4/30/2012. Background. Objectives. Project Site. Methods. Methods






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Ruth Lee, RN, MScN, PhD |Andrea Baumann, PhD |Jennifer Blythe, PhD |Daniela Dijmarescu, RN

Transition and Integration into Employment

Internationally Educated Nurses (IENs) and

English as a Second Language (ESL) nurses

face substantial challenges integrating into

the Canadian nursing workforce.



The goal of this project is the integration of

60 IENs and ESL nurses into the workforce,

by enhancing their communication, clinical

and cultural competencies.

Hamilton Health Sciences (HHS) is a family

of 6 hospitals and a cancer centre, the largest

healthcare organization in the

Hamilton-Wentworth region of Southern Ontario.

Project Site


HHS has over 10,000 employees, 3200 of

whom are nurses.

Develop a suite of tools and processes

for integration.

Build capacity of 30 HHS experienced nurses

who act as Clinical Integrators to facilitate


o act as C


teg ato s to ac tate

the integration.

Evaluate program components and over

all project.

Needs Assessment

Focus groups were employed to assess needs

of Clinical Integrators, HHS Clinical Managers

and Participants (IEN/ESL Nurses) to facilitate


and Participants (IEN/ESL Nurses) to facilitate

the integration of the latter into the




Clinical Integrators

Meeting registration requirements

Building confidence


Allaying fears about accented English

Providing feedback based on their own





Clinical Managers

Creating a supportive workplace

No-blame culture of patient safety (minimize

the risk of hiding errors for fear of reprisal)


the risk of hiding errors for fear of reprisal)

Conflict among nurses of different


Managers needed understanding of the

cultural backgrounds and experiences of

their nurses.




Communication (cultural cues)

Increased orientation time


Bridging programs

More resources

1) Centre for Internationally Educated Nurses (CARE):

Workplace Communication Course – 5 , (110 Registrants) 2) Mohawk College, Bridging Internationally Educated

Nurses (BIEN): Learning Resource Centre/Simulation

Laboratory- 127 Participants, I-CELBAN – 56 Participants

Community Collaborative


y p , p

3) Hamilton Centre for Civic Inclusion (HCCI):

Cultural Competency Awareness Training-1 Session, 13 attendees

4) Nursing Health Services Research Unit (NHSRU):

Evaluation of effectiveness of Interventions & Project

4)HHS Job coaching /Mock Interviews -102


5)HHS Intranet: Share Point Website – 140


6)HHS/CNO Learning Plan HHS Policies and

Community Collaborative


6)HHS/CNO Learning Plan, HHS Policies and

Procedures on the Intranet-140 Participants 7)HHS Networking Program “Nurses Nurturing

Nurses” (N3) based on the American Academy of Medical-Surgical Nurses program -42 Dyads

•Job shadowing and attendance at

nursing orientation

Additional Activities

•Lunch and Learn sessions for networking •Attend conferences and presentations


Internationally Educated Nurse (IEN) and English as a Second Language (ESL)

Nurse Integration Project Structure

Government of Ontario, Ministry of Citizenship and Immigration, Labor Market Integration Unit

Signing Authority: Hamilton Health Sciences (HHS), President and Chief Executive Officer

Project Lead:

HHS, Office of Nursing Recruitment and Retention Advisory CouncilHHS Nursing

HHS IEN/ESL Advisory Committee Members

Internal Partners

HHS Human Resources HHS Professional Affairs HHS Office of Human Rights HHS Quality Patient Safety and Clinical Resource Management External Partners BIEN CARE NHSRU HCCI

Evaluator, McMaster University Nursing Health Services Research Unit

Co- Principal Investigators:

Senior Consultant, Nursing Recruitment and Retention

Chief of Nursing Practice

Associate Vice President, Faculty of Health Sciences International and Co-Director of the Nursing Health Services Research Unit

Co- Investigator:

Program Manager, BIEN Executive Director, CARE

Study Coordinator:

Project Manager

Community Collaboration Employment Model (CCEM): Bridging the Gap for IEN/ESL Nurses |Project Partners Role

EMPLOYER Hamilton Health Sciences (HHS) Project Role: Effectively hire and integrate IEN/ESL nurses into the workforce


Centre for Internationally Educated Nurses (CARE)

EVALUATION McMaster University Nursing Health Services Research Unit (NHSRU) Project Role: Independent evaluator Bridging Internationally Educated Nurses(BIEN) Program Project Role: Enhance clinical skills and language assessment

Project Role: Profession specific communications in workplace course Hamilton Centre for Civic Inclusion (HCCI) Project Role: Enhance cultural competency for integration of IEN/ESL nurses

Participants – Total 140

•IENs with English as a Second Language: 103 •IENs with English as a First Language: 8 •ESL nurses graduated from


•ESL nurses graduated from

Canadian Universities /Colleges: 29

Clinical Integrators – Total 40 •HHS Nurses



The partners were responsible for evaluating

the interventions that they implemented.

The NHSRU collated, reported the results



S U co ated, epo ted t e esu ts

of all evaluation components and evaluated the

overall success of the Project and the

Community Engagement Employment Model.

•Participants exiting the Project revealed a high

degree of satisfaction both with the interventions and the assistance given by project staff and partner organizations.

•Participants appreciated the support of the project in

helping them to obtain jobs.

•The coaching of the Project Manager was


g j g

frequently mentioned.

•Participants wished they had the opportunity to

participate in a similar Project earlier.

Participants referred other IEN/ESL nurses to join

•All numeric targets of the project were surpassed •The CCEM proved a successful framework for tapping

into the expertise of major stakeholders to provide i t i t ti


and Lessons Learned

appropriate interventions.

•The Project Team received the 2012 HR Summit

Award “Employer Champion of Internationally Educated Professional”

•Allowed project to evolve based on feedback from

Partners, Clinical Integrators, Clinical Managers and Participants.

•The roles of Project Partners and Researchers became

better defined, throughout the course of Project implementation

Hi h ti f i t ti b P ti i t


and Lessons Learned

•High rating of interventions by Participants. •Share Point Website for the Participants required

additional resources, including social media, beyond those currently available to the project.

Project Challenges/Strategies

•Small research sample/Increase sample size •Different intake criteria amongst partners (IEN/ESL nurses)/Consolidation of CCEM

•Current economic outlook resulting in limited hiring/Project g g j looking to community for hiring opportunities

•Great need for emotional support and integration for IEN/ESL nurses

•Increased need for workplace exposure and career progression/Additional activities planned and added


Project Challenges/Strategies

•Lengthy registration process with College of Nurses of Ontario for IENs/Early referral to start the process •Settlement and Integration Services

Organization/HHS Job Coaching and Mock Interview process

•Some Participants faced challenges accessing some interventions due to work, personal responsibilities and travel issues/ Accommodation of Interventions around Participant schedules

Consolidate CCEM: Bridging the Gap for

IEN/ESL Nurses within the next three years.

New project stakeholders with new roles as

project disseminators include Hamilton

Next Steps

project disseminators include Hamilton

Region Long Term Care Network.

Share lessons learned and strategies with

other health care organizations.

We would like to acknowledge the generous funding support of the Government of Ontario, Ministry of Citizenship and Immigration.


Appreciation is also extended to Participants, Clinical Integrators/HHS staff and Community Partners for their

Contact Information

Daniela Dijmarescu, Project Manager HHS IEN/ESL Nurse Integration Project Chedoke Site, Wilcox Building,119A

Tel.: 905-521-2100 ext. 77512 BB:905-870-1209 Fax: 905-521-7959





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