (OR = 1.152, 95% CI [1.008, 1.316]).
Pung et al. (2017)	Cross-sectional, quantitative, primary data	Singapore, 2 long-term care institutions, N = 97 international nursing staff	Job satisfaction	Higher job satisfaction was associated with older nurses (β = 0.015), nurses who were taught English in their native country (β = 0.486), less stress related to new situations (β = −0.109), higher language ability (β = 0.141), and less alienation (β = −0.223).	Higher job satisfaction was associated with fewer job-related difficulties (β = −0.182).
			Intention to leave	None	None
Geun et al. (2018)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 201 Asian FENs	Intention to leave (measured as level of turnover)	None	Lower turnover was associated with higher levels of perceived quality of orientation (OR = 0.64, 95% CI [0.44, 0.95]) and affective commitment (OR = 0.52, 95% CI [0.28, 0.95]).
Saquib et al. (2019)	Cross-sectional, quantitative, primary data	Saudi Arabia, N/R, N = 977 expatriate nurses	Burnout (Measured as level of stress and general distress)	None	Mild-to-moderate stress was associated with a higher likelihood among groups dissatisfied (OR = 2.6, 95% CI [1.63, 4.11]) with their workload compared to those satisfied with it. General distress was associated with a higher likelihood among groups who were dissatisfied with their workload (β = 6.8) and teamwork (β = 6.0) compared to those who were satisfied with them.
Zaghloul et al. (2019)	Cross-sectional, quantitative, primary data	Saudi Arabia, 30 hospitals, N = 999 expatriate nurses	Burnout (measured as level of stress)	Severe stress was associated with significantly higher odds in Arab (OR = 32.18, 95% CI [7.51, 137.87]), Pakistani (OR = 6.09, 95% CI [2.10, 17.563]), and Indian (OR = 4.45, 95% CI [2.26, 8.75]) populations compared to the control group, which included Filipino and Indonesian populations.	None
Almansour et al. (2020)	Cross-sectional, quantitative, primary data	Saudi Arabia, 3 hospitals, N = 743 expatriate nurses	Job satisfaction	Lower job satisfaction was associated with South African (β = −0.42, 95% CI [−0.65, −0.20]), British (β = −0.30, 95% CI [−0.61, 0.00]), and other nationalities (β = −0.33, 95% CI [−0.55, −0.10]) compared to those with Saudi nationality. Lower job satisfaction was associated with males (β = −0.17, 95% CI [−0.33, 0.00]) compared to females. Higher job satisfaction was associated with more years of work experience (β = 0.01, 95% CI [0.00, 0.01]).	None
Saquib et al. (2020)	Cross-sectional, quantitative, primary data	Saudi Arabia, 22 hospitals, N = 977 expatriate nurses	Burnout (measured as level of stress)	None	Severe stress was associated with groups who always (OR = 2.5, 95% CI [1.1, 5.8]) felt job insecurity compared to those who never felt it. Severe stress was associated with groups who always (OR = 3.9 95% CI [1.7, 8.7]) and usually (OR = 4.2, 95% CI [1.9, 9.1]) experienced fear of litigation compared to those who never did.
Schilgen et al. (2020)	Cross-sectional, quantitative, primary data	Germany, Homecare services, N = 105 immigrant nurses & 182 non-immigrant nurses	Burnout (measured as level of psychosocial distress)	Higher psychosocial distress was associated with being on fixed-term contracts (β = 0.214).	Higher psychosocial distress was associated with greater workplace autonomy and control (β = 0.252) and worse relationships with colleagues and superiors (β = −0.287).
Wesołowska et al. (2020)	Cross-sectional, quantitative, primary data	Finland, N/R, N = 188 foreign-born nurses and 610 native nurses	Burnout (Measured as level of job strain)	None	Higher job strain was associated with a higher frequency of workplace discrimination (β = 0.12, 95% CI [0.09, 0.16]).
Billah et al. (2021)	Cross-sectional, quantitative, primary data	Saudi Arabia, N/R, N = 977 expatriate nurses	Job satisfaction (measured as level of job dissatisfaction)	Job dissatisfaction was associated with nurses who worked in Saudi Arabia for less than 5 years (OR = 3.3, 95% CI [1.53, 7.08]) and those who worked for 5 to 9 years (OR = 2.1, 95% CI [1.00, 4.44]) compared to those with 10 or more years of experience	Job dissatisfaction was associated with nurses who reported communication problems with Arabic patients (OR = 1.6, 95% CI [1.00, 2.46]) compared to those who did not. Job dissatisfaction was associated with nurses experiencing job insecurity (OR = 3.1, 95% CI [1.89, 5.02]) compared to those who did not.
Primeau et al. (2021)	Cross-sectional, quantitative, primary data	Canada, N/R, N = 1,951 IENs	Job satisfaction (measured as level of career satisfaction)	Lower career satisfaction was associated with nurses who migrated more recently (r = −.32), started working more recently in their first jobs (r = −.322), longer tenure in their current employer (r = −.290), and licensed more recently (r = −.325). Higher career satisfaction was associated with more consistent employment: full-time (M = 8.31, SD = 1.93), followed by part-time (M = 8.05, SD = 2.03), and occasional nurses (M = 7.85, SD = 2.42). Greater career satisfaction was associated with RNs (M = 8.35, SD = 1.89), followed by registered psychiatric nurses (M = 8.02, SD = 2.33), and LPNs (M = 6.87, SD = 2.48).	Lower career satisfaction was associated with nurses who had held their current position for fewer years’ experience (r = −.257). Higher career satisfaction was associated with higher perceptions of achieving their career goals (r = .579). Higher career satisfaction was associated with nurses working in hospitals (M = 8.28, SD = 1.96), followed by community hospitals (M = 8.13, SD = 2.09), and long-term care hospitals (M = 7.96, SD = 2.09). Greater career satisfaction was associated with nurses who reported no discrimination in mentorship (M = 8.56, SD = 1.71), leadership roles (M = 8.63, SD = 1.71), promotion (M = 8.73, SD = 1.66), and professional development (M = 8.42, SD = 1.68) compared to those who faced discrimination (M = 7.54, SD = 2.24), (M = 7.49, SD = 2.26), (M = 7.75, SD = 2.18), (M = 7.21, SD = 2.35).
Roth et al. (2021)	Cross-sectional, quantitative, primary data	Germany, 2 hospitals, N = 64 internationally trained nurses and 103 host nurses	Burnout	Higher burnout in the climate was associated with lower levels of language fluency (β = −17.720). Greater burnout in the climate was associated with nurses who had 3 to 5 years of professional experience (β = 24.000) compared to those with more than 5 years of experience. Higher personal burnout was associated with nurses with 3 to 5 years of work experience (β = 20.69) compared to those who had more than 5 years of work experience.	None
Zanjani et al. (2021)	Cross-sectional, quantitative, primary data	Australia, N/R, N = 200 OQNs	Burnout (measured by the level of perceived stress)	Higher perceived stress was associated with lower sociocultural adaptation (r = −.14).	None
			Job satisfaction	Higher job satisfaction was associated with higher sociocultural adaptation (β = 0.24, 95% CI [0.13, 0.36]).	None
Hua et al. (2023)	Cross-sectional, quantitative, primary data	Japan, N/R, N = 206 FENs	Job satisfaction	Higher job satisfaction was associated with more language fluency (r = .182), greater comfort with Japanese (β = 0.024), more years of nursing practice in Japan (r = .207), and more nursing experience in country of origin (r = .165).	Higher job satisfaction was associated with lower experience with workplace discrimination (β = −0.32) and lower intention to leave in their current organization (OR = 0.96, 95% CI [0.94, 0.00]). Higher job satisfaction was associated with nurses who received orientation upon employment (β = 0.16) compared to those who did not. Higher satisfaction was associated with nurses working part-time (β = 0.15) compared to those working two shifts per week. Lower job satisfaction was associated with nurses working night shifts (β = −0.22) compared to those working two shifts per week.
			Intention to leave	Higher intention to leave in current organization was associated with higher intention to leave in Japan (r = .369), younger age (r = −.237), less years of residence in Japan (r = −.211), and greater intention to leave in nursing profession (r = .549). Higher intention to leave in nursing profession was associated with greater intention to leave in Japan (r = .519), lower years of nursing practice in Japan (r = −.270), younger age (r = −.213), less years of residence in Japan (r = −.212), and greater comfort with Japanese (OR = 1.78, 95% CI [1.18, 2.68]). Lower intention to leave in the current organization was associated with more years of nursing practice in Japan (OR = 0.45, 95% CI [0.25, 0.79]). Lower intention to leave in the nursing profession (OR = 0.27, 95% CI [0.09, 0.81]) and in Japan (OR = 0.11, 95% CI [0.02, 0.66]) was associated with married nurses compared to those who were single.	Higher intention to leave in current organization was associated with lower years of nursing practice in Japan (r = −.344), lower job satisfaction (r = −.369), and higher workplace discrimination (r = .209). Higher intention to leave in the nursing profession was associated with lower job satisfaction (r = −.243).
Shatnawi et al. (2023)	Cross-sectional, quantitative, primary data	Saudi Arabia, 2 hospitals, N = 421 migrant nurses	Job satisfaction	Higher job satisfaction was associated with younger age (r = −.07) and longer years of experience in intensive care in Saudi Arabia (r = .02).	None
Yasin et al. (2024)	Cross-sectional, quantitative, primary data	Qatar, N/R, N = 293 expatriate nurses	Job satisfaction	None	Higher job satisfaction was associated with higher job resources provided to nurses (β = 0. 798, 95% CI [0.734, 0.848]).
Shoki et al. (2023)	Cross-sectional, mixed methods, primary data	Japan, 137 hospitals, N = 40 migrant nurses	Intention to leave	None	Lower intention to quit was associated with higher satisfaction with content of work (r = –.453), human relationships in workplace (r = –.353), number of night shifts (r = –.394), and balance between work and private life (r = –.437).
			Job satisfaction	None	None
Högstedt et al. (2024)	Longitudinal, mixed methods, primary data	Sweden, N/R, N = 189 IENs & 213 DENs	Burnout (measured as level of perceived stress)	Lower stress was associated with male gender at time 2 (β = −0.41) and time 3 (β = −0.35). Higher stress was associated with nurses from regular nursing programs than those from bridging program (β = 0.44).	Higher stress was associated with lower structural empowerment (β = −0.06 at Time 2; β = −0.06 at Time 3), more criticism (β = −0.22 at Time 2; β = −0.28 at Time 3), and lower cooperation at Time 3 (β = −0.30).
Hua et al. (2024)	Cross-sectional, quantitative, primary data	Japan, N/R, N = 187 Foreign-born nurses	Job satisfaction	Higher job satisfaction was associated with being married (t = −2.38) and non-Chinese nationality (t = −2.71). Higher job satisfaction was associated with higher language confidence (β = 0.15).	Higher job satisfaction was associated with lower workplace discrimination (β = −0.38).
Robinson et al. (2024)	Cross-sectional, quantitative, secondary data (2023) 3	U.S., 7 hospitals, N = 178 IENs	Intention to leave (measured as level of retention)	ADN IENs were significantly less likely to be retained than BSN or MSN IENs (χ² = 16.61, Cramer’s V = 0.305).	None
Chang & Gu (2025)	Cross-sectional, quantitative, primary data	Japan, 119 hospitals, N = 214 OQNs	Job satisfaction	Higher job satisfaction was associated with older age (≥ thirties) compared with those in their twenties (U = 67.17 vs. 58.26). Higher job satisfaction was associated with Southeast Asian nationality compared with East Asian nationality (X2 = 70.16 vs. 61.53). Higher job satisfaction was associated with lower immigration-related stress, particularly stress related to not feeling at home (β = −0.312) and language (β = −0.182).	Higher job satisfaction was associated with lower immigration-related stress, particularly stress related to occupation (β = −0.374) and discrimination (β = −0.338).
Gazineo et al. (2025)	Cross-sectional, quantitative, primary data	Italy, N/R, N = 244 Italian nurses working abroad	Job satisfaction	Higher job satisfaction was associated with older age and having children, and nurses not intending to return to Italy.	Higher job satisfaction was associated with nurses who perceived better salary conditions abroad. Higher job satisfaction was associated with working in Switzerland and Germany, while nurses in the United Kingdom reported the lowest satisfaction
Ignacio et al. (2025)	Cross-sectional, quantitative, primary data	U.S., 1 hospital, N = 120 Filipino RNs	Intention to leave (measured as level of retention intention)	Higher intention to leave was associated with higher burnout (β = −0.279) and higher secondary traumatic stress (β = −0.366). Lower intention to leave was associated with stronger interpersonal skills (β = 0.689) and having an anchor in personal life (β = 0.430).	Lower intention to leave was associated with higher professional attachment (β = 0.960).
			Burnout	Higher burnout was significantly associated with lower intention to stay (β = −0.279)	None
Jun et al. (2025)	Cross-sectional, quantitative, primary data	U.S., N/R, N = 151 Korean American nurses	Job satisfaction	Higher job satisfaction was associated with older age (55–64) (5.98 ± 0.82) compared to younger age (18–34) (5.25 ± 1.12).	Higher job satisfaction was associated with higher organizational commitment (r = .69), lower psychological contract breach (r = .62), higher person–organization fit (r = .70), and higher person–work setting fit (r = .34). Higher job satisfaction was associated with working in the Chicago area (5.90 ± 0.94), while lower job satisfaction was associated with working in New York City (5.31 ± 0.91).
Thankachen et al. (2025)	Cross-sectional, quantitative, primary data	Ireland, N/R, N = 447 migrant healthcare workers	Burnout (measured as level of occupational stress and psychological distress)	Higher job stress and higher psychological distress were associated with fewer than 10 years in Ireland (job stress: β = 0.154; psychological distress: β = 0.303).	Higher job stress and higher psychological distress were associated with working in the public sector compared to the private sector (job stress: β = −0.150; psychological distress: β = −0.126)

Note. OR, odds ratio; CI, confidence interval; M, mean; SD, standard deviation; r, Pearson correlation coefficient; β, standardized regression coefficient; t, t-test statistic; χ², chi-square test statistic; Cramér’s V, measure of association; U, Mann–Whitney U test statistic; N/R, not reported; U.S., United States; IEN, Internationally Educated Nurse; FEN, Foreign-Educated Nurse; OQN, Overseas-Qualified Nurse; DEN, Domestically Educated Nurse; ADN, Associate Degree in Nursing; BSN, Bachelor of Science in Nursing; MSN, Master of Science in Nursing; RN, registered nurse.

¹A Survey of Hospital Registered Nurses from the Hospital Nurse Workforce in New York (2008).

²The 2008 survey of nurses employed by hospitals in Florida and hospital organizational data from the American Hospital Association (AHA).

³Data from human resources/orientation records from a large southeastern U.S. health care system and the NSI Nursing Solutions 2023 report.

Job Satisfaction

Job satisfaction, the most frequently evaluated outcome, was examined in 19 studies (Appendix 2). Of these, 18 studies reported the measures used to assess IEN job satisfaction, whereas Pittman et al. (2014) did not provide details about the measure (Appendix 2). Among the 18 studies that reported measures, four studies utilized McCloskey and Muller’s Satisfaction Scale (NMSS) (Muller & McCloskey, 1990), and two studies utilized the Job Satisfaction Questionnaire (JSQ) (Singapore Nursing Board, 2012). Diverse measures were used in other studies, such as the Index of Work Satisfaction (IWS) (Stamps, 1997) in Itzhaki et al. (2013) and the Acute Care Nurses Job Satisfaction Scale-Revised (ACNJSS-R) (Yasin et al., 2023) in Yasin et al. (2024) (Appendix 2).

Of the 18 studies that specified job satisfaction measures (Appendix 2), three—Neff and Harman (2013), Billah et al. (2021), and Shoki et al. (2023)—did not report mean satisfaction scores or provide sufficient data to calculate them. In the remaining 15 studies, mean overall satisfaction scores were reported. Owing to the diversity of measures of job satisfaction, a direct comparison of findings across studies was not possible; thus, mean job satisfaction scores in these 15 studies were converted to a 100-point scale and, using this scale, they were categorized in groups by quartile. No studies reported mean satisfaction scores that were classified in the lower two satisfaction quartiles; however, nine studies reported mean scores in the third job satisfaction quartile and six in the highest quartile (Appendix 2). In summary, measures of job satisfaction were diverse, with findings in 15 studies suggesting a pattern of moderate to high IEN job satisfaction.

Burnout

IEN-reported burnout was investigated in 13 studies (Appendix 2). Measures of burnout varied, and only three studies directly assessed burnout using standardized, validated measures (Appendix 2). First, Neff and Harman (2013) used the Emotional Exhaustion subscale from the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1986), which captures emotional exhaustion as a primary element of burnout. Second, Roth et al. (2021) used the Safety, Communication, Operational Reliability, and Engagement (SCORE) questionnaire (Sexton et al., 2018), which includes dimensions related to personal burnout and burnout climate. Third, Ignacio et al. (2025) employed the burnout subscale from the Professional Quality of Life (ProQOL) scale (Stamm, 2005), which assesses the negative effects of work-related stress. In the remaining 10 studies, burnout was inferred from concepts that are believed to be related to burnout, such as depression, anxiety, stress, job strain, and psychosocial stress. For instance, N. Saquib et al. (2019), Zaghloul et al. (2019), and J. Saquib et al. (2020) applied the Depression, Anxiety, Stress Scale-21 (Lovibond & Lovibond, 1995), while An et al. (2016) and Zanjani et al. (2021) used the Perceived Stress Scale (Cohen et al., 1997; Cohen & Williamson, 1988; Hamarat et al., 2001).

Of the 13 studies reporting burnout, eight did not provide overall mean burnout scores or sufficient numerical data to calculate them (Appendix 2). For the descriptive purposes of this review, mean scores of findings of IEN burnout were converted to a 100-point scale and categorized into four groups by quartile. Four studies reported burnout levels that were categorized in the second quartile (An et al., 2016; Högstedt et al., 2024; Neff & Harman, 2013; Wesołowska et al., 2020), and one study (Thankachen et al., 2025) reported a mean burnout level that was categorized in the highest burnout quartile (Appendix 2). In summary, measures of IEN burnout varied widely with findings in five studies suggesting a pattern of moderate to high IEN burnout.

Intention to Leave

Intention to leave was examined in 11 studies (Appendix 2), and, of these, four studies used standardized, validated measures (Appendix 2). For example, Cheng and Liou (2011) employed the Anticipated Turnover Scale (ATS) (Hinshaw et al., 1985), and Hua et al. (2023) used the Intention to Leave Scale (Y. C. Chen et al., 2019). In the remaining seven studies, intention to leave was measured using investigator-designed measures (Appendix 2); in Bae (2012), for instance, it was measured with a one-item binary scale. Of 11 studies, nine did not report overall mean scores for intention to leave (Appendix 2). Given the limited data, it was not feasible to summarize the evidence pertaining to IEN intention to leave.

IEN Characteristics and IEN Workplace Outcomes

IEN-reported job satisfaction, burnout, and intention to leave were associated with diverse IEN characteristics (Table 4). This heterogeneity was a limitation in the synthesis of evidence, and broad patterns in the findings are summarized below.

Higher IEN job satisfaction was associated with older age (Chang & Gu, 2025; Gazineo et al., 2025; Itzhaki et al., 2013; Pung et al., 2017), years residing in the host country (Billah et al., 2021; Hua et al., 2023; Shatnawi et al., 2023; Zanjani et al., 2021), and fluency in the language of the host country (Pung et al., 2017; Hua et al., 2023, 2024). Lower job satisfaction was infrequently studied, but some evidence indicated it was associated with male gender and challenges in the transition to the host country. Higher IEN burnout was associated with diverse IEN characteristics, such as IEN nationality, years in the host country, and sociocultural adaptation. Lower burnout was associated with male gender. Finally, higher intention to leave was associated with younger age (Cheng & Liou, 2011; Hua et al., 2023), years in the host country (Cheng & Liou, 2011; Hua et al., 2023), and other IEN characteristics, such as years in the nursing profession, adaptation to the host country, and intention to leave the nursing profession. Lower intention to leave was associated with many factors, such as older age, marital status, and working as a registered nurse compared to an associate degree nurse (Table 4).

IEN Work Conditions and IEN Workplace Outcomes

IEN-reported job satisfaction, burnout, and intention to leave were associated with a wide range of workplace characteristics (Table 4). As above, this heterogeneity limited synthesis across studies, and broad patterns in the evidence are summarized below.

Higher IEN job satisfaction was associated with lower levels of discrimination in the workplace (Hua et al., 2023, 2024; Pittman et al., 2014; Primeau et al., 2021) and a wide range of organizational supports for work (An et al., 2016; Gazineo et al., 2025; Jun et al., 2025; Primeau et al., 2021; Yasin et al., 2024), such as nursing leadership style, having an orientation program, opportunities for promotion, and IEN perceptions of organizational commitment. Lower job satisfaction was associated with unfavorable work environments (Goh & Lopez, 2016; Neff & Harman, 2013), lack of organizational support (An et al., 2016; Pittman et al., 2014), and other workplace characteristics. High IEN burnout was associated with diverse gaps in organizational support for nurses (Högstedt et al., 2024; Neff & Harman, 2013; J. Saquib et al., 2020; N. Saquib et al., 2019; Schilgen et al., 2020), such as low teamwork high workload, job insecurity, discrimination, criticism, and low cooperation. Finally, high intention to leave was associated with diverse limitations in organizational support for nurses (Cheng & Liou, 2011; Geun et al., 2016; Neff & Harman, 2013), such as discrimination, limited managerial support, and low commitment to nurses. Low intention to leave was associated with supportive colleagues and other favorable work conditions (Bae, 2012; Geun et al., 2018; Goh & Lopez, 2016), and others, such as managerial support (Table 4).

Discussion

Guided by Sorensen’s (2021) “Conceptual Model for Integrated Approaches to the Protection and Promotion of Worker Health and Safety,” this scoping review synthesized evidence from 34 studies examining workplace outcomes among IENs. The generalizability of the review findings was limited by study designs, settings, the diversity of outcome measures, and study samples. First, 33 studies used observational, cross-sectional designs, and only one used a longitudinal design. This pattern in design limits understanding of how IEN outcomes change over time and the degree to which IEN characteristics and work conditions potentially cause changes in outcomes. Second, the 34 reviewed studies were conducted in 12 countries; for example, 12 studies were conducted in the U.S., 6 in Saudi Arabia, and 18 studies were set in 10 other countries. Thus, our comparison of studies is limited by variations in national culture and health care systems that likely influence workplace experiences and outcomes (Al-Bannay et al., 2014; Handtke et al., 2020). Third, comparison of findings across studies was limited by the heterogeneity in measures of workplace outcomes. For example, job satisfaction was studied in 18 studies with 12 different instruments and burnout was studied in 13 studies with 11 instruments. Finally, although publication activity has increased in recent years—with 16 of the 34 studies published in the past 5 years—only two studies in this period were conducted in the U.S.. Considering the impact of the COVID-19 pandemic and evolving workforce policies (Buchan et al., 2022; World Health Organization [WHO], 2020), studies using more recent data are needed to describe workplace outcomes. Clearly, this heterogeneity complicates synthesis across studies and increases the risk of bias in the findings; however, despite these limitations, broad patterns in findings of this scoping review may serve as a useful guide for emerging policy and research.

Of 15 studies that reported total IEN job satisfaction, IENs reported moderate to high levels of satisfaction with their work. This pattern is consistent with findings from recent, nationally representative U.S. data on IENs. Using the 2018 and 2022 National Sample Survey of Registered Nurses (NSSRN), Zhang et al. (2025) found that 58.5% of IENs reported being moderately satisfied with their job compared with 52.0% of U.S.-trained nurses, and only 2.9% of IENs reported extreme dissatisfaction compared with 5.4% of U.S.-trained nurses. These levels of IEN satisfaction are broadly similar to job satisfaction observed among RNs overall. In the 2022 NSSRN, approximately 80% of U.S. RNs reported being extremely or moderately satisfied with their primary nursing position in 2021 (Health Resources and Services Administration [HRSA], 2024a). Similarly, national workforce data indicate that job satisfaction among U.S. nurses has improved in recent years; in a 2023 national survey of 2,427 nurses, 46% reported being satisfied with their current job, up from 28% in 2022, and 52% reported satisfaction with their choice to work in the nursing profession, reflecting a 44% increase from the prior year (Nurse.Org, 2024). Taken together, the scoping review indicates that IENs report moderate to high job satisfaction, with levels similar to those reported by the U.S. nursing workforce overall.

In contrast to these moderate to high levels of job satisfaction, our review also found that IENs reported moderate or high levels of burnout. This pattern is consistent with evidence that burnout remains prevalent among nurses in U.S. hospital settings. In the 2022 NSSRN, 82.3% of RNs who had been in the same position for at least 1 year reported feeling burned out at some point in their careers (HRSA, 2024b). Similarly, in a large multicenter study of 15,738 nurses across 60 U.S. Magnet hospitals, Aiken et al. (2023) found that 47% of nurses met criteria for high burnout, with hospital-level prevalence ranging from 28% to 66%. In the same study, 40% of nurses reported intending to leave their current hospital if possible, and 53% reported a great deal of job-related stress, underscoring the pervasiveness of occupational strain even in hospitals recognized as good places to work.

Thus, the coexistence of moderate to high job satisfaction and substantial burnout among IENs mirrors a broader pattern observed in the nursing workforce more generally. This pattern aligns with the job demands–resources framework, which posits that meaningful work and professional commitment can coexist with burnout when job demands remain chronically high and resources are insufficient (Bakker et al., 2023). For IENs, job satisfaction may also partly reflect the value placed on professional opportunity, economic stability, and successful migration, even when daily work remains highly demanding (Bakhshi et al., 2023; G.Chen et al., 2024; Hu & Tung, 2025). At the same time, burnout may be intensified by workplace stressors as well as transition-related challenges, including cultural adaptation, discrimination, and employment-related insecurity (Balante et al., 2021; Thomas et al., 2025). In some cases, employment-linked immigration arrangements may also limit mobility, making continued employment possible even under conditions of high strain (Oja-Lipasti et al., 2025). Empirical evidence from U.S. health care systems confirms that inadequate staffing, heavy workloads, and unsupportive work environments are the primary drivers of nurse burnout and intent to leave (Aiken et al., 2023; Al Sabei et al., 2019; Shah et al., 2021). Together, these findings suggest that relatively high job satisfaction does not necessarily indicate low occupational strain among IENs.

Our findings also identified a small set of IEN characteristics that were associated with workplace outcomes, particularly age, host-country tenure, and sociocultural adaptation. Across studies, older age and longer residence in the host country were associated with higher job satisfaction and lower intention to leave, suggesting that professional maturity and successful adaptation to the host-country context may buffer occupational strain (Shatnawi et al., 2023; Zanjani et al., 2021). Prior research similarly highlights host-country integration—including language proficiency and familiarity with workplace norms—as key drivers of favorable IEN outcomes, reinforcing the importance of dynamic adaptation processes rather than static demographic characteristics alone (Hua et al., 2024; Yasin et al., 2024).

Work conditions emerged as even more salient and consistent predictors of outcomes than individual IEN characteristics. Across studies, lower discrimination and stronger organizational support—such as supportive leadership, structured orientation programs, teamwork, and perceived organizational commitment—were consistently associated with higher job satisfaction and lower burnout and intention to leave (Högstedt et al., 2024; Hua et al., 2023; Primeau et al., 2021). Conversely, unfavorable work environments characterized by high workload, limited managerial support, and discrimination were strongly linked to burnout and intention to leave, aligning with earlier evidence that organizational context is a primary driver of nurse workforce instability (Gazineo et al., 2025; J. Saquib et al., 2020). Together, these findings extend prior research by demonstrating that while individual IEN characteristics shape workplace experiences, modifiable organizational factors play a central and persistent role in determining job satisfaction, burnout, and intention to leave among IENs across diverse settings.

Given the central role of modifiable work conditions in shaping IEN workplace outcomes, nurse managers are important but not sufficient actors in influencing job satisfaction, burnout, and intention to leave. In this review, supportive leadership, structured orientation, teamwork, and lower workplace discrimination were repeatedly associated with higher job satisfaction and lower burnout. Although many of these factors are visible at the unit level and often shaped by nurse manager practices, sustainable improvement is unlikely to result from reliance on a single role alone. These findings align with prior literature indicating that nurse managers play an important role in facilitating effective onboarding, fostering inclusive team climates, and supporting mentorship and peer support for IENs (Pressley et al., 2022; Smith et al., 2022), although these efforts are most sustainable when reinforced through broader organizational policies and resources. Evidence further suggests that interventions focused solely on individual coping or resilience are insufficient; instead, sustained reduction in burnout requires coordinated organizational and leadership action to address psychosocial work conditions, including workload distribution, discrimination, and perceived organizational commitment (Ghazal et al., 2019; Nardi et al., 2020; Teixeira et al., 2022). Together, this evidence suggests that improving IEN workplace outcomes requires coordinated action across unit, organizational, and system levels rather than nurse manager-led efforts alone.

In addition to work conditions, our findings suggest that IEN workplace outcomes are shaped by a range of external pressures that extend beyond the immediate work environment. Several studies in this review identified migration- and transition-related challenges, including licensure and credential recognition processes, job insecurity during immigration transitions, sociocultural isolation, and financial pressures associated with migration—that may compound workplace stress. These findings are consistent with evidence from international migration research demonstrating that immigration policies, regulatory barriers, and recruitment arrangements create structural vulnerabilities for IENs that extend beyond employer control (Ghazal et al., 2019; Oja-Lipasti et al., 2025; Smith et al., 2022). International reports similarly document that visa retrogression, fluctuating immigration policies, and non-standardized licensure pathways contribute to job insecurity, constrained mobility, and psychological strain among IENs (Bakhshi et al., 2023; Buchan et al., 2022; Organization for Economic Cooperation and Development, 2023). In the U.S., economic analyses further show that immigrant nurses often incur substantial migration-related costs and ongoing financial pressures, including remittances and debt tied to recruitment and credentialing, which may compound workplace stress and burnout risk (Bakhshi et al., 2023). Together, this body of evidence suggests that efforts to mitigate burnout among IENs must extend beyond unit-level and organizational interventions to include coordinated policy-level strategies addressing immigration, licensure, and ethical recruitment systems.

Limitations

This scoping review has several limitations. First, although the search was comprehensive, the general nature of the search terms (e.g., job satisfaction, burnout) may have led to the omission of relevant studies, especially those using different terminology in similar contexts. In addition, some terms, such as burnout, were not well-defined, indicating findings might not fully capture the spectrum of IEN work-related experiences and challenges. Second, owing to the diversity of measures that were used to identify IEN workplace outcomes, a direct synthesis of outcomes across studies of the same outcome was not feasible; addressing this limitation while at the same time providing a preliminary summary of findings, study procedures included transformation of outcomes data to groups and a broad summary of levels of workplace outcomes. Thus, substantial risk for bias limits our reported summary of the level of outcomes, such as job satisfaction and burnout. This risk of bias was accepted as the general, descriptive synthesis of the evidence supported the objectives of this scoping review and provided a preliminary scope of evidence across studies. Third, the heterogeneity in study settings and outcome measures limited our ability to synthesize evidence across studies. For example, the review includes comparisons of outcomes reported by IENs working in the United States, Saudi Arabia, and other countries. Fourth, some reviewed studies were conducted over a decade ago, which may limit their applicability to the current workplace environment. Fifth, most studies relied on self-reported outcomes rather than objective workforce indicators such as turnover or retention. Burnout was also frequently assessed indirectly through related concepts, including stress, anxiety, and depression, which may have reduced comparability across studies. Finally, the reliance on cross-sectional and non-experimental designs in many studies prevented a description of causality between identified factors and workplace outcomes. These limitations underscore the need for larger, methodologically robust research to support IENs effectively.

Implications

This review indicates implications for research, practice, and policy that directly follow from the patterns identified in the reviewed literature.

Research Implications

• First, large, sufficiently powered studies are needed to provide comprehensive descriptions of IEN workplace outcomes and factors that drive outcomes, such as age, experience, and race (Creswell & Creswell, 2023; Higginbottom et al., 2013). Accurate workforce data are also essential. Current national databases, including the NSSRN, do not consistently and comprehensively identify IENs, limiting the ability to track their numbers and characteristics at the federal level (Bakhshi et al., 2023; Xu & Kwak, 2007). Updating national surveys to accurately identify and track IENs would provide essential data for effective workforce planning and inform policies that support IEN integration and well-being.

• Second, addressing moderate to high levels of job satisfaction and burnout among IENs will require longitudinal studies that explore changes in outcomes over time; moreover, mixed-method designs are also necessary to combine quantitative surveys and qualitative interviews and investigate the mechanisms that drive outcomes, such as how IEN cultural adaptation impacts job satisfaction and retention. Quantitative data on adaptation levels and job satisfaction, alongside qualitative interviews, will also show how adaptation factors influence workplace outcomes. Understanding these dynamics is essential for creating tailored support systems to enhance IEN job satisfaction and retention. Future research should also compare IEN workplace outcomes with those of other immigrant health care workers, including physicians and non-clinical or administrative staff, to clarify which challenges are specific to nursing and which reflect broader patterns related to migration, workplace integration, and professional authority.

• Finally, standardized measurement tools, such as the MBI, Job Satisfaction Survey (JSS), and Nursing Work Index (NWI), should be used to ensure consistent and comparable findings across studies (Aiken & Patrician, 2000; Maslach & Jackson, 1986; Spector, 1985). These validated tools provide reliable measurements of workplace outcomes while improving the comparability of findings across health care studies, thereby supporting the development of evidence-based strategies to enhance the workplace.

Practice Implications

Findings from this review indicate that organizational and managerial factors are more consistently associated with IEN workplace outcomes than individual IEN characteristics, underscoring the importance of practice-level interventions that target modifiable work conditions. Nurse managers are well positioned to influence key drivers identified in this review—including workload, discrimination, teamwork, and perceptions of organizational support—through leadership practices that shape daily work environments. Evidence suggests that structured orientation programs, ongoing mentorship and peer-support models, and inclusive leadership practices are associated with improved well-being and retention among IENs (Högstedt et al., 2024; Primeau et al., 2021; Smith et al., 2022).

Importantly, effective support for IENs requires a two-way approach. While IENs benefit from tailored onboarding and orientation to host-country clinical and cultural norms, sustainable integration depends on concurrent efforts by U.S. nurses and leaders to develop cultural humility, inclusive practices, and supportive team environments (Kamau et al., 2022; Lovejoy et al., 2021). Consistent with broader nursing workforce research, these findings reinforce that resilience-focused interventions alone are insufficient and that meaningful reductions in burnout require sustained organizational investment in inclusive, well-supported, and adequately staffed work environments (Aiken et al., 2023; Griffiths et al., 2018).

Policy Implications

The findings of this review suggest that improving IEN retention and well-being will require coordinated policy action beyond individual health care organizations. Policies that streamline and harmonize licensure and credential recognition processes across jurisdictions may reduce prolonged periods of job insecurity and underemployment for IENs. In addition, aligning immigration pathways with workforce planning—such as providing clearer timelines, portability of work authorization, and protections during status transitions—may help mitigate uncertainty that contributes to burnout and turnover. Strengthening oversight of IENs’ recruitment practices and reinforcing ethical recruitment standards may further reduce financial and contractual vulnerabilities experienced by IENs. Together, these policy approaches shift responsibility from individual nurses and employers toward system-level solutions that support a stable, sustainable, and ethically recruited nursing workforce.

Conclusion

This scoping review maps evidence of IEN workplace outcomes and experiences across multiple countries and diverse health care settings. Across studies, IENs reported moderate to high job satisfaction alongside moderate to high levels of burnout, reflecting a pattern that is similar in some respects to the broader nursing workforce. However, the review also identified distinct factors affecting IENs, including discrimination, migration-related challenges, and barriers related to licensure, credentialing, and workplace transition.

While individual characteristics such as age and host-country tenure were associated with workplace outcomes, work conditions—including workload, discrimination, managerial support, and perceptions of organizational commitment—emerged as more consistent and potentially modifiable drivers of job satisfaction, burnout, and intention to leave. These findings help fill important gaps in knowledge by showing that many of the factors associated with IEN workplace outcomes are addressable at the organizational and system levels. Together, the evidence underscores the need for multilevel strategies that extend beyond individual resilience to strengthen inclusive work environments, reduce discrimination, enhance support structures, and promote workforce stability and IEN well-being.

Appendix 1.

Study Characteristics (N = 34).

Study (year)	Design	Sample size	Country / Setting	Sample age M (SD)	Sample nationality	Sample years worked in host country M (SD)
Cheng & Liou (2011)	Cross-sectional, Quantitative	195	◼ The United States ◼ 1 hospital	39.92 (9.94)	Philippines, China	13.35 (9.70)
Bae (2012)	Cross-sectional, Quantitative	245	◼ The United States ◼ 100 hospitals	◼ IENs: 44.58 (10.87) ◼ U.S. RNs: 36.72 (10.56)	N/R	N/R
Hurtado et al. (2012)	Cross-sectional, Quantitative	237	◼ The United States ◼ 4 Nursing homes	40.9 (11.3)	Caribbean, Africa	4.2 (4.1)
Itzhaki et al. (2013)	Cross-sectional, Quantitative	167 (71 FSU RNs & 96 Filipino RNs)	◼ The United States ◼ N/R	◼ FSU RNs: 30.92 (5.11) ◼ Filipino RNs: 43.72(11.5)	FSU, Philippines	◼ FSU RNs: 6.2 (4.38) ◼ Filipino RNs: 15.45 (12.1)
Neff & Harman (2013)	Cross-sectional. Quantitative	8,853 (1,072 IENs & 7,781 U.S. RNs)	◼ The United States ◼ 176 hospitals	◼ IENs: 44.8 (9.3) ◼ U.S. RNs: 45.1 (11)	the United States, Philippines, Canada, Europe, Latin America, Africa, others	◼ IENs: 14 (10.3) ◼ U.S. RNs: 16.5 (11.6)
Pittman et al. (2014)	Cross-sectional, Quantitative	502	◼ The United States ◼ N/R	N/R	Philippines, China, Columbia, Gambia, Ghana, Grenda, Guyana, India, Indonesia, Jamaica, Jordan, Kenya, Lebanon, Mexico, Moldova, Myanmar, Nepal, Slovakia, South Korea, Canada, Australia, France, Germany, the Netherlands, New Zealand, Portugal, the United Kingdom	N/R
Timilsina Bhandari et al. (2015)	Cross-sectional, Quantitative	151	◼ Australia ◼ 5 hospitals	36.4 (8.0)	Canada, New Zealand, South Africa, the United Kingdom, the United States, India, China, Philippines, Nepal, Malaysia, Japan	4.06 (3.5)
An et al. (2016)	Cross-sectional, Quantitative	105	◼ The United States ◼ N/R	52 (10.7)	South Korea	15.5 (13.1)
Geun et al. (2016)	Cross-sectional, Quantitative	201	◼ The United States ◼ N/R	46.0 (10.8)	China, India, South Korea, Philippines, Taiwan	N/R
Goh & Lopez (2016)	Cross-sectional, Quantitative	495	◼ Singapore ◼ 1 hospital	N/R	Philippines, Malaysia, China, India, Myanmar nations	N/R
Pung et al. (2017)	Cross-sectional, Quantitative	97	◼ Singapore ◼ 2 long-term care institutions	N/R	Malaysia, Philippines, Myanmar nations	N/R
Geun et al. (2018)	Cross-sectional, Quantitative	201	◼ The United States ◼ N/R	46.0 (10.8)	China, India, South Korea, Philippines, Taiwan	N/R
Saquib et al. (2019)	Cross-sectional, Quantitative	977	◼ Saudi Arabia ◼ N/R	32.0 (7.47)	Arab countries, Philippines, Indonesia, India, Pakistan	N/R
Zaghloul et al. (2019)	Cross-sectional, Quantitative	999	◼ Saudi Arabia ◼ 30 hospitals	32 (7.17)	Arab countries, Philippines, Indonesia, India, Pakistan	N/R
Almansour et al. (2020)	Cross-sectional, Quantitative	743	◼ Saudi Arabia ◼ 3 hospitals	35.2 (9.2)	Saudi Arabia, Philippines, India, Jordan, South Africa, Malaysia, British, others	11.6 (8.9)
Saquib et al. (2020)	Cross-sectional, Quantitative	977	◼ Saudi Arabia ◼ 22 hospitals	32 (7)	Arab countries, Philippines, Indonesia, India, Pakistan	N/R
Schilgen et al. (2020)	Cross-sectional, Quantitative	287 (105 immigrant nurses & 182 non-immigrant nurses)	◼ Germany ◼ Homecare services	◼ Immigrant nurses: 43.7 (11.84) ◼ Non-immigrant nurses: 48.11 (11.37)	N/R	N/R
Wesołowska et al. (2020)	Cross-sectional, Quantitative	798 (188 IENs & 610 native nurses)	◼ Finland ◼ N/R	◼ IENs: 42.19 (9.62) ◼ Native nurses: 34.36 (8.87)	N/R	N/R
Billah et al. (2021)	Cross-sectional, Quantitative	977	◼ Saudi Arabia ◼ N/R	32.1 (7.2)	India, Pakistan, Philippines, Indonesia, Arab countries (e.g., Syria, Egypt, and Yemen)	N/R
Primeau et al. (2021)	Cross-sectional, Quantitative	1,951	◼ Canada ◼ N/R	N/R	N/R	N/R
Roth et al. (2021)	Cross-sectional, Quantitative	167 (64 IENs & 103 host nurses)	◼ Germany ◼ 2 hospitals	N/R	Republic of Serbia, Bosnia-Herzegovina, others	N/R
Zanjani et al. (2021)	Cross-sectional, Quantitative	200	◼ Australia ◼ N/R	32.79 (6.91)	India, Philippines, China, others	N/R
Hua et al. (2023)	Cross-sectional, Quantitative	206	◼ Japan ◼ N/R	29.6 (3.6)	China, Taiwan, Indonesia	N/R
Shatnawi et al. (2023)	Cross-sectional, Quantitative	421	◼ Saudi Arabia ◼ 2 hospitals	N/R	N/R	N/R
Yasin et al. (2024)	Cross-sectional, Quantitative	293	◼ Qatar ◼ N/R	N/R	N/R	N/R
Shoki et al. (2023)	Cross-sectional, Mixed methods	40	◼ Japan ◼ 137 hospitals	32.3 ± 4.2	Indonesia, Philippines, Vietnam	3.9 (3.1)
Högstedt et al. (2024)	Longitudinal, Mixed methods	402 (189 IENs & 213 Domestically educated nurses)	◼ Sweden ◼ N/R	32.6 ±7.65	N/R	11.0 ± 2.42
Hua et al. (2024)	Cross-sectional, Quantitative	187	◼ Japan ◼ N/R	30.01±4.46	China, Mongolia, Indonesia, Taiwan	N/R
Robinson et al. (2024)	Cross-sectional, Quantitative	178	◼ The United States ◼ 7 hospitals	N/R	N/R	10.0 (5.2)
Chang & Gu (2025)	Cross-sectional, Quantitative	214	◼ Japan ◼ 119 hospitals	N/R	China, Vietnam Philippines, Indonesia, Myanmar	N/R
Gazineo et al. (2025)	Cross-sectional, Quantitative	244	◼ Italy ◼ N/R	N/R	Italy	N/R
Ignacio et al. (2025)	Cross-sectional, Quantitative	120	◼ The United States ◼ 1 hospital	N/R	Philippines	N/R
Jun et al. (2025)	Cross-sectional, Quantitative	151	◼ The United States ◼ N/R	N/R	Korea	N/R
Thankachen et al. (2025)	Cross-sectional, Quantitative	447	◼ Ireland ◼ N/R	N/R	N/R	N/R

Note. SD, standard deviation; N/R., not reported; IENs, internationally educated nurses; RNs, registered nurses; FSU, Former Soviet Union.

Appendix 2.

IEN Workplace Outcome Measures.

IEN Workplace outcome	Measure	Characteristics of the measure (Items, Score ranges, Meaning of scores)	Study	IEN-reported workplace outcomes from Each Study
Job Satisfaction	Investigator-designed, one-item measure	◼ 1 item ◼ Item score range = 1 to 4 ◼ Higher scores indicate higher job satisfaction.	Neff & Harman (2013)	The overall mean scores for job satisfaction were not reported. Among a total of 1,072 IENs, 27.6% reported being very satisfied with their job, 54.8% were moderately satisfied, 14.0% were a little dissatisfied, and 3.6% were very dissatisfied.
	Index of Work Satisfaction Scale (IWS) (Stamps, 1997)	◼ 59 items (Part A – 15-items, Part B – 44 items) ◼ Item score range = 1 to 7 ◼ Higher mean scores indicate higher job satisfaction.	Itzhaki et al. (2013)	The overall mean scores for job satisfaction were not reported. The mean scores for individual job satisfaction components among ranged from 2.46 to 5.1 among Filipino nurses and from 2.99 to 3.86 among nurses from Former Soviet Union.
	Job Satisfaction of Overseas-Qualified Nurses (JSOQN) (Aiken & Patrician, 2000; Mueller & McCloskey, 1990; Stamps, 1997)	◼ 36-items ◼ Possible total score range = 0 to 224 ◼ Higher scores indicate higher job satisfaction.	Timilsina Bhandari et al. (2015)	The total score on the JSOQN for RNs from an English-speaking background is 180. The total score on the JSOQN for RNs from a non-English-speaking background is 174.
	Job Satisfaction Index (Brayfield & Rothe, 1951)	◼ 5-items ◼ Item score range = 1 to 7 ◼ Higher mean scores indicate higher job satisfaction.	An et al. (2016)	The overall mean job satisfaction score with SD among Korean immigrant nurses was 5.40 ± 0.85.
	Job Satisfaction Questionnaire (JSQ) (Singapore Nursing Board, 2012)	◼ 37-items ◼ Item score range = 1 to 5 ◼ Higher scores indicate higher job satisfaction.	◼ Goh & Lopez (2016) ◼ Pung et al. (2017)	◼ The overall mean job satisfaction score with SD among migrant nurses was 3.43 ± 0.43. ◼ The overall mean job satisfaction score with SD among international nurses was 3.65 ± 0.60.
	McCloskey and Muller’s Satisfaction Scale (NMSS) (Muller & McCloskey, 1990)	◼ 31-items ◼ Item score range = 1 to 5 ◼ Possible total score range = 31 to 155 ◼ Higher mean scores indicate higher job satisfaction.	◼ Almansour et al. (2020) ◼ Hua et al. (2023) ◼ Shatnawi et al. (2023) ◼ Gazineo et al. (2025)	◼ The overall mean job satisfaction score with SD among expatriate nurses was 3.24 ± 0.52. ◼ The total job satisfaction score with SD among IENs was 94.1 ± 17.6. ◼ The overall mean job satisfaction score with SD among expatriate nurses was 2.9 ± 0.52. ◼ The overall mean score for job satisfaction was 101.4 ± 19.2.
	The Generic job satisfaction scale (Macdonald & Maclntyre, 1997)	◼ 1-item ◼ Item score range = 1 to 10 ◼ Higher scores indicate higher job satisfaction.	Primeau et al. (2021)	The overall mean job satisfaction score with SD among IENs was 8.20 ± 2.01.
	Single-Item Job Satisfaction Scale (Cicolin et al., 2014; Dolbier et al., 2005)	◼ 1-item ◼ Item score range = 1 to 5 ◼ Higher scores indicate higher job satisfaction.	Billah et al. (2021)	The overall mean scores for job satisfaction were not reported. Among 977 expatriate nurses, 790 reported “no” to overall job dissatisfaction (80.9%), and 187 reported “yes” (19.1%).
	The Nurse International and Transition Questionnaire-2 (NIRTQ2) (Buchan et al., 2006; Nguyen et al., 2008)	◼ 54-items ◼ Item score range = 1 to 5 ◼ Higher mean scores indicate higher job satisfaction.	Zanjani et al. (2021)	The overall mean job satisfaction score with SD among overseas-qualified nurses (n = 200) was 3.72 ± 0.78.
	Acute Care Nurses Job Satisfaction Scale-Revised (ACNJSS-R) (Yasin et al., 2023)	◼ 13-items ◼ Item score range = 1 to 6 ◼ Higher mean scores indicate greater job satisfaction.	Yasin et al. (2024)	The overall mean job satisfaction score with SD among expatriate nurses was 4.1307 ± 0.89.
	Investigator-designed, seven – item measure	◼ 7-items ◼ Item score range = 7 to 35 (1 = not satisfied, 5 = very satisfied) ◼ Higher scores indicate greater job satisfaction.	Shoki et al. (2023)	The overall mean scores for job satisfaction were not reported.
	Japanese version of the Mueller-McCloskey Satisfaction Scale (JMMSS) (Shijiki, 1997)	◼ 31-items ◼ Total score range 31 to 155 (1 = very dissatisfied, 5 = very satisfied) ◼ Higher scores indicate high job satisfaction.	Hua et al. (2024)	The overall mean score for job satisfaction was 94.36 ± 17.90.
	Job satisfaction subscale of the Safety Attitudes Questionnaire–Short Form (SAQ-SF) (Sexton et al., 2006)	◼ 5-items ◼ Total score range 0 - 100 (1 = strongly disagree, 5 = strongly agree) ◼ Higher scores indicate greater job satisfaction.	Chang & Gu (2025)	The overall mean score for job satisfaction was 63.38 ± 21.21.
	Primary Care Organizational Questionnaire (Hall et al., 2006)	◼ 3-items ◼ Total score range 3 - 21 (1 = strongly disagree, 7 = strongly agree) ◼ Higher scores indicate a higher level of job satisfaction.	Jun et al. (2025)	The overall mean score for job satisfaction was 5.61 ± 1.02.
Burnout	Job Content Questionnaire (Karasek et al., 1998)	◼ 49-items ◼ Item score range = 1 to 4 ◼ Higher scores indicate greater job strain.	Hurtado et al. (2012)	The overall mean scores for job strain were not reported. Among 237 immigrant workers, 29.6% (n = 70) experienced job strain.
	Emotional exhaustion subscale (part of Maslach Burnout Inventory) (Maslach & Jackson, 1986)	◼ 9-items ◼ Possible total score range = 0 to 54 ◼ Higher scores indicate higher emotional exhaustion.	Neff & Harman (2013)	The overall mean score with SD for emotional exhaustion among the 1,072 IENs was 22.3 ± 13.5.
	Depression, Anxiety, Stress -21 (DASS-21) (Lovibond & Lovibond, 1995)	◼ 21 items (7 items for each subscale of depression, anxiety, and stress) ◼ Possible total score range = 0 to 21 (For each subscale) and 0 to 63 (For the total DASS-21) ◼ Higher scores indicate higher depression, anxiety, and stress.	◼ Saquib et al. (2019) ◼ Zaghloul et al. (2019) ◼ Saquib et al. (2020)	◼ The overall mean scores for depression, anxiety, and stress were not reported. Among the 977 nurses, 40.5% had mild-to-moderate depressive symptoms, while 13.3% had severe depressive symptoms; 32.8% reported mild-to-moderate anxiety symptoms, and 32.9% severe anxiety symptoms; 27.7% experienced mild-to-moderate stress, and 10.6% reported severe stress. ◼ Among 999 expatriate nurses, 54.2% experienced depression, 65.4% anxiety, and 38.9% stress. ◼ Among 977 expatriate nurses, 32.9% suffered from severe to extremely severe anxiety, 13.3% from depression, and 10.6% from stress.
	Copenhagen Psychosocial Questionnaire (COPSOQ) (Llorens et al., 2019)	◼ 84-items (with 26 scales); 3 scales used (Influence at work – 6 items; Social support from supervisors and colleagues – 6 items; Recognition – 3 items) ◼ Item score range = 1 to 100 ◼ Higher scores indicate higher psychosocial stress.	Schilgen et al. (2020)	The overall mean scores for COPSOQ were not reported. The mean scores with SD for individual components among migrant nurses were as follows: ○ Influence at work: 49.95 ± 27.70 ○ Social support from supervisors and colleagues: 67.53 ± 25.03 ○ Recognition: 64.67 ± 27.88
	Karasek’s Job Demand–Control model (Karasek, 1979; Landsbergis et al., 1994) using items from the Nurse Stress Index (Harris, 1989; Kivimaki & Lindstrom, 1992) and the Job Content Questionnaire (Karasek, 1985)	◼ 5 items (2 for job demands, 3 for job control) ◼ No total score range; Job strain = Mean job demands – mean job control ◼ Higher scores indicate greater job strain.	Wesołowska et al. (2020)	The mean ± SD job strain score among IENs was –0.64 ± 1.64, compared with –0.62 ± 1.30 among native nurses (p = .867).
	Section 1 Safety Culture Domains from SCORE (Safety, Communication, Operational reliability, Engagement) questionnaire (Sexton et al., 2018)	◼ 34-items (with a total of 66-items) ◼ Item score range = 0 to 100 ◼ Higher scores indicate higher levels of personal burnout and burnout climate.	Roth et al. (2021)	The overall mean scores for SCORE were not reported. The mean scores with SD for individual burnout climate and personal burnout component among internationally trained nurses were 55.4 ± 22.5 and 46.9 ± 23.1, respectively.
	Perceived Stress Scale (Cohen &Williamson, 1988; Cohen et al., 1997; Hamarat et al., 2001)	◼ 10-items ◼ Item score range = 0 to 4 ◼ Higher mean scores indicate greater perceived stress.	◼ Zanjani et al. (2021) ◼ An et al. (2016)	◼ N/R ◼ The overall mean perceived stress score with SD among Korean immigrant nurses was 2.01 ± 0.39.
	Stress subscale of the Satisfaction with Work Questionnaires (SWQ) (Engström et al., 2006)	◼ 4-items ◼ Total score range 4 - 20 (1 = never, 5 = very often) ◼ Higher scores indicate greater perceived stress.	Högstedt et al. (2024)	The overall mean score for perceived stress was 2.30± 0.76 at Time 2 and 2.22 ± 0.73 at Time 3.
	Burnout subscale (part of Professional Quality of Life (ProQOL)) (Stamm, 2005)	◼ 10-items ◼ Total score range 10 - 50 (1 = never, 5 = very often) ◼ Higher scores indicate greater burnout.	Ignacio et al. (2025)	N/R
	Brief Job Stress Questionnaire (BJSQ) (Shimomitsu, 2000)	◼ 57-items ◼ Total score range 57 to 228 (1 = strongly disagree, 4 = strongly agree) ◼ Higher scores indicate greater occupational stress	Thankachen et al. (2025)	The overall mean scores for occupational stress were 44.9 ± 6.8.
	Kessler Psychological Distress Scale (K6) (Kessler et al., 2003)	◼ 6-items ◼ Total score range 0 to 24 (0 = none of the time, 4 = all of the time) ◼ Higher scores indicate greater psychological distress	Thankachen et al. (2025)	The overall mean score for psychological distress was 7.2 ± 5.4.
Intention to leave	Anticipated Turnover Scale (ATS) Hinshaw et al., 1985)	◼ 12-items ◼ Total possible score range = 12 to 105 ◼ Higher scores indicate higher chances to leave one’s current job.	Cheng & Liou (2011)	The overall mean intention to leave score with SD among Asian nurses was 29.61 ± 6.81.
	Investigator-designed, one-item measure	◼ 1 item ◼ Possible score range = 0 (plan to leave within 3 years) to 1 (plan to stay)	Bae (2012)	The overall mean scores for intention to leave were not reported. Among 117 child immigrant RNs, 39.32% reported an intent to leave within 3 years. Among 55 adult immigrant RNs, 29.09% expressed an intent to leave. 26.03% of the 73 IENs had an intent to leave.
	Investigator-designed, one-item measure	◼ 1-item ◼ Possible score range = 0 (plan to stay for a year) to 1 (plan to leave)	Neff & Harman (2013)	The overall mean scores for intention to leave were not reported. Among 1,072 FENs, 80.6% planned to stay with their current employer for at least another year.
	Investigator-designed, four-items measure	◼ 2-items ◼ No Likert scale used; participants select from predefined categorical options.	Geun et al. (2016)	The overall mean scores for turnover were not reported. Among 201 Asian FENs, unit-level turnover was 40.3% (n = 81) and organization-level turnover was 31.8% (n = 64).
	Investigator-designed, one-item measure	◼ 1-item ◼ Possible score range = 0 (plan to leave) to 1 (plan to stay)	Goh & Lopez (2016)	The overall mean scores for intention to leave were not reported. Among 495 international nurses, 16.6% (n = 82) reported an intent to leave, while 83.4% (n = 413) did not.
	Investigator-designed, one-item measure	◼ 1-item ◼ Possible scale range = 0 (plan to leave next year) to 1 (not plan to leave next year)	Pung et al. (2017)	The overall mean scores for intention to leave were not reported. Among 97 migrant nurses, 32% (n = 31) reported an intent to leave next year, while 68% (n = 66) did not.
	Investigator-designed, four-items measure	◼ 2-items ◼ No Likert scale used; participants select from predefined categorical options.	Geun et al. (2018)	The overall mean scores for turnover were not reported. Among 201 Asian FENs, unit-level turnover was 40.3% (n = 81) and organization-level turnover was 31.8% (n = 64).
	Intention to Leave scale (Chen et al., 2019)	◼ 3-items ◼ Item score range = 1 to 4 ◼ Higher scores indicate a higher intention to leave.	Hua et al. (2023)	The overall mean scores for intention to leave were not reported. The median score for intention to leave the current organization, the nursing profession, and Japan was 2.0.
	Intention to Quit scale (Furuya & Tani, 2008)	◼ 3-items ◼ Item score range = 3 to 15 (1 = never, 5 = always) ◼ Higher scores indicate a higher intention to quit.	Shoki et al. (2023)	The overall mean score for intention to quit was 7.9 ± 3.3.
	Investigator-designed measure, one-item measure	◼ 1-item ◼ Item score range = 0 to 1 (0 = terminated, 1 = retained in organization) ◼ Higher scores indicate retention.	Robinson et al. (2024)	The overall mean score for retention was not reported. Among 178 IENs, 72.5% were retained and 27.5% terminated.
	McCain’s Intent to Stay Scale (McCloskey, 1990)	◼ 5 items ◼ Total score range 5 to 25 (1 = strongly disagree, 5 = strongly agree) ◼ Higher scores indicate greater intention to stay.	Ignacio et al. (2025)	The overall mean score for retention was not reported.

Note. IENs, Internationally Educated Nurses; RNs, Registered Nurses; FENs, Foreign-Educated Nurses; SD, Standard Deviation; N/R, Not Reported.