In the Netherlands, more and more nurses with an international background, such as refugees and migrants, are starting to work in healthcare. Many of them already have a lot of knowledge and experience, but it is not always easy to quickly adapt to the Dutch healthcare system and a new language. That is why the programme "Empowering Newcomers Nurses" was developed.

This study aims to better understand how the programme works in practice. Participants and supervisors will be asked about their experiences to identify what works well and what could be improved. The costs and the benefits are also taken into account. The results will be used to further improve the programme.

It will also be assessed whether the work environment is inclusive and welcoming for participants. For example, this may involve (unconscious) microaggressions, exclusion, or negative comments, including those that may be discriminatory or racist. By making these experiences visible, it becomes easier to address them and make improvements. In addition, scientific articles will be published so that other hospitals can also learn from these insights.

Who can participate? Nursing newcomers who are already participating in the programme or who will start the programme soon are invited to take part in the study. Sometimes participants with another paramedical background also take part. For this study, it is expected that over a period of 9 years about 160-230 participants will take part in total, of whom 120-150 will be from the northern region of the Netherlands. This number is not strictly required, but it helps to better understand how the programme works, what works well, and where improvements may be possible. In this way, a more complete picture of the programme can be obtained.

The increasing shortage of nurses in the Netherlands significantly impacts healthcare capacity. Currently, half of all job vacancies in the Netherlands are in healthcare, trade, and business services. Reports indicate that nursing faces the largest labor market shortages among the healthcare professions, with 10,500 vacancies in 2021 and an expected 24,900 by 2031. Enhancing personnel inflow is one of the solutions. In that regard, the Dutch system does not appear to be well-equipped to support the integration of refugees and migrants certified as nurses in their country of origin, into healthcare positions. Recognition of qualifications is characterized by long delays and there is a lack of guidance. In practice, it also takes a considerable amount of time to reach a sufficient level of language proficiency, especially if individuals are unable to work and have limited exposure to the Dutch language. This slows down the speed at which the tests for obtaining a declaration of professional competence, required for Dutch healthcare licensure, are completed. Consequently, many qualified newcomers in healthcare are either underemployed or unemployed. In 2022, the UMCG assessed the interest among nursing newcomer in the Northern region to participate in a fast-track integration programme (Appendix 1). As sufficient interest was confirmed, such a programme was developed that includes a vocational language and intercultural communication course, after which participants begin working as assistant nurses, salaried as care assistants, while receiving guidance toward BIG registration before taking the examinations required for BIG registration. In this process, data were prospectively collected on whether the participating newcomers successfully completed the different phases of the program, the duration of these phases, and the stage of integration and employment situation from which they entered, and consent was obtained from participants to store these data. The programme was initially developed at the UMCG and grew into a multicentre initiative. In collaboration with Healthcare of the North ('Zorg voor het Noorden', ZvhN), a regional network across the three northern provinces, it has expanded to four non-academic hospitals. As this improvement process, which was not initially conceived as a research project, appeared to be successful, it was subsequently decided to analyze the outcomes in a scientific manner. The primary objective is to determine the proportion of participants who are either progressing as planned or successfully completed the program. In addition, a qualitative analysis and a societal business case is conducted to identify where the benefits lie, thereby providing guidance for sustainable implementation once philanthropic funding is phased out. Additionally, the study aims to analyze potential racial microaggression in the workplace.

Inclusion Criteria:

• refugee or migrant with a nursing background or other paramedical background and sufficient indications that the relevant hospital department is prepared to cooperate in a fast-track integration trajectory
• holding at least a diploma equivalent to the Dutch MBO-4 level
• having practical experience, preferably in a hospital setting
• residence in one of the three northern provinces
• sufficient learning capacity to participate in a language course at the University of Groningen's Language Centre based on the intake and, if available, a study skills test
• a successful application interview

Exclusion Criteria:

• diploma lower than Dutch MBO-4 level
• refugee or migrant with a background as medical doctor

The study population consists of newcomers to the Netherlands with a nursing background including refugees with residence status and other migrants. Participants have obtained a nursing qualification outside the Netherlands and enroll in a program designed to support their integration into the Dutch healthcare system.