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collaboration, cultural competency, cultural differences, Ebola, expatriate nursing, humanitarian aid workers, Liberia



  1. Wilson, Deborah MPH, MSN, RN
  2. Jallah, Darlington S. MPH, RN


Purpose: This qualitative study was conducted to explore the perceptions and concerns of Liberian RNs who work for international nongovernmental organizations (NGOs) in Liberia, and to elicit insights and suggestions about how to improve collaboration between national and expatriate nursing staff.


Methods: Five focus groups involving 19 nurses and an individual interview with one nurse were conducted. A semistructured interview guide was used to gather perspectives and garner suggestions. A phenomenological approach was used to identify emergent themes.


Results: Regarding positive experiences, participants from all 10 NGOs reported that working with expats gave them opportunities to be mentored, learn new skills, and try out new techniques and equipment. Negative experiences included problems with disrespect and expats' lack of cultural competency. Participants spoke of adverse patient outcomes that resulted when expats made assumptions and wouldn't listen to national staff.


Conclusions: The findings indicate that changes are warranted in the current work culture between national and expatriate nursing staff. Improving collaboration between national and expatriate RNs could lead to higher-quality care and better patient outcomes. Predeployment training for expatriates that incorporates the voices of national staff is recommended; this would raise awareness of the realities of nursing in low-resource settings and promote respect for national staff.