Internationally Qualified Nurses’ Perceptions of Patient Safety: New Zealand Case Studies

Twenty five percent of the current New Zealand nursing workforce comprises internationally qualified nurses (IQNs). For a significant proportion of IQNs, English is an additional language and the social, cultural and historical context of the health systems from their country of origin differs significantly to that of New Zealand. International studies have found that despite many of these IQNs having extensive nursing experience prior to entering a new country, the challenges involved with transition can have implications for patient safety. This study aimed to investigate IQNs’ perceptions of the competencies that pertain to patient safety. The study was informed by an interpretive-constructivist approach that acknowledges these perceptions are constructed within a social, cultural, and historical context. A qualitative multiple case study design was used with the Communities of Practice (CoP) theory as the conceptual framework. The primary data source was semi-structured interviews with four IQNs while they attended a Competency Assessment Programme (CAP) to obtain New Zealand nursing registration. The IQNs’ email reflections and programme documents were used as additional data. Thematic analysis of the individual cases followed by cross-case analysis revealed similar perceptions concerning patient safety across the four cases. Exposure to Nursing Council of New Zealand’s (NCNZ) competencies for safe nursing practice during the CAP course did not notably change the participants’ initial perceptions. The most significant finding of this study was that the social, cultural, and historical context of the health system and nursing role mediates how maintaining patient safety will be perceived and enacted in practice. The findings also highlighted the importance of engaging with participant perspectives in order to identify specific areas required for learning and transfer of information. These findings had important implications for further development of educational and healthcare agency support for IQN transition.