The integration of immigrant nurses at the workplace in Malta: a case study

• DOI: https://doi.org/10.1108/IJMHSC-06-2017-0024
• Pages: 269-289
• Date: 10 September 2018
• Published date: 10 September 2018
• Author: Sandra C. Buttigieg,Kevin Agius,Adriana Pace,Maria Cassar
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work, economy & organizations,Labour movements

The integration of immigrant nurses at the

workplace in Malta: a case study

Sandra C. Buttigieg, Kevin Agius, Adriana Pace and Maria Cassar

Abstract

Purpose –The purpose of this paper is to identify the extent to which immigrant nurses have integrated

within the Maltese healthcare system.

Design/methodology/approach –This research consisted of a qualitative case study approach which was

conducted within Malta’s four public entities in the secondary care sector. In this case study, data were

collected through 34 semi-structured interviews with ten nursing managers, 12 Maltese nurses and 12

immigrant nurses. The data were analysed using content analysis. Data were collected between June 2015

and July 2015.

Findings –Four themes emerged from the data. These were: human resources management, language

barrier, cultural differences and discrimination. The recruitment of nurses to Malta from other countries

translated into several positive and favourable outcomes, such as the sharing of knowledge. However, a

number of negative and unfavourable outcomes are also indicated in the data including language barrier and

discrimination.

Research limitations/implications –This paper presents a discussion of the issues experienced within a

healthcare system in relation to the mobility of nurses. Increasingly, the nursing workforce across the globe

comprises of professionals from various nationality, origin, training, culture and professional ethos. The

findings are presented in an effort to inform policy makers, management and administrative structures

regarding the issues pertaining to the prevalent growing reality of mobility in nurse populations.

Originality/value –This research study provides a unique contribution to the literature regarding the

phenomenonof nurse mobilitybecause it embracesthe integration of nursesas a two-way process.Since data

was collected fromimmigrant nurses as well as from local nursesand nursing managers, this studyhopes to

offer a differentpoint of view from previousstudies which largelyfocused on the views of immigrantnurses only.

Keywords Discrimination, Cultural differences, Adaptation into host health system,

Integration into host health system, Migrant nurses, Nurse mobility

Paper type Case study

Summary statement

Why is this research or review needed?

■Nurse mobility is a widespread and growing phenomenon.

■It presents a critical discussion of the implications and challenges associated with the

integration of qualified nurses from one healthcare system to another.

What are the key findings?

Six themes emerged following data analysis, namely:

■The recruitment of nurses to Malta from other countries translated into several positive and

favourable outcomes, such as sharing of knowledge.

■However, a number of negative and unfavourable outcomes are also indicated in the data as

foreign nurses encountered difficulties while integrating within the Maltese healthcare system

including language barrier and discrimination.

Received 25 June 2017

Revised 21 May 2018

Accepted 25 May 2018

Sandra C. Buttigieg is based at

the Department of Health

Services Management, Faculty

of Health Sciences, University

of Malta, Msida, Malta and

School of Social Policy,

University of Birmingham,

Birmingham, UK.

Kevin Agius and Adriana Pace

are both based at the

Department of Health Services

Management, Faculty of Health

Sciences, University of Malta,

Msida, Malta.

Maria Cassar is Senior Lecturer

at the Department of Nursing,

Faculty of Health Sciences,

University of Malta,

Msida, Malta.

DOI 10.1108/IJMHSC-06-2017-0024 VOL. 14 NO. 3 2018, pp.269-289, © Emerald Publishing Limited, ISSN 1747-9894

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■Various efforts, including adaptation programmes, have been developed within the Maltese

healthcare systemwith significant favourable effect. Nevertheless,it is evident that a number of

challenges associated with integrating nurses effectively are not being adequately addressed.

How should the findings be used to influence policy/practice/research/education?

■The findings of the research study should provide information and insight which may inform

nurses who engage in professional mobility.

■The findings may also inform managers and policy makers involved in the recruitment,

employmentand professionaldevelopment of nurseswho mobilise from one countryto another.

■Various recommendations have been listed in this regard, against the ultimate scope of

contributing towards the enhancement of quality of care delivered by the nurses.

Introduction

Over the last four decades nurse mobility has been distinguished as a growing global

phenomenon (Schilgen et al., 2017). Malta has experienced such phenomenon whereby

the rate of incoming nurses, far exceeded the numbers of nurses moving away from the

healthcare system.

Nurses who move from one healthcare system or county to another system or country carry

different labels in the literature and in management structures. These include expatriate nurses,

immigrant nurses and overseas nurses. For the purpose of this research study, the term/ title

“immigrant nurse”is used to refer to a nurse who would have completed one’s education and

perhaps worked in one country and later mobilised to Malta in view of taking up professional

employment.

Nursing is a well-known scarce asset all over the world (Littlejohn et al., 2012). There are various

reasons leading to this shortage, including an ageing nursing workforce, women have more

career choice, unavailability of educational facilities as well as the poor image of the profession

(Gerrish and Griffith, 2004).

Apart from the challenges which the nursing profession is facing, Malta is also tackling the issues

of a growing healthcare sector, where the Maltese population is in better health, thus is living

longer and the demand for healthcare is continuously on the rise. Furthermore, the provision of

more long-term care beds is an issue that must be faced and addressed unceasingly. Thus, the

healthcare system is continuously growing to accommodate for these demographic changes

while at the same time nurses are a scarce resource (Pricewaterhousecoopers, 2012).

Local health authorities have considered various solutions to maintain optimal nurse-patient

ratios, as determined by international standards and considered various solutions to address

these problems. Efforts were done to increase the number of nursing student places. These

measures included the training of clinical nurses to teach and assess students in practice, the

formation of agreements with private hospitals to increase the availability of clinical placements as

well as the restructuring of the four-year nursing programmes to a more intense three-year

programme. Furthermore, the numerus clausus was officially lifted (Sammut, 2012).

Despite the several efforts, this was not enough to relieve the shortage of nurses. Another solution

was to recruit immigrant nurses and the first recruitment process was concluded by September

2013 (Galea Debono, 2013).

In 2016, immigrant nurses, coming both from EU and non EU countries, accounted for 9 per cent

of the total nursing workforce employed within the Maltese healthcare system (Sansone, 2016).

According to the Health Minister, the workforce in the Maltese public system stands at 3,150

nurses. Despite this strong workforce, this is not enough as healthcare is continuously growing

(Fearne, 2016). There are around another hundred nurses working within the private health and

social sectors to meet the demands.

Several measures are being taken before and after recruiting immigrant nurses including

a three-month course in basic Maltese. Furthermore, nurses need to have adequate

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