Impact of immigration-specific stress on safety attitudes: a national cross-sectional study on overseas qualified nurses in Japan.

Background: Many countries have addressed the global issue of nursing shortage by recruiting overseas nurses who are also qualified in the host country. Nevertheless, such nurses may encounter various obstacles in their personal and professional lives in the host country, leading to apprehensions about their perceptions of workplace safety in healthcare organisations.

Objective: This study investigated the current state of immigration-specific stress among overseas qualified nurses (OQNs) working in Japan and its impact on safety attitudes.

Settings: Invitation letters with a Quick Response (QR) code for a survey were sent to 119 hospitals across Japan that accepted OQNs as per the Ministry of Health, Labour and Welfare. Additionally, the survey QR code was shared with OQN-specific social media groups.

Participants: The inclusion criteria were being born and having received basic nursing education outside Japan, passing the Japanese national nursing examination, and current employment in the Japanese healthcare organisations. Valid responses were received from 214 OQNs.

Methods: Data were collected via an online survey, including the Demands of Immigration Scale and Safety Attitudes Questionnaire-Short Form (SAQ-SF) to measure stress and safety attitudes evaluation, respectively. Spearman's correlation analysis and a generalised linear model were used to analyse the relationship between immigration-specific stress and safety attitudes as perceived by OQNs.

Results: The findings showed that various safety attitude dimensions were significantly impacted by stressors such as 'Not at home', 'Occupation' and 'Discrimination'. Notably, 'Occupation' disadvantages perceived by OQNs significantly affected all the safety attitude dimensions, such as 'Teamwork climate' (B=-5.69, [-7.78, -3.60], p<0.001), 'Job satisfaction' (B=-9.38, [-12.32, -6.44], p<0.001) and 'Stress recognition' (B=5.86, [3.17, 8.54], p<0.001).

Conclusions: The findings underscore the significance of implementing effective strategies such as enhancing the sense of belonging, providing better career advancement prospects and opportunities and addressing workplace discrimination to improve safety attitudes among OQNs. These interventions are crucial for enhancing patient safety in Japan.