From leadership research to district action: Building sustainable talent pipelines: An ecosystem perspective on workforce integration and retention for internationally educated nurses

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

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.

Study methods

The aim of this study was to thematically review data gathered through focus groups relating to talent management practices for IENs in Irish hospitals. In order to uncover the subjective perceptions and experiences of IENs, qualitative methods were selected with face-to-face semi-structured focus groups as the data collection method [26]. We chose semi-structured focus groups because this format ensured we covered core topics with sufficient openness to let IENs interactively construct and share their experiences and meanings in a safe, exploratory setting, guided by the interpretive philosophical stance [26]. This approach allowed us to hear their lived experiences, e.g., how they made sense of the key topics discussed, rather than treating their views as fixed “responses” [27]. As reflexive TA researchers, we acknowledged that our professional backgrounds, values, and assumptions shaped every stage of this study, including question formulation, focus group facilitation, coding choices, and the writing process. None of us has personally migrated, but between us, we bring expertise in nursing research, qualitative methods, leadership, organisational behaviour, and talent management. Our expertise could predispose us to system-level or staff-level influences. Therefore, we recorded these assumptions in short reflexive memos, discussed them in peer debriefs, revisited the full transcripts to explore alternative interpretations, and documented any shifts in our understandings. Additionally, we had no employment or supervisory ties to participants or sites that were part of this research. Each of us had a different role within this project. NR was the lead researcher, co-conceptualised the study, and moderated all focus groups; EB co-conceptualised the project and helped establish its foundations; PM led the analytic process. All authors contributed to the iterative development of the themes and co-authored the write-up.

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Map one recurring source of staff workload with voluntary staff input. Agree one reversible schedule, support or task-allocation change and name its owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Compare workload hours, a consistent voluntary wellbeing measure, absence and retention intentions with the pre-pilot baseline. Report response rates and avoid causal claims from an uncontrolled comparison. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Nuala Ryan; Elaine Berkery; Patryk Makowski. Building sustainable talent pipelines: An ecosystem perspective on workforce integration and retention for internationally educated nurses. PLOS One (2026-08-20). https://doi.org/10.1371/journal.pone.0356179

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.