Rethinking Onboarding for Internationally Educated Nurses: Centering Belonging in Orientation Practices

Abstract

This commentary examines six recent publications on the onboarding and transition experiences of internationally educated nurses (IENs) and foreign-educated nurses (FENs) into Western healthcare systems. Across these works, consistent barriers emerge, including language and communication mismatch, cultural disorientation, discrimination, scope-of-practice differences, and inconsistent organizational support. Despite two decades of largely convergent findings, the field remains mostly descriptive, with no experimental studies evaluating the effectiveness of onboarding strategies such as mentorship, tailored orientation, or peer support programs. This commentary argues that the persistence of "one-way integration logic," where adaptation is seen as the sole responsibility of the IEN, has limited progress toward more equitable, organization-level solutions. Drawing on the concept of "two-way" workplace integration, this piece calls for reframing onboarding as a shared organizational responsibility rather than an individual adjustment process. A tiered, time-staged onboarding framework is proposed. It spans pre-arrival orientation, an extended clinical bridge period, and a longitudinal career-integration phase, paired with standardized outcome metrics. This approach aims to move the field beyond perception-based recommendations toward evaluable, evidence-based interventions that can improve retention, job satisfaction, and workplace equity for IENs.