Enhancement of Nurse Migration and Nurse Shortages Solution among G20 Countries

To explore push, pull and retention factors affecting indonesian nurses decision to stay in the nursing profession. Identifying influencing factors that determine Indonesian nurses' decisions to remain working in Indonesia gives a better understanding of nurses' migration and therefore are necessry to explore. Studies examining nurse migration's push and pull factors have been carried out extensively. A study exploring factors that make nurses stay in their home countries, such as Indonesia needs to be conducted to provide different insights for related parties. A qualitative descriptive study was conducted with 52 managers and 181 nurses from hospitals and community health centres across four different regions in Indonesia, including DKI Jakarta, Lampung, South Kalimantan and West Nusa Tenggara. A purposive sampling method was used. The data were collected online (via Zoom) and offline through semi-structured interviews and focus group discussions. A content analysis was performed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed. Five categories were developed: non-financial support, sense of togetherness, following the husband, social image and powerlessness. Socio-cultural factors influence Indonesian nurses to stay working in their country despite their economic and career development difficulties. Socio-cultural circumstances have become powerful factors affecting Indonesian nurses to stay working in Indonesia. There is a need for harmonisation of policies related to nursing migration between recipient and source countries. Moreover, policies should go beyond education, competency and credentialing regulations and include addressing social costs and needs, such as the possibility of migrating nurses' families to the recipient countries.

The faculty shortage in nursing: Global implications

Migration of Lebanese nurses: A questionnaire survey and secondary data analysis

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.

BackgroundThis paper presents data on the remittances sent by migrant nurses to their families "back home". It gives voice to the experiences of migrant nurses and illustrates the financial obligations they maintain while working overseas. Although the international economic recession has decreased global remittance flows, they remain resilient. Drawing on the experiences of migrant nurses in Ireland, this paper indicates how and why migrants strive to maintain remittance flows, even in an economic downturn.MethodsA mixed-methods approach was employed, and the paper draws on data from qualitative in-depth interviews undertaken with 21 migrant nurses in addition to a quantitative survey of 336 migrant nurses in Ireland.ResultsThe survey of migrant nurses revealed that 87% (293) of the sample sent remittances on a regular basis. According to respondents, remittances made a huge difference in the lives of their family members back home. Remittances were used to ensure that family members could obtain access to health and education services. They were also used to provide an income source for family members who were unemployed or retired.As remittances played an essential role in supporting family members back home, respondent migrant nurses were reluctant to reduce the level of their remittances, despite the onset of a global recession. Respondents noted that an increased demand for remittances from their families coincided with a reduction in their own net salaries – as a result of increased taxes and reduced availability of overtime – and this was a cause for concern for Ireland's migrant nurses.ConclusionThis paper provides insights into the importance of remittances in funding social support for family members in home countries. It also illustrates the sacrifices made by migrant nurses to ensure continuation of the remittances, particularly in the context of an economic recession.

In recent years a number of countries, including the United Kingdom (UK) and Ireland, have recruited a large number of overseas nurses to address the shortage of qualified nurses in their own health services. The issues which have received much attention were mainly related to the ethics of ‘poaching’ nurses from other countries (see e.g. Singh et al., 2003) and the ways to address the global nursing shortage (Buchan 2006). There is also a growing literature on the experience of migrant nurses and how they integrate (or not) into the health systems and social and cultural fabric of their host countries. The study reported by Teresa Cummins in this issue of Journal of Advanced Nursing (pp. 1611–1616) adds to this literature by focusing on migrant nurses’ perceptions and attitudes of integration into the perioperative setting in Ireland (Cummins 2009). As expected, communication issues such as understanding the host culture, tradition and accents was a challenge for these nurses. While the majority rated themselves as ‘assertive’ towards nursing and medical colleagues, they had difficulties in delegating to ancillary staff. In response to patients’ concerns, these nurses felt ‘the need to reassure patients of their competence and skills in caring for them’ (p. 1613). On the positive side they reported that orientation and induction programmes and support from preceptors were beneficial to them. As Cummins recognized, the use of a quantitative approach limited further probing into why these nurses found it difficult to be assertive and to delegate, especially to ancillary staff. Cummins concluded by stressing the ‘need for more cultural education to promote awareness and understanding’ (p. 1615) for both migrants and hosts. The recent recruitment drive of migrant nurses in the UK and Ireland has tailed off. It would be easy to confine these issues to history and to forget these nurses. Those who recruited them have a duty to continue to provide support to enable them to fully contribute to, and benefit from, the society they currently live in. The lessons of studies, such as the one discussed here, are important for countries such as Saudi Arabia and the United Arab Emirates, which historically have relied heavily on migrant nurses. Demographic, economic and political changes in Europe have resulted in increased movement of people across borders. This means that both health service users and healthcare professionals are increasingly likely to reflect cultural diversity. For nursing to adapt to this change, it is important that training for cultural competence be built into nursing curriculae. Some of the problems faced by migrant nurses are the same as those of other migrant workers. Nurses have the opportunity to make a valuable contribution to this field of research. Cummins should be congratulated for rising to this challenge.

To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. An exploratory qualitative study was conducted using face-to-face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. Cultural value-based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention.

Call to action for advocacy of immigrant nurses during COVID-19 pandemic.

Despite the fact that there is unmet demand for nurses in health services around the world, some nurses migrate to destination countries to work as domestic workers. According to the literature, these nurses experience contradictions in class mobility and are at increased risk of exploitation and abuse. This article presents a critical discussion of the migration of nurses as domestic workers using the concept of 'global care chain'. Although several scholars have used the concept of global care chains to illustrate south to north migration of domestic workers and nurses, there is a paucity of literature on the migration of nurses to destination countries as domestic workers. The migration of nurses to destination countries as domestic workers involves the extraction of reproductive and skilled care labor without adequate compensatory mechanisms to such skilled nurses. Using the case of the Canadian Live-in Caregiver Program, the study illustrates how the global movement of internationally educated nurses as migrant domestic workers reinforces inequities that are structured along the power gradient of gender, class, race, nationality, and ethnicity, especially within an era of global nursing shortage.

Aim: To understand how migrant nurses perceive their needs for autonomy, competence and relatedness are satisfied and relate how these contribute to regional workplace retention. Design: A qualitative descriptive study. Methods: Data were collected through semistructured interviews among 17 migrant nurses employed at a hospital in regional Australia. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. The self-determination theory provided a framework for the study. Results: One overarching theme, facing challenges with determination to make oneself at home, was identified, with themes: migration and relocation to a regional area, commencing and adjusting to the workplace and integrating with the community. These are further explained with subthemes: experiencing personal vulnerabilities, experiencing familial challenges and adjustment, building connections, finding one's feet, finding meaningful work through nurse empowerment, valuing relationships at work, and embracing the regional lifestyle. Conclusion: An unfamiliar work environment and culture may challenge migrant nurses' needs for autonomy, competence and relatedness, potentially impacting their integration. Supportive work environments, valued workplace relationships, community support and networking with peers from similar backgrounds can assist migrant nurses successfully transition, which may impact long-term retention.

In any health system, the health worker determines the nature and quality of services provided. Data demonstrate that most health systems across the globe face nursing shortages, varying across regions and rural-urban distribution. Although nursing services are an integral part of both preventive and curative aspects of India's health system, the nursing estimates of the country shows that India has been facing shortage of nurses since independence. Studies show that professional, social and economic reasons are considered to be behind the nursing shortage in India. Similar reasons induce Indian nurses to look for migration opportunities in other countries. The high income countries have discovered India as a new source of well trained, English-speaking nurses to overcome their nursing shortages. This has resulted in mass migration of nurses from India which in turn may lead to non-availability of standard quality health services especially to the poor section of the population in the country. Strong political commitment is required for improving the nursing situation in India.

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. To predict the international migration of nurses to the UK using widely available data on country characteristics. 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. 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. 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.

The increasing demand for care workers in the global North has spurred the migration of the care workforce, especially of female nurses from the global South. This development is redefining women’s roles as breadwinners and the instigators of family migration. However, the migration of nurses from the global South-to-North needs further investigation into how these women are empowered to lead the migration process and the factors that influence the decision. I will explore the roles of migrants’ individual skills and competencies along with the demand for care workers in the UK’s labour market. This study is based on data from 49 in-depth qualitative interviews with Nepali care workers in the UK and their parents in Nepal. I argue that in the case of the migration of trained nurses from the global South to the North, individual and contextual factors become more important and influential than gender and power relations in the family in the decision-making processes. As a step towards addressing human resource shortages in the health and social care sectors, the UK has recently reached a bilateral agreement with Nepal to recruit Nepali nurses. While the migration of Nepali nurses is likely to increase, empowerment to migrants and adherence to ethical recruitment could be mutually beneficial for participating countries, migrants and their families.

Background Indonesia has become one of the international nurse migration players that has supported the Code that was endorsed by the World Health Assembly, year 2010. In reference to the Code, the Minister of Health (MoH) as designated by the national authority, issued the regulation on the management of Indonesian nurses’ migration. This study aimed to monitor the implementation of the Code on state policy changing in facilitating nurse migration. Go to: Materials and methods Qualitative and quantitative data were collected in order to understand the impact of the Code on Indonesian nurse migration. A triangulation approach was achieved through semi-structured interviews with key stakeholders, and records review of nurses’ migration in the last two years. Go to: Results The Global Code of Practice contributed to shape the migration policy at the national level. This regulation provided a shift change of migration policy, which can be conducted by a country that had an agreement with Indonesia or a country that had a law on migrant protection. Acknowledging the importance of the Code, the MoH translated the Code into Indonesian, and disseminated the material to multiple stakeholders. By the spirit of this Code, Indonesia received financial and technical cooperation and agreement with Japan on the improvement of nursing capacity. The challenge faced by the MoH was a need for strong regulation which could accommodate the relevant players to coordinate on the national level, notably for the MoH, National Board for The Placement and Protection of Indonesia Manpower, Ministry of Foreign Affairs and private recruiters. Quantitative data showed that there was a significant flow of nurse migration, especially on nurses’ movement before and after the code was adopted. Nurse migration was increased four-fold between 2010 (567 nurses) to 2012 (2512 nurses) compared to three years before the Code was adopted. Indonesia’s government should carefully assess the flow of migration as the country has suffered a shortage of nurses. Lack of HRH information system and no integrated national HRH observatory hinder the policy maker to promote a strategic approach in nurse migration. Go to: Conclusions The Code has been utilized by the Ministry of Health to manage migration. This guideline at the least provides direction that may be used where appropriate in the formulation and implementation of nurse migration. A stronger regulation which not only ties the MoH, but also other stakeholders in health migrant placement needs to be established. Further, strengthening HRH information system and research on the impact of migration on Indonesia’s health system must be conducted soon.

The aims of the study were to examine how seven variables impacted upon the intention of hospital nurses to continue working as nurses and to investigate whether there are generational differences in these impacts. There is a critical shortage of trained nurses working as nurses in Australia, as in many other Organisation for Economic Co-operation and Development member countries. The retention of nurses has been examined from the traditional management perspectives; however, this paper presents a different approach (Meaning of Working theory). A self-report survey of 900 nurses employed across four states of Australia was completed in 2008. The sample was hospital nurses in Australia from three generational cohorts - Baby Boomers (born in Australia between 1946 and 1964), Generation X (1965-1979) and Generation Y (1980-2000). Six variables were found to influence the combined nurses' intentions to continue working as nurses: work-family conflict, perceptions of autonomy, attachment to work, importance of working to the individual, supervisor-subordinate relationship and interpersonal relationships at work. There were differences in the variables affecting the three generations, but attachment to work was the only common variable across all generations, affecting GenYs the strongest. The shortage of nurses is conceptualized differently in this paper to assist in finding solutions. However, the results varied for the three generations, suggesting the need to tailor different retention strategies to each age group. Implications for management and policy planning are discussed.