Playing the game: a grounded theory study of the integration of internationally qualified nurses in the Australian healthcare system

Chun Tie, Ylona Audrey Diana (2019) Playing the game: a grounded theory study of the integration of internationally qualified nurses in the Australian healthcare system. PhD thesis, James Cook University.

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Twenty-nine per cent of registered nurses in Australia received their first nursing qualification in a country other than Australia. Therefore, understanding the process of successfully transitioning internationally qualified nurses into a foreign healthcare system is vital to ensure the provision of safe, quality nursing care for all Australians.


The aim of this study was to explore how internationally qualified registered nurses and Australian qualified registered nurses adapt to working together in the Australian healthcare system and develop a theory that explains this process.

Research question

What is the process by which internationally qualified registered nurses are integrated into the Australian healthcare system?


Grounded theory methodology was used in this study. Concurrent data collection/generation and analysis of online survey data (n = 186) and individual participant interviews (n = 15) was undertaken. Storyline was used as a technique of advanced analysis to integrate and present the theory. Two focus groups (n = 9 and n = 7) were held to evaluate and validate the theory.


International and Australian nurses work together to enable the successful integration of international nurses into practice. Four phases underpin professional socialisation, enculturation and adaption to the cultural norms of the workplace: (i) joining the game: adapting to context—observing and learning the cultural norms; (ii) learning the game: becoming socialised—receiving support; (iii) playing by the rules: aligning scope— communicating for quality care; and (iv) the end game—integration. These phases interconnect to form the final theory of 'playing the game'—a grounded theory of the integration of international nurses in the Australian healthcare system.


Nurse migration trends to Australia have seen an increase in international nurses from developing countries. Context of the work milieu as the dynamic playing field is instrumental in understanding how authentic leadership and positive work environments support integration processes. Consequences for unsuccessful integration are significant and result in: negative work environments; patient dissatisfaction; adverse events; damaged reputations of registered nurses, organisations and the profession; and loss of skilled and experienced registered nurses from the profession.


The findings of the research are significant for the nursing workforce in Australia in relation to the recruitment, retention and integration of experienced registered nurses. Promotion of cultural responsiveness education and integration strategies prevents the attrition of experienced registered nurses. Recommendations are made to inform policies and practices for sustaining a workforce that will provide quality nursing care for all Australian citizens, regardless of the place of origin of the nurse or where they obtained their initial nursing qualification.

Item ID: 58980
Item Type: Thesis (PhD)
Keywords: Australia; Healthcare Systems; Grounded Theory; Integration; Nurses, International; Storyline
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Copyright Information: Copyright © 2019 Ylona Audrey Diana Chun Tie.
Additional Information:

For this thesis, Ylona Chun Tie received the Dean's Award for Excellence 2020, which recognises excellence in Higher Degree by Research and recipients of this award are commended by independent expert examiners as having made a substantial contribution to their field of research.

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 2: Chun Tie, Ylona, Birks, Melanie, and Mills, Jane (2018) The experience of internationally qualified registered nurses working in the Australian healthcare system: an integrative literature review. Journal of Transcultural Nursing, 29 (3). pp. 274-284.

Chapter 3: Chun Tie, Ylona, Birks, Melanie, and Francis, Karen (2019) Grounded theory research: a design framework for novice researchers. SAGE Open Medicine, 7. pp. 1-8.

Chapter 5: Chun Tie, Ylona, Birks, Melanie, and Francis, Karen (2019) Playing the game: a grounded theory of the integration of international nurses. Collegian, 26. pp. 470-476.

Date Deposited: 24 Jul 2019 02:31
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111099 Nursing not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 100%
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