GLOBAL RESOURCE SHARING is essential to the growth and development of nations around the world. In nursing, it includes the sharing of intellectual property, scientific and technological developments, and clinical practice models. International networking ensures global resource sharing to advance clinical nursing practice, graduate and undergraduate education, and research.
Epidemics, pandemics, and other major health issues affect the wellbeing of societies and healthcare professionals internationally. As such, global resource sharing and international networking are important to nurses at all levels.
Despite the importance of these practices, little guidance is available on strategies for networking across countries and cultures. Behavioral and communication nuances exist in all nations and cultures and may be difficult to navigate, even for those with experience, so international networking guidelines to inform nurses about important aspects of social interactions across nations are necessary. Cultural intelligence and ethical principles should underpin any cross-cultural interactions, but the establishment of formal guidelines may be beneficial for nursing professionals with limited international networking experience.
This article discusses the formation of basic guidelines for international networking among nurses. Based on the authors' collective professional experience and a review of the existing literature, it outlines the benefits of and strategies for international networking. It also highlights social and behavioral considerations that may facilitate social networking and presents guidelines for further discourse.
Benefits of networking
The benefits of an international network of collaborators have been identified in the literature. One major benefit of these networks is the strengthening of academic and clinical connections. For nurses, this leads to new relationships within the field and helps them maintain and strengthen existing relationships with their colleagues. These relationships foster the possibility of ongoing collaboration over a long period of time.1
Another benefit of an international network is the fresh perspectives offered on clinical, educational, and research scenarios. This exposure to different ideas and strategies creates opportunities for cross-learning encounters that offer alternative experiences and lessons.2 Revelations from cross-learning encounters may highlight unexplored paths that nurses from one country can borrow from those of another, and international networks can expand perspectives based on the experiences and recommendations of those involved.3 Similarly, these groups offer an opportunity to unify intellectual and material resources to identify and solve problems relevant to the network.4
Many healthcare professionals, including nurses, face complex issues surrounding patient care in institutions and community settings. The solutions to these issues may also be complex. International networks give colleagues with complementary skills an opportunity to create productive associations, share resources, and develop missions to tackle common international issues using different perspectives and experiences.5,6 For example, the COVID-19 pandemic offers a contemporary opportunity for international collaborative networking to disseminate knowledge.
Two of the authors are involved in an international collaboration in which they worked with nursing students from Costa Rica using an online platform to deliver live, interactive medical education information sessions (MEISs) to a service workers association in upstate New York, which then offered the MEISs to its members as a healthcare benefit. Similarly, two other authors are involved in an international collaboration that includes Ireland and the US that has focused on mental health among nurses during the COVID-19 pandemic.
International networking also fosters the development of new knowledge. The interconnection of academic and clinical contacts between different countries likely increases the knowledge capacity of those involved through exposure to ideas from others.7,8 This helps disseminate information and integrate it into real-world practice.9 For example, several of the authors have participated in international projects that focused on global nursing and healthcare issues requiring local, national, and international review board approval and documentation of human subjects assurances and protections. These projects include topics such as incivility in healthcare and the curriculum needed to address maternal health issues in Latin America.10
Additionally, international collaboration among nurses may include meeting potential partners, accessing job opportunities, sharing common clinical and academic work, and improving understanding of the domestic and international regulations that govern clinical practices and procedures, as well as increased education, research, and scholarship opportunities.7,10-13
Networking methods
Many methods are available for international networking, both virtually and in person. One common practice involves use of social media platforms. Professional nursing organizations and schools of nursing have taken to social media to contact or maintain communication with potential, current, and past students.14 These popular public platforms are used to share biographical information about an individual or group. They also facilitate international discussion on current events, healthcare issues, public policies, ethical concerns, and employment opportunities. Additionally, they highlight existing relationships between individuals and groups around the globe. For direct, virtual, real-time interactions, several applications feature video conferencing, teleconferencing, and text messaging capabilities. These allow users to host conferences or meetings in real time with groups of various sizes from all around the world. Many also allow for screen- and document-sharing.
In-person networking includes trade shows, exchange programs, conferences, roundtable discussions, and job fairs. International conferences offer a great way for individuals and groups to meet industry peers, expand their knowledge, solve problems, present ideas, propose collaborations, and acquire knowledge beyond their specific field.15 Conferences held over several days may also involve several events, such as networking dinners, to allow participants to socialize informally. These provide opportunities to share experiences and exchange information for future networking.
Professional conferences offer attendees access to groundbreaking, evidence-based practice in a collaborative and social setting, but time and funding are the primary barriers for healthcare professionals looking to attend these in-person events.16 Similarly, question-and-answer forums may include multiple disciplines to assist in the exchange of ideas and experiences.17 These forums can facilitate brainstorming between professionals at all levels. Web-based conferences may offer a more economic solution, but they also have limitations. For example, the asynchronous mode of social and professional engagement can create a disconnect among those in attendance.
In a 2019 study, Hu and colleagues noted that the availability of internal and external grants had made it possible for the researchers involved with a global anesthesia project to travel to events and related conferences.11 The present authors' Brockport International Peru trips and work with Sacred Valley Health offer current examples of mutually beneficial collaboration and resource-sharing. For these trips, the authors developed a homestay program that allowed for culturally meaningful exchanges of language, food, and customs between the students and their Peruvian hosts and ultimately reduced the cost of travel. They also collaborated with the University of Buffalo to bring NP students and a faculty member to assist with physicals. Similarly, the authors collaborated with Niagara County Community College to bring undergraduate students majoring in Spanish and a faculty member to assist in communication during these trips. Peruvian teachers also educated the other trip participants in Spanish in a culturally appropriate context that allowed them to interact using the language in real-life situations for ease of learning.
Professional organizations also allow for international networking. These associations facilitate innovation, collaboration, and communication within a particular profession such as nursing. Many offer forums to disseminate knowledge and opportunities for professional development.18 Although membership often requires an annual fee, the benefits of the opportunities offered may outweigh the costs.
Barriers to networking
International networking remains a goal of healthcare professionals from all backgrounds, but many barriers exist. Policies, regulations, and scope-of-practice rules differ between states, provinces, territories, and countries. Similarly, limited international guidelines and standards for practice represent a significant barrier to global practice and programs. Professional titles and credentials, and how they are determined, can be misleading for novice nurses looking to meet international contacts. The development of an international directory to outline how nursing credentials and positions are formulated would be beneficial.
Cultural differences in language can hinder international networking. For example, emails and messages may require additional attention to norms such as the degree of formality and culturally sensitive etiquette. Similarly, live networking can be hampered by unfamiliar accents and words. For example, common terms in healthcare settings such as the "operating room" may be called the "operating theater" or "theater" in international settings. Clarification is key in maintaining effective communication.
International time differences for synchronous virtual collaboration can be another challenge. Scheduled meetings may be difficult for partners in different time zones to prioritize around their other daily routines and responsibilities. One strategy to equalize the scheduling inconveniences associated with different time zones is to shift meeting times so the same individuals are not inconvenienced repeatedly.
Other barriers for international networking and collaborative correspondence include seasonal differences, holidays or other protected dates, availability and out-of-office notifications, and changes to contact information. Virtual and in-person networking activities must be scheduled carefully to allow for maximum participation. Team member dedication, motivation, and flexibility are vital to the stability, longevity, and success of international networking.
In this article, the authors have proposed guidelines to facilitate international networking among nurses. The first seven can be considered entry-level (see Entry-level recommendations); the next five can be considered intermediate (see Intermediate-level recommendations); and the remaining guidelines can be considered advanced guidelines for nurses (see Advanced-level recommendations). The following discussion elaborates on key points in these proposed guidelines.
Social and professional presence
Many healthcare professionals use social media to stay current on nursing issues, education, and professional forums.14 Nursing organizations and healthcare institutions have developed professional codes of conduct to which nurses must adhere when communicating on social media. Issues related to patient privacy and institutional reputations are of great concern. These codes of conduct are essential to monitoring and managing these issues.14
Differences in posting and sharing practices between various healthcare professions and disciplines may result in professional exclusivity, factions, or gaps in interprofessional interactions and the dissemination of information.19 Network centrality using accessible multifunctional network platforms such as video conferencing software is important in assisting in the interprofessional transfer of knowledge.19 Additionally, question-and-answer forums within multiple disciplines can facilitate the exchange of ideas and experiences.17
Confronting the "isms"
Social attitudes and beliefs based on biases and oppression exist around the world. The "isms" describe ableism, ageism, classism, ethnocentrism, monolingualism, racism, and sexism. These are all examples of social attitudes, beliefs, practices, or attributes that can interfere with international networking relationships and activities. Yielding to widely known and accepted definitions, the authors do not aim to redefine or expand upon them (see "Isms" defined).
Bias and negative attitudes can be revealed during social networking encounters by way of words, actions, inactions, or other behaviors. For example, sexism can threaten international networking efforts in countries where most nursing professionals are women. Ageism can also negatively impact networking, which is concerning because a large percentage of the international population is aging and the scope of prejudice is expected to increase.20,21 Additionally, ableism can threaten international networking efforts for individuals with disabilities such as nurses who are deaf or hard of hearing and primarily use sign languages or assistive communication devices or technologies.22
The aforementioned "isms" represent just some of the social attitudes, beliefs, practices, or attributes that may threaten the creation, sustainability, and progress of international networking. While the authors' discussion is only a superficial acknowledgment of their presence and power, nursing professionals must remain mindful of the "isms" and the ways they operate in isolation or in combination to jeopardize international relationships and networking activities. International collaboration and discussion to provide more breadth, depth, and detail on this topic is warranted.
Through both formal and informal study, nurses must educate themselves about the cultures, languages, challenges, and practices of countries other than their own. Similarly, those who plan, lead, or coordinate international networking activities must incorporate education related to these topics.
Networking considerations
The use of proper titles and salutations is crucial to international networking. For example, in some settings professionals may be addressed by their highest educational achievement or credential, such as "Dr. Smith." In other areas, it may be customary to refer to their academic achievements instead, such as "Professor Smith." When in doubt, ask the individual how he or she wishes to be addressed to prevent misunderstandings.
Best practices for virtual networking should include as many collaboration methods as possible or necessary to reach all team members. Video conferencing using platforms with captioning; transcript generation; and interpreter, speaker, and nonspeaker highlighting are ideal. Platforms that offer shared electronic work spaces or documents are also essential. All participants should be included in conversations, especially those who are not visible via video.23 Participants must be flexible about changing methods and mindful of those joining virtual meetings using a phone or the meeting platform's chat-only function.
Making connections
International networking is not only rewarding, but it is also essential to the growth, development, and advancement of the nursing profession. It broadens the scope of practice, education, and research and provides nurses an opportunity to connect with colleagues around the world and get involved with important collaborative work. The authors' guidelines are based on the existing literature, as well as many years of accumulated experience, and aim to inspire nurses to engage in successful international networking while avoiding missteps along the way. The authors hope this will stimulate continued work toward establishing formal international networking guidelines for nurses.
Ableism: when actual or potential network partners consciously or unconsciously fail to include or engage individuals with actual or perceived disabilities in their actual or potential networks or activities.
Ageism: when the language or behaviors of actual or potential network partners reveal a negative bias toward individuals based solely on their age; for example, by oversimplifying information and making it childlike or by avoiding and marginalizing older individuals.
Classism: when the language or behaviors of actual or potential network partners stress greater or lesser value on the contributions or representations of others based on actual or perceived social or economic status within the global hierarchy of social and/or economic systems.
Ethnocentrism: when the language or behaviors of actual or potential network partners express superiority of their nation or national resources, policies, or practices over others within their actual or potential networks.
Monolingualism: when actual or potential network partners lack the ability to communicate proficiently with other actual or potential network partners in more than one language.
Racism: when actual or potential network partners consciously or unconsciously fail to include people, or nations with populations of people, with certain skin tones, hair textures, or other social, biological, or genetic markers in their actual or potential networks.
Sexism: when the language or behaviors of actual or potential network partners assert a desire, lack of desire, respect, or lack of respect for relationships or activities with other actual or potential network partners solely on the basis of sex assigned at birth and/or perceived gender of one individual by another.
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