Orientation of a nurse recruited from abroad to work and working life

The new employee should always be familiarised with at least the following:

• work tasks
• goals and areas of responsibility
• facilities, equipment and devices
• shifts and workplace schedules
• sources of information and support at the workplace
• safe and healthy working methods
• work-related hazards and how to operate in disruptions and emergency situations.

Orientation should also cover the work community’s practices and rules, such as equality and respectful behaviour, as well as building relationships with colleagues. 

Orientation requires time and resources in the early stages, but it is a worthwhile investment that yields long-term benefits. In the orientation of nurses recruited from abroad, it is important to note that the nurses do not necessarily know the culture, practices, legislation of Finnish working life or the special features of the healthcare sector. Even if these topics have been discussed in pre-departure training, the different practices and rules often still require additional learning.

Despite pre-departure training, nurses may experience surprises and challenges when starting work and settling in Finland.

Pre-departure training is organised while the nurses are still in the country of origin. In addition to Finnish language studies, it usually includes learning about the Finnish culture, society, working life and practical matters related to living in Finland.

The recruiting organisation and the recruitment agency should agree on the contents and objectives of the training so that it will meet the actual needs. It is important to ensure that the employees make the decision to move to Finland based on realistic information and not on unrealistic expectations.

In addition to Finland’s well-known attraction factors, the training should also address, for example, the price level, wage level, taxation and climate of Finland in a realistic manner. Arriving nurses may also benefit from more comprehensive information about their future workplace and tasks. This would help the recruited nurse orient themself to their work in advance. The job titles in the healthcare sector and their job descriptions and pay levels should also be discussed before arriving in Finland.

Orientation to the organisation and reception to the unit can be initiated, for example, by sending advance material from the organisation and arranging an online meeting with the nurse before their move to Finland.

When an organisation recruits several people from abroad at the same time, it is practical to organise part of the orientation for the group of people arriving at the same time.  The responsible party may be, for example, HR management or the coordinator responsible for recruitment from abroad.

Orientation organised in a centralised manner should cover a broad range of matters related to Finnish working life. The themes to be addressed may include: 

• Information related to the employment relationship
  • Working time legislation
  • Wage formation and taxation
  • Annual holidays
• Work ability, illness and wellbeing
  • Illness and sick pay
  • Occupational health care services
  • Organisational practices that support employees’ work ability
• Occupational safety and health
  • Workplace safety regulations
  • Prevention of hazardous situations
  • Right to a safe working environment
• Family leave and other absences
  • Parental leave
  • Study leave and other statutory leaves
• Education and development opportunities
  • Training provided by the employer
  • Support for career development
• Cooperation at the workplace
  • Cooperation between the employee and the employer
  • The employee representative system and trade unions as well as advocacy and support for employees in representing their interests

Understanding these matters is central to understanding the nurse’s own rights and responsibilities.

It may also be a good idea to provide information on Finnish society, daily life in Finland, leisure activities and the opportunities offered by the third sector. Clear instructions and contact information help the nurse contact the right party and find the information and support they need.

The organisation may also appoint a person or team responsible for coordinating the support of nurses recruited from abroad. The advantage of such an arrangement is that information is concentrated in one place: nurses know who to contact when questions arise. This will also save supervisors’ working time. 

There are many methods of implementation

Centralised orientation can be implemented in many different ways. One way is to organise a longer onboarding event as soon as the nurses arrive in Finland, for example, lasting 1–2 days.  After this, the orientation can be continued at regular meetings with the entire group.

Alternatively, the orientation can take the form of shorter group meetings, lasting a few hours, which are organised in the early stages, for example, every few weeks. Regular meetings will provide nurses who have moved to Finland at the same time with an opportunity to share experiences and receive support from each other.

The events and meetings can be organised online or as face-to-face events. The benefits of a face-to-face event may include facilitating interaction and building trust. Nurses starting their work at the same time can also get to know each other and network with each other.

Recordings and clear written materials

Part of the orientation can be carried out using recordings and clear written materials, which nurses recruited from abroad can familiarise themselves with at a time that suits them best. However, in this case, it is important to arrange an opportunity to ask questions and discuss matters that remain unclear.

The same recordings and materials can also be used for groups to be recruited later.

Orientation can also be centralised so that nurses working in different departments and units of the same organisation are simultaneously oriented by one instructor in, for example, Apotti recording. When each instructor or supervisor does not familiarise the nurse separately, less resources are spent.

In orientation, it is important to ensure that all essential matters are understood even in a situation where Finnish language skills are still developing. The organisation should outline in advance whether a bridge language can be used in the orientation, and if possible, the orientation material can also be translated into English, for example. This would ensure the quality and consistency of the orientation material for all users. However, it should be noted that not everyone necessarily speaks fluent English or is familiar with all the terminology in the healthcare sector in English. 

A nurse recruited from abroad will get to know their tasks in more detail in their unit. The supervisor has the overall responsibility for orientation, but orientation is also a matter for the entire work community. 

The supervisor is responsible for the planning and success of the orientation.

• Ensures that sufficient resources are available for orientation.
• Ensures that the new employee receives the necessary support.
• Monitors the running of the orientation and, if necessary, identifies development areas.

Good cooperation among the work community is the key to successful orientation.

• Everyone in the work community has the capacity to help and offer their support in daily situations.

Modified and complemented orientation plan

It is a good idea to base the orientation plan on the unit’s current plan. However, the plan should be modified and complemented from the perspective that the new employee enters the work unit directly from abroad and has no previous experience of Finnish working life or healthcare in Finland.

When preparing the orientation plan, it is good to be aware of what kind of orientation is organised centrally in the organisation for employees recruited from abroad. This will avoid overlap, although repetition is usually useful in orientation.

In work communities and units that have long had employees with an immigrant background and various language backgrounds, orientation plans often include matters that are also useful in the orientation of employees recruited from abroad. In this case, the orientation plan may only require some fine-tuning to ensure that it will also work well for the employees recruited from abroad. 

Taking into account the background of the new nurse

In the orientation in individual units, it should be noted that the educational backgrounds and work experience of nurses recruited from abroad may vary. For example, some have acquired a registered nurse degree abroad and some have a background as a practical nurse or a care giver. Work experience may also vary from demanding tasks in specialised medical care to more limited work experience in the field.

Previous work experience in different countries may have modified the nurse’s views of different tasks in various job roles. For example, a registered nurse’s work in Finland is often more comprehensive than in some other countries, and the work may also include basic care if necessary. The job descriptions should be defined and discussed with the recruited nurse. 

Time and repetition

It is a good idea to reserve more time than usual for the orientation of nurses recruited from abroad. Repetition may also be necessary, as the nurse accumulates a great deal of new information in the early stages of moving to Finland. When there is still little experience of the new working environment, it may also be challenging to adopt and remember things. The person receiving the orientation should be encouraged to tell and ask questions when anything at work or at the workplace raises questions or wonderment.

It is also best to consider in advance how and on what schedule the orientations are run and new things taken on. Is it possible to proceed in phases so that the topics to be learned are handled in stages?  Clear objectives set for step-by-step orientation help the nurse, the instructor and the supervisor to monitor progress.

Getting to know workplace practices and colleagues

In orientation, it should be noted that workplaces and work communities often have unwritten rules and practices. In fact, it is useful at the workplace and at the unit, to identify, verbalise and communicate these “obvious” practices openly. This will make it easier to understand and adopt practices. At the same time, it is a good idea to consider whether the workplace has practices that unintentionally exclude some of the employees.

In orientation, it is also important to ensure that the new employee is offered opportunities to get to know their colleagues. The entire work community plays a crucial role in this. A nurse recruited from abroad can be assigned a person from the work community to help them get to know their colleagues. It may also be agreed that familiarisation with the work community is the task of a workplace instructor assigned for the nurse. 

A workplace instructor is assigned for practical nursing students in apprenticeship training. Similarly, registered nurses in qualification training can be assigned a workplace instructor to help them in taking over their duties.

Instructors play a key role in the success of the new employee’s orientation. Instructors support the new employee and help them strengthen their professional skills and take on work tasks. Instructors are also able to promote the inclusion of a nurse recruited from abroad into the work community through their actions.

The workplace instructor and the nurse usually work closely together, and this stage should be long enough.

Two-instructor model

One instructor is usually assigned for a nurse recruited from abroad, but especially in the early stages of orientation, there may be two instructors. The two-instructor model facilitates shift planning and ensures that at least one of the instructors is mainly present to support the new employee.

It is important to manage the workload of instructors so that no single instructor has too many instructees at the same time. They should have enough time to invest in guidance.

Training and networks for instructors

When selecting an instructor, it is good to take into account their interest in the guidance task as well as their possible foreign background, personal experience of working abroad or language proficiency, if this brings added value to the orientation. For example, an instructor who has personal experience of moving to Finland or abroad for work may find it easier to understand the experiences and challenges faced by a nurse in a new country.

To support the work of instructors, training can be organised that focuses, for example, on developing guidance competence and matters related to diversity and language awareness. The organisation can also promote networking between instructors, for example by organising meetings and workshops in which experiences and good practices are shared.

Smooth orientation through cooperation between supervisor and instructor

• Systematic approach: 
  The supervisor’s task is to ensure that the orientation is systematic, that the work unit has guidance competence and that the instructors are not left alone with their responsibilities.
• Planning of shifts: 
  Make sure that the nurse recruited from abroad always has someone available for support during a shift.
• Sufficient time for guidance: 
  Reserve separate times for the instructor and the nurse to discuss intriguing matters and problematic situations with the supervisor.
• Notebook for the person receiving orientation: 
  Introduce a notebook in which the nurse can write down questions that emerge during their shift. Review the questions in the notebook regularly with the instructor and/or supervisor.
• Follow-up and feedback: 
  Have regular meetings with both the instructor and the person receiving the orientation, together and separately. At the meetings, discuss the progress of the orientation and agree on the next steps. 

Moving to Finland may bring surprises, such as differences between expectations and reality, for example, in terms of price level, daily work or job descriptions. The integration of nurses recruited from abroad into Finland, and its potential challenges, may also be reflected at the workplace. The recruited nurses are often also far from their friends, family and safety networks. They may therefore need support in adapting to the new living environment.

The questions that arise may be related to official processes, housing, opening of bank accounts and tax card matters. Many nurses recruited from abroad also wish to have their families in Finland and need help in the complex and long family reunification processes.

When the nurses arrive in Finland through a recruitment agency, the agency may take care of acute settling-in measures, if so agreed between the recruiting organisation and the recruitment agency. Clear definition of responsibilities between the parties involved in the recruitment process is therefore of paramount importance. Some recruitment agencies also offer support in daily matters, and the organisation can acquire this service for its recruited nurses.

Support in daily matters and regular meetings

Recruitment from abroad may mean that supervisors – and more broadly the work community – may face issues that are not exactly part of their job description. It is good to prepare for the situation at least so that the nurse in need of support can be directed to the right party. It may also be agreed in the organisation that the tasks or job description of a certain person, team or unit include supporting nurses recruited from abroad in daily matters. This way, each supervisor does not need to investigate matters independently; instead, information is collected in a centralised manner.

By organising regular meetings for a group of nurses recruited from abroad, the organisation can support not only their orientation into working life but also the settling-in and integration into Finland.

In the joint meetings, practical everyday issues can be discussed, opportunities for leisure activities can be explored, and the issues that have arisen can be clarified, for example, with regard to children’s schooling, housing or, for example, gym membership. The meetings also provide an opportunity to share experiences with peers, create new friendships and network with other nurses recruited at the same time.