Structured Onboarding of International Nurses in an Italian Healthcare Organization: An Exploratory Multi-Stakeholder Pilot and Feasibility Observational Study

Background/Objectives: International nurse recruitment is increasingly important, but early integration depends on language, professional adaptation, organizational welcome, and retention support. Evidence from non-English-speaking healthcare systems and multi-stakeholder implementation evaluations remains limited. This study aimed to evaluate a structured onboarding pathway as an exploratory, response-level pilot and a feasibility platform. Methods: Anonymous five-point Likert questionnaires were administered to clinical coaches, ward teams, and newly hired international nurses at conceptual time points T0, T1, and T2. T0 was partly retrospective because the first survey wave, administered at approximately 3 months, asked respondents to rate both arrival status and current status. Analyses were response-level; T0–T1 ratings were summarized with a paired within-row sensitivity analysis when both ratings were available, whereas T2 could not be linked to the earlier wave. Results: The primary dataset contained 410 anonymous response-level observations, mostly from ward-team proxy ratings. Median language proficiency ratings were 3 (IQR 2–3) at T0, 3 (IQR 3–4) at T1, and 3 (IQR 3–4) at T2; the proportion of ratings at or above the pragmatic adequacy threshold (≥3) rose from 53.5% to 76.4% and 91.0%, respectively. For professional training/competence, median ratings were 3 (IQR 2–4), 3 (IQR 3–4), and 3 (IQR 3–4), with corresponding adequacy-threshold proportions of 53.5%, 78.0%, and 89.7%. However, stakeholder-specific patterns differed, and international nurses’ self-rated language proficiency followed a non-monotonic pattern. In the nurse-specific analytic subset (14 anonymous response rows), overall welcome was associated with intention to stay (Spearman rho = 0.73, FDR-adjusted p = 0.016) and willingness to recommend the experience (rho = 0.86, FDR-adjusted p = 0.002). Conclusions: The pilot generated hypotheses and, more importantly, mapped feasibility requirements for a future confirmatory study. Although the findings should not be interpreted causally or as paired longitudinal evidence, they provide an initial overview of issues related to the integration of international nurses in non-English-speaking healthcare settings. A future study should prospectively collect pseudonymized identifiers, objective and validated measures, and a pre-specified longitudinal analytic model.