Internationally Educated Nurse (IEN) Integration in Nova Scotia: A Provincial Realist Evaluation

BACKGROUND: Canada is committed to supporting internationally educated nurse (IEN) integration into the healthcare system, as a strategy to address post-pandemic nursing shortages. The province of Nova Scotia has emerged as a Canadian exemplar with the development of NICHE (Nova Scotia's International Community of Healthcare Workers Engagement) programme, which anchors intersectoral collaboration between the government, the nursing regulator and healthcare systems in service of streamlining IEN integration. METHODS: We conducted a province-wide realist evaluation of the integration of IENs into the Nova Scotia healthcare system and community. We collected data from interviews with 24 participants, comprised of IENs and stakeholders at meso- and micro-healthcare system levels. We used a theory-driven approach to data analysis which utilised elements of content analysis, reflective dialogue and the construction of CMOCs (context-mechanism-outcome configurations). RESULTS: We constructed three main CMOCs which highlight facilitators for IEN integration related to (1) the development of adaptive programme pathways for IENs, (2) the critical role of IEN allies and advocates within healthcare systems, and (3) the shift in focus from recruitment to retention. CONCLUSIONS: The study findings describe the contextual factors and key mechanisms that promote 'successful' IEN integration which may be useful for leaders and policymakers integrating IENs into their local health human workforce. The findings raise important questions about supporting IEN retention, consistent with the vision for a healthy and sustainable nursing workforce. The findings from this study underscore the need for further evaluation research in on the topic of IENs.