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Nursing Education in Punjab and its Role in Overseas Migration

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Abstract

This chapter examines the changing role of nursing as a career option for young people in Punjab. The paper contextualizes the substantial growth of nursing education institutions in the context of international migration opportunities. Based on survey and interview data gathered at nursing schools and colleges across Punjab, the paper demonstrates how opportunities linked to the global nursing labour market substantially motivate the uptake of the profession in Punjab. The allure of working overseas is not just accounted for by salary differences, but also by the perceived advantages of continued training and career development that overseas employment (particularly in the west) offers. The chapter recommends policy changes in Punjab to enhance the attractiveness of the conditions and career development of nursing in order to compensate for the substantial draw the international market offers trained nurses.
... Indian nursing students migrate internally for educational and work purposes (Nair, 2012), and there are significant regional networks between Southern India and the Gulf states (George, 2005). In northern India, nurses focus their attention on North America, Europe and Australia (Bhutani, et al., 2013). The analysis of current global migration circuits suggests a colonial circuit still marks the system via the hegemony of the English language (Piller and Takahashi, 2010). ...
... This data is indicative of the transformation that has occurred in both the level of interest and the occupational status of nursing in Punjab. Field research during the 2008-12 period indicated the changing occupational landscape for nursing (Bhutani, et al., 2013). In the case of nurse migrants, the emergence of agencies that intersect nursing educational and migrant opportunities present novel examples of transnational migrant agency in Punjab, since they mostly focus on women as independent migrants. ...
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Migration, Mobility and Multiple Affiliations studies Punjabi transnational life from perspectives that have relevance for contemporary policy, planning and governance. It analyses the spatially widespread, integrated and complex Punjabi diaspora while reflecting its vulnerability in an increasingly globalized world. Besides an overarching introduction and a historical overview, this book covers shifting contours of international migration, social structure and organizational links, the interrelationship between education and migration, and family networks of the Punjabi emigrants.
... Very few had children, which likely reflected their relatively young age (mostly concentrated in the twenty-to-thirty-year age range). We also asked whether respondents had family members in nursing, as we were interested in exploring ideas of occupational reproduction within families and the cultivation of a culture of migration (Connell 2014;Bhutani, Gupta, and Walton-Roberts 2013). Just under 40 per cent of the sample had a family member (sibling, mother, aunt, or cousin) working in nursing, and of those family members, three-quarters were working overseas. ...
... In order to operationalize the research and recognize the complexity of data collection at the national scale in India, we focused our empirical research in two states. In terms of regional differences, Kerala has long been seen as the main source location for nurse outmigration [33], and Punjab has seen a substantial increase in training capacity, especially for nurses, for export [34]. Kerala and Punjab were chosen due to the states' level of health care training capacity and their high degree of outward orientation in terms of international migration; Kerala and Punjab are in the top three Indian states with the highest share of total emigrants (outmigrants) residing in another country [35]. ...
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Background This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Methods Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. ResultsShortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Conclusions Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.
... Further details exploring the rise of international nursing migration from Punjab can be found in our earlier study (Bhutani, Gupta, and Walton-Roberts 2013). In this paper we further examine how the culture of migration in Punjab is adapting to international nursing opportunities, and how these migratory geographies have altered over the last decade or so. ...
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Globalisation, supply–demand dynamics, uneven development, enhanced connectivity including the better flow of information, communication and the reduced cost of travel have encouraged the global integration of nursing labour markets. Developed regions of the world have attracted internationally educated nurses (IENs) because of growing healthcare needs. India, along with the Philippines, has become a key supplier of nurses in the global economy. Traditionally the supply of nurses was heavily regionalised in south India, especially Kerala, but of late Punjab, in north India, has played an increasing role in nurse training and migration as the profession has become more respected and more international. This paper uses survey and interview data to detail the recent interest in nursing as a channel for independent female international migration from Punjab, and to examine how migratory ambitions have developed over the last decade in parallel with the changing status of nursing as an internationally respected profession. We identify growing interest in international migration for nursing students and their increased intention to pursue employment opportunities in Australia and New Zealand. This research highlights how nursing and care migration are increasingly structured by international circuits of training and employment, and how such circuits alter migrant and occupational geographies on the ground in sending regions.
... The Indian recruiter was initially based in Punjab (northern India) and Kerala (southern India). Many states in India have seen growth in those seeking employment in the nursing profession; however, Kerala remains the primary source region (Bhutani et al., 2013). The majority (67%) of students enrolled in this program came from Kerala. ...
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International students have become an increasingly important dimension of Canada‘s educational and immigration policy landscape, which has led to the development of pathways from educational to working visa status. In this report we present an analysis of international student numbers, visa transition rates, processes and government policy evolution with regard to international student entry to Ontario between 2000 and 2012. The report’s findings suggest four major areas of change: increasing male dominance in the number of student entries; the rise in international student entries into the college sector; the increasing importance of international students as temporary workers post-graduation; and the profound shift in source countries for Ontario-bound international students. Policy knowledge in areas related to these issues is vital to Ontario's ability to compete for international students, who can become potential immigrants, while maintaining high-quality postsecondary educational institutions.
... These tendencies toward global competition for skilled workers place health professionals as one of the key labour market sectors open to international transfer . Nursing in particular presents one case where skilled labour migration is evident (Kingma, 2006), and indeed in some regions the opportunities for overseas migration are often one of the main reasons candidates enter the profession (Bhutani et al., 2013). These workers generally seek a better life for themselves and their families, and in the process their migration contributes to an ongoing differentiation of the healthcare delivery map. ...
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Book: The growth of international travel for purposes of medical treatment has been accompanied by increased academic research and analysis. This Handbook explores the emergence of medical travel and patient mobility and the implications for patients and health systems. Bringing together leading scholars and analysts from across the globe, this unprecedented Handbook examines the regional and national experiences of medical tourism, including coverage of the Americas, Europe, Africa, the Middle East, and Asia. The chapters explore topics on issues of risk, law and ethics; and include treatment-focused discussions which highlight patient decision-making, patient experience and treatment outcomes for cosmetic, transplantation, dental, fertility and bariatric treatment.
... Nursing has also emerged as an area of growing interest for the corporate health sector in India as private health services continue to develop (Walton-Roberts 2015), in light of the growth of medical tourism and middle-class demand (Crone 2008). Nursing's increased popularity has resulted in a diversification of college entrants in terms of religious, regional, gender and caste/class background (Bhutani et al. 2013). The changing social perception of nursing in India in light of international migration opportunities is indicative of how gender narratives can be transformed through transnational interaction. ...
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In this paper, I explore the migration of Indian-trained nurses enrolled in a post-graduate critical/geriatric care programme at a Canadian public college. Calling upon recent literature on gender, modernity and mobility in India, I examine the extent to which skilled transnational migration is shaped by gender relations established in India. While feminized international migration suggests increased autonomy of female migrants, this research highlights two important dimensions of such migration. The first is that family migration strategies are major determinants of the occupational choice and migration processes that daughters engage in, and the second is that the moral subjectivity of daughters is maintained through transnational methods of care and control.
... Research in India began while a visiting researcher at the Centre for Development Studies in Kerala in 2008-9, and Panjab University Chandigarh in Punjab in 2010-11. In Chandigarh I collaborated with faculty and students, who participated in ethics training prior to gathering interview and survey material (Bhutani et al. 2013). This paper draws upon some of this material, as well as secondary sources. ...
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In Canada half of all internationally educated nurses (IENs) are employed in Ontario, and in 2010 the top three countries where new IENs had received their training were the Philippines, India and China. This presentation reports on preliminary results from an ongoing research project examining the experiences of IENs from the Philippines and India who intend to enter Ontario's nursing profession indirectly via temporary migration streams. The preliminary survey results will be presented, including differences in the characteristics and experiences of the two groups as they follow migration and occupational pathways to enter Canada and the nursing profession in Ontario. The preliminary findings will highlight some of the issues the data reveal in terms of specific settlement experiences, issues of effective conversion of pre-migration training into professional practice post-migration, and how policy shifts toward temporary and two-step migration may be shaping the nature of IENs' indirect pathways into practice.
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