Empowering Nursing Newcomers Program (EMPOWER)

Empowering Nursing Newcomers

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.

Study Overview

• Status: Recruiting
• Conditions: Refugees; Nursing; Education, Professional; Cultural Diversity; Migrants

Detailed Description

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.

• Study Type: Observational
• Enrollment (Estimated): 227

Contacts and Locations

• Study Contact: Name: Arthur Wijsmuller, MD PhD; Phone Number: +31625646662; Email: a.r.wijsmuller@umcg.nl
• Study Contact Backup: Name: Petra Veltman; Phone Number: +31629442932; Email: p.m.v.veltman@umcg.nl

Study Locations

• Netherlands
  • Provincie Groningen
    • Groningen, Provincie Groningen, Netherlands, 9713 GZ
      • Recruiting
      • University Medical Center Groningen
      • Contact: Arthur Wijsmuller, MD PhD; Phone Number: +31625646662; Email: a.r.wijsmuller@umcg.nl
      • Contact: Petra Veltman; Phone Number: +31629442932; Email: p.m.v.veltman@umcg.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

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.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Nursing newcomers; Fasttrack integration trajectory

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion participants progressing as planned or successfully completing the program	The proportion of participants who either progressed as planned, successfully completed the program by obtaining a (conditional) certificate of professional competence, or transitioned to employment as care assistants	From enrolment through programme completion (up to 36 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Societal business case	Societal business case: Conducted by Social Finance NL (SFNL), this analysis quantifies the programme's societal impact by mapping participant trajectories and expressing effects in financial terms where possible. Outcomes are calculated over a four-year period: two years during programme participation and two years following exit. Effects not attributable to the programme are accounted for using a zero alternative scenario, with assumptions on attribution, indexation, and discount rates applied.	Approximately 2-3, 6 and 9 years after study start.
Qualitative analysis	A qualitative analysis to assess the impact of the programme on participants and departments. The UMCG project coordinator invites participants to complete an anonymous survey developed jointly by Regioplan and UMCG (Appendix). The survey contains 46 multiple-choice questions and 35 open-ended questions assessing participant experiences, satisfaction, and perceived programme effectiveness.	Approximately 2-3, 6 and 9 years after study start.
The influence of WEF-identified skills on the need for additional guidance	Competencies of participants are assessed using a survey optimized during the early stages of the study. The survey evaluates participants across multiple domains identified by the World Economic Forum (WEF) as the most in-demand skills by organizations: cognitive skills, self-efficacy, collaboration, ethics, physical skills, management skills, and technological skills. The outcome measure assesses the relationship between participants' competency levels and the need for additional guidance or support during the programme. An ordinal, Likert-type scale with three response options will be used. The scale ranges from 1 to 3, with clearly defined response categories. Data are collected systematically at predefined intervals through the REDCap system to ensure comprehensive coverage of all competency domains.	Approximately 5, 7 and 9 years after study start.
Racial microaggressions in the workplace assessed using the modified Racial Microaggressions Scale (RMAS)	This outcome measures the occurrence of potential unconscious and conscious racial microaggressions in the workplace and identifies opportunities to address and mitigate unconscious forms. Participants complete a modified Racial Microaggressions Scale, originally developed by Torres-Harding et al. and modified by King et al. The RMAS includes six subscales: invisibility, criminality, dysfunctional culture, sexualization, foreigner/not belonging, and environmental microaggressions. This instrument is widely used and validated for assessing microaggressions in workplace settings.	Approximately 5-6 years and 9 years after study start.

Collaborators and Investigators

• Sponsor: University Medical Center Groningen

Publications and helpful links

Helpful Links

• This link provides access to an online registration form for the Newcomers in Nursing program. The form allows newcomers living in the Netherlands who have a nursing background obtained abroad to express their interest in participating in the program.

Study record dates

Study Major Dates

• Study Start (Actual): March 4, 2022
• Primary Completion (Estimated): April 15, 2026
• Study Completion (Estimated): March 1, 2031

Study Registration Dates

• First Submitted: March 9, 2026
• First Submitted That Met QC Criteria: March 24, 2026
• First Posted (Actual): March 30, 2026

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Nursing; Refugees; Education, Professional; Cultural Diversity; Social Integration; Credentialing; Transients and Migrants
• Other Study ID Numbers: 22944

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No