Playing the game: A grounded theory of the integration of international nurses

Ylona Chun Tie, Melanie Birks, Karen Francis

Research output: Contribution to journalArticlepeer-review


Background: Migration trends to Australia have seen an increase in international nurses, with twenty-nine percent of current registered nurses having received their first nursing qualification outside of Australia. The process international and local nurses navigate to enable successful integration into the Australian healthcare system is unclear. 

Aim: To explore how international nurses and Australian nurses adapt to work together in the Australian healthcare system and to develop a theory that explains this process. 

Methods: Grounded theory methodology was used. Concurrent data collection/generation and analysis of online-survey data (n = 186) and in-depth interviews (n = 15) was undertaken. Storyline was used as a technique of analysis to develop, construct and present the theory. Focus groups (n = 9 + 7) were conducted to confirm the relevance of the theory. 

Findings: Nurses work together to enable successful integration of international nurses. Four phases underpin this adaptation to the cultural norms of the workplace: (i) Joining the game; (ii) Learning the game, (iii) Playing by the rules, and (iv) The end game. These phases comprise the grounded theory Playing the game: Integration of internationally qualified registered nurses in the Australian healthcare system. 

Discussion: Additional orientation programs and collegiate support for international nurses were significant factors influencing successful adaption to the cultural context of the work environment. Defining the role and scope of practice of the registered nurse in the Australian context provided challenges. 

Conclusion: Supportive colleagues were critical to successful integration and retention of experienced nurses irrespective of where nurses obtain their nursing qualification. Additional orientation programs for international nurses could improve the experience of nurses migrating to work in Australia.

Original languageEnglish
Pages (from-to)470-476
Number of pages7
Issue number4
Publication statusPublished - Aug 2019
Externally publishedYes


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