Equity in Action: Disrupting Systemic Barriers to Specialty Skill Utilisation Among Internationally Qualified Nurses in Australia

BACKGROUND: Internationally qualified nurses (IQNs) form a critical part of the global health workforce, yet persistent structural inequities continue to limit their recognition and career mobility. Health systems in developed countries rely on IQNs to address shortages, but structural bias, credential hierarchies, and historically embedded knowledge valuation systems impede the full utilisation of their specialty skills. While regulatory standards are designed to protect patient safety, misalignment between global education systems and local recognition frameworks can inadvertently produce inequitable outcomes. AIM: To explore how IQNs transfer and apply their specialty skills within the Australian health system and to identify the equity-oriented facilitators and barriers that shape this process. DESIGN: A meta-synthesis of a sequential explanatory mixed-methods research program, underpinned by a pragmatic and explicit equity framework informed by principles of fairness, transparency, and recognition of global competence. METHODS: Four interconnected studies (online surveys, interviews, and focus groups) were conducted with IQNs and recruiting managers across Australia. Phase 3 involved a meta-synthesis of findings from Phases 1 and 2, which were previously published, using joint display analysis and meta-inference generation to examine structural, organisational, and individual determinants of specialty skill utilisation. RESULTS: Findings across four primary empirical studies reported in six peer-reviewed publications reveal that IQNs bring advanced specialty expertise that can enhance care quality and equity. However, system-level constraints, including recruitment bias, fragmented transition pathways, and inconsistent recognition of international qualifications, restrict their impact. Equity-focused transition programs and inclusive leadership development for both IQNs and recruiting managers emerged as critical mechanisms for change. CONCLUSION: Harnessing IQNs' specialised skills is not only a workforce imperative but a matter of justice. Balancing regulatory standards for patient safety with equitable recognition practices will enable nurses to act as agents of transformative change. PATIENT OR PUBLIC CONTRIBUTION: The study involved 115 participants (n = 71 IQNs; n = 44 recruiting managers) whose lived experiences illuminate the urgent need for inclusive policy reform and equity-driven workforce transformation.