Inclusion of a nurse recruited from abroad into the work community

Work in healthcare and social sector is largely carried out as teamwork, even if the employees have their own areas of responsibility which they manage independently. The work runs better when employees help and support each other and feel comfortable asking others for help and advice at a low threshold.

When there is mutual trust in the work community, employees trust each other’s abilities and professional skills, intentions and honesty. Mutual trust is linked to the extent to which the work community dares to bring up problems and mistakes. Bringing up challenges and errors enables them to be solved and prevents future errors, which in turn improves the effectiveness of work and the quality of care.

The need to belong – to a community or with other people – is one of the basic psychological needs of a human being. As employees, we need not only a sense of belonging to the work community but also the experience that we are appreciated and accepted as we are. According to studies, the experience of communality is one of the most significant factors affecting well-being at work and commitment to the workplace. On the other hand, experiences of exclusion put a strain on people, cause poor well-being and reduce commitment to the workplace. 

A new employee’s inclusion in the work community is not a given. The openness and receptiveness of work communities to new employees may vary greatly.

A nurse recruited from abroad may face challenges in entering the work community. These challenges may be greater than what a new employee typically faces. Key reasons for this may include language barriers, cultural differences and differences in professional practices.

Even if nurses recruited from abroad have studied Finnish/Swedish as part of the pre-departure training, it is often still challenging to communicate with the acquired language proficiency when arriving in Finland. Especially spoken language may be difficult to understand. Insufficient language skills can reduce social initiative and make it difficult to get to know colleagues and may lead to a sense of isolation. It is therefore important that the members of the work community actively work to engage with the new employee.

Especially in the early stages – before language proficiency has accumulated – the members of the work community should also be able to adapt their speech so that the person learning Finnish/Swedish can understand at least part of it.

Flexible language use

To ensure that language problems do not become an obstacle to a new employee’s entry into the work community, it is recommended that language use is approached flexibly. This also means making it clear to the new employee that if they wish, they can communicate with their colleagues in English, for example.

Not all members of the work community necessarily speak English, and it is best that the work community discusses and agrees on practices related to language and a bridge language. Employees recruited from abroad should also be informed of the situations in which and with whom they can use English alongside Finnish.

Workplaces and work communities may have different approaches to the use of a bridge language. Some workplaces have policies stating that only the actual working language of the organization should be used. However, it should be noted that this may make it more difficult for an employee recruited from abroad that has newly arrived into the country to enter the work community.

Communication and discussion

Recruiting employees from abroad may raise many kinds of questions, concerns and opinions in a work community where recruitment directly from abroad has not previously taken place. Possible questions may include:

• Why are nurses recruited from abroad in general?
• Is the recruitment ethical and will the employees be exploited?
• Does the professional skills of those coming from abroad correspond to the competence needed in the work?
• How does this affect one’s own work? Will one’s work become more burdensome when colleagues who are only learning the language used in the work join the team and do not know the Finnish healthcare system or Finnish nursing practices?

The initial attitude of work community members to recruitment from abroad may vary from negative and questioning to positive and curious. It challenging for a new employee to enter the work community if their arrival is viewed negatively. Discussions in the work community and adequate access to information have a significant impact on the formation of attitudes.

It is a good idea for the organisation to inform the entire personnel that recruitment from abroad will be carried out. In the communication, particular attention should be paid to the units in which the nurses will be placed. In addition to communication, it is also important that the work community discusses the matter and addresses the questions and possible concerns raised by recruitment from abroad.

The unit can organise joint information and discussion events for the work community even before those recruited from abroad arrive in Finland. The supervisor should also prepare for discussions in the future whenever the need arises. This way, the questions concerning members of the work community will be addressed.

Especially in organisations where employees are recruited from abroad for the first time, questions and wishes related to the recruitment can be collected and collated jointly from different units by means of a survey. The results of the survey will provide an idea of what kind of questions should be handled in the work units and what kind of information and support is needed.

When the placement of the nurses in different units is known, it is good to inform the members of the work community of the employees coming to the work unit. This includes sharing details such as their educational background, the tasks in which they will start their work and what kind of tasks and possible limitations are included in this job description in the early stages.

Preparing reception and orientation in the work community

When the work community of the work unit jointly plans reception and orientation, this streamlines their implementation and prepares and tunes the work community for the coming.

In the orientation, attention should also be paid to familiarising the future employee with their colleagues and that the new employee can feel welcome in the work community.

It is a good practice for one of the employees in the work community to be assigned as the mentor of the new employee. The mentor’s task is to introduce the new employee to their colleagues. However, the entire work community should be socially proactive in getting to know the new colleague and involving them in their group.

In general, nurses recruited from abroad for practical nurse apprenticeship training have an assigned instructor at the workplace. Instructors may also be assigned for those undergoing registered nurse qualification training. It is best to clearly agree on whether the instructor is also responsible for introducing the nurse to colleagues or whether a mentor is also assigned alongside the instructor to support introduction to the work community.

You can find more information about orientation in the section Orientation.

Preparing for language issues in the work community

The work community should also discuss issues related to language use and agree on related policies. It is best to prepare for the need to use a bridge language at the beginning of both orientation and interaction with people recruited from abroad. In discussions led by a supervisor, it is advisable to agree on how the use of a bridge language is treated and how the language learner’s Finnish/Swedish learning process is supported in the work community.

The members of the work community need skills for successful communication with language learners and for supporting the language learner’s learning process. These skills should be promoted especially if the members of the work community are not previously accustomed to working in multilingual work communities where some of the colleagues are language learners. These skills can be supported by providing training and various materials, such as instructions.

For more information on language issues, see the section Language question.

The functioning of work communities, an inclusive culture and the promotion of psychological safety should be permanently included in the supervisor’s and work community’s agenda. This applies to work communities in general, but especially to diverse work communities. According to studies, immigrants, linguistic minorities and members of other minorities experience more exclusion and negative interaction in their work communities than others.

An essential part of building positive and respectful interaction is policies on what kind of behaviour, practices and treatment of others are not tolerated in the work community and the organisation: discrimination, harassment, inappropriate treatment, racism and bullying in the workplace. There must be a shared understanding of these policies.

In addition the policies, procedures for acting and intervening in situations if necessary are needed. The procedures must be known and there must be competence and courage to use them.

More information on building an inclusive culture and weeding out non-tolerated actions:

• The Diversity and Inclusion in an Expert Organisation guide:
  Getting everyone involved – building a community and networks

How to weed out racism and xenophobia?

It is essential that all members of the work community know and understand:

• What is racism?
• How can racism manifest itself?
• Why is racism harmful?
• How to intervene in racism?
• That racism is not tolerated in the organisation!

Racism can occur in subtle forms. Recognising it can be challenging if you are not the target. It is also important to understand that unjustified claims of racism are harmful. Those can reduce the credibility of real experiences and observations of racism and of reports of them.

It must be ensured that the members of the work community are familiar with the organisation’s procedures related to non-tolerated behaviour, such as racist behaviour, and dare and know how to act accordingly. Work communities should be provided with information on how to recognise racism and how to intervene in it.

Those who have been subjected to racism and inappropriate treatment in their work community often report that they are left alone in these situations: other colleagues present will not intervene even if they do not necessarily accept the behaviour. It is important to strengthen a culture in which people do not remain bystanders, but dare and know how to intervene constructively in the situations. It is good to understand that the passivity of bystanders enables the continuation of racist treatment.

Naturally, racist or inappropriate behaviour of patients/customers or relatives should also be intervened in. This can be perceived as particularly challenging. It would be good for supervisors to receive training and/or support for this.

Patients with serious memory disorders with racist attitudes pose their own problems, for which repeated intervention does not lead to permanent changes in behaviour. In such situations, solutions should be considered on how to avoid the nurse’s exposure to racist treatment and how to alleviate the burden of such treatment.

How to support those who are subjected to racist treatment?

In addition to weeding out and intervening in racism, organisations should also plan and agree on how to support those subjected to racist treatment.

Those who have been subjected to racist treatment report that supervisors can downplay their experiences when they talk about them. This can be due to the fact that the severity of the problem and the negative effects of the experiences on well-being are not understood. Downplaying experiences and their significance may increase the stress caused by the experiences.

Facing the experiences with appropriate seriousness, listening and demonstrating empathy is an important form of support. Another form of support is debriefing discussions, in which situations experienced as racist are discussed, supporting work ability and well-being at work.

Organisations can set up peer support groups where employees can share their experiences and feelings with others with similar experiences.

High-quality and comprehensive information package for anti-racism work:

• Online course on anti-racism for professionals (Finnish Institute for Health and Welfare)

 It is a good idea to agree on language policies that promote communality in informal situations where employees communicate with each other, such as during breaks and in situations where clients or their family members are not present. 

In multilingual work communities, there is often one or more people who speak the same first language (mother tongue), the same dialect, or who have a common strong language other than an agreed working language.  The use of one’s mother tongue or other fluent language is understandably natural and effortless when there is an opportunity to do so. 

No linguistic exclusion

Use of a language in situations where there is one or more persons who do not understand the language used will exclude those who lack proficiency in the language. Linguistic exclusion is often unintentional – the intention is not to exclude others. On the other hand, linguistic exclusion has also been found to be deliberately used to exclude others from interaction or to create boundaries between different groups. In any case, studies have shown that exclusion, whether intentional or unintentional, arouses negative emotions and distrust in those who face it.

One policy that promotes communality may be that the language used in informal situations, such as coffee breaks, may be any language as long as everyone in the situation knows the language. When a person who does not know the language enters the space, the language is changed to a commonly agreed language of the organisation. This is done even if the person entering the space is not expected to be interested in participating in the discussion.

Situations in the work community regarding language may differ from one another, and language learners should also be taken into account in language policies. In the early stages of language learning, breaks are not necessarily refreshing and restorative if you have to make an effort with the language during the break. Those recruited from abroad may therefore refrain from taking joint breaks, which does not promote their inclusion into work groups. In other words, in work communities, it is a good idea to carefully assess what kinds of policies are suitable for the work community, and the policies may need to be updated time to time. 

Language policies must be jointly agreed on

People’s tendency to use their mother tongue whenever possible is natural and strong. It is also known from studies that in practice, employees do not start following language guidelines issued from above. In making the policies active, it is essential that the employees understand the meaning and importance of following the language policies. In other words, it is necessary to discuss and jointly agree on language policies in the work community, which means that they will also be followed significantly better. Embedding the policies usually takes some time and may require reminders.   

It is also good to agree on a language policy for situations where clients or patients are present. Even if the situation does not include communicating with the client/patient, communication between employees in a language that the client/patient does not understand will exclude them from the situation and may cause negative reactions.   

Once the policies have become familiar and their significance is understood, non-exclusive language is integrated as a smooth and natural part of the daily life of the workplace. However, it should be noted and remembered that when new employees enter the work community, they must be familiarised with language guidelines. 

Various networks form in organisations, both formal and informal. Being a member of networks has many important meanings. Formal networks that are more directly related to work can be used to influence matters that are important to oneself and to gain valuable information and tips as well as an understanding of the organisation’s activities in a broader sense.   

For various reasons, workers with an immigrant background are excluded from networks more often than others. Networking opportunities for nurses recruited from abroad, as well as other people with an immigrant background, should therefore be supported in various ways. This can be achieved, for example, by actively inviting people to work groups. Organisations can also actively build networks between nurses recruited from abroad.

Peer support, information and tips for work and more

Cross-unit networks of nurses recruited from abroad have many benefits. These provide peer support as well as useful information and tips on matters related to working in the organisation and professional integration as well as settling in and integration into the country. Nurses previously recruited from abroad may also help in this.   

Networking between people recruited from abroad takes place partly naturally when, for example, the organisation organises joint orientation events for those who arrived in the country at the same time. The workplace can also organise activities or events, such as network meetings, where the nurses also become familiar with each other. Partly, the nurses also get to know each other in apprenticeship training and qualification training. However, it should be noted that some may be excluded from the acquaintances and friendships created in education, which is why the organisation should also pay attention to the matter. 

Support for formal and informal networks

If the organisation does not organise joint events for those recruited from abroad, such as joint welcome and orientation events, it is worth considering whether it is necessary to separately support the building of networks between nurses recruited from abroad and how this is implemented.  Both formal networks with agreed physical or virtual meetings and informal networks based on people knowing each other and knowing of each other can be valuable in terms of well-being at work and integration into society. However, belonging to informal networks may be more random. It is important that no one is excluded from networks.

Network activities should be planned so that, for example, representatives of the organisation, such as management or HR, also participate in network meetings. Such an arrangement supports dialogue and discussion, which also provide the organisation with information and understanding of development needs. However, an open and safe atmosphere at the meetings is a prerequisite, in which case challenges can also be discussed openly.