‘’The word Loneliness sounded to me like another cliché expressed or experienced by other people until I experienced it first-hand as a migrant nurse… far from home, from the people I have always known and Loved, from the way of life I have always known, now in a foreign land, trying to fit it, trying to give my best to a system and people who barely make the efforts to prove that I do count, to understand the ‘’me’’ as a ‘’person’’, to prove that I am welcomed in many ways …. the huge impact of this on my mental wellbeing and resultantly my mental health can hardly be expressed explicitly in one piece of document’’
- Personal reflections of an anonymous migrant nurse
The theme for this year’s mental health awareness week ‘’Loneliness and its effect on mental health is certainly welcomed by all. This construct undoubtedly affects diverse groups of individuals in many ways, in different shapes or forms. As a migrant professional myself living and working in the united kingdom, I feel I am rightly positioned to share my views on the different strand of Loneliness that uniquely affects individuals with similar backgrounds like myself, both from my personal experiences, and perspectives shared by others with same predicaments and a few from research and literature on this subject matter.
That said, although my views or the views shared in this write up may attempt to speak for most internationally recruited nurses, I additionally recognise that not all our experiences are the same and these views certainly may not represent us all, pardon me if you fall in the latter category my fellow migrant nurses. The intention is not to dismiss the beautiful experiences that some have, regardless of the circumstances we find ourselves in, the aim is to try to be a voice somehow to most who have been made voiceless, due to this very phenomenon, ‘’loneliness’’. I will attempt to create some awareness of the uniqueness of the loneliness that is experienced by ‘US’’ in a few summarised paragraphs below.
Loneliness has been conceptualised and defined in a variety of ways but is generally recognised as a complex and multidimensional emotional state related to, but distinct from, social isolation. It is linked with the quality (including meaningfulness) of social relationships and reflects a discrepancy between desired and actual social interactions. Loneliness may also link closely to feelings of boredom, unfulfillment, detachment, and lack of communication and connection to other people.
A widely used definition of the experience of loneliness stems from Perlman and Peplau (1984) and refers to loneliness as an individual’s perceived divergence between their desired and their actual social network. Notably, whereas social isolation refers to the objective description of a person’s social contacts, loneliness remains a highly subjective experience. One might feel lonely despite a large social network and a high quantity of social contacts, and vice versa, one might have only a few social contacts but not feel lonely (Cacioppo et al. 2015). These aspects of lived experience relate closely to another way of describing loneliness as ‘‘an enduring condition of emotional distress that arises when a person feels estranged from, misunderstood or rejected by others and/or lacks appropriate social partners for desired activities, particularly activities that provide a sense of social integration and opportunities for emotional intimacy”
Migration is a transition in life that entails changes in cultural, social, and emotional belonging. Establishing new roots and ties in the receiving country is one of the main tasks of immigrants in their process of socio-cultural and psychological adaptation. A failure to establish bonds with the receiving country can lead to social isolation and loneliness. Immigrants leave behind their familiar surroundings and must reorient themselves in a new context. In the new country, they are not only confronted with an unfamiliar physical environment but also with new cultural aspects, such as the values and practices of the host population,(Berry 2017).
The net migration rates reached their highest recorded levels in the United Kingdom in 2015, by 2021 almost 15% of NHS staff in England report a nationality other than British, this is the statistic on the nationality of NHS staff for doctors, nurses, and other groups. Migrants also contribute to the larger percentage of the ethnic diversity and minority of the UK population. The diversity of the UK population continues to grow in terms of the range of ethnic identities and the proportion of the population identifying as non-White British. While the collective terms ‘migrant’ and ‘minority ethnic’ conceal heterogeneity, there is important patterning of social isolation and loneliness by migration status and ethnicity.
While loneliness and social isolation are not bound to specific groups and ages, migration can be a risk factor as recent studies suggest. Overall, the causes of loneliness in migrants, internationally recruited nurses as such, can be attributed to a lack of opportunities to develop positive social ties, negative social interactions, not feeling valued or valuable professionally, dissatisfaction with existing social ties, and a lack of sense of cultural belongingness just to mention a few. In sum, social isolation and loneliness are complex and widespread problems, with migrant and minority ethnic people facing some particular risks.
Let’s take a look in general at the sense of belonging and perceived loneliness in the context of migration. This sense of belonging is a multifaceted concept, which is related to identification, connectedness, attachment, feeling at home, or the feeling of fitting in, (Halse 2018). The need to belong is universal and includes two criteria: the individuals’ need for (positive, not conflict-laden) social interactions and their need for an effective, reliable and caring bond with others. Belonging can refer to different entities, such as place, i.e. the feeling of being attached to geographic areas or symbolic spaces, and social entities, i.e. family or peers, social institutions (e.g. school), or transnational and global networks (Halse 2018). According to research, a combination of both geographical and social aspects of belonging is beneficial for immigrants, that is, adjustment to build up both geographic bonds (i.e. to the place where one lives) and close social ties that make them feel safe and comfortable in the receiving context.
A closer look at the sense of cultural belonging among immigrants reveals a rather interesting concept. Acculturative processes are key when it comes to the establishment of a sense of cultural belonging to a new living context. While acculturation refers to changes in cultural patterns regarding everyday practices, attitudes, and beliefs, the ways in which different cultural elements are negotiated within a person’s self-construal have been described by the concept of (multi)cultural identity. Various modern multidimensional models of acculturation claim that migrants establish new bonds to the receiving country while also retaining ties to the culture of origin, while a new sense of belonging is created, earlier experiences of belonging might leave a lasting imprint. This means that some form of belonging in the receiving country is important, yet the group to which migrants feel they belong is less important(i.e. either to members of the receiving culture or peers from the culture of origin). When the processes of psychological or socio-cultural adaptation are experienced as difficult to attain or not in line with one’s own cultural expectations, acculturative stress might occur. The concept of acculturative stress describes the difficulties of immigrants regarding their intercultural contacts in the receiving society and was coined by Berry (2006) as ‘a stress reaction to life events that are rooted in the experience of acculturation. Acculturative stress is thus linked to the feeling of not belonging, not fitting in, and is related to uncertainty, loneliness, anxiety, poor mental well-being, and high risk of depression in the context of migration (Berry 2006).
Further exclusionary processes and structures on the national level which are linked to migrant/minority ethnic identities present additional risks. Cumulative exposure to racial discrimination can increase social isolation and loneliness. Wider societal discourses and negative media portrayal can undermine a sense of belonging and self-worth. For new arrivals, limited English language skills, uncertain legal status, lack of familiarity with processes and few local co-ethnic ties can hamper the development of supportive social networks. Additionally, broader policy relating to housing and resettlement, immigration and entitlement to public services and welfare, will often impact differentially on social relationships by ethnicity.
At the employer level, both in private health intuitions and the NHS, racism, and discrimination still operate in various visible and more subtle ways to increase the risk of loneliness among migrant health professionals or nurses. Private sector employees have been noted for using exorbitant and unfair employment contracts to prevent migrant nurses from leaving their current toxic working environments if they so wish. There is usually a lack of initial support to help foreign recruits to be fully abreast with the system of delivery of care in their respective facilities. Various level of research continues to highlight the high level of inequalities and discrimination faced by employees from ethnic minority backgrounds. Most NHS intuitions in theory claim to be working hard towards an all-inclusive work culture, unfortunately, sometimes this feels like just acts of Tokenism. The diverse high leveled skills that migrant nurses arrive in this country with are either left unharnessed, or simply overlooked and not appreciated for many reasons, leaving ‘’US’’ feeling either unwanted or simply less valued professionally. Sadly, most of the time, we are made to feel we have very few choices, or actually, we truly do not have easy alternatives to consider most of the time.
Probably enough highlights of the problems for now, how can make the life of migrants be made more meaningful. At the national level, to ensure social connectedness within all policy areas, and embrace diversity and equality, the ‘’all migrants are welcome ethos’ should be backed with practical efforts, to create migrant and minority friendly local media. The healthcare sectors should actively work towards creating an all-inclusive work culture by ensuring strong leadership inequality issues and migrant-friendly policies, placing migrants/minorities in key roles deservingly. Workplace policies should aim to buffer hostile national policies, validate entitlements, show respect, be culturally responsive, recognise the need for connection, support positive connections and challenge racism/discrimination, ensure a diverse workforce, and create varied opportunities to show competence. There should be encouragement for positive bonding ties through support for shared identity groups, validation of membership, and engendering respect for these groups for their role in the provision of safe spaces to support positive connections. Workplace wellbeing support should be individualised, person cantered, and culturally sensitive, with individually targeted approaches such as enhancing social skills, addressing maladaptive social cognitions, and enhancing coping techniques and problem-solving skills.
We as internationally recruited nurses also have our own role to play in this, I guess. My personal journey has been with great difficulty, not as smooth plain as I imagined but most importantly there have been great lessons learned. I share in the shock we get from all the changes we need to battle with when we arrive here, the feeling of suddenly being taken out of our comfort zone and protective nest, and probably someday, I may write a story about ‘’what I wish I knew before I embarked on my migration journey’’, it is such a long list and this story will be better saved for another day. As hard as it may be, we need to have our resilient, curious, and adaptive caps on all the time. I will say to you, don’t forget to join the trade unions- they are great support, please join the international nurses’ groups-lots of them for our specific countries of origin. Do get in touch with colleagues that have arrived in the country ahead of you, they are experienced resources. It is hard to deal with the toxic workplace culture sometimes, but please don’t let things slide, follow your institution's reporting and escalations procedure if you feel you have been treated unfairly. Speak up when well-being support is not tailored for your needs, don’t be afraid. Don’t be afraid of losing yourself in the process of adaptation, let's accept the change as part of our lives’ journeys and make the most of it.
In conclusion, kudos to all of ‘’US’’ for contributing our best to the health care system in the United Kingdom, please let's applaud ourselves and never lose sight of the fact that we bring a lot to the table, whether appreciated or not. Let’s not forget that we are the boldest and most courageous professionals, willing to take a step away from our comfort zones, in the quest for something more, whatever the motives may be. Lastly, let's reach out for help when we are feeling lonely, or experiencing a negative turn in our well-being and mental health. Let’s not suffer in silence.
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