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Care and Global Migration in the Nursing Profession: a north Indian perspective
Abstract
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 international migration of health workers has long been an issue of state health policy concern, but as health services have become corporatized, privatized, and commoditized, health worker migration is increasingly orchestrated via global service mechanisms (Collyer and White, 2011), which can be seen as a commodity that is formed and exported by state and private capitalist interests. This is particularly relevant in Asia, seen as the primary driver of the globalization of health service delivery (Crone, 2008) and a key region for both internal and outward movements of health care workers, particularly nurses (Walton-Roberts, Bhutani, and Kaur, 2017;Castro-Palaganas et al., 2017). ...
... These international opportunities mean that spatial mobility is a core feature of health occupations, and candidates in lower-and middle-income nations increasingly select health careers because of the global migration prospects they offer (Connell, 2014;Walton-Roberts, Bhutani, and Kaur, 2017). Spatial mobility has thus become part and parcel of the very choice to enter the health occupations, and this spatial dimension informs the delivery, costs, and regulation of education and training in key supply markets in various ways, including reducing quality and increasing costs (Baumann and Blythe, 2008;Walton-Roberts, 2015). ...
... Zachariah and Rajan (2007) found that after the unemployed, students constituted the second largest outmigration group from Kerala at 25.8 per cent, leading them to argue that Kerala's post-matric education capacity was underdeveloped. Relying on internal migration for the provision of nursing education is not without its risks, since the state of nursing education in In terms of international mobility, there are well-worn regional migration networks between southern India and the Gulf States and Organization for Economic Cooperation and Development (OECD)markets (Percot, 2016;George, 2005), together with international migration from northern India to North America, Europe, and Australia (Walton-Roberts, Bhutani, and Kaur, 2017). The UK has a long history of recruiting from India, and in the wake of the WHO voluntary code for ethical recruitment, India has remained a key source of recruitment because it 'has remained a disturbingly grey area so far, as a poor developing country with an apparently heaving mass of world-class employees' (Ahmed, 2001). ...
Mobilities of Labour and Capital in Asia - edited by Preet S. Aulakh January 2020
... This article engages with these calls, and examines the labour market experiences of 'skilled' migrants with nursing qualifications in Canada, focusing on the experiences of nurses from the Philippines and India. These two countries are among the top sources for care workers and nurses employed in OECD nations such as the U.S.A. (Squires, Ojemeni, andJones 2016), Canada (Walton-Roberts, Bhutani, andKaur 2017), and the UK (Baker 2018). While having skills suggests these nurse migrants may fare better than the majority of less-skilled domestic workers, more detailed examination suggests migrant nurses paradoxically experience occupational (im)mobility. ...
... Despite the challenges of this occupational migration system, young people in many lowerand middle-income nations have chosen health careers specifically because of the migration prospects they offer (Connell 2014;Walton-Roberts, Bhutani, and Kaur 2017). Their integration into global markets is a key site through which to understand how care labour is spliced into international markets based on systems of professional credential assessment. ...
... The intersection of care chains globally can be understood in light of formal policy frameworks as well as informal networks of recruitment. Care chains can be manifested locally or may be international or inter-regional in scope, for example the migration of health workers is increasingly operating as a form of export industry for both the Philippines and India (Rodriguez 2010;Walton-Roberts, Bhutani, and Kaur 2017). The systematic development of such export policies provided care workers from the Philippines for Canada's LCP program, which is the product of a highly formalised policy process that incorporates sending and receiving policy frameworks (Cabanda 2017). ...
The twenty-first century has witnessed a number of significant demographic and political shifts that have resulted in a care crisis. Addressing the deficit of care provision has led many nations to actively recruit migrant care labour, often under temporary forms of migration. The emergence of this phenomenon has resulted in a rich field of analysis using the lens of care, including the idea of the Global Care Chain. Revisions to this conceptualization have pushed for its extension beyond domestic workers in the home to include skilled workers in other institutional settings, particularly nurses in hospitals and long-term care settings. Reviewing relevant literature on migrant nurses, this article explores the labour market experiences of internationally educated nurses in Canada. The article reviews research on the barriers facing migrant nurses as they transfer their credentials to the Canadian context. Analysis of this literature suggests that internationally trained nurses experience a form of occupational (im)mobility, paradoxical, ambiguous and contingent processes that exploit global mobility, and results in the stratified incorporation of skilled migrant women into healthcare workplaces.
... Many nurses wish to travel and work abroad, and then return with knowledge and experience to share with their home country. Marriage prospects are also increased due to social status, as the modification of traditional dowry payment expectations now can include assets such as nursing qualifications (Walton-Roberts et al., 2017). Lessening cultural obligations and traditions give nursing a higher status professionally and support the attractiveness of nursing education for Indian women from all social collectives. ...
... Like that of the Philippines, a culture of migration is now evident in Indian nursing ambition, with many migrating to Aotearoa (Tsai, 2020;Walton-Roberts et al., 2017;WHO, 2017). The ...
Aotearoa New Zealand faces a workforce shortage of nurses nationally. One current approach to address the labour deficit is recruiting internationally qualified nurses (IQNs) into the workforce. Undertaking a competency assessment programme (CAP), entailing targeted study and clinical assessment, supports IQNs to meet Nursing Council of New Zealand requirements for nursing registration in Aotearoa. However, CAP providers offer the course with diverse approaches and there are no standardised curricula. Furthermore, to date, there is no empirical evidence on the utility of the CAP for IQNs regarding how well the programme meets its intended objectives from the perspective of the IQNs. This research aimed to identify the elements of the CAP that a specific cohort of IQNs found relevant and useful in their first two years of working as a registered nurse (RN) in Aotearoa. A secondary aim was to ascertain if, and how, the course was perceived to enhance their acculturation into the Aotearoa nursing profession.
A qualitative research method of focused ethnography framed the methodological approach. Semi-structured interviews occurred with purposive sampling of CAP graduated IQNs from the Philippines and India, representing the largest practising IQN groups nationally. Twelve participants—eight from the Philippines and four from India—with between 3 and 17 years working as RNs in Aotearoa, were recruited from the upper North Island of Aotearoa. Thematic analysis of the data resulted in two main themes describing the participants’ experiences on the CAP: 1. navigating new professional practice and 2. the need for language proficiency and positive social support. Sub-themes arising were unfamiliarity with new clinical areas and nursing roles, feeling deskilled, and misunderstanding the healthcare concepts of cultural safety and te Tiriti O Waitangi. In addition, communication barriers, with English not being a native language, Aotearoa accents and new professional terminology, significantly influenced their experiences. Finally, novel research findings were the participants’ new understandings of the symmetrical power balances between healthcare professionals in Aotearoa and recognition of the importance of the support gained from engaged and knowledgeable clinical preceptors.
This research found that the participants did not view their CAP experience as having a significant impact on learning new clinical skills, knowledge, or experience of their host country’s nursing workplace. Additionally, the curricula were not seen to have provided substantial educational and clinical experience benefits regarding the Aotearoa cultural context with the exception of specific cultural practices (Tikanga) and their application to nursing service provision for Māori. Recommendations from the research are for a comprehensive multiple stakeholder review of the current CAP curriculum, specifically regarding the clinical practice model used for recontextualising nursing practice and transitioning IQNs into the Aotearoa workforce, and the provision of targeted te Tiriti O Waitangi healthcare education: and the potential for new registration pathways in-keeping with recent global trends with a focus on key nursing knowledge examinations, and mandatory modules on Aotearoa cultural context. A further recommendation is – the inclusion of extended orientation periods and mandating a period of professional supervision for IQNs in the post-registration employment period.
... Regardless, the implementation of the Migrant Workers Act, and the Magna Carta of Women are impor- tant in helping to ensure responsible migration, and in offering equal access for women to training, resulting in the Philippines being ranked in the top 10 in terms of gender equity (World Economic Forum 2016). The relative success of nurse migrants in destination countries in comparison with domestic workers and healthcare assistants, their economic earning capacity, improved status, and increased mobility, freedom, and rights, has made nursing one of the most popular degrees in the Philippines; this is increasingly the case in India as well (Walton-Roberts, Bhutani, and Kaur 2017). ...
... Part of the explanation for this concern with quality and accessibility of nursing education emanates from the priva- tisation and commercialisation of nursing education in both countries (Hazarika 2013;Sengupta and Nundy 2005). In both countries educational institutions offering nursing degrees make explicit links between nursing and overseas employment (Hollup 2012(Hollup , 1296Masselink and Lee 2010;Walton-Roberts 2015), and research suggests that nursing has become an occupation that young Indians are attracted to because it offers opportunities for overseas, not domestic, employment (Walton-Roberts, Bhutani, and Kaur 2017). Private training institutes are keen to service, as well as encourage this demand ( Rao et al. 2011). ...
This paper examines nurse migration from India and the Philippines through the lens of the sustainable development goals (SDGs) 4.3 (access to training), 10.7 (orderly and responsible migration) and 3.c (retention of health workers). The international migration of health workers has increasingly featured on the agenda of global health agencies. Ameliorating the negative impact of international nurse emigration from low-income nations has been addressed by several western governments with the adoption of ethical recruitment guidelines, one element of an orderly migration framework. One of the challenges in creating such guidelines is to understand how the emigration of trained nurses influences health education and clinical training systems within nurse exporting nations such as India and the Philippines, and how these relate to various SDGs. This paper maps the connections between India’s and the Philippines’ increasing role in the provision of nurses for international markets and the SDGs related to training and migration governance and the retention of health workers. The paper calls for greater attention to the global structuring of migrant mobility in order to assess national abilities to meet SDG goals in these areas.
... Old colonial ties are relevant to the understanding of the choices and strategies adopted by migrant nurses in the present (Alonso-Garbayo and Maben 2009). In many Asian countries, nursing training paves the way to migration on a professional level, a valued alternative to the low-skilled domestic or care work usually associated with migrant women (Gaetano and Yeoh 2010;Walton-Roberts, Bhutani and Kaur 2017). 2 Thirdly, and relatedly, the analysis of migrant nurses offers insights into how gender, class and family relations are intertwined in contemporary migration flows. ...
The international mobility of nurses represents an important lens
through which to understand the socio-economic determinants and
effects of migration. This chapter focuses on the migration of
nurses from the southern Indian state of Kerala to Central Italy in
order to analyse the role of religious networks and institutions in
shaping the inflow of Malayali nurses into the healthcare sector. In
addition, the analysis highlights how religion and gender combine
to shape the racialization of migrant nurses as ‘suitable’ workers.The analysis unravels how religious
networks provide migrant nurses with educational and labour
opportunities, but they also act as guarantors of their respectability:
such networks are perceived in both Kerala and Italy as a source of
moral guidance and control over young women’s professional and
personal conduct. At the same time, nurses’ career possibilities are
strongly influenced and constrained by limited labour rights, and by
racialized and gendered notions of ‘good Christian care’.
... There is shortage of nurses worldwide. Globalization, demand-supply dynamics, asymmetrical development and improved connectivity with the better information flow, communication and decreased travel expenses have vitalized the international migration of nurses 5 . According to a survey, conducted by World Health Organization, it was revealed that 77% of developed nations are experiencing shortage of nurses and nearly all these countries are relying in abroad trained nurses to ease the situation 6 . ...
There is no doubt that consequences of health workforce migration are serious for any developing country. The world's largest health care migrating population is from India. India has a population of 1.38 billion, about 17.7% of the world’s population and we, as a nation, are struggling to prepare future-ready health care professionals and our own health professionals’ needs are not met. However, large numbers of Indian nurses migrate to developed countries due to numerous factors. Economic factors are consid- ered main force for migration, but not always purely responsible, as nurses look for safety, security, re- spect, and dignity of their profession. This scoping review is employed to find causes, consequences, and strategies related to international migration of Indian Nurses.
Key words: Migration, Nurses’ migration, Indian nurses, Migrant nurses, Global migration
Indian nurses coming to the U.S. on H‐1B visas that tie them to employers are often the breadwinner for spouses and other family members on dependant visas, where the dependant spouses do not have the ability to work due to visa regulations, thus upsetting complex gender dynamics in the household. In this paper, we investigate how Indian immigrant nurses in the U.S. navigate their status as the primary migrant and, family breadwinner with the incessant feminizing discourse of immigrant nurses as selfless healers. The paper is based on in‐depth interviews with 30 Indian migrant nurses and their husbands, 10 immigration experts such as lawyers, legislators and activists, 3 years of ethnography in nursing conferences that Indian nurses in the U.S. attended, and in the homes and churches that the nurses and their families attended. Using the construct of “the caring self” our analysis shows that the nurses are continuously subjected to the discourse of nursing work as healing work in formal and informal contexts such as, by recruitment agencies, at nursing conferences, by superiors and peers at work, in their churches and at home. The internalization of the discourse of immigrant nurses as healers often prevent the nurses from processing and verbalizing their gendered and racialized experiences at work, demands of caregiving at home and the community at large. Nursing work as healing work becomes their path toward making of the caring self in the new country. As such, we argue that immigrant nurses operate in a “migrant care work regime” which is bolstered by the intersections of migration policies and a feminized and racialized discourse of migrant nursing work, creating the trope of the constant care worker that shapes the material realities of nurses as immigrant women care workers in the U.S.
In the context of dominant patriarchal gender roles, the discourse on domestic violence in (heterosexual) families directs attention to women’s experience of abuse from their male partners. Introducing international migration in this equation, however, complicates the discourse. Focusing on immigrants who live with a degree of precarity (undocumented immigrant families, dependents, and immigrant families on temporary legal statuses), I argue that a more expansive and nuanced meaning of violence should be applied to immigrant domestic strife because the contexts in which international migration occurs has the potential to inflict harm on all members of the family, including men. The central argument is supported with ethnographic material and semi-structured interviews conducted with immigrant Sikh families in the United States and Punjab, India, analysis of news reports on abandoned Sikh husbands and wives as well as secondary literature. An integral part of the analysis involves reflection on the meaning of family violence in the context of international migration.
Background
Given India’s high patient load on the existing healthcare setup, as well as political, social, and organizational challenges, the nursing sector is facing various problems, therefore leading to substandard nursing experiences leading to poor patient care at the parallel healthcare setups, specifically homecare. This paper presents self-managed organizations (also referred to as horizontal management structures) as an effective alternative to existing hierarchical management structures overladen with bureaucracy. Therefore, we are exploring the strategies at self-managed homecare organizations that can make nursing a better and meaningful experience.
Method
This research paper employs semi-structured interviews to explore the strategies that help create a better nursing experience in horizontal organizational structures. The interviews focused on various aspects, including finances, organizational structure, value system, information flow, concept, and purpose of self-managed homecare organizations that might influence the nursing experience. Theoretical sampling was used to include seven nurses, fifteen patients and twelve management members to examine the nursing experience at self-managed homecare organizations.
Results
The themes and subthemes revealed what we term the Qualitative Success Enablers (QSEs) of self-managed organizations in the Indian setting emerged from thematic analysis of data. The reflexive thematic analysis yielded three themes: Insightfulness, Enhancing Nursing Experience through Job Enrichment, and Autonomy-Enabled Intrapreneurship. The findings indicate that the horizontal management structure represented by the studied organization in India has shown considerable success in times laden with uncertainties during the COVID-19 pandemic, especially during the delta wave, which revealed the frailty of existing healthcare infrastructure. The organization successfully maintained a better nursing experience and gained patient and employee satisfaction, as revealed by in-depth semi-structured interviews and their analysis.
Conclusion
In a world of unique challenges, we stand on the brink of significant transformations. Self-managed organizations (SMOs) are vital in India's homecare sector for enhancing nursing experiences and overall organizational performance. Fostering a trust-based environment within SMOs is integral to delivering effective services. The autonomy to design nursing jobs, insightfulness, and innovativeness in the nursing job through suitable training activities, various job enrichment methods, and finding meaningfulness in a job through softer aspects of caregiving result in enhanced nursing experience at SMOs.
International skilled heath worker migration is a key feature of the global economy, a major contributor to socio-economic development and reflective of the transnationalization of health and elder care that is underway in most OECD nations. The distribution of care and health workforce planning has previously been analysed solely within national contexts, but increasingly scholars have shown how care deficits are being addressed through transnational responses. This Element examines the complex processes that feed health worker migrants into global circulation, the losses and gains associated with such mobility and examples of good practices, where migrants, sending and destination communities experience the best possible outcomes. It will approach this issue through the lens of problems, and solutions, making connections across the micro, meso and macro within and across the sections.
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.
Migration industries include a diverse array of migration-related services provided by the state, commercial agents, humanitarian organisations and migrant social networks. The work performed by this array of providers, both non-state and state actors, includes facilitating, filtering/channelling and constraining migration. As a powerful example of how migration industries work in general, we examine their dynamics in the care sector as part of glocal (care) chains involved in the migration of nurses. The article provides a conceptualisation of the role of the ‘migration industry’ as part of a changing global business in the field of care work. We direct our attention to the drivers and institutions that facilitate and shape the arrangements of international care mobility and the constitution of glocal urban assemblages. Drawing on three models of nurse migration – bus stop (Philippines–Singapore), two-step (India–Canada) and triple-win (Vietnam–Germany) – we show how the socio-spatial configurations of glocal urban assemblages linked to the three models yield different social integration outcomes for migrant nurses.
This chapter reviews the contemporary geographical study of health care work. Initially it examines key ‘on the ground’ transformations in health and health care which are fundamentally geographical in their making, form and consequences; transformations which have demanded a geographical research perspective be taken as well-aligned vantage point with which to report and understand them. These include increasing spatial diffusion of health professionals and roles; the transition of health care settings; the role of technologies in overcoming spatial limitations; the increasing emphasis on community and the social model of health; the embeddedness of geographical scales and concepts in policy and administration, and the globalization of work roles and responsibilities. The chapter then moves on to examine how a number of academic developments—including in medical/health geography—have at the same time coalesced to provide an additional set of motivations and opportunities for geographical scholarship on health care work. Finally, it describes the main theoretical traditions and approaches which have constituted ‘geographies of health care work’ as a current multidisciplinary academic enterprise and field—including spatial science, political economy, social constructionist/humanist, and most recently non-representational theory, providing examples of recent empirical research which has been framed by each.
Market-based migrant intermediaries play an important role in
skilled migration. Skilled workers, especially in regulated
professions such as nursing, face increasingly complex testing and
credential assessment systems. ‘Regimes of skill’ control and filter
membership to these professions by reproducing already existing
power imbalances in the global regulation of skilled labour. This
paper examines these processes in the case of Indian trained
nurses who use educational brokers to enrol in Canadian postgraduate
programmes with the intention of practising in the
Canadian health care system. The study elaborates on the ‘regime
of skill’ in nursing, revealing its maintenance through interactional
and transnational connections between intermediaries, educators
and regulators in terms of codifying and translating skills and
competencies between jurisdictions with different cultural and
professional histories and norms of nursing. Findings reveal that
intermediaries operate transnationally in a symbiotic manner with
more powerful actors in order to exploit regimes of skill and
expand their market share.
India’s governmental regulation of emigration and the emergence of the country’s migration industry have both been largely guided by the facilitation of low-skilled outmigration. Taking the rapidly growing migration of nursing professionals from India as a point of departure, this chapter seeks to understand the way the Indian state’s concerns and interests entangle with that of an emerging migration industry in significant ways. Recounting in detail a case of migration fraud, it argues that there is a dialectic relationship between the character and functioning of the migration industry and state policy.
The connection between international education and immigration has drawn the attention of scholars interested in exploring how immigrants strategically use international education as a means to facilitate their migration projects, including their successful integration in their chosen countries of migration. My article contributes to this literature by focusing on the experiences of foreign nurses who enter Canada as international students enrolled in vocational nursing programs, subsequently transition to temporary work permits, and from there to permanent residence. I analyze the classed implications of this mode of entry, contrasting it with another popular form of temporary entrance: temporary foreign work programs. Vocational nursing education, as undertaken by these nurses, is the gateway through which they enter Canada, and the courses offering such education are deemed “worth” costly tuition fees only insofar as they provide a sound stepping stone to the next phase of migration. In this scenario, the connection between international education and immigration has become articulated to such a degree that vocational nursing education, having lost its original significance, is reframed as convenient “drive-by” for immigration, something to be gotten over in a quick and cursory manner, albeit offering significant benefits in terms of residence rights not available to temporary workers in other immigration categories. At the same time, the influx of foreign nurses is revitalizing vocational programs and contributing to the development of the region.
Based on our survey conducted in Tamil Nadu, this paper analyses the characteristics of Indian migrant nurses and the factors influencing their migration. India is considered the second largest exporter of nurses after the Philippines. Many Indian nurses have migrated to work in OECD countries, the Gulf countries and some ASEAN countries. While Indian nurses are migrating overseas to fill shortages at their destinations, India has itself been suffering from an acute scarcity of nurses since its independence in 1947. Therefore, the large scale of nurse migration is a serious threat to the Indian healthcare system. The results of the survey imply that international migration by nurses can be explained in part by the gap between the private sector and the public sector in terms of salary and working environment. Since the impact of social status on the migration decisions of nurses has lessened, economic factors are the crucial determinant of international migration of nurses. Policy intervention in this area is the necessary first step to solving this long-standing problem. The priority in any policies formulated should be given to nurses working in the private sector whose salaries are considerably lower than those in the public sector and whose voices are unheard.
This study was aimed to explore the perception of outgoing nursing students towards nursing profession and perceived future job orientation. Sample of 530 outgoing GNM, B. Sc. (N) and Post Basic B Sc Nursing students was recruited through proportionate stratified random sampling from conveniently selected twelve nursing colleges of Punjab State. Semi-structured questionnaire was administered to collect data. Findings revealed that majority of the students (83.2%) were self motivated to join nursing. Majority (99.1%) of the students, perceived nursing profession as an opportunity to serve humanity and a way to get due recognition in the society (69.6%). Two third of (69.4%) the nursing student perceived their profession as dignified and respectful as well as a way to get due recognition in society (69.6%). There was almost equal percent of the students who planned to join teaching (46.4%) and bed side nursing (45.5%) after completion of course. A vast majority (93.4%) of the students were not interested to change their profession. Male students were significantly more interested in bed side nursing as compared to female students (p=0.04). More than half of the urban students (52.5%) were interested to join teaching followed by bed side nursing (39.5%); on contrary, the rural students were predominantly interested to join bed side nursing (50%) followed by 41.8% teaching job (p=0.039). The present study concluded that the perception of nursing profession among nursing students is changing towards positive side and majority of the students perceived that nursing is a profession with bright prospects and it provides due recognition in society.
The global race for skilled immigrants seeks to attract the best global workers. In the pursuit of these individuals, governments may incidentally discriminate on gender grounds. Existing gendered differences in the global labour market related to life course trajectories, pay gaps and gendered divisions in occupational specialisation are also present in skilled immigration selection policies. Presenting the first book-length account of the global race for talent from a gender perspective, Gender, migration and the global race for talent will be read by graduate students, researchers, policy-makers and practitioners in the fields of immigration studies, political science, public policy, sociology and gender studies, and Australian and Canadian studies.
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.
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.
Provide an up-to-date national picture of the medical, midwifery and nursing workforce distribution in Australia with a focus on overseas immigration and on production sustainability challenges.
Using 2006 and 2011 Australian census data, analysis was conducted on medical practitioners (doctors) and on midwifery and nursing professionals.
Of the 70,231 medical practitioners in Australia in 2011, 32,919 (47.3 %) were Australian- born, with the next largest groups bring born in South Asia and Southeast Asia. In 2006, 51.9 % of medical practitioners were born in Australia. Of the 239,924 midwifery and nursing professionals in Australia, 127,911 (66.8 %) were born in Australia, with the next largest groups being born in the United Kingdom and Ireland and in Southeast Asia. In 2006, 69.8 % of midwifery and nursing professionals were born in Australia. Western Australia has the highest percentage of foreign-born health workers. There is a higher percentage of Australia-born health workers in rural areas than in urban areas (82 % of midwifery and nursing professional in rural areas are Australian-born versus 59 % in urban areas). Of the 15,168 additional medical practitioners in Australia between the 2006 and 2011 censuses, 10,452 (68.9 %) were foreign-born, including large increases from such countries as India, Nepal, Philippines, and Zimbabwe. We estimate that Australia has saved US$1.7 billion in medical education costs through the arrival of foreign-born medical practitioners over the past five years.
The Australian health system is increasingly reliant on foreign-born health workers. This raises questions of medical education sustainability in Australia and on Australia's recruitment from countries facing critical shortages of health workers.
Purpose
To describe the demands of immigration of Indian nurses who immigrated to the United States, and to compare the demands of immigration of Indian nurses who immigrated less than 3 years ago to those who immigrated 3 or more years ago.
Methods
A comparative descriptive design was used to examine the Demands of Immigration (DI) total and subscale scores of Indian nurses (n = 105) who immigrated to the United States between 1985 and 2005, who were categorized into two groups: those who immigrated less than 3 years ago (n = 44) and those who immigrated 3 or more years ago (n = 61). The DI total score and subscale scores (loss, novelty, occupation, discrimination, language and not feeling at home) are reported. Study findings are related to previous research on immigration of women and nurses. Recommendations for future research are included.
Results
There was a significant difference between groups in total DI scores and language and novelty subscale scores.
Conclusion
Additional research in these areas could help to assess the demands of immigration of Indian nurses and immigrant nurses from other countries.
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.
Background
India faces an acute shortage of nurses. Strategies to tackle the human resource crisis depend upon scaling up nursing education provision in a context where the social status and working conditions of nurses are highly variable. Several national and regional situation assessments have revealed significant concerns about educational governance, institutional and educator capacity, quality and standards. Improving educational capacity through nursing faculty development has been proposed as one of several strategies to address a complex health human resource situation. This paper describes and critically reflects upon the experience of one such faculty development programme in the state of Andhra Pradesh.
Discussion
The faculty development programme involved a 2 year partnership between a UK university and 7 universities in Andhra Pradesh. It adopted a participatory approach and covered training and support in 4 areas: teaching, research/scholarship, leadership/management and clinical education. Senior hospital nurses were also invited to participate.
Summary
The programme was evaluated positively and some changes to educational practice were reported. However, several obstacles to wider change were identified. At the programme level, there was a need for more intensive individual and institutional mentorship as well as involvement of Indian Centres of Excellence in Nursing to provide local (as well as international) expertise. At the organisational level, the participating Colleges reported heavy workloads, lack of control over working conditions, lack of control over the curriculum and poor infra-structure/resources as ongoing challenges. In the absence of wider educational reform in nursing and government commitment to the profession, faculty development programmes alone will have limited impact.
Nursing care has been mentioned in the Indian culture from the times of the Vedas. However, according to World Health Organization, the nursing workforce in India is still insufficient to meet the needs of the country. The purpose of this article is to examine the status of nursing education and the nursing workforce in India and the challenges faced by the profession. Data supporting the statements made in the article were obtained from the Nursing Council of India, the Ministry of Health and Family Welfare, the Government of India Web sites, printed journals and communication with experts in the field. In India, there is a need to train approximately a million nurses to meet the current shortfall of health workers in the country. The nursing "brain drain" suggests that it may be one of the factors responsible for this shortfall. Further, nursing education faces challenges, such as streamlining nursing education, enriching the curriculum, strengthening faculty development and increasing the use of innovative teaching and learning techniques.
When in the middle of the seventies, Indian nurses started to be hired for newly built hospitals in the Gulf, it was an unexpected opportunity for the most adventurous of them to ensure unexpected good wages. One generation later, thousands of young girls, predominantly Christians from Kerala, fill up the nursing schools all over India with the intention of migrating after graduation. Hence the nursing diploma is obviously considered as a passport opening the world not only to the nurse herself, but also to her relatives. Families encourage this female migration since it is very consciously regarded as a privileged opportunity to increase social mobility.The migration opportunity has consequently changed the status of nurses, which used to be rather low in India. It has also been a chance for the young nurses to set up life strategies, based on the experience of the older migrants. Migration to the Gulf is now considered as an intermediate step before further migration to the West, the new open line. For the young nurses, migration doesn't only mean a better status and a better economical situation, it is moreover a way to get more autonomy or agency, as women, than they can get in their own country.
In response to recent findings regarding migration of health workers out of Africa, we provide data from a survey of Indian nurses suggesting that up to one fifth of the nursing labour force may be lost to wealthier countries through circular migration.
Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management.
Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (USAID). The VLDP is a Web-based leadership development programme that combines face-to-face and distance-learning methodologies to strengthen the capacity of teams to identify and address health challenges and produce results.
The USAID-funded Leadership, Management and Sustainability (LMS) Program, implemented by MSH, and the USAID-funded Capacity Project, implemented by IntraHealth, adapted the VLDP for HR managers to help them identify and address HR challenges that ministries of health, other public-sector organizations and nongovernmental organizations are facing. LOCAL SETTINGS: Three examples illustrate the results of the VLDP for teams of HR managers: 1. the Uganda Protestant and Catholic Medical Bureaus 2. the Christian Health Association of Malawi 3. the Developing Human Resources for Health Project in Uganda.
The VLDP is an effective programme for developing the management and leadership capacity of HR managers in health.
Appropriately Indian is an ethnographic analysis of the class of information technology professionals at the symbolic helm of globalizing India. Comprising a small but prestigious segment of India’s labor force, these transnational knowledge workers dominate the country’s economic and cultural scene, as do their notions of what it means to be Indian. Drawing on the stories of Indian professionals in Mumbai, Bangalore, Silicon Valley, and South Africa, Smitha Radhakrishnan explains how these high-tech workers create a “global Indianness” by transforming the diversity of Indian cultural practices into a generic, mobile set of “Indian” norms. Female information technology professionals are particularly influential. By reconfiguring notions of respectable femininity and the “good” Indian family, they are reshaping ideas about what it means to be Indian.
Radhakrishnan explains how this transnational class creates an Indian culture that is self-consciously distinct from Western culture, yet compatible with Western cosmopolitan lifestyles. She describes the material and symbolic privileges that accrue to India’s high-tech workers, who often claim ordinary middle-class backgrounds, but are overwhelmingly urban and upper caste. They are also distinctly apolitical and individualistic. Members of this elite class practice a decontextualized version of Hinduism, and they absorb the ideas and values that circulate through both Indian and non-Indian multinational corporations. Ultimately, though, global Indianness is rooted and configured in the gendered sphere of home and family.
In this rich interdisciplinary study, Sujani Reddy examines the consequential lives of Indian nurses whose careers have unfolded in the contexts of empire, migration, familial relations, race, and gender. As Reddy shows, the nursing profession developed in India against a complex backdrop of British and U.S. imperialism. After World War II, facing limited vocational options at home, a growing number of female nurses migrated from India to the United States during the Cold War. Complicating the long-held view of Indian women as passive participants in the movement of skilled labor in this period, Reddy demonstrates how these “women in the lead” pursued new opportunities afforded by their mobility. At the same time, Indian nurses also confronted stigmas based on the nature of their “women’s work," the religious and caste differences within the migrant community, and the racial and gender hierarchies of the United States. Drawing on extensive archival research and compelling life-history interviews, Reddy redraws the map of gender and labor history, suggesting how powerful global forces have played out in the personal and working lives of professional Indian women. © 2015 The University of North Carolina Press. All rights reserved.
In the paper, we are looking at the relationship between globalisation and the professional project, using nursing in Kerala as an exemplar. Our focus is on the intersection of the professional project, gender and globalisation processes. Included in our analysis are the ways in which gender affects the professional project in the global south, and the development of a professional project which it is closely tied to global markets and global migration, revealing the political-economic, historical, and cultural factors that influence the shape and consequences of nurse migration.
This chapter introduces readers to the general contours of Indian nurse immigration as well as the long histories connecting Indian nursing labor and U.S. imperial interests on the subcontinent and within the confines of its own national boundaries. By doing so, it complicates transnational or nation-state bound frameworks for analyzing this immigration pattern. At the same time, it highlights the tension between productive and reproductive labor as these play out amongst women workers performing a historically gendered form of "woman's work." The chapter also specifically complicates the ways in which readers can think of Cold War Indian labor immigration to the United States as indicative of either a "postcolonial" or "post-civil rights" historical turn. Finally, this piece introduces readers to Reddy's interdisciplinary methods and source materials.
Social Change in India shows the shift of focus that occurred during Florence Nightingale's more than forty years of work on public health in India. While the focus in the preceding volume, Health in India, was top-down reform, notably in the Royal Commission on the Sanitary State of the Army in India, this book documents concrete proposals for self-government, especially at the municipal level, and the encouragement of leading Indian nationals themselves. Famine and related epidemics continue to be issues, demonstrating the need for public works like irrigation and for greater self-help measures like "health missioners" and self-government. The book includes sections on village and town sanitation, the condition and status of women, land tenure, rent reform, and education and political evolution toward self-rule. Nightingale's publications on these subjects appeared increasingly in Indian journals. Correspondence shows Nightingale continuing to work behind the scenes, pressing viceroys, governors, and Cabinet ministers to take up the cause of sanitary reform. Her collaboration with Lord Ripon, viceroy 1880-84, was crucial, for he was a great promoter of Indian self-government. Social Change in India features much new material, including a substantial number of long-missing letters to Lady Dufferin, wife of the viceroy 1884-88, on the provision of medical care for women in India, health education, and the promotion of women doctors. Biographical sketches of major collaborators, a glossary of Indian terms, and a list of Indian place names are also provided. Currently, Volumes 1 to 11 are available in e-book version by subscription or from university and college libraries through the following vendors: Canadian Electronic Library, Ebrary, MyiLibrary, and Netlibrary.
The global race for skilled immigrants seeks to attract the best global workers. In the pursuit of these individuals, governments may incidentally discriminate on gender grounds. Existing gendered differences in the global labour market related to life course trajectories, pay gaps and gendered divisions in occupational specialisation are also present in skilled immigration selection policies. Presenting the first book-length account of the global race for talent from a gender perspective, Gender, migration and the global race for talent will be read by graduate students, researchers, policy-makers and practitioners in the fields of immigration studies, political science, public policy, sociology and gender studies, and Australian and Canadian studies.
BackgroundA profound nursing shortage exists in India. Increasingly nursing students in India are opting to migrate to practise nursing abroad upon graduation. Perceptions and attitudes about nursing are shaped during student experiences.PurposeThe purpose in conducting this research was to illuminate student nurses' perceived challenges of nursing in India.Setting and SampleThis study took place at a hospital-based, private mission non-profit school of nursing in Bengaluru, India. Purposive sampling of nursing students yielded 14 participants.Methods
Photovoice, a qualitative participatory action research methodology, was used. Data were collected between August 2013 and January 2014. A strong international collaboration between researchers resulted in qualitative thematic interpretation of photographs, critical group dialogue transcripts, individual journal entries and detailed field notes.ResultsTwo main themes were identified including the perceived challenges of a hierarchal system and challenges related to limited nursing workforce capacity. Subcategories of a hierarchal system included challenges related to image, safety, salary and balance. Subcategories of limited workforce capacity were migration, work overload, physical demand, incongruence between theory and practice, and knowledge.DiscussionNursing as a profession in India is still in its infancy when measured against standard criteria.Implications for Health PolicyChange in health policy is needed to improve salary, safety for nurses, and nurse to patient ratios to address hierarchal and workforce capacity challenges in India.
Migration of health workers from relatively poor countries has been sustained for more than half a century. The rationale for migration has been linked to numerous factors relating to the economies and health systems of source and destination countries. The contemporary migration of health workers is also embedded in a longstanding and intensifying culture of migration, centred on the livelihoods of extended households, and a medical culture that is oriented to superior technology and advanced skills. This dual culture is particularly evident in small island states in the Pacific, but is apparent in other significant migrant source countries in the Caribbean, Sub-Saharan Africa and Asia. Family expectations of the benefits of migration indicate that regulating the migration and attrition of health workers necessitates more complex policies beyond those evident within health care systems alone.
With a subtle yet penetrating understanding of the intricate interplay of gender, race, and class, Sheba George examines an unusual immigration pattern to analyze what happens when women who migrate before men become the breadwinners in the family. Focusing on a group of female nurses who moved from India to the United States before their husbands, she shows that this story of economic mobility and professional achievement conceals underlying conditions of upheaval not only in the families and immigrant community but also in the sending community in India. This richly textured and impeccably researched study deftly illustrates the complex reconfigurations of gender and class relations concealed behind a quintessential American success story. When Women Come First explains how men who lost social status in the immigration process attempted to reclaim ground by creating new roles for themselves in their church. Ironically, they were stigmatized by other upper class immigrants as men who needed to "play in the church" because the "nurses were the bosses" in their homes. At the same time, the nurses were stigmatized as lower class, sexually loose women with too much independence. George's absorbing story of how these women and men negotiate this complicated network provides a groundbreaking perspective on the shifting interactions of two nations and two cultures.
Foreign-educated and foreign-born health workers constitute a sizable and important portion of the US health care workforce. We review the distribution of these workers and their countries of origin, and we summarize the literature concerning their contributions to US health care. We also report on these workers' experiences in the United States and the impact their migration has on their home countries. Finally, we present policy strategies to increase the benefits of health care worker migration to the United States while mitigating its negative effects on the workers' home countries. These strategies include attracting more people with legal permanent residency status into the health workforce, reimbursing home countries for the cost of educating health workers who subsequently migrate to the United States, improving policies to facilitate the entry of direct care workers into the country, advancing efforts to promote and monitor ethical migration and recruitment practices, and encouraging the implementation of programs by US employers to improve the experience of immigrating health workers.
While the employment of migrant women as care workers in European welfare states is increasing, the rate, extent and nature of this increase vary. The article draws on empirical research on migrant care work to develop links between three levels of analysis – micro, meso and macro. The main aim is to progress analysis of the meso level by developing indicators attached to three sets of regimes – care regimes, migration regimes and employment regimes. It is argued that variations emerge in the ways these three regimes intersect within any one country. These intersections allow us to look across different sites, markets and sectors of care work and, in so doing, reveal a degree of growing convergence across Europe in the employment of migrant care labour. This convergence contributes, at the macro level, to a transnational political economy of care.
Gendered values, norms and preferences shape the intrinsic motivation to provide care for others. This article situates an analysis of this motivation within the broader literature on gender inequality, explaining why it has costly consequences for women in both the home and the labour market, even as it provides considerable personal satisfaction and social benefit. Further movement towards gender equality may depend on the success of political and cultural efforts to ‘de‐gender’ normative obligations to care.
There has been a parametric increase in the scale and complexity of global international migration in the last fifteen years. Asia has been prominent in this change with countries in the region being important sources and destinations of migrants. This paper summarises the main developments which are occurring in south-north migration, student migration, forced migration, north-north migration and international labour migration. In the transformation of international population movement in the region a most striking feature is the strong pattern of circularity in movement and the networks which are established between origin and destination. It is argued that several global changes have been instrumental in these changes. These include the three ‘Ds’: demography, development and democracy. It is shown that increasing gradients of difference between nations in the pattern of growth (or lack of it), in the workforce, in income and poverty levels and in patterns of governance, have been important drivers of the migration. Moreover they are likely to increase in their impact over the next two decades. In addition, the impact of global environmental change on migration is considered, as are the effects of proliferating social networks and the global migration industry.
Over the last 50 years, the volume and significance of international migration has grown rapidly. Every region of the world, and most of the states within them, are now countries of immigration or emigration-and some-timesboth. This article examines international migration trends since the Second World War and reviews UNESCO programme activities. In view of the social, economic, cultural and human rights aspects of migration, the Organizationhas focused considerable efforts on its two distinct but related components: internal and international. The social, cultural, educational and occupational problems specific to women migrants-a theme which, in the 1980s, took on increasing importance and independence as reflected in a number of UNESCOmeetings and publications-is reviewed at some length. The complexity of recent migration flows, emerging issues and the need to provide viable policy responses has led UNESCO to develop new methods of research and support for policy formulation by establishing regional migration research networks.
PIP
This article reviews the situation of labor migrants from Kerala state, India, who were 40-60% of all contract workers in the Middle East and who returned after the mid-1980s. Descriptions are provided of the characteristics of return migrants, the Kerala economy, return migration policies, and impact studies of returnees. About 500,000 returned to Kerala. Returnees were middle aged, with low levels of education, skills, and experience. About 50% of returnees remained unemployed. The other 50% either retired or sought self-employment or other wage labor. Surveys conducted in 1985, 1987, 1993-93, and 1997 reveal that returnees peaked during the 1990s. By 1997, returnees to the Kadinamkulam panchayat included about one-sixth who were women. Most returnees had worked in Saudi Arabia, United Arab Emirates, and Kuwait. The reasons for return were poor working and living conditions, lack of opportunity or contract for staying longer, or forced repatriation. Upon return, 50% of the women and about 16% of the men remained unemployed. Return wages were about the same as before the migration. Returnees complained about the lack of support from government and society. Impact studies do not differentiate migration effects from development effects in general. Evaluation should focus on multidimensional impacts and individual attainment of emigration goals.
Abstract In this article I explore marriage as a strategy of family migration among a transnational community of middle-class Jat Sikhs. Family reunification and status aspirations are examined as central concerns of the transnational movement of Jat Sikhs from India to Canada. It is argued that Jat Sikh transnationalism and gender are mutually-constitutive: migration strategies can construct women, as well as men, as agents of marital citizenship, and in facilitating migration, transnational marriage may transform practices and notions of gender and status. The article is based on preliminary ethnographic research among Jat Sikh brides in Toronto and Vancouver, and forms part of a larger study of gender, modernity and identity in Indo-Canadian Jat Sikh marriages.
Low fertility and ageing in high-income countries will greatly increase their demands for aged care workers which are unlikely to be met from within internal labour markets. It is likely that immigration will be increasingly used to meet these labour needs. This paper analyses the situation in Australia where the number of aged care workers needed will triple over the next quarter of a century. It is shown that most such workers do not qualify for immigration under the existing skill-driven regime. It is argued that careful consideration needs to be given to the development of a circular migration programme to partially meet these needs. Such a scheme would involve a conceptual leap by the Australian government, but there is sufficient time to develop and test a best-practice model for such migration. This could potentially deliver a ‘triple bottom line’ not only to meet Australia's needs, but also protect the rights of and ensure benefits to the migrant workers, and assist development in home nations. Copyright © 2009 John Wiley & Sons, Ltd.
Modern nursing is complex, ever changing, and multi focused. Since the time of Florence Nightingale, however, the goal of nursing has remained unchanged, namely to provide a safe and caring environment that promotes patient health and well being. Effective use of an interpersonal tool, such as advocacy, enhances the care-giving environment. Nightingale used advocacy early and often in the development of modern nursing. By reading her many letters and publications that have survived, it is possible to identify her professional goals and techniques. Specifically, Nightingale valued egalitarian human rights and developed leadership principles and practices that provide useful advocacy techniques for nurses practicing in the 21st century. In this article we will review the accomplishments of Florence Nightingale, discuss advocacy in nursing and show how Nightingale used advocacy through promoting both egalitarian human rights and leadership activities. We will conclude by exploring how Nightingale's advocacy is as relevant for the 21st century as it was for the 19th century.
This joint paper attempts an unusual collaborative approach that offers an understanding of the problems that registered nurses of India have faced. Through this paper, the problem of ‘social status’ in both historical and contemporary landscapes, representing a relatively rare attempt to bridge the gap between studies of the institutions of colonial society, and studies of the current fortunes of their post-colonial inheritors are located. [CWDS].
In most countries of the world there is a shortage of nurses but nowhere is it so acute as in the developing world. With International Nursing Day on 12 May 2010, Kathryn Senior investigates.
This major work combines theoretical innovation with systematic empirical substance to explore the contours and dynamics of a major global social phenomenon - the globalization of reproductive labour. Grounded in careful historical analysis, the book offers important insights into key actors in contemporary globalization processes: migrant care workers. Expanding the traditional focus on domestic workers, the book presents a significant analysis of the international migration of professional nurses and religious care workers and the part they play in forging the 'new' global reproductive economy. Covering a range of countries in Europe, Asia, the Middle East, Africa and the Americas, this innovative inter-disciplinary analysis of a major global phenomenon of our time is an essential reference for scholars of migration, globalization and gender.
Health care services represent one of the most rapidly growing sectors in the world economy. Today's health sector labor market and workforce are international, fast becoming global. Migration on a massive scale offers countless business opportunities, not only for the private sector but also for the public sector. The migration pathway is often filled with a significant number of obligatory stops. Many people and circumstances along the way will either facilitate or prevent progress. There will be a need for certain services and a series of goods to complete the migration. These will be provided by a wide range of agencies, institutions, entrepreneurs, regulatory bodies, and businesses. This article looks at the current global workforce and explores the commercialization or the business of nurse migration and its impact.
This article addresses two dimensions of the complex interrelationship between the family and international labor migration in Indonesia: the role of the family in influencing labor movements out of Indonesia; and the consequences of this movement on family well-being, structure, and functioning. Research on this topic in Indonesia is highly limited due mainly to the recency of large scale international labor migration, inadequate data collection systems, a high incidence of undocumented migration, and failure of available research to be sensitive to family related issues. Against a rapidly changing economic and social situation, two major overlapping systems of migration have developed. The official system is focused strongly on the Middle East (although other Asian destinations are increasing in significance) and is dominated by female migrants. The undocumented system is much larger in volume, is focused upon Malaysia, involves more males than females, and is becoming permanent in some cases. The role, status, and experiences of women migrants in relation to their families (decision making, networks, remittances) are discussed with recommendations for other areas needing further research attention.
This paper "summarises some of the major changes which have occurred in international migration to, from, and within Asia in the last two decades....A number of theoretical challenges are put forward regarding the complex interrelationships between international population movements, economic development and social change. The employment of systems approaches, neoclassical economic theory, social networks and institutional approaches, and the potential role of population geography in developing a more comprehensive explanation of the changing dynamics of international migration in the region, are discussed. Also considered are the gender dimension in migration, remittance flows and their consequences, and policy issues."