Retaining internationally recruited nurses is a challenge

“Action research was used to identify problems in work communities, but also to help these communities develop intercultural work and interaction,” says Professor Pirkko Pitkänen, director of the MULTI-TRAIN research project.

“Action research was used to identify problems in work communities, but also to help these communities develop intercultural work and interaction,” says Professor Pirkko Pitkänen, director of the MULTI-TRAIN research project.

The Finnish social and health sector is going through a process of internationalisation, but employees of non-Finnish origin are still relatively rare.

A recent study has developed methods to make intercultural work smoother.

Intercultural interaction in the social and health care sector can result in friction, particularly because of language skills, but this much is already well known. The MULTI-TRAIN action research project started from a fairly simple motive: the researchers were underwhelmed by the originality of the previous research results.

“Multicultural work communities have been studied for years, and the studies have repeatedly identified the same problems. The biggest obstacles to multicultural cooperation are the lack of language skills and the need to update professional skills,” says Pirkko Pitkänen, professor of educational policy and multicultural education at the Faculty of Education, University of Tampere.

The repetition of results means that things are not changing.

“We wanted to see whether we could change things if, rather than just mapping the problems through research, we also helped work communities to fix them,” Pitkänen continues.

MULTI-TRAIN, which was a joint Academy of Finland-funded project of the University of Tampere and the University of Eastern Finland, explored and developed intercultural work in five social and health units: Hatanpää Hospital and Koukkuniemi Retirement Home in Tampere, Karhula Hospital in Kotka, Kuopio University Hospital, and Mainio Vire elderly care (now part of the Mehiläinen company) in the Helsinki region.

Work methods were developed in close cooperation with the work communities.

Social and health care work is being internationalised in different ways. Non-Finnish workers who have already moved to Finland may have studied here or in their country of origin before entering the sector. Alternatively, they may have been recruited from abroad and thus arrived in Finland for the specific purpose of working in the sector.

Four of the organisations involved in the MULTI-TRAIN study had recruited small numbers of staff from abroad.

“International recruitment is a complicated process requiring an immense amount of work, both in Finland and in the country of origin”, says Doctoral Researcher and Project Specialist Päivi Vartiainen, from Tampere University of Applied Sciences.

Direct international recruitment was launched in Finland with a four-year pilot programme that started to recruit nurses from the Philippines in 2008. The nurses began their work as trainees and continued to undertake further training to qualify as registered nurses in Finland. So far, about 300 nurses have been recruited from the Philippines.

In addition, nurses have been recruited from Spain and Greece since 2010.

After the labour shortages in the Finnish social and health sectors were thought to have disappeared, international recruitment declined.

The workers interviewed at Hatanpää Hospital did not think that international recruitment was economically reasonable. They also sometimes found that their co-workers, who did not have good Finnish language skills, could be a burden at busy times. However, the clinical skills of the Filipino nurses were highly appreciated.
“The licencing of care professionals who come from the EU and EEA countries to Finland runs smoothly, but they seldom stay in Finland for longer periods of time,” Vartiainen says.

Cultural differences are not only due to national or linguistic differences. Differences in the interpretation of situations in the workplace are also caused by regional, organisational, educational and ethnic backgrounds.
Researcher Katja Keisala from the University of Tampere participated in the study at Karhula Hospital in Kotka and Koukkuniemi Retirement Home in Tampere.

The MULTI-TRAIN study began with an extensive round of interviews and the establishment of development teams at the participating work communities. Tailor-made training courses and other interventions were designed and implemented by the project researchers in collaboration with the development teams. The impact of the actions was evaluated and the necessary measures were planned together.

Of the work methods developed during the study, Koukkuniemi, for example, still uses the mentoring instructions created during the intervention, and substitute employees get a more thorough induction from the regular employees.

“Koukkuniemi is an example of a work community that really took the new methods to heart,” Keisala says.
The research results were published in a book: Pitkänen Pirkko, Keisala Katja, and Niiranen Vuokko (eds): Tavoitteena sujuva arki. Kulttuurien välinen työ sosiaali- ja terveydenhuollon työyhteisöissä (Aiming for smoother everyday work: Intercultural work in social and health care organisations). Tampere University Press 2017.

Social and health professionals in Finland

• At the end of 2014, 385,482 employees worked in social and health care, which is 17 per cent of the employed population.
• Some 4.6 per cent were of non-Finnish origin.
• In total, 8.6 per cent of doctors, 4 per cent of nurses and 3.8 per cent of practical nurses had non-Finnish backgrounds.
(Source: Statistical report 1/2018 of the National Institute for Health and Welfare)

Text: Tiina Lankinen
Photograph: Jonne Renvall