Shobha Nepali

RN, MN Sydney MCN Neonatal Intensive Care Flinder

PhD candidate

Ethnography of Workplace Experiences of Immigrant Nurses in an Australian NICU

Supervisor: Professor Trudy Rudge

As the world has shrunk to a global village due to the movement of people from one nation, society and culture to another, the phenomenon of nurse migration has made the nursing workforce diverse and multicultural. The recruiting countries around the world, on one hand, are fulfilling their shortages in nursing workforce and exploiting the expertise of world’s talented nursing workforce, while on the other hand, facing the challenges of training and transitioning culturally, ethnically and linguistically diverse staff. Moreover, nurses who migrate to other countries often experience various difficulties in their new workplaces. The specialty units of hospitals such as Neonatal Intensive Care Unit (NICU) particularly pose challenges for new immigrant nurses because it differs from most other areas of practice in terms of the unique patient population, the highly intensive nature of care provided, prompt and accurate decision making for potentially rapidly changing patients’ conditions and the ‘hi-tech’ work environment requiring a high level of competency in operating modern life-saving technologies. The requirement of communication and interaction with parents of the admitted newborns, nurse colleagues, doctors, allied health professionals and other team members is prominent in NICU that adds more sociality to a social unit of a hospital. Thus, the workplace should support and nurture the positive experience of immigrant nurses as well as everyone in the unit.

The aim of this project is to explore the experiences of immigrant nurses in Australian NICU so as to develop strategies to better support immigrant and other nurses in their workplaces.

The findings from the literature review highlight the different scope of nursing practice and the related issue of deskilling between source and destination countries; the higher status of nurses and the nursing profession in destination countries compared with source countries; the problem of information exchange leading to a sense of alienation among immigrant nurses in their new workplaces; and the stress of, on the one hand, being constantly under surveillance or, on the other, invisible. The literature also draws attention to the cultural shock that immigrant nurses experienced in their new workplaces and their perceptions of being deskilled and discriminated against. While the literature demonstrates some knowledge about experiences of immigrant nurses, little relates to the workplace issues. Not a lot of studies are conducted in high-acuity settings such as NICU perhaps because the most of the immigrant nurses work in aged care and general wards. The research studies mostly adopted interviews as their means of data gathering and have therefore, provided more subjective information. Interactions and exchanges within a unit need to be explored to understand everyday happenings and consequences. Thus, I clearly see a need for a study that addresses the workplace culture, social interactions and relationships and how they can be nurtured for the benefit of all stakeholders: immigrant nurses, local nurses and other health care professionals.

NICU as a unit of health care structure has particular ward culture that requires an ethnographic approach to uncover the way the unit runs every day, how social relations and interactions take place between immigrant nurses and their colleagues and how immigrant nurses make sense of their everyday lives in a foreign hi-tech and highly-sensitive workplace. Since ethnography tells rigorous stories about daily lives of people living in a particular setting, its scope has broadened and many disciplines and sub-disciplines such as nursing use the approach to view and interpret the behaviour and traditions of the people and phenomena under study.

My passion on neonatal nursing led me to Australia but I found my initial days challenging in a highly sensitive hi-tech work environment of Australian Neonatal Intensive Care Unit (NICU). I wondered how fellow immigrant nurses fare in a new workplace and how local nurses feel about working with culturally, ethnically and linguistically different colleagues like me. I am therefore interested in studying the social relations between these nurses and develop a model that can support and nurture better workplace experiences for everyone in the unit.