First generation immigrant and native nurses enacting good care in a nursing home

Background: Several studies have investigated the experiences of first-generation immigrant nurses in new workplaces. Yet, little is known about how native nurses and newcomers collaborate in their care for aging residents in European nursing homes. Objective: To gain a deeper understanding of interactions between first-generation immigrant nurses and native nurses in their care for aging residents in a Dutch nursing home. Methods: Ethnography, including 105 h of shadowing immigrant and native nurses, 8 semi-structured interviews with 4 immigrant and 4 established nurses, and 2 focus group discussions with 8 immigrant and 6 established nurses in a Dutch nursing home. Data were analyzed by a post-positivist grounded theory coding approach. Ethical consideration: The Medical Ethical Review Committee of the Leiden University Medical Center approved this study. Results: The interactions between established staff and newcomers were influenced by norms, rules and regulations, policies and protocols. In daily practice and institutional structure, we observed both opportunities and challenges. The strict time schedules and the requisite standards of care were opportunities related to nurses' expectations. Residents' needs were sometimes challenging and inhibited newcomers' active participation. However, sometimes new practices were developed where nurses created common ground, tinkered, and formed an inclusive playing field to enact good care. Conclusion/ discussion: This study shows that despite obstacles, there was room to make small changes in the rules of the game of nursing. These moments of tinkering may be sufficient to establish a stable, inclusive workforce for first-generation immigrants and give room to the evolvement of hybrid professional identities. Implications: The findings of this Dutch study are relevant for nursing ethics related to "good care" and nurses in other cultural contexts on how the integration of immigrant nurses in European countries in general could be facilitated.Public Health and primary careGeriatrics in primary car