Foreign nurses in the U.S.A.: what are the challenges?

Most of the nurses come from Philippines, India, Canada and increasingly from China and Africa.

What are the challenges that these nurses face working in a foreign country?

1. Communication. Communication does not just involve language proficiency.

Lack of knowledge and experience in a foreign culture can result in misunderstandings, mistakes, inappropriate word choice and unintentional insensitivity. Unfamiliarity with slang and idiomatic expressions can result in hurt feelings and wrongfully attributed perceptions.

2. Because of cultural differences and lack of language proficiency, even though foreign nurses speak English, they also suffer from challenges in interpersonal relationships.

Asian nurses in particular, may be seen as having good clinical skills, but not having leadership potential because they are not assertive. Assertiveness is a quality that is important in leadership positions in this country.

3. Differences in work roles and practices. In the U.S., nurses expect to have equal footing or at least a collaborative relationship with physicians.

In some countries, the physicians have a more paternalistic role, and nurses are expected to follow orders without questions. In the U.S., physicians and other nurses might perceive them to be less than competent if they do not speak up or question medical orders.

4. Alienation and prejudice. When foreign nurses were in their native countries, they belonged to the "majority". In their host country, they are now in the "minority" and may be subjected to prejudice from uninformed patients, co-workers and even the administration.

Patients might refuse to be taken care of by a foreign educated nurse because they do not feel that the nurse is educationally qualified, or physically incapable ("I don't think she can take care of my husband; she's too tiny!"), or from prejudice.

5. Cultural adjustment or acculturative stress. Acculturation is a time of intense learning and a time of intense stress.

Not only is the foreign nurse learning how to cope in her personal (family distance, isolation), environmental/logistical and social issues in her daily non-work life, but also learning and adapting to new nursing care standards and work practices.

With all these challenges, foreign educated nurses possess amazing resilience and commitment to quality nursing practice.

What can you do as a foreign nurse to overcome these challenges?

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