No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Why do nurses migrate? A review of recent literature
Journal of Nursing Management
Abstract
Aim To identify the reasons why nurses continue migrating across international borders.
Background International nurse recruitment and migration have been increasing in the last decade and recent trends show an increase in the movement of nurses between developing and developed countries, resulting in a worldwide shortage of nurses.
Methods A manual and electronic database literature search was conducted from January 2004 to May 2010. Qualitative content analysis was completed for the final 17 articles that satisfied the inclusion criteria.
Results Motivators to nurse migration were linked to financial, professional, political, social and personal factors. Although economic factors were the most commonly reported, they were not the only reason for migration. This was especially evident among nurses migrating between developed countries.
Conclusion Nurses migrate for a wide variety of reasons as they respond to push and pull factors.
Implications for nursing management It is important for nurse managers in the source countries to advocate incentives to retain nurses. In the recipient countries the number of international nurses continues to increase implying the need for more innovative ways to mentor and orientate these nurses.
... Factors associated with German nurses leaving the nursing workforce are mainly associated with workforce burnout, which is due to poor work environment including high workload, low recognition, poor teamwork, and staff shortages. This in turn is related to poor quality and safety in patient care [18,19]. Additionally, poor leadership, limited growth opportunities, restricted autonomy as well as burnout contribute to the intention to leave the nursing profession [20]. ...
... Migrant nurses typically move from rural to urban areas and from developing to industrialized nations [25]. As a high-income nation that is politically stable and has a strong economy, Germany can offer a range of incentives such as high quality of life and personal safety as well as opportunities for professional development and further qualification that are very attractive for migrant health workers [19]. Nurses who migrate to Germany are mainly from Austria, Eastern Europe, Southern Europe, and African countries [18]. ...
... To guide data-analysis, a tentative conceptual model based on the literature described in the background section and on factors related to the intention to leave the nursing profession was developed ( Fig. 1) [8,[18][19][20][21][22]. The conceptual framework was use as a heuristic tool rather than a theory that provided strong hypothesis. ...
Background
The shortage of qualified nurses is a problem of growing concern in many countries. Recruitment of internationally trained nurses has been used to address this shortage, but successful integration in the workplace is complex and resource intensive. For effective recruitment and retention, it is important to identify why nurses migrate and if their expectations are met to ensure their successful integration and promote a satisfying work climate for the entire nursing team. The aim of this study was to examine the perceptions of safety culture, work-life-balance, burnout and job demand of internationally trained nurses and associated host nurses in German hospitals.
Methods
A multicentric, cross-sectional study was conducted with internationally trained nurses ( n = 64) and host nurses ( n = 103) employed at two university hospitals in the state of Baden-Wuerttemberg, Germany. An anonymous paper-based survey was conducted between August 2019 and April 2020. The questionnaire included sociodemographic questions, questions regarding factors related to migration, and the German version of the Assessment of your work setting Safety, Communication, Operational Reliability, and Engagement (SCORE) questionnaire. SCORE is divided into three sections: Safety Culture Domains ( six subscales ), Work-Life-Balance ( one subscale ), and Engagement Assessment Tool ( four subscales ).
Results
Nurses who migrated to Germany were primarily seeking better working conditions, a higher standard of living, and professional development opportunities. Internationally trained nurses reported lower work-related burnout climate (Mean 55.4 (SD 22.5)) than host nurses (Mean 66.4 (SD 23.5)) but still at a moderately high degree (Safety Culture Domains). Host nurses indicated a higher workload (Mean 4.06 (SD 0.65)) ( Engagement Assessment Tool ) and a lower Work-Life-Balance (Mean 2.31 (SD 0.66)) (Work-Life-Balance) compared to nurses who trained abroad (Mean 3.67 (SD 0.81) and Mean 2.02 (SD 0.86), respectively). No differences were detected for the other subscales. The Safety Culture Domains and Engagement Assessment Tool showed room for improvement in both groups.
Conclusion
The study suggest that the expectations migrant nurses had prior to migration may not be met and that in turn could have a negative impact on the integration process and their retention. With increasing recruitment of internationally trained nurses from within Europe but also overseas, it is crucial to identify factors that retain migrant nurses and assist integration.
Trial registration
The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register ( DRKS00017465 ).
... According to Buchan, ‗shortage' does not only refer to a shortage in the number of nurses who are qualified but also to a shortage in the number of nurses willing to work as nurses in the existing circumstances (Buchan, 2006;Buchan, 2000). Consequently, the lack of proper work opportunities or working conditions pushes many nurses to drop out of the nursing labor market, seek job in another sector of employment or even emigrate and seek a job outside their home country (Aiken et al., 2004;Aiken et al., 2001;Dywili et al., 2013). The latter category is particularly important since emigrant nurses are relatively difficult to lure back into the nursing labor market in their home country. ...
... Literature has referred to numerous push factors that have contributed to job dissatisfaction among nurses and consequently led to the nursing shortages and emigration (Child and Mentes, 2010;Dywili et al., 2013;Marć et al., 2019;Roche et al., 2010;Sasso et al., 2019). These factors include: unattractive salaries, gender-based discrimination, undervaluation of the nursing profession, understaffing, performing non-nursing tasks, poor patient safety practices, emotional exhaustion, and the persistence of violence against health workers and more so against nurses (Child and Mentes, 2010;Dywili et al., 2013;Marć et al., 2019;Roche et al., 2010;Sasso et al., 2019). ...
... Literature has referred to numerous push factors that have contributed to job dissatisfaction among nurses and consequently led to the nursing shortages and emigration (Child and Mentes, 2010;Dywili et al., 2013;Marć et al., 2019;Roche et al., 2010;Sasso et al., 2019). These factors include: unattractive salaries, gender-based discrimination, undervaluation of the nursing profession, understaffing, performing non-nursing tasks, poor patient safety practices, emotional exhaustion, and the persistence of violence against health workers and more so against nurses (Child and Mentes, 2010;Dywili et al., 2013;Marć et al., 2019;Roche et al., 2010;Sasso et al., 2019). On the other hand, research has cited various pull factors contributing to nurses leaving the profession or seeking a job outside their country. ...
Background:
The nursing workforce is critical for the provision of quality health-care and positive patient outcomes. There is a global trend of migration of nurses from under-developed to developed countries due to attractive job offers in the host countries. Lebanon presents such a case where nurses are migrating abroad, leading to shortages in the nursing workforce in their home country.
Objectives:
The aim of this study was to investigate reasons for the migration of Lebanese nurses, and incentives that would attract them back to their home country in order to enhance the nursing workforce in Lebanon.
Design:
This study is a cross-sectional survey of emigrant Lebanese nurses.
Settings:
Recipient countries where Lebanese nurses emigrated.
Participants:
440 Emigrant Lebanese nurses were identified through the registration database of the Order of Nurses in Lebanon. The survey was sent to all of them via email; 153 responses were received.
Methods:
Data were collected from November 2017 to March 2018. Analysis included univariate and bivariate tests to present descriptive statistics of the respondents, and to examine region of residence and gender in relation to their current job satisfaction, reasons for leaving Lebanon, intention to return to Lebanon, and aspects that would attract them back to their home country. Logistic regression analysis was used to determine the socio-demographic and work-related characteristics associated with the odds of returning to practice nursing in Lebanon.
Results:
A total 136 completed responses were considered. Emigrant Lebanese nurses were highly educated, with more years of work experience, and older than nurses remaining in their home country. Top reasons for nurses to leave Lebanon included unsatisfactory salary or benefits, better work opportunities in other countries, and lack of professional development or career advancement. The majority of surveyed nurses (59%) expressed willingness to return to practice nursing in Lebanon. Aspects that would attract emigrant Lebanese nurses back to their home country include attractive salary or better benefits and opportunities for professional development, career advancement, or continuing education. Emigrant Lebanese nurses residing in the Gulf, staff nurses, and nurses with more years of work experience were more likely to return to practice nursing in Lebanon.
Conclusion:
Highly educated and experienced nurses are departing from Lebanon. This presents a challenge for the less experienced nurses remaining in the country, who could benefit from the mentorship and experience of their migrating peers. Creating an environment that could enhance the professional development of nurses in Lebanon, with financial incentives could retain the nursing workforce in the country.
... From the investigation, they found that the root reason for the migration was the social and economic problems of every country's health care system, such as poor planning of the health workforce, lack of job satisfaction, economic instability, discrimination and corruption (Mejia et al. 1979). Therefore, the migration of health labour would not be fixed on its own and would take the commitment of governments to resolve the more complex social and economic issues of their health care systems (Kingma 2006;Dywili et al. 2013). The next sections provide a brief review of nurse migration including the push and pull factors, the global nursing migration trends and the effect that migration has on the source and receipt countries and individual migrants. ...
... The underlying reasons for nurse migration are complicated (Dywili et al. 2013;Li et al. 2014). There are push factors from donor 'source' countries and pull factors from recipient 'destination' countries that influence nurses' migration (Mejia et al. 1979;Kingma 2006). ...
... The pull factors include high salaries, job satisfaction, safe work environments, professional development opportunities, political and economic stability, active recruitment strategies, and planned health care systems (Mejia et al. 1979;Kingma 2006;Smith et al. 2009). Other pull factors are the presence of family and friends, and a large expatriate community in the recipient country (Buchan & O'May 1999;Dywili et al. 2013). The push factors include poor planning concerning the health workforce, poor remuneration and salaries, lack of job satisfaction, economic instability, lack of resources to work effectively, high workload, poor management and leadership, discrimination, corruption, professional isolation, lack of education and training, inadequate utilisation of trained personnel, and work-associated risks such as exposure to HIV/AIDS without the proper protection equipment (Mejia et al. 1979;Padarath et al. 2003;Kingma 2006;Smith et al. 2009;Dywili et al. 2013 (Brush 2008). ...
Background: Job satisfaction is a vital concept in nurse retention. Two reasons are thought to contribute to the severe scarcity of nurses in Saudi Arabia: (a) the nursing profession is considered a low status profession with associated negative public perceptions; and (b) cultural barriers that restrict female access to education and employment, particularly in jobs that require contact between genders. The substantial shortage of Saudi nurses in the Saudi Arabian health system has led to a heavy reliance on foreign nurses. This historical dependence on massive numbers of non-Saudi nurses from countries around the globe, and a fragmented approach to their recruitment, has led to inequalities in the remuneration and treatment of nurses. The multicultural nature of the workforce and its potential impact on job satisfaction renders an investigation into the role of nationality a research priority.
Aim: To examine whether nationality has an effect on job satisfaction and ‘intention to leave’ among nurses in Saudi Arabian government hospitals.
Methods/Design: A design of mixed quantitative and qualitative methods was utilised in this study. The quantitative element utilised a survey approach; this approach consisted of McCloskey and Mueller’s Satisfaction Scale, which was used to measure nurses’ job satisfaction across eight types of satisfaction. Additional questions addressed their intention to leave and demographic variables. The qualitative approach utilised semi-structured interviews to further explain any identified associations. The study was conducted in three major government hospitals in Saudi Arabia. The study sample consisted of 747 participants who completed the questionnaire, of whom 26 also participated in semi-structured interviews. Data were collected over a nine-month period between May 2014 and February 2015.
... According to OECD, the migration of health care professionals has dramatically increased in scale due to the liberalization of markets and changes in population dynamics over the past two decades (OECD, 2007;Eckenwiler, 2009). Active recruitment 12-Jan-21/99 is additionally increasing the numbers: for example, international nurse recruitment and migration have been increasing in the last decade and recent trends show an increase in the movement of nurses between developing and developed countries, resulting in a worldwide shortage of nurses (Lewitt & Jaworsky, 2007;Dywili et al., 2013). ...
... There are currently several factors contributing to and causing the global migration of care work and care workers, apart from the factors above. Research has shown that better remuneration for the work abroad, professional advancement prospects and better career opportunities, a safer working environment and a better quality of life are the main reasons for migration (Dywili et al., 2013;Isaksen, 2011). Additionally, one such factor is the ways the governments structure their policies around the questions of care. ...
This book deals with innovation and gender. It explores women’s inventions and innovations and recognition of that work, including the creative work leading to innovations and the varied forms of innovation, ranging from social to technological innovations. The contexts of innovations are crucial because innovations seldom occur in isolation or as the result of work done by one person alone. In this book, the new and the old economy are analysed in relation to innovations. In the following sections we will also focus on examples which illustrate inventions and innovations by women and show some interesting examples affecting everyday life. Equally, it is also essential to realise, that there is no reason for discussion about women to be held distinct from discussion related to innovation. This is not only because many innovations occur because of female innovators, but also because innovations are often designed specifically for women, for men, for specific age groups or for other certain types of users. More generally, the incremental process of innovation has elements of gender involved in many ways, even if we do not notice it as consumers. Gender related elements are considered and attached to many products or services, even before they appear (Poutanen & Kovalainen, 2013; Poutanen & Kovalainen, 2016). This is in marked contrast to efforts to argue the contrary by attempting to separate gender from innovation (e.g. Bath, 2014).
... The underlying economic motives of participants migrating are based on the desire to earn a higher stipend and to increase their welfare, while the main factors encouraging nurses to work abroad are the family's economic condition and the low salary earned in the country of origin. This was in accordance with studies which mentioned economic considerations as the main driver in nurse migration (Dywili et al., 2013;Efendi et al., 2016;Nursalam et al., 2020). Social motives involved the privileged status -as Indonesian nurses were recruited and hired at facilities owned by the Government of Kuwait. ...
... This finding also aligns with a study which mentioned that a good working environment, societal respect and recogni- Efendi et al. / KONTAKT tion of nurses are anticipated as reasons why nurses decide to migrate, and that they hope for greater job security and less workload as well as autonomy (Dywili et al., 2013). The other reason was that, from the perspective of being workers in a different country, their improved skills and knowledge obtained from overseas work experience would support the sustainability of their nursing career. ...
Introduction: Indonesia is recognized as an active player in the sending of health professionals, including nurses, abroad. Indonesian nurses are also placed in Middle Eastern countries, such as Kuwait. Nevertheless, there is little research exploring the life experience of Indonesian nurses living and working in Kuwait. Methods: The design of this study was qualitative with a phenomenological approach. Participants in this study were 21 Indonesian nurses who have lived and worked in Kuwait for a minimum of one year. The participants were recruited from hospitals in Kuwait. This study used a semi-structured interview which was conducted in appointed places. Data were then transcribed verbatim and thematically analyzed. Results: Five themes were identified, namely: Escalating career prospects; Immersing in the local culture; Added value for Muslims; Language barriers; and Dealing with homesickness. Discussion: Participants' economic and social motives reflected different migration goals. Meanwhile, living in a Muslim country lessens the stress and may serve as a benefit during migration. Conclusions: Indonesian nurses who work in Kuwait tend to enjoy a good experience and decent salary. However, they may need upskilling in terms of the acquisition of the language needed in the receiving country. In addition, cultural adaptation and making adjustments to manage homesickness were among the strategies for surviving in the workplace whilst working in Kuwait.
... In general, push factors include economic hardship, political instability or a lack of opportunities, while pull factors include improved employment prospects, living conditions, and education (Castles & Miller, 2009). Within nursing migration, IENs commonly cross borders to enjoy more appealing remuneration, working conditions, and career mobility alongside the allure of novel experiences and adventures (Dywili et al., 2011;Kingma, 2006). Nonetheless, these migratory patterns are shaped by the interplay between push and pull factors, with the latter typically exerting a more substantial influence (Kline, 2003). ...
Aim
To explore the social integration strategies adopted by internationally educated nurses during acculturation and to elucidate their role in facilitating successful adaptation to their host countries.
Background
With their remarkable resilience, internationally educated nurses navigate numerous challenges in their acculturation process in the host country.
Introduction
While the importance of effective social integration strategies in the acculturation and subsequent retention of internationally educated nurses is well known, the specific strategies adopted by these nurses have not been extensively explored. This study aims to fill this gap with its unique and significant focus on these strategies.
Methods
Eight electronic databases were searched for English articles from inception to October 2023 to ensure a comprehensive review. The quality of the included studies was appraised using the Critical Appraisal Skills Program checklist. A meta‐synthesis was performed using Sandelowski and Barroso's two‐step approach, and a thematic analysis was performed according to Braun and Clarke's framework.
Findings
This review included experiences of 258 internationally educated nurses across 16 primary studies and has yielded the overarching theme of ‘fostering a sense of belonging’. The overarching theme is supported by three themes: (1) cultivating social capital, (2) employing effective communications, and (3) engaging with the community.
Discussion
Internationally educated nurses' social integration is a complex process that leverages support networks, establishing connections and overcoming communication barriers. However, the most crucial element is the active involvement of the host community, which plays a significant role in internationally educated nurses’ acculturation journey.
Conclusion and implications for nursing practice
This review has highlighted the importance of social integration in internationally educated nurses’ acculturation journey. Interventions such as having a supportive social network, providing a customised communication programme, organising engagement activities and granting overseas home leave are practical strategies that can enhance this journey.
... Nurse practitioners may relocate their practice location to different states for job autonomy (Shakya & Plemmons, 2020) or personal reasons, but they are unlikely to change locations solely for prescribing certain medications (Dywili et al., 2011). Therefore, the interstate changes in nurse practitioners' practice locations are likely exogenous to their opioid prescribing behavior. ...
Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority.
... of curriculum or just for experience that can be an asset to their foreign education as well as employment. According to Kingma (2007), the nurses migrate for several reasons but not only for financial purposes; however, the migration pattern is influenced by the socio-economic aspects in both, country of origin as well as host country. Likewise, Dywili, Bonner and O'brien. (2013) have concluded that economic concerns were not the predominant reason for migration despite being commonly noted but there were several factors such as financial, professional, political, social, and personal. In the context of Pokhara, Nepal, some of the common factors reported by nurses in my study have been discussed below: ...
Due to unfulfilled expectations in local health-care industry, the participating nurses working in private hospitals in Pokhara were willing to migrate abroad where their aspirations could be met. The irritation, worry, and unhappiness with their career were revealed by the focused-group discussion, in-depth interview, and kuragraphy methods utilized in this study among young nurses in Pokhara. Some of the nurses had already registered for overseas studies and jobs while still working in hospitals and awaiting their visas. As globalization has stimulated the movement of people, the concept of globalization in association with neo-classical and new economic theory of migration, transnationalism, neoliberalism and world-systems from an anthropological standpoint has been applied to analyze the reasons of participant nurses to migrate where the study found that the main reasons for them to migrate were low pay, an uncertain future, a lack of career opportunities, job pressure, and the trend of out-migration. These competent nurses desired to work in core nations have considered semi-periphery as a secondary option. Through the stories of young nurses, this study exposes the dire condition in Nepal’s health-care industry which is motivating nurses to relocate in destination countries resulting brain-drain.
... The analyzed literature on the subject shows that nurses with higher education are more willing to migrate [68], and the age of nurses emigrating from developed countries was lower than that from developing countries. As many as 60% of them were less than 34 years old [68,69]. ...
The economic emigration of young people from rural areas in Poland, and in particular the emigration of young medical personnel, is a relatively little-recognized phenomenon. What distinguishes this study from many works on related topics is that the subject of the study is the tendency or desire to migrate itself, and not the study of the migration motives of people who have already emigrated. The main aim of the research was to identify the migration conditions of young nurses from rural areas. An additional goal was to determine the directions and types of foreign migrations and their impact on the competitiveness and sustainable development of the studied region. The research was conducted in five voivodeships of Eastern Poland among students at state medical universities. The research tool was a survey, the essence of which was to provide data on the purpose of migration of young people, chances of finding a job abroad, and identification of push and pull migration factors. Based on the logistic regression model, a number of factors were identified explaining the tendency to migrate, such as economic factors, gaining professional experience, and prospects. The influence of factors pushing migration should be reduced through state policy tools. The intensity of migration may significantly impact the sustainable development of healthcare in Poland in the near and distant future.
... 6 This is in keeping with research showing that migrating nurses are increasingly moving from low-and middle-income countries to high-income countries. 6,7 Migration may be voluntary or compulsory. People who voluntarily emigrate from their home countries generally do so in search of better living and working conditions. ...
Background
Brain drain refers to the emigration of scientists and other educated professionals from a low- or middle-income country to a high-income country for work. In recent years, this trend has increased, particularly in the health care arena. Prior studies among nurses and nursing students indicate that migration mainly occurs from low- and lower middle-income countries to high-income countries. This study aimed to explore the attitudes of Turkish nurses, nurse academics, and nursing students toward brain drain and the factors associated with these attitudes.
Methods
The study used a mixed-methods research design. The quantitative part of the study was conducted with 1,018 participants. The qualitative part was conducted with 26 participants from the larger sample who volunteered for focus group interviews. Data were collected from June through August 2022 using an online survey, the Attitude Scale for Brain Drain, and a semistructured interview guide.
Results
Of all participants, 84.3% indicated that they wanted to work and live abroad. Nearly 95% stated that there was a risk of brain drain in the nursing profession, with economic factors given as the most significant reason. As age and years of professional experience increased, brain drain tendency decreased. Nurses and nursing students had higher brain drain tendencies than nurse academics. In focus group interviews, participants reported concern that the brain drain might lead to losses in the qualified nursing workforce and increase the workload for the remaining nurses in the migrant-sending country, while cultural adaptation issues can be difficult for nurses in the migrant-receiving country.
Conclusions
Brain drain in the nursing profession continues to be a current, crucial problem. This study showed that among Turkish nurses, nursing students, and nurse academics, the desire to work abroad was quite high, and all three groups had high brain drain tendency scores. Brain drain has serious consequences for both migrant-receiving and migrant-sending countries. These findings can help inform the development of initiatives aimed at preventing or mitigating nursing brain drain.
... This result may be related to job security, which is higher in nurses with permanent employment. Also, similar studies point to the lack of job security (Santric-Milicevic et al., 2015) and obtaining better job opportunities in the destination country among the reasons for the migration of nurses to other countries (Dywili et al., 2013). Thus, less experienced nurses are less inclined to stay in their previous organizations, looking to create ideal conditions for themselves. ...
Background: Like other countries in the world, Iran is facing the problem of a shortage of nurses. Meanwhile, many Iranian nurses migrate to other countries every year. The present study aims to assess the relationships between migration intention, workload, and a healthy work environment for nurses.
Methods: This cross-sectional correlational study was conducted in 2020 using a proportional stratified sampling of 360 nurses working in the Iran University of Medical Sciences (IUMS) teaching hospitals. The study data were collected through a demographic questionnaire, the nurses’ intention to migrate questionnaire, the NASA task load index, and the American Association of Critical-Care Nurses Healthy Work Environment Assessment. In this study, we used the independent t-test, analysis of variance, and the Pearson correlation coefficient for data analysis at a significance level of
... (2) La OMS señala que alrededor de 3,7 millones de enfermeras ejercen en un país distinto al de su nacimiento o formación. (3) Para los países de origen, esto podría representar un problema grave en sus sistemas de salud, lo que puede desencadenar escasez de enfermeras y afectar la calidad y el acceso de la atención sanitaria. (4,5) La migración internacional de enfermeras se debe, en gran medida, a la escasez crónica de enfermeras en los países de ingresos altos (6,7) y, por otra parte, a la escasez de médicos, enfermeras y parteras a nivel mundial. ...
Introducción: Se espera que la migración de profesionales de enfermería mexicanos aumente en los próximos años debido a la escasez de enfermeras en todo el mundo. Es urgente estudiar las condiciones de trabajo de las enfermeras mexicanas en los países de acogida desde una perspectiva transcultural.
Objetivo: Examinar las percepciones laborales de las enfermeras mexicanas que ejercen en un entorno clínico en Alemania desde una perspectiva transcultural.
Métodos: Se realizó un estudio etnográfico focalizado entre noviembre de 2020 y mayo de 2021. La muestra (n = 11) involucró a profesionales de enfermería de México que trabajan en un entorno clínico en Alemania. Los datos se recogieron mediante entrevistas semiestructuradas a través de la plataforma digital Zoom. Las entrevistas fueron grabadas en audio previo consentimiento informado. Se utilizó un análisis temático para analizar los datos; QUIRKOS, un software de análisis de datos cualitativos ayudó en el proceso. Resultados: Se identificaron tres temas: las condiciones estructurales de trabajo, que describen las características del trabajo que influyen en la realización del cuidado transcultural de enfermería; la diversidad cultural de los cuidados, que describe la variabilidad del significado de los cuidados de enfermería; y la práctica transcultural, que describe las percepciones culturales de las enfermeras en relación con los cuidados que prestan en Alemania.
Conclusiones: Las condiciones estructurales de trabajo y la diversidad cultural de los cuidados favorecen o impiden la calidad de los cuidados que prestan las enfermeras mexicanas en Alemania. Los hallazgos sugieren la necesidad de abogar por políticas que mejoren las condiciones de trabajo de las enfermeras en México y en Alemania.
... 9 Although these memorandums provide financial benefits to the sending countries, perhaps it is informed by the relentless determination of nurses and midwives to migrate regardless of how disincentive the process has become. Previous research has investigated the factors that contribute to the migration of nurses and midwives, with studies such as Nair et al. 10 and Dywilli et al. 11 providing valuable insights. ...
Background
There has been an increased rise of African nurses and midwives migrating to high income countries despite varying policies and restrictions to promote retention. The need to comprehensively understand the factors influencing the exodus is critical for policy formulation at the global, national, and facility levels.
Aim
To provide a comprehensive and a systematic review of the factors influencing African nurses and midwives’ migration to high income countries and the factors influencing such migrations.
Methods
A systematic review and meta-synthesis design guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines would be used. Databases including CINAHL, Pubmed, MEDLINE, and EbscoHost will be searched using a PICOS selection criteria framework. Two independent reviewers would be involved in data extraction and meta-synthesis. A third reviewer would provide an arbitrary judgement when disagreements persist after discussion. A meta-synthesis and thematic analysis would be utilised to identify emerging themes and reporting themes identified in the literature.
Ethics and dissemination
The study does not require ethical approval. The findings would be published in peer-review journals and presented at conferences.
PROSPERO registration number: CRD42023395013
Strengths and limitations
The study would shed a comprehensive light on factors influencing the migration of African trained nurses outside the continent. This is relevant in informing policies that promote retention.
The review is conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The methodology is rigorous and meets the standards of the PRISMA guidelines.
Studies published in any language other than English would be excluded.
The period restriction set could also limit the number of studies found for a comprehensive review.
... The migration process of nurses is influenced by various push and pull factors. [21][22][23] The enactment of a comprehensive and systematic policy that regulates nurse migration from upstream to downstream has been one of the pull factors contributing to the success of migration. 24 Managing workforce resources for overseas mobility requires a clear strategy and regulation. ...
Background
The Indonesian policymakers need to respond to the current challenges, particularly the excess of nurses and the increased demand for nurses in the global market.
Objective
This study aimed to present the perception of policymakers and stakeholders on the management of overseas migration of Indonesian nurses.
Methods
This study is a descriptive qualitative design where data were collected through structured interviews with key stakeholders representing the Indonesian government, namely the Ministry of Health (MOH), the Ministry of Labour (MOL), Ministry of Education (MOE) and the Indonesian Migrant Workers Protection Agency (BP2MI). The in-depth interviews involved participants who were responsible for managing Indonesian nurses’ migration. The qualitative data were analyzed thematically using a content analysis approach.
Results
The issues involving nurses’ migration policy are quite complex and sectoral. Themes emerging from this study include the move towards global market orientation, addressing challenges on international nurse migration, strengthening coordination among stakeholders and making the most of opportunities. All the themes reflect that the country should work hard to achieve the balance between quantity and quality of nursing resources for the international market.
Conclusion
As regulator and executor of Indonesian nurse migration, various government policies have responded to the low number of Indonesian nurses’ migration overseas, emphasizing the three cycles of migration: pre-migration, migration and post-migration. The preparation of resources, regulations and placements for Indonesian nurses abroad open the opportunity to the international nursing labour market. Hence, the policies need to be strengthened from upstream to downstream to make Indonesian nurses more competitive and adaptive in global market.
... There is an urgent need to assess physicians' job satisfaction in low-income and middle-income countries since they struggle with complex labor dynamics more often than their peers who work in high-income developed countries [6]. In addition, job dissatisfaction may lead to the migration of health workers in many developing countries overseas, causing specialists shortages [7][8][9]. Although job satisfaction in physicians is relevant, its assessment is highly complex as it requires evaluating various factors and dimensions of the work environment. ...
Background
To assess the validity and reliability of the set of scales (general professional activity, health services management, and working conditions) on the different areas of job satisfaction in Peruvian physicians based on the data from the National Survey of Satisfaction of Users in Health (ENSUSALUD).
Method
We carried out a psychometric study based on the secondary data analysis of Questionnaire 2 of ENSUSALUD-2016. Participants were selected from a two-stage stratified national probability representative sampling by political region. Validity was assessed by exploratory and confirmatory factor analyses, and measurement invariance analysis. We assessed the reliability using internal consistency coefficients (alpha and omega). The set of scales were composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center.
Results
We included 2137 participants in the analysis. The general professional activity scale with six items (Comparative Fit Index, CFI = 0.946; Root Mean Square Error of Approximation, RMSEA = 0.071; Standardized Root Mean Square Residual, SRMR = 0.035), the health services management scale with eight items (CFI) = 0.972; RMSEA = 0.081; SRMR = 0.028), showed good measurement properties for the one-dimensional model. The working conditions scale with eight items for individual conditions and three items for infrastructural conditions (CFI = 0.914; RMSEA = 0.080; SRMR = 0.055) presented adequate measurement properties with a two-dimensional model. The invariance analysis showed that comparisons between sex, age, civil status, medical speciality, working in other institutions, work-related illness, chronic disease, and time working in the healthcare center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90).
Conclusions
The set of scales has a solid factorial structure and measurement invariance, making it possible for group comparison. The study achieved stability in the scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative of the country level.
... Australia has received an increasing number of overseas qualified nurses from the African continent in recent years as the country wrestled with a nursing shortage particularly in their rural communities. [5][6][7][8][9][10] Literature has shown extensive exploration of the experiences of overseas qualified nurses in their destination countries, Australia included. [11][12][13][14][15][16][17] However, literature shows minimal discussion of the experiences of overseas qualified nurses in the rural areas of their destination countries, 8,18 much less the unique experiences of African nurses working in rural Australia. ...
... Assessing of physician´s job satisfaction in low-and middle-income countries is urgently required, since they struggle more often with complex labor dynamics like limited nancial compensation, lack of opportunities for career development, workload and poor legal safety compared to their peers who work in high-income developed countries [7]. In many developing countries, job dissatisfaction may lead to the migration of health workers overseas, causing specialists shortages [8][9][10]. Although assessing the satisfaction of physicians in their workplaces is highly relevant, their measurement constitutes a great challenge. ...
Background: To assess the evidences of validity and reliability of a set of scales on different areas of job satisfaction (general professional activity, health services management, and working conditions) in Peruvian physicians based on data from the National Survey of Satisfaction of Users in Health (ENSUSALUD).
Method: We carried out a psychometric study based on secondary data analysis. Participants were selected from a two-stage probabilistic national representative sampling stratified by political region. Validity was assessed by exploratory and confirmatory factor analysis and measurement invariance analysis. Reliability was assessed by internal consistency coefficients (alpha and omega). The set of scales was composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center.
Results: We included 2,137 participants in the analysis. General professional activity scale with 6 items (CFI=0.946; RMSEA=0.071; SRMR=0.035) and the health services management scale with 8 items (CFI=0.972; RMSEA=0.081; SRMR=0.028) showed good measurement properties for the one-dimensional model. The scale of working conditions presented adequate measurement properties with a two-dimensional model (CFI=0.914; RMSEA=0.080; SRMR=0.055): individual conditions (8 items) and infrastructural conditions (3 items). The invariance analysis presented that comparisons can be made between sex, age, civil status, medical specialty, working in other institutions, work-related illness, chronic disease, and time working in health care center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90).
Conclusions: The set of scales solid factorial structure and measurement invariance, which makes it possible for group comparison. They also achieved stability in their scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative at the country level.
... Assessing of physician´s job satisfaction in low-and middle-income countries is urgently required, since they struggle more often with complex labor dynamics like limited nancial compensation, lack of opportunities for career development, workload and poor legal safety compared to their peers who work in high-income developed countries [7]. In many developing countries, job dissatisfaction may lead to the migration of health workers overseas, causing specialists shortages [8][9][10]. Although assessing the satisfaction of physicians in their workplaces is highly relevant, their measurement constitutes a great challenge. ...
Background: To assess the evidences of validity and reliability of a set of scales on different areas of job satisfaction (general professional activity, health services management, and working conditions) in Peruvian physicians based on data from the National Survey of Satisfaction of Users in Health (ENSUSALUD).
Method: We carried out a psychometric study based on secondary data analysis. Participants were selected from a two-stage probabilistic national representative sampling stratified by political region. Validity was assessed by exploratory and confirmatory factor analysis and measurement invariance analysis. Reliability was assessed by internal consistency coefficients (alpha and omega). The set of scales was composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center.
Results: We included 2,137 participants in the analysis. General professional activity scale with 6 items (CFI=0.946; RMSEA=0.071; SRMR=0.035) and the health services management scale with 8 items (CFI=0.972; RMSEA=0.081; SRMR=0.028) showed good measurement properties for the one-dimensional model. The scale of working conditions presented adequate measurement properties with a two-dimensional model (CFI=0.914; RMSEA=0.080; SRMR=0.055): individual conditions (8 items) and infrastructural conditions (3 items). The invariance analysis presented that comparisons can be made between sex, age, civil status, medical specialty, working in other institutions, work-related illness, chronic disease, and time working in health care center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90).
Conclusions: The set of scales solid factorial structure and measurement invariance, which makes it possible for group comparison. They also achieved stability in their scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative at the country level.
... Assessing of physician´s job satisfaction in low-and middle-income countries is urgently required, since they struggle more often with complex labor dynamics like limited nancial compensation, lack of opportunities for career development, workload and poor legal safety compared to their peers who work in high-income developed countries [7]. In many developing countries, job dissatisfaction may lead to the migration of health workers overseas, causing specialists shortages [8][9][10]. Although assessing the satisfaction of physicians in their workplaces is highly relevant, their measurement constitutes a great challenge. ...
To assess the evidences of validity and reliability of a set of scales on different areas of job satisfaction (general professional activity, health services management, and working conditions) in Peruvian physicians based on data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Participants were selected from a two-stage probabilistic national representative sampling stratified by political region. We included 2,137 participants in the analysis. General professional activity scale with 6 items (CFI=0.946; RMSEA=0.071) and the health services management scale with 8 items (CFI=0.972; RMSEA=0.081) showed good measurement properties for the one-dimensional model. The scale of working conditions presented adequate measurement properties with a two-dimensional model (CFI=0.914; RMSEA=0.080): individual conditions (8 items) and infrastructural conditions (3 items). The invariance analysis presented that comparisons can be made between sex, age, civil status, medical specialty, working in other institutions, work-related illness, chronic disease, and time working in health care center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative at the country level.
... There are many reasons why healthcare staff migrates and decides to work in a country different than its home country (for more see e.g. Mesquita & Gordon, 2005;Bonner & O'Brien, 2013;Oosthuizen, 2005). ...
This paper focuses on the issue of the migration of Polish healthcare staff. The goal of the paper is to analyze selective migration flows of Polish citizens using the example of healthcare staff and compare the results of the completed analysis with aggregated emigration flows. The completed analysis draws from data from the OECD database (2019) – Health Workforce Migration and International Migration Outlook from 2007 to 2017. There was created a unique data set, which made it possible to specify in greater detail the differences in preference when selecting a destination between common emigrants from Poland and healthcare staff. It was also possible to observe whether preferences differed among doctors and nurses and how their preferences differed over time. This paper uses statistical descriptions in order to record the development of emigration flows and correlation analyses for expressing changes in the preferences of Polish healthcare staff.
... Researchers have studied the motivating factors, also referred to as push-pull factors, for nurse migration and found that in general nurses migrate for professional growth, financial benefits, and educational advancement [5,6]. While the pull factors included improved working conditions and better opportunities, push factors include poor remuneration, lack of professional development, and stressful working conditions [6]. ...
Background:
The migration of Caribbean nurses, particularly to developed countries such as Canada, the United States, and the United Kingdom, remains a matter of concern for most countries of the region. With nursing vacancy rates averaging 40%, individual countries and the region collectively are challenged to address this issue through the development and implementation of sustainable, feasible strategies. The aim of this scoping review is to examine the amount, type, sources, distribution, and focus of the conceptual and empirical literature on the migration of Caribbean nurses, and to identify gaps in the literature.
Methods:
Identified records were selected and reviewed using Arksey and O'Malley's scoping framework. A comprehensive search was conducted of eight electronic databases and the Google search engine. Findings were summarized numerically and thematically, with themes emerging through an iterative, inductive process.
Results:
Much of the literature included in our study (N = 6, 33%) originated in the United States. Publications steadily increased between 2003 and 2016, and half of them (N = 9) were journal articles. Many (N = 6, 33%) of the records used quantitative methods. The themes identified were as follows: (1) migration patterns and trends; (2) post-migration experiences; (3) past and present, policies, programs, and practices; and (4) consequences of migration to donor countries. More than half (N = 11, 56%) of the literature addressed nurse migration policies, programs, or practices, either solely or in part. Several gaps were identified including the need for evaluation of the effectiveness of current nurse migration management strategies and to study policies, trends, and impacts in understudied Caribbean countries.
Conclusion:
This review demonstrates the need for future research in key areas such as the impact of nurse migration on health systems and population health. The literature tends to focus on Caribbean countries with higher levels of nurse migration. However, data regarding this phenomenon in other Caribbean countries is needed for a more comprehensive understanding of the plight of the Caribbean region and would answer the call from the International Organization for Migration to study policies, trends, and impacts in understudied Caribbean countries.
... Den globale koden er et viktig bidrag til at fattige land ikke blir tappet for helsepersonell (Helsedirektoratet 2010 s.7). Internasjonale studier viser likevel til utfordringer ved at fattige land blir tappet for kvalifiserte sykepleiere, for å dekke behovet for helsepersonell i rike land (Rodriguez, 2010;Isaksen, 2010Isaksen, , 2012Dywili, Bonner & O'Brien, 2013;Delucas, 2014). Filippinsk økonomi er avhengig av at penger overføres fra migrerte arbeidere til hjemlandet (remittering) og 10 % av det filippinske BNP (over 30 milliarder kroner) er overførte penger gjennom remittering (FNsambandet, 2016). ...
The healthcare system need our competence - why not use it? A qualitative study of Filipino nurses experience of their way to accreditation in Norway
Healthcare professionals educated outside the EU/EEA are an important source of labor in the Norwegian healthcare system, where nurses and auxiliary nurses from the Philippines constitute the largest group. Complicated authority requirements are attached to accreditation in Norway. The study explores how Filipino nurses with three different approvals in the authorization process, experience the process of accreditation in Norway, using qualitative research interviews. The results show that nurses face challenges related to the authorization process in Norway, which they experience as unworthy, unfair, baffling and economically burdensome, but also with experiences of hope for good prospects. A predictable and a dignified authorization process for Filipino nurses should be developed, so that their knowledge and competence can be included and appreciated in the Norwegian health care services.
... Interestingly, local nurses reported less favourable NWE and were less satisfied than expatriate nurses. Consistent with previous Omani findings ( Al Maqbali 2015), this finding is attributed to the fact that expatriates seek overseas jobs to get better wages and work conditions which may not be as satisfactory in their home countries (Dywili et al. 2013). Further, local nurses' expectations of work conditions, tasks, wages ...
Aims:
To (1) examine the level and variability of nurse work environment and job satisfaction and (2) explore how nurse job satisfaction in tertiary hospitals in Oman is influenced by the nurses' characteristics and work environment.
Background:
In Oman and the Middle East, a scarcity of research addressing nurse work environment and job satisfaction exists. Such evidence is necessary for policymaking to positively impact nurse job outcomes, and therefore, quality of care.
Methods:
We used a cross-sectional descriptive design employing a sample of 454 local and expatriate nurses who responded to a self-administered questionnaire.
Results:
The work environment was favourable, and it positively correlated with job satisfaction. Nationality, education, hospital type, staffing, resources and participation in hospital affairs were significant predictors of nurse job satisfaction. The greatest amount of variation in nurse job satisfaction was explained by the work environment.
Conclusion:
The influence of work environment on nurse job satisfaction is greater than nurse characteristics and hospital and unit types. Enhancing nurse participation in hospital affairs and providing adequate staffing and resources are central means of establishing healthy work environments, which is an auspicious, cost-effective strategy for satisfying, and therefore, retaining nurses.
Implications for nursing and health policy:
To enhance nurse work environment and job satisfaction in Oman and the Middle East, nurse and health leaders need to consider developing work and professional regulations and adopting policies to promote staffing, resources, wages, and benefits for nurses and encourage their promotion and career advancement; and foster nurse participation in hospital affairs.
... The included articles were critiqued using the step-by-step guide to critiquing quantitative and qualitative research described by Ryan et al. 22 Subsequently, we employed conventional content analysis describe by Hsieh and Shannon to map the content of the articles across the roles in the framework in Table 1. 23 This framework is an amalgamated version of the 7 roles from the professional competency profiles for physiotherapy, physician, occupational therapy, and pharmacy in Canada. Sentences from the included articles were mapped across each role if it had a close meaning to either the "key" or/and "enabling" competency statements in each of the roles from the professional competency profiles. ...
Purpose: To review experiences of internationally educated healthcare professionals (physiotherapists, occupational therapists, physicians and pharmacists) in their new country and to map these experiences using a competency framework.
Method: Database (Medline, EMBASE, CINAHL, and PsycINFO) were systematically searched to include articles published between 2000 and 2017 and described the experiences of internationally educated healthcare professionals (IEHPs) in physiotherapists, occupational therapists, physicians and pharmacist in attaining registration in new country. The data were synthesised using conventional content analysis. Emerging themes were mapped across a competency framework based on the profiles of the selected professions.
Result: Thirteen articles were included; most were conducted in Canada and among internationally educated medical doctors. Themes were mapped to all the roles in the professional competency profiles except the Health Advocate role. Communicator role was the most frequently discussed; internationally educated healthcare professionals often needed to improve in culture-specific communication including verbal and non-verbal cues during assessment, documentation and treatment of clients. A pictorial representation was created for describing internationally educated healthcare professionals' deficiencies in roles/ competencies for professional practice. In this representation, cultural-language and confidence deficits contribute to the deficiencies seen in roles and competencies among internationally educated healthcare professionals in their new country.
Conclusion: Internationally educated healthcare professionals' ability to fulfill the explicit roles in the competency profiles may depend largely on having good cultural-language competence as well as confidence. Exposing the internationally educated healthcare professionals to local practice is one of the strategies for cultural-language and confidence enhancement, consistent with findings reported in the nursing profession.
Aim
To evaluate the effect of the fear of violence of nurses working in Turkey on their intention to migrate and to examine the mediating role of psychological well‐being on this effect.
Background
Many countries are concerned about nurses’ fear of violence and their intention to migrate. The fear of violence at work may influence nurses’ intention to migrate. Additionally, psychological well‐being may impact this process. However, the impact of the fear of violence at work on the intention to migrate, as well as the moderating effect of psychological well‐being in a nursing context, is not well understood.
Methods
We conducted this cross‐sectional study on a sample of 221 nurses from two public hospitals. We collected survey data between November 2022 and January 2023 using three scales. We analyzed the data using SPSS, AMOS, and HAYES. We followed the STROBE statement guidelines for cross‐sectional studies.
Results
Nurses reported a moderate intention to migrate and a moderate to high level of fear of violence and psychological well‐being. Fear of violence is positively associated with the intention to migrate. Mediation analyses indicated that the association between fear of violence and intention to migration was mediated by psychological well‐being.
Discussion and conclusion
The fear among nurses of being exposed to violence increases their intention to migrate. However, high psychological well‐being can reduce this intention.
Implications for nursing and health policy
Nursing managers, policymakers, and decision‐makers need to take serious precautions against the fear of violence in the future and make necessary improvements for nurses who witness violence. To achieve this, it can begin by paying attention to the high psychological well‐being of each nurse.
Aims
To (1) explore the intramigration experience of HCWs within Nigeria, (2) explore the migration intention of health care workers (HCWs) in Nigeria and (3) identify the predictors of migration intention among HCWs in Nigeria.
Design
Cross‐sectional study.
Methods
The online survey was used to collect data from 513 HCWs in Nigeria between May and June 2023. Crude and adjusted logistic regression were used to identify factors associated with emigration intention. Analyses were performed on SPSS version 26 at a 95% confidence interval.
Results
The study found that 34.4% had intramigration experience, and the rate of intention to emigrate to work in another country was 80.1%. The United Kingdom was the most preferred destination (109 HCWs), followed by Canada (92 HCWs) and the United States (82 HCWs). At the multivariate level, emigration intention was associated with the experience of burnout and duration of practice as a HCW. Nurses had higher emigration intentions than medical doctors.
Conclusions
Many HCWs in Nigeria appear to have emigration intent, and nurses are more likely to be willing to migrate than doctors. The Nigerian government may want to explore strategies to reverse the emigration intent of the HCWs in Nigeria.
Aim
To examine the experiences of internationally qualified nurses, including those from culturally and linguistically diverse backgrounds, transitioning to and working in the aged care sector of high‐income countries.
Design
A scoping review.
Data Sources
CINAHL, MEDLINE and PSychINFO databases were searched to find eligible literature published from January 2010 onwards.
Review Methods
This scoping review was based on the framework by Arksey and O'Malley and the PRISMA‐ScR guidelines. The literature search was conducted by the first author, and all three authors reviewed the retrieved studies for eligibility and inclusion.
Results
Fourteen articles were eligible. Data was categorized into three broad themes: stress of migration and transition; miscommunication, racism and discrimination; and aged care specific challenges which included two sub‐themes ‘shock of aged care’ and ‘bottom care’.
Conclusion
Internationally qualified nurses, particularly if they are culturally and linguistically diverse, face unique stresses and challenges in aged care and face barriers in the recognition of skills and qualifications. The under‐utilization of skills is not only a loss in terms of patient care but is linked to fears of de‐skilling, losing professional development and opportunities for career progression.
Impact
Internationally qualified nurses are positioned as a solution to aged care shortages in high‐income countries; however, there is a scarcity of research exploring their experiences. In the context of the global aged care staffing crisis, an understanding of the stresses and challenges faced by internationally qualified nurses will further strengthen efforts to recruit, support and retain skilled nurses in aged care.
Background :There has been a notable rise in the number of African nurses and midwives migrating to high-income countries despite varying policies and restrictions to promote retention. The need to comprehensively evaluate existing policies addressing the exodus is crucial to future policy formulation and steps in addressing drivers of nurses and midwives brain drain in Africa.
Aim:To explore the existence of migration policies that address the drivers of nurse and midwives’ migration outside Africa and determine the characteristics and implementation of these policies.
Methods: The review would be guided by the JBI methodology for systematic reviews of text and non-research evidence. Databases including CINAHL, PubMed, Academic Search Complete via Ebscohost and ISI Web of Science will be searched using a PICOS selection criteria framework. Grey literature would be gathered from Google Scholar, government and organisational websites. Two independent reviewers would be involved in searching, study selection, data extraction and data analysis. A third reviewer would provide an arbitrary judgement during conflicts when disagreements persist after discussion. A meta-synthesis would be used to identify and report emerging themes in the literature.
Ethics and dissemination: The study does not require ethical approval. The findings would be published in peer-review journals and presented at research conferences.
Background
Countries around the world are struggling to cope with a shortage of nurses and are increasingly relying on internationally educated nurses to fill the gap. Internationally educated nurses represent 9% of the Canadian nursing workforce, but this is expected to grow as the shortage continues. This study aimed to identify and understand the experiences of internationally educated nurses who came to Canada to seek nursing work.
Methods
A cross-sectional survey of a random sample of internationally educated nurses was conducted. Descriptive statistics were used to analyze the survey responses. The survey also included an open-ended question about experience with the move to Canada to work as a nurse. Responses to the open-ended question were content analyzed and triangulated with the survey data.
Results
A total of 2,107 internationally educated nurses responded to the study (47% response rate). Most were female (95%) and married (80%), and almost half were from the Philippines (49%). Professional (e.g., salary & benefits, 60%) and personal (e.g., quality of life, 56%) reasons drove migration to Canada, but 76% reported no recruitment incentives, and most (56%) relied on friends and family for information about nursing in Canada. Significant barriers to practicing in Canada included the licensure exam (75%), and obtaining information about different types of practice in Canada (56%).
Conclusions
The findings from this study provide important information about internationally educated nurses’ perceptions and experiences of coming to Canada to obtain work in nursing. Improving the means for seeking employment by overseas nurses is a key area that regulatory agencies, health managers and policy leaders need to understand and address. Strategies to improve the barriers nurses face, particularly those related to licensure are important considerations.
Aim:
Examine perceptions of nurses who obtained a recognised nursing qualification in Germany about the integration of internationally qualified nurses (IQN) in the German nursing workforce.
Design:
Qualitative interview study.
Methods:
Semi-structured interviews with 21 state-qualified nurses who had graduated from a German nursing program were conducted either face-to-face or by telephone. Nurses were selected using the purposive sampling method. Additionally, to reach a sufficient sample size, snowball sampling was applied. Each interview was pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and sub-themes. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist for qualitative research.
Results:
Two main themes including sub-themes were identified: (a) Enabling Factors to Workplace Integration: motivated nursing team, structured orientation program, support by a preceptor, additional practical skills and specific language training and (b) Barriers to Workplace Integration: lack of language proficiency, cultural differences, othering and racism/discrimination. The findings of the study suggest that working in a diverse workplace can be challenging, it is therefore important for successful integration to recognise not only the experiences of IQN but also the perceptions of nurses who work with internationally qualified peers. No patient or public contribution.
Registration number:
The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (REDACTED).
Every year, almost 19,000 nurses leave the country, according to the Philippine Employment Agency to work abroad. This study aims to discover the different factors that motivate Boholano Nurses to work Abroad in terms of Economic Factors, Job-related Factors, Socio-political Environment Factors, and Personal/Family-related Factors based on the Push and Pull Theory of Motivation by Everett Lee. A descriptive quantitative approach utilizing a random sampling method was used, and the study was conducted in Bohol, Philippines, through an online platform Google Forms. Statistical treatment includes percentage, frequency, weighted mean, Spearman rank, correlation, and chi-square. A total of 36 BSN Graduates of the University of Bohol in the school year 2018 -2019, with a 95% confidence interval and a margin of error of 5%, a sample size of 33 is randomly selected. Privacy, confidentiality, and voluntary consent were observed during data gathering. Results showed that the top two motivational factors are economic factors, followed by job-related factors. The bottom two factors are socio-political factors and personal/family-related factors. The study revealed that Boholano Nurses are overall highly motivated to work abroad, with Economic factors as their greatest motivation, mainly due to the high salary increments and retirement benefits employers outside the country offer. It also concludes that no significant relationship exists between profile and motivational factors.
Aim:
The study aimed to determine the emigration intentions of specialist nurses (SNs) and ascertain the influencing factors, implications and mitigating factors in Ghana.
Design:
A cross-sectional study.
Methods:
The sample was composed of 225 participants conveniently selected from a tertiary facility in Ghana. A turnover intention scale and the researchers' developed questionnaire were used to collect the data between June 1 and September 30, 2021. Data were analysed through descriptive statistics and linear regression.
Results:
The composite mean score for specialist nurses' intention to migrate was high (mean = 3.43); and the push factors accounted for the intentions explaining 48.6% of the variation (R2 = 0.486, F(5, 219) = 38.46, p < 0.001). The associated challenges of specialist nurses' emigration are increased cost of training new specialist nurses, poor quality of specialist nursing care, burnout syndrome among staff and poor patient health outcomes.
Background:
The international mobility has increased cultural diversity in social- and health care. As such, ethical and cultural competence is an essential skill among educators. They are promoting the ethical and cultural competence and professional growth of students with diverse backgrounds and, therefore, must be ethically and culturally competent.
Aim:
The aim of the study was to identify distinct ethical and cultural competence profiles of social- and health care educators and explore the associated factors.
Research design:
A descriptive cross-sectional survey design was used to collect quantitative observational data in 2020-2021. Competence profiles were identified by K-means clustering based on answers to an instrument focussing on educators' ethical and cultural competence.
Participants and research context:
Participants (N = 1179, n = 243) were social- and health care educators based at 10 universities of applied sciences and 10 vocational colleges in Finland.
Ethical considerations:
The research adhered to good scientific practice. A research permit was received from each educational institution that participated in the study. The privacy of the participants was protected throughout the study.
Results:
The analysis identified three profiles of educators (A, B, C) based on self-assessed ethical and cultural competence. Profile A educators demonstrated high scores across all three competence areas. Profile B educators had high scores for ethical knowledge and intermediate scores for other competence areas. Profile C educators demonstrated intermediate scores across all three competence areas. An educator's pedagogical education was found to significantly influence which profile they belonged to.
Conclusions:
The educators generally evaluated their ethical and cultural competence highly. Educators understand the importance of professional ethics in their work, but they need additional support in developing ethics skills in their daily work. Among all educators, there is a need for developing international and culturally diverse collaboration.
Aim:
This study explores perceptions of Continuing Professional Development (CPD) opportunities among stakeholders in the profession of nursing in Nepal.
Design:
Qualitative study using focus group discussions (FGDs).
Methods:
Eight FGDs were conducted in three major cities of Nepal with nursing stakeholders including nurse managers, matrons and directors/managers of private and public nursing colleges, representatives of nursing organizations, government officials, nursing academics and practitioners from the government and private sectors. The data were analysed thematically using Creswell's six steps of analysis and the Standards for Reporting Qualitative Research (SRQR) guideline was followed.
Results:
The study generated three major themes: (a) policy level including the national situation of CPD, political influence and training guided by the policy; (b) organizational level incorporating perceptions towards forms of CPD, staff shortage, poor staff retention, seniority for training, financial constraints and lack of continuity of training; and (c) individual level including motivation for training and lack of relevant training.
People generally want to do what is morally right. This is also true in the workplace, as research consistently shows. Yet every day we encounter situations in which people in organizations act in ways that appear immoral. How can this be? This chapter explains the paradox of morality as a key issue: it is exactly because people are so motivated to think of themselves as morally good that they are reluctant to acknowledge or consider the moral flaws of their actions. Our analysis reveals why it is not always easy to do what is morally right, despite good intentions. Even where people agree about key moral principles, they may differ on what these would prescribe in specific situations. In a moral dilemma, people often disagree which is the lesser of two evils. When facing such dilemmas in the workplace, people turn to others to help determine what decisions and actions are appropriate. Standard solutions aiming to improve moral behavior of people in organizations can be optimized by taking into account these hidden forces relating to social identities and self-views. Explicit efforts to influence moral behavior in organizations are unlikely to be effective if they are not aligned with more implicit forces defining the ethical climate in the workplace.
Background: Continuing professional development for nurses is internationally recognised as a key factor in improving quality of care, career progression, job satisfaction and professionalization. Meeting the global and national challenge of Universal Health Coverage will require a flexible and skilled workforce. Since nurses are the backbone of health care in Nepal, their professional development is a key contribution to this task. Objective: To explore the views of senior nurses on the need and opportunities for continuing professional development in nursing in Nepal and current barriers to its development. Methods: Purposive sampling was used to identify participants and semi-structured interviews were conducted until saturation was reached. Interviews were transcribed verbatim and analysed using thematic analysis. 19 senior nurses, female (n=17) and male (n=2) working across the sector as clinicians, teachers and managers in Nepal participated in this study. Results: Analysis revealed several themes and subthemes, including: the conceptualisation of CPD in Nepal; provision and funding; barriers – fiscal, political and geographical challenges; and future priorities which included a discussion around basic skills versus advanced practice. Conclusions: The study provides an overview of opportunities and challenges for equitable access to continuing professional development in Nepal. Our findings illuminate the need for nurse leaders to work with policy makers and nursing organisations to establish the priorities for continuing development in light of increasing demand and expectations of health services.
Globally, Philippine-educated nurses have made vital contributions to health care; however, there is a lack of in-depth knowledge about emigrating nurses’ initial motives to become nurses, their educational experience and their transition in the host country’s health care context. This research aimed to explore Philippine-educated nurses’ educational experience in their home country and their expectations of competence in Norway. The study utilized an explorative design consisting of qualitative interviews with 10 Filipino nurses. A hermeneutic approach was used to analyze and interpret the empirical material. The findings and interpretations underline that Philippine-educated nurses mainly are externally motivated; their educational program is very demanding, but their level of competence does not meet the competence expected in the host country. Although these nurses lack training in elderly care, the Philippine nursing curriculum emphasizes patient care and mastery of basic nursing skills, which are qualities that should be valued and utilized in host countries.
Aim
To identify and analyse the cultural attitudes, beliefs and practices of internationally educated nurses towards end‐of‐life care in the context of cancer.
Background
Cultural heritage shape beliefs and practices about cancer and end of life, which complicates nursing care delivery. While previous studies centred on diverse patients’ perspectives and cultural competence of healthcare professionals, little analysis available focusing on the cultural attitudes and beliefs of care providers from diverse backgrounds.
Design
Mixed methods systematic review.
Data sources
CINAHL, MEDLINE, Embase, PsychINFO and Scopus were searched between January and March 2020. No date limit was applied.
Review methods
Quality appraisal was conducted using the mixed‐method appraisal tool. Convergent segregated synthesis was undertaken. Findings were thematically synthesised with the final synthesis presented narratively.
Results
Seven studies were included: three qualitative, two quantitative and two mixed methods. None of the studies focused on the end‐of‐life care experiences of IENs in the context of cancer. One study reported views on cancer, with all studies analysing the cultural attitudes, beliefs and practices of internationally educated nurses towards end‐of‐life care. Three main themes were identified: the philosophy of care, approaches to care and perceptions of death and dying.
Conclusion
The distinct gap in research on understanding the cultural attitudes and beliefs of internationally educated nurses in end‐of‐life care in the context of cancer demands further research. Several aspects of end‐of‐life care were in conflict with internationally educated nurses’ cultural attitudes, beliefs and practices. As these nurses are integral in achieving culturally competent care, further understanding of this phenomenon is required to advance the delivery of culturally sensitive care to patients.
Impact
Stakeholders, including the nursing workforce, need to play an active role in providing a culturally inclusive workplace. Support measures are necessary to reduce the impact of cultural conflicts experienced by internationally educated nurses.
In their socio-professional integration (SPI) trajectory, internationally educated nurses (IENs) seek out support from community peer networks (CPNs). The purpose of this research was to explore the relevance of these networks. An exploratory qualitative study, guided by a pragmatic constructivist epistemology, was conducted in two CPNs of IENs who had completed their training in France. Fifteen persons participated in a semi-structured interview: 6 IENs, 4 peer-volunteers and 5 partners or SPI experts. Qualitative analyses result in four interrelated themes to describe the idea of relevance: 1) a temporal dimension reveals systemic learning capacities of CPNs in their provision of individual responses to IENs, in addition to their iterative adjustments to changing political realities of SPI and 2) a focus on the well-being of IENs in a 3) context of nursing manpower retention. A fourth theme suggests that the voluntary nature of CPNs modulates their relevance. Further synthesis provides an understanding of the relevance of CPNs that, primarily, appears in their timely responses to IENs’ realities, on an individual level. In particular, our resultant systemic model suggests that increasing the relevance of CPNs would require to further channel resources on their own specific actions and purposes, aided by facilitators; rather than attempting to build uncertain alliances with partners who, inevitably, pursue different interests. This research on a grassroots strategy by and for IENs draws attention to an engaged social nursing practice that illustrates the discipline’s emancipatory knowing, in acknowledgement of the political aims of the nursing profession.
Dans leur trajectoire d’intégration socioprofessionnelle (ISP), les infirmières formées à l’étranger (IFE) sollicitent des réseaux communautaires de pairs (RCP). Le but de cette recherche fut d’explorer la pertinence de ces réseaux. L’étude comporte un devis qualitatif exploratoire selon une posture constructiviste pragmatique. Réalisée dans deux RCP d’IFE ayant complété leur formation en France, 15 personnes ont participé à un entretien : 6 IFE, 4 pairs-bénévoles et 5 partenaires ou experts de l’ISP. L’analyse résulte en une conception de la notion de pertinence selon quatre thèmes : 1) une dimension temporelle qui traduit une dynamique apprenante des RCP, tant dans les réponses individuelles aux IFE qu’aux ajustements apportés suivant l’évolution de réalités politiques de l’ISP ; et 2) une visée de bien-être des IFE ; ceci dans 3) un contexte de rétention d’infirmières. Le quatrième thème suggère que la nature bénévole des RCP module leur pertinence. Une synthèse offre une compréhension systémique de la pertinence des RCP pour les IFE. Celle-ci se situerait surtout à un niveau individuel, en réponse aux réalités des IFE. Cette modélisation suggère, en outre, que l’accroissement de la pertinence des RCP enjoint de se concentrer sur leurs actions et finalités propres, avec l’aide de facilitateurs, plutôt que de mettre des énergies sur la création d’alliances incertaines avec des partenaires aux intérêts divergents. Cette recherche sur une stratégie de type grassroots par et pour des IFE illustre une pratique sociale d’infirmières engagées faisant appel au savoir émancipatoire de la discipline infirmière et aux visées politiques de la profession.
Background
More and more high-income countries hire internationally educated nurses as part of their workforce. While the factors that push and pull internationally educated nurses to migrate and influence their workforce integration have been widely reported in the literature, little is known about internationally educated nurses’ career development and whether they are satisfied with their nursing career in Canada.
Objective
This study aims to identify the main correlates of internationally educated nurses’ career satisfaction.
Methods
A cross‐sectional analysis of data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses, was conducted. Measures of career satisfaction included individual, job and career characteristics as well as organizational-related and integration process factors. Non-parametric Mann-Whitney U and Spearman rank correlation tests were used to examine the association of the various factors with career satisfaction.
Results
Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on sociodemographic characteristics, organizational setting, and geographic location. Older and more experienced internationally educated nurses tended to be more satisfied with their career than their younger or less experienced colleagues were. Furthermore, male were inclined to be less satisfied than their female counterparts, and having children tended to make all three groups (men, women and overall) more satisfied. The higher the level of education prior to immigrating the lower the career satisfaction. Internationally educated nurses who identified as White or Asian had the highest level of career satisfaction, whereas those who identified as Black tended to be the least satisfied. Career satisfaction was the highest among those who live in the Prairie Provinces (Alberta, Saskatchewan and Manitoba), and Ontario, the lowest in the Atlantic Provinces (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador). As for organizational characteristics, full-time nurses were more satisfied than those working part-time or with occasional employment. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career.
Conclusion
Our findings highlight the need for organizations to ensure a healthy work environment for internationally educated nurses, free of discrimination, where they can attain their career goals.
Tweetable abstract: More and more countries rely on internationally educated nurses to ease their nursing shortages. This study aims to identify the main correlates of internationally educated nurses’ career satisfaction, using non-parametric Mann-Whitney U and Spearman rank correlation tests on data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses. Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on the internationally educated nurses’ sociodemographic characteristics, organizational settings and geographic location. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career. Our findings highlight the need for organizations to ensure environment free of discrimination, where internationally educated nurses can attain their career goals.
Background:
A brain drain is a migration of employees in their quest for an improved level of living conditions, better earnings, access to advanced technology and secure political conditions in diverse places worldwide. The brain drain of nurses is an ongoing phenomenon that impacts the quality and quantity of the nursing workforce and affects the quality of care. The nurses' brain drain is commonly known as a result of the interplay of many factors. So, identification of these factors and how to manage them is a timely topic in nursing research.
Aims:
This study aims to investigate determinants of the nurses' brain drain and mitigating factors from nurses' perspectives in Egypt.
Methods:
Mixed-methods research was conducted using a concurrent triangulation design. A sample of 325 nurses who were working at an Egyptian university hospital answered a brain drain questionnaire while the qualitative investigation was guided by a semi-structured interview with a purposive sample of 35 nurses to elicit exploratory perspectives on factors causing brain drain and mitigation strategies. Results were analysed using inferential statistics and thematic data analysis.
Results:
Both push and pull factors can predict about 99.6% and 97.5% of the nurses' brain drain, respectively. Seven themes were derived from the qualitative content analysis, and six themes were categorised under 'push-pull' factors. In addition, the 'mitigating factors theme' was identified with five sub-factors as possible solutions. Economic and work environment reasons were reported as the most influential for nurses' brain drain.
Conclusions:
Policymakers could use the identified factors from quantitative and qualitative data for creating a system that would improve nurses' conditions and policies, and prevent nurses' migration. Nursing leaders have a significant role with non-remuneration strategies in retaining nurses through creating an empowering work environment. In addition, shared governance, a strong nursing syndicate role and professorial marketing would be essential mitigating factors for the nurses' brain drain.
High graduation of nurses and limited job opportunities in Indonesia may lead to the emigration of students particularly through facilitated migration. This study aimed at identifying the prevalence of nurses with intention to work in Japan and predictors of their intention to migrate as well as having a definite plan to work in Japan. The study adopted cross‐sectional design with a sample of 1,407 Indonesian nursing students. Factors associated with having migration intention, as well as a definite plan to work in Japan, were age, residence, and overseas experience. Other factors related to a definite plan to work abroad were family income, mastering a foreign language, knowledge about the nurse migration related to Indonesia‐Japan cooperation, and their motivations to migrate to Japan. Sustainability of this international recruitment of nurses is possible by understanding the context of both source and destination countries. Maximizing benefits of migration of nurses for Indonesia and Japan requires structured policies targeting the educational sector and addressing the sustainability issues.
This article is protected by copyright. All rights reserved.
Purpose
The purpose of this integrative review was to describe the experience of being outsiders in nursing as described by Black African Born Nurses and Student Nurses (BABN&SN) in the U.S., give voice to their experiences in U.S. academia and healthcare settings, discuss the implications of the BABN&SN othering on the U.S. healthcare systems, and offer recommendations to address the issues based on the literature.
Methods
An integrative review approach discussed by Whittemore and Knafl was utilized to review literature from nursing journal published from 2008 to 2019.
Results
Major findings include collegial/peer isolation and loneliness; racism and discrimination, unwelcoming environment, silencing of voices, personal resilience, and sense of belonging. The results of this review indicate that BABN&SN experience in U.S. nursing contribute to harrowing periods of feeling like ‘an outsider.’
Conclusions
BABN&SN are integral part of the U.S. nursing workforce and the healthcare system. Academic and work environments that support all nurses and students, despite their perceived differences, are essential to promoting an inclusive environment. Understanding the relational pattern that guides the BABN&SN socialization into nursing is vital to developing targeted support especially when entering the clinical practice environment.
Human migration is the movement of people from one place to another with the intentions of settling, permanently or temporarily at a new location. People may migrate as individuals, in family units or in large Groups.
Migration is an important issue in the lives of many humans. Who are the migrants? What is the pattern of migration? What are the causes of migration? What are the health effects of migration? What are the characteristics of health care providers who deal with migrants? Physicians? Nurses? Is migration described in the Bible?
Biblical verses dealing with migration were examined from a contemporary viewpoint.
Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs’ outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs’ description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.
This article addresses the theoretical integration of macro and micro dimensions of global workforce migration, detailing overseas nurses’motivations for working in the UK. The discussion is based on focus group interviews with overseas nurses in three areas in the UK. Their motivations for migrating are contrasted with their experiences of frequently being stereotyped as economic migrants who come from poor countries to gain financial benefits. These conflicting perspectives on overseas nurses’ motivations are explored through a discussion of Bauman’s notion of global and local values, which conceptually combines issues of globalization with the migrants’ perspectives. Giddens’ concept ‘life politics’ is introduced to take further account of individuals’experiences and perspectives. Our data suggest that overseas nurses take a global, transnational perspective on life. Likewise, the simplistic understanding of overseas nurses as economic migrants appears to reflect a local perspective where the lives of individuals are seen to be confined within the borders of nation states. The analysis suggests how perspectives on migration are shaped by individuals’ values and life orientations interfacing with conditions of globalization.
Background: ‘Push’ and ‘pull’ factors motivate Filipino registered nurses (RNs) to leave for employment in foreign countries making the Philippines the leading source country for nurses overseas.
Objective: To assess the current RN-staffing situation in Philippine hospitals.
Design: A self-administered survey was mailed to a sample of 200 Philippine hospital chiefs of nurses.
Results: According to respondents, the majority of RNs in their hospitals (73%) were aged 40 years and younger and female (85%); government hospital RNs earned higher wages than private hospital RNs; and on average, RN vacancy rates and RN turnover rates were lower in government hospitals than private hospitals. All respondents reported no difficulty recruiting RNs with less than 12 months of work experience. However, recruitment of more experienced RNs was somewhat or very difficult for private hospitals compared with government hospitals. Higher salaries, better benefits and good career opportunities were identified as most effective incentives for both recruitment and retention.
Conclusions: RN staffing in government hospitals is more favourable than in private hospitals as measured by employment tenure, vacancy rates, turnover rates and ability to recruit and retain more experienced RNs. On average, respondents reported over half (59%) of total RN turnover was the result of nurse migration overseas.
The May 2010 adoption of the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel created a global architecture, including ethical norms and institutional and legal arrangements, to guide international cooperation and serve as a platform for continuing dialogue on the critical problem of health worker migration. Highlighting the contribution of non-binding instruments to global health governance, this article describes the Code negotiation process from its early stages to the formal adoption of the final text of the Code. Detailed are the vigorous negotiations amongst key stakeholders, including the active role of non-governmental organizations. The article emphasizes the importance of political leadership, appropriate sequencing, and support for capacity building of developing countries’ negotiating skills to successful global health negotiations. It also reflects on how the dynamics of the Code negotiation process evidence an evolution in global health negotiations amongst the WHO Secretariat, civil society, and WHO Member States.
Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country.
A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country.
An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility.
Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration.
The overseas qualified nurse (OQN) has become an important part of the Australian nursing workforce. Efforts to enhance their adjustment to work and life in Australia have been recommended in the literature. This study examines the experiences and needs of a group of OQNs at a major metropolitan tertiary referral hospital in Australia. Using a descriptive survey, 56 nurses reported their experiences with three major themes emerging, career and lifestyle opportunities, differences in practice and homesickness. Nurses from culturally and linguistically diverse backgrounds reported not being employed in their chosen specialty and rating the utility of ward and hospital orientations more positively when compared to English speaking background nurses. From the study results an organisational and a personal approach has been undertaken to aid in the adjustment of OQNs into the nursing workforce.
It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.
The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.
The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.
Recruiting nurses from other countries is a long-standing practice. In recent years many countries in the developed world have more frequently recruited nurses from the developing world, causing an imbalance in the health services in often already impoverished countries. Despite guidelines and promises by developed countries that the practice should cease, it has largely failed to do so. A consortium of authors from countries that have experienced significant nurse poaching consider the ethical aspects behind this continuing practice.
As a result of the shortage of nurses, Dutch health care organizations want to recruit nurses from outside Europe (e.g. Indonesia, South Africa). The Dutch government, however, is not encouraging this policy and prefers to recruit within the European Union. In order to better support such nurses, it is important to know the problems European nurses encounter in The Netherlands. This study is about the experience of nurses from other European countries in The Netherlands. This paper addresses itself to three principal questions. First, how many nurses qualified in other EU or EU candidate states are starting to work in The Netherlands. Second, why do they come to The Netherlands. And finally what problems do they encounter when working in The Netherlands. A questionnaire has been send to all registered nurses trained in another EU or EU candidate state. The response has been 987 or 67%. Thus, far approximately 1500 nurses from other EU/candidate states have come to The Netherlands. Personal reasons, including marriage, are the most important reasons for their coming here. Half of the nurses took one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. The nurses had to make a number of adjustments. Major difficulties were unfamiliarity with Dutch laws and the fiscal and social security systems, recognition of their qualifications and application for permits. Some basic issues, such as how to write a letter of application, caused problems. The language and unfamiliarity with the Dutch health care system made it difficult to find a job. When they had gained employment in nursing these problems remained the most serious. The conclusion is that international employment mobility in nursing is rather low in the case of The Netherlands. If the Dutch government decides to encourage the employment of nurses from abroad, several measures can be taken to make working in The Netherlands more attractive.
Migrant health workers are faced with a set of options that are a combination of economic, social and psychological factors and family choices (1). They trade decisions related to their career oppor-tunities — and to financial security for their families — against the psychological and social costs of leaving their country, family and friends. The comments of health workers themselves reflect the “push and pull” nature of the choices underpinning these “journeys of hope” as, for example, those collected in Ghana by Dovlo (2). Demotivating working conditions, coupled with low salaries, are set against the likelihood of prosperity for themselves and their families (by remit-tances), work in well-equipped hospitals, and the opportunity for professional development. In this issue of the Bulletin, Saravia & Miranda (pp. 608–615) point out that young, well-educated individuals are most likely to migrate, especially in pursuit of higher education.Employers in the countries of origin have their own perspective. They are unable to fulfil their mandates to provide equitable access to health care because the necessary health workers are not available. In many cases, the country is losing its investment in the education of health professionals, as well as losing the contribution of these workers to health care. Governments have to compete for health workers by making their condi-tions of work more attractive; they may also highlight the imbalance in com-petition between themselves and the receiving employers. Arguments from this perspective will inevitably include ethical and moral dimensions.Employers in receiving countries take a different position, driven by their need to provide sufficient health workers to meet the demand for services within the constraints of budget planning and the imperfections of the labour market. Kupfer et al. (pp. 616–619) discuss
The paper reports on a survey of recently arrived international nurses working in London, to assess their demographic profile, motivations, experiences and career plans.
A postal survey was conducted in October-December 2004 on a sample of 1000 nurses who were London-based international members of the Royal College of Nursing (RCN). The usable response rate was 40%. Registration data from the Nurses and Midwives Council (NMC) were also analysed.
The Philippines, Nigeria and South Africa were the three most commonly reported countries of training (in total, more than 30 countries of training were reported). Sixty per cent of the nurses from sub-Saharan Africa and more than 40% from South Africa and India/Pakistan/Mauritius were aged 40 or older; the youngest age profile was reported by the Australia/New Zealand/USA nurses. Two thirds of all the respondents indicated that a recruitment agency had been involved in their move to the United Kingdom (UK). Three quarters of the respondents (76%) reported that they were required to complete a supervised practice course/period of adaptation in the UK in order to be eligible to practice as a nurse in the UK. Two thirds (69%) of respondents were working in NHS hospitals in London, 13% were working in the private sector hospitals and 10% were working in private sector nursing homes. Most of the nurses reported they were the major or sole wage-earner contributing to household income. More than half of the respondents (57%) reported that they regularly sent remittances to their home country. The majority of respondents (60%) indicated that they planned to stay for at least five years, but just under half (43%) also reported that they were considering a move to another country.
One critical issue for UK policy-makers is to determine if internationally recruited nurses will stay on in the UK, move back to their home country, or move on to another. That these nurses have made at least one international move means they are likely to have the propensity to move again. As such, retention efforts in the UK will have to take account of their career aspirations.
Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.
There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries.
A purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited. Ten overseas nurses were also recruited. A phenomenological approach was used with semi-structured interviews as the data collection method.
There were pronounced differences in opinions between the Irish and the overseas directors on recruitment and its effects on the health systems of the source countries. Difficulties in the retention of staff were highlighted by both groups of directors. Other findings included the language and cultural differences experienced by the overseas nurses.
Recruitment of overseas nurses should not be left to the individual employer even in the presence of government guidelines. An international effort from all the involved parties is required to formulate a solution to this complex issue in order to protect both the health systems of individual countries and the nurse's right to migrate.
Background:
Nursing is becoming a mobile profession. Nurse migration is multifactorial and not limited to financial incentives. Non-economic factors that might lead to migration include poor recruitment and retention strategies, poor job satisfaction and working conditions, socio-political and economic stability, and the poor social image of the nursing profession. Lebanon is facing a problem of excessive nurse migration to countries of the Gulf, North America and Europe. No study has been conducted to understand the determinants and magnitude of the problem.
Objective:
The objective of this study is to provide an evidence base for understanding the incidence of nurse migration out of Lebanon, its magnitude and reasons.
Design:
A cross-sectional research design comprising both quantitative and qualitative methods was employed to achieve the stated objectives. This includes a survey of nursing schools in Lebanon, survey of nurse recruitment agencies, secondary data analysis and survey of migrant nurses.
Results:
An estimated one in five nurses that receive a bachelors of science in nursing migrates out of Lebanon within 1 or 2 years of graduation. The majority of nurses migrate to countries of the Gulf. The main reasons for migration included: shift work, high patient/nurse ratios, lack of autonomy in decision-making, lack of a supportive environment, and poor commitment to excellent nursing care. Further, nurses reported that combinations of financial and non-financial incentives can encourage them to return to practice in Lebanon. The most recurring incentives (pull factors) to encourage nurses to return to practice in Lebanon included educational support, managerial support, better working conditions, utilization of best nursing practices and autonomy.
Conclusion:
Nurse migration and retention have become major health workforce issues confronting many health systems in the East Mediterranean Region. Our study demonstrated that nurse migration is a product of poor management and lack of effective retention strategies and sufficient knowledge about the context, needs and challenges facing nurses. Nurse migration in Lebanon underscores the importance of developing a monitoring system that would identify implications and help implement innovative retention strategies. Nurse migration out of Lebanon is likely to persist and even increase if underlying factors are not properly resolved.
To examine emerging trends in global nurse migration and those effects on nurse workforce planning and development efforts in select donor and recipient countries.
This integrative literature review is an analysis of current literature (journal articles, media, and press releases) and data from various sources (PUMS, NSSRN, CGFNS, Nurse & Midwifery Council) to explicate new trends in nurse migration.
Rapid changes in nurse migration are significantly challenging nurse workforce management efforts in both donor and recipient nations.
As the market demand for nurses around the globe escalates, the changes and consequences associated with nurse migration are increasingly in need of policy solutions that indicate the needs and motivations of all stakeholders.
Registered nurses represent the largest single health care profession in the United States and are an integral part of the health care workforce. This country is currently faced with a shortage of nurses. Even more frightening, evidence of a declining nurse workforce has become a global
issue. To counter the domestic decline in their profession, recruiters are courting nurses in countries abroad. The practice of importing nurses into the United States raises various concerns. The complexity of immigration and licensing, for example, emphasizes legal obstacles to this temporary
solution. Further, critics of international recruitment point to ethical issues regarding the "brain drain" of talent from other nations. This paper examines international recruitment of registered nurses as a response to the nursing shortage, with particular focus on the Philippines.
Background: The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce.
Aim: To predict the international migration of nurses to the UK using widely available data on country characteristics.
Method: The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization.
Results: The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK.
Conclusion: Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.
PALESE A., CRISTEA E., MESAGLIO M. & STEMPOVSCAIA E. (2010) Italian–Moldovan international nurse migration: rendering visible the loss of human capital. International Nursing Review57, 64–69
Aim: To describe the process of the migration of Moldovan nurses to Italy.
Background: Formerly a part of the Soviet Union, the Republic of Moldova gained independence in 1991. Currently, there are 25 848 nurses (60.6 per 10 000 inhabitants) working mainly in the public health system. Each year, around 2000 nurses leave the country in search of better working conditions and a better quality of life.
Methods: A longitudinal study design was adopted (2006–2007). In the first phase, we contacted all known nurses living in Moldova and their available colleagues following a snowball sampling strategy. Inclusion criteria were nurses who had decided to migrate to Italy and had already prepared the migration documents and/or were awaiting their departure. In the second phase, we interviewed the same sample of nurses on arrival in Italy.
Findings: After one year, only 25 nurses out of the 110 initially interviewed (22.7%) had arrived in Italy; none were working as nurses. The cost of the migration process incurred by each nurse was around 3278 euros, and the waiting time from the decision to leave until arrival was around 24 months.
Conclusions: All Moldovan nurses involved in this study, once they arrived in Italy, ceased to exist from an official perspective. Policy and recommendations need to be developed to ensure the integration of Moldovan-educated nurses into the health-care system and to monitor the amount of human capital (in terms of care drain, brain drain and youth drain) that this process risks wasting.
BEATON M and WALSH J. Nursing Inquiry 2010: 17: 173–183 Overseas recruitment: experiences of nurses immigrating to Newfoundland and Labrador, 1949–2004
Overseas recruitment of nurses has been part of health-care in Newfoundland and Labrador, Canada for over a century. The International Grenfell Association began recruiting overseas in 1893 for nursing stations in Labrador and from the 1920s to 1940s, overseas recruitment was used to provide nurses for rural areas of the province. Beginning in the 1950s, government and provincial hospitals used this strategy to resolve nursing shortages as did Memorial University to attract faculty for the new nursing degree programme that started in the 1960s. Today, overseas recruitment continues for nurse midwives. Overseas recruitment brought challenges for those who came, for local nurses and for the profession. Many nurses returned home but others opted to stay. Overseas recruitment and the contribution these nurses made to nursing and health-care in Newfoundland and Labrador are significant but undocumented parts of our history. We undertook an oral history project to document their experiences, explore the challenges of overseas recruitment and preserve this record of nursing history. Forty-one nurses who immigrated to Newfoundland and Labrador between 1949 and 2004 and practised in all regions and settings were interviewed. Analysis of the data identified themes related to the nurses’ immigration experience and adaptation to the culture and health-care of Newfoundland and Labrador.
Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country. In this article, the authors report findings from an empirically grounded study that examines the experience of IENs who entered Ontario's workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as 'different' from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice and the role of patients and families in decision-making. In addition, problems with English language fluency cause work-related stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides important insights as policy and management decision-makers balance the tension between increasing the IEN workforce and the delivery of safe patient care.
Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA.
Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information.
This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA.
These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally.
Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses.
This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible.
WHO's Multinational Study of the International Migration of Physicians and Nurses, the subject of this paper, was the first step of WHO's response to a mandate calling for a study of health manpower migration and for collaborative efforts to regulate such migration where found to be undesirable. The study, which is both diagnostic and prescriptive, is based on an extensive library of published and unpublished literature. Major reports emanating from the study were: an analytical review of the literature; a statistical report on stocks and flows of migrant physicians and nurses for each of 137 countries; and a final report which provides an in-depth analysis of the characteristics of the migrants, the dimensions, directions, possible determinants, and consequences of the migration, and the actions taken by countries to regulate migration. It also suggests options for dealing with undesirable migration.
Perhaps the most important finding is that countries which produce far more physicians and nurses than they can economically afford become donors of such manpower and those that produce fewer than they can afford become recipients. Almost all other factors either derive from or are secondary to the economic factor.
International nurse migration — moving from one country to another in the search of employment — is the focus of this article. The majority of member states of the World Health Organization report a shortage, maldistribution and misutilisation of nurses. International recruitment has been seen as a solution. The negative effects of international migration on the ‘supplier’ countries may be recognised today but are not effectively addressed.
Nurse migration is motivated by the search for professional development, better quality of life and personal safety. Pay and learning opportunities continue to be the most frequently reported incentives for nurse migration, especially by nurses from less-developed countries. Career opportunities were considered key incentives for nurses emigrating from high-income countries. Language was reported to be a significant barrier. The positive global economic/social/professional development resulting from international migration needs to be weighed against a substantial ‘brain and skills drain’ experienced by supplier countries. The vulnerable status of migrant nurses is also of concern in certain cases. The focus on short-term solutions as opposed to resolving the problem of a worldwide shortage of nurses causes great concern. Recent initiatives attempt to curb or channel international recruitment. The delicate balance between recognising the right of individual nurses to migrate and a collective concern for the health of a nation’s population must be achieved.
To describe the push and pull factors of migration in relation to international recruitment and migration of nurses.
Review of literature on nurse migration, examination of effects of donor and receiving countries, and discussion of ethical concerns related to foreign nurse recruitment.
The primary donor countries are Australia, Canada, the Philippines, South Africa, and the United Kingdom (UK); the primary receiving countries are Australia, Canada, Ireland, the UK, and the United States (US). The effects of migration on donor countries include the loss of skilled personnel and economic investment; receiving countries receive skilled nurses to fill critical shortages with less economic investment. Ethical concerns include the potential for exploitation of foreign nurses.
Nurses migrate to seek better wages and working conditions than they have in their native countries. Given the current conditions, developed countries continue to actively recruit foreign nurses to fill critical shortages. Migration is predicted to continue until developed countries address the underlying causes of nurse shortages and until developing countries address conditions that cause nurses to leave.
There is currently a global shortage of nurses. Developing countries such as Malawiare among those hardest hit by this shortage. The demands on available nurses have increased and at the same time there is a lack of interest in becoming a nurse owing to the poor working conditions among those still employed in the service. It is questionable if developed nations should recruit nurses from countries such as Malawi, where severe human resource constraints are being experienced. We argue in this article that the current phenomenon of nurses leaving developing nations for western countries is complex. Human rights issues of individual autonomy and public interest are at stake.
The aims of this paper are to review the literature to determine what factors are contributing to the nursing shortage in the United States of America (USA) and discuss possible solutions to this current and future nursing shortage.
The need for nurses is often depicted as cyclical in nature. Throughout history, the USA has experienced a series of nursing surpluses and shortages. However, the current shortage has been characterized as being unlike those experienced in the past. Trends of an ageing Registered Nurse (RN) workforce and limited supply to fill the impending vacancies are some of the unique aspects that bring a new dimension to an old problem. Today's nursing shortage will not be resolved by simply returning to the solutions of yesteryear, and strategies to reduce its impact will have to be more creative and focus on the long-term.
Integrative literature review of published literature on the current nursing shortage in the USA from 1999 to 2001.
Four main areas were identified as the major contributors to the nursing shortage in the USA: the ageing RN workforce; declining enrollment; the changing work climate; and the poor image of nursing. Solutions to the shortage followed similar themes to the contributing factors and encompassed four main areas: exploring recruitment efforts; exploring retainment efforts; improving the image of nursing; and supporting legislation that helps to rectify the shortage.
There is firm evidence that the USA amidst a nursing shortage. Much is known about the many contributing factors but now nurses need to become proactive to help secure the future of their workforce. By forming partnerships within the profession and with other influential parties, nurses can be in the forefront of resolving their workforce issues.
The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.
Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.
Opportunity is the driving force of migration. Unsatisfied demands for higher education and skills, which have been created by the knowledge-based global economy, have generated unprecedented opportunities in knowledge-intensive service industries. These multi-trillion dollar industries include information, communication, finance, business, education and health. The leading industrialized nations are also the focal points of knowledge-intensive service industries and as such constitute centres of research and development activity that proactively draw in talented individuals worldwide through selective immigration policies, employment opportunities and targeted recruitment. Higher education is another major conduit of talent from less-developed countries to the centres of the knowledge-based global economy. Together career and educational opportunities drive "brain drain and recirculation". The departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs. To favourably modify the asymmetric movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies to: provide world-class educational opportunities, construct knowledge-based research and development industries, and sustainably finance the required investment for these strategies. Brazil, China and India have moved in this direction, offering world-class education in areas crucial to national development, such as biotechnology and information technology, paralleled by investments in research and development. As a result, only a small proportion of the most highly educated individuals migrate from these countries, and research and development opportunities employ national talent and even attract immigrants.
The migration of health workers within and between countries is a growing concern worldwide because of its impact on health systems in developing and developed countries alike. Policy decisions need to be made at the national, regional and international levels to manage more effectively this phenomenon, but those decisions will be effective and correctly implemented and evaluated only if they are based on adequate statistical data. Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited (because they often give only a broad description of the phenomena) and not as timely as required. There is also a conflict between the wide range of potential sources of data and the poor statistical evidence on the migration of health personnel. There are two major problems facing researchers who wish to provide evidence on this migration: the problems commonly faced when studying migration in general, such as definitional and comparability problems of "worker migrations" and those related to the specific movements of the health workforce. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.
The migration of nursing professionals from developing countries such as Zimbabwe to industrialised countries is taking place at an alarming rate, with little signs of slowing down. In Africa, nurses form the backbone of the healthcare delivery system and their migration has a huge negative impact on health service provision. Drawing on evidence from selected health institutions, the paper shows the magnitude of migration of nurses from Zimbabwe. The paper also shows that public to private health sector migration of nurses is occurring at a significant rate. The effects of such movements are examined in detail. For instance, at the health institution level, nurse migration has led to staff shortages, and health institutions located in the disadvantaged areas have been the worst affected. The paper calls for the adoption of an integrated approach in managing and addressing the concerns of the nursing professionals.
This theoretical study examines the ethics of international nurse recruitment from the conceptual framework of stakeholder interests. It argues that there are stakeholders at individual, institutional, national and international levels, with overlapping but, more often, different or even conflicting interests. Depending on the interests of given stakeholders, different conclusions regarding the ethics of international nurse recruitment may be reached. There is no right or wrong with these varying ethical positions because they reflect different beliefs and philosophies that are not amenable to value judgment. To illustrate and support this line of argument, this article analyzes the underpinnings of two ethical standards published by the International Council of Nurses and the UK Department of Health. In addition, a case study on China augments the argument by demonstrating limitations of the one-size-fits-all approach to the issue. The most important question in understanding and evaluating the ethical standards of international nurse recruitment is to know whose interests they are designed to represent and protect.
A number of common issues and challenges face every country; however, their impact varies greatly across different countries. A particular concern in relation to nurse migration is its effect on adding to the imbalance in nursing resources that already exists in different regions and different countries. The number of nurses recruited into developed countries has increased significantly during the past decade, particularly from developing countries. Understanding and addressing the impact of migration requires not only examining what pulls nurses into destination countries but also what pushes them from source countries. We must also address the ethical issues involved in international recruitment. We must also not lose sight of nurses currently in the workforce. Effective national policies for recruiting and retaining nurses would reduce the need for recruiting from other countries.
To identify the factors responsible for the international migration of Indian nurses.
The paper is based on the responses of 448 nurse practitioners, nurse educators and nurse administrators to a questionnaire administered to them in December 2004-January 2005. Key factors were identified by the analysis of contingency