Building sustainable talent pipelines: An ecosystem perspective on workforce integration and retention for internationally educated nurses

Nuala Ryan, Elaine Berkery and Patryk Makowski

PLOS ONE, 2026, vol. 21, issue 8, 1-22

Abstract: Background: With the domestic supply of nurses failing to meet healthcare demands, sourcing nurses globally has become a key strategy in healthcare. Taking an Ecosystem approach, our study is designed to advance and deepen our understanding of how recipient country systems at the macro, exo, meso and microsystems layers can affect talent management practices for internationally educated nurses (IENs). Objective: The objective of this study is to answer the following research question: How do the different layers of a host country’s ecosystem impact the talent management practices for internationally educated nurses?. Methods: Using face-to-face semi-structured focus groups, data were collected from 21 IENs in Ireland. The results were managed and organised using the NVivo™ version 14 software, while Braun and Clarke’s reflexive thematic analysis approach was used to analyse the qualitative data based on their six-phase framework. Results: The experiences of IENs moving to Ireland suggest that at the macrosystem, national policy and structures around housing, early childhood education and visa deployment are adversely affecting their ability to work and stay. At the exosystem layer, they highlight clear recruitment ‘reality gaps’ and role mismatch on their arrival, as well as systems and language uncertainty. Finally, IENs describe how issues with organisational leadership and meso and microsystems can create a difficult day-to-day work environment. Conclusion: Through the ecosystem approach, we consider the broader macro and exosystems, as well as the more commonly researched micro and mesosystems, and their impact on talent management for IENs. The research findings show how national environments provide the context in which the exo, meso and microsystems operate and suggest the important need for policymakers as well as healthcare organisations to understand and adopt a holistic, multisystem view of how IENs are managed from a talent perspective.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0356179

DOI: 10.1371/journal.pone.0356179

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