Nursing education abroad
What shapes the experience of international nursing students?
Over the past two decades, tertiary education has become increasingly internationalised, with English-speaking countries such as Australia, Canada, the United Kingdom, and the United States attracting a significant influx of students from around the world. Many are drawn to nursing.
International students contribute to their host countries' economies, enrich cultural diversity, and help address workforce needs. Student nurses, for instance, assist in filling immediate workforce gaps, particularly in areas like aged care.
Several countries have immigration policies that permit international students to register and seek employment post-graduation. In Australia, 70% of international nursing graduates join the local workforce after completing their studies. Overseas-born registered nurses and carers help bridge existing workforce shortages, especially in high-demand areas such as aged care, rural and remote communities, and specialised healthcare settings.
Various factors within the learning environment influence international nursing students' outcomes. Understanding what facilitates or hinders their progress is crucial to ensuring their success and well-being, enabling them to effectively contribute their skills to the healthcare workforce.
A recently published scoping review systematically mapped existing research to explore the factors influencing international undergraduate nursing students' experiences and perceptions of their learning environments in foreign countries. The primary aim was to provide guidance and insights to inform the development of resources that support international students throughout their educational journey.
Language barriers were frequently reported, leading to frustration and embarrassment in both academic and clinical settings. Navigating complex medical terminology, colloquialisms, and diverse accents proved challenging. Some students felt that domestic peers perceived them as less knowledgeable due to their accents or difficulties with English, resulting in feelings of devaluation and discrimination.
Cultural differences also posed challenges, affecting social integration and interactions. Discrimination based on accent, language proficiency, or race was a reality for many in both classroom and clinical environments. Such experiences can lead to feelings of devaluation, humiliation, social isolation, and significantly impact students' well-being and learning.
Inadequate support from mentors and faculty, combined with the rigorous academic demands of nursing programs, further compounded stress levels among international students.
The scoping review also identified factors that positively influence international nursing students' educational experiences. Students often employ strategies such as seeking mentorship and participating in simulated role-play sessions. Mentorship supports their professional development and integration into the nursing field, aiding in navigating complexities and cultivating competencies. Simulation provides opportunities to practice skills in a controlled environment, enhancing critical thinking, communication, and decision-making abilities.
Institutional support plays a vital role as well. Orientation programs and peer networks facilitate students' adjustment. The availability of resources, including instructional videos and faculty support, enriches learning experiences. For example, teaching videos offer accessibility and flexibility, aiding in the comprehension and retention of complex concepts. Personalised support from faculty addresses unique challenges and enhances understanding. Moreover, positive interactions in culturally diverse healthcare settings promote students' cultural competency. Enhancing language proficiency and cultural integration are essential components of their educational journey. Creating supportive, inclusive environments that value diversity is imperative to foster success, well-being, and the development of valuable contributors to the healthcare workforce.
The World Health Organization’s State of the World's Nursing 2020 report emphasises the need for investment in nursing education and that strengthening nursing education is essential to address global health challenges and achieve universal health coverage. The scoping review’s findings, identifying barriers such as language and cultural challenges alongside enablers like mentorship, simulation, and targeted institutional support, highlight the specific areas where investment in nursing education can most effectively support international nursing students.
The Scoping Review is available in the peer-reviewed journal, JBI Evidence Synthesis:
Kalembo, Fatch Welcome; Wilson, Sally; Solomons, Terena; Ngune, Irene; Lim, Eric; Bosco, Anna; Kebble, Paul; Taplin, John; Brown, Janie
JBI Evidence Synthesis. 23(5):840-875, May 2025.