Transnational nurse migration: future directions for medical anthropological research

Draining the specialized nursing brains, the emigration paradigm of Ghana: A cross-sectional study

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.

Ways of walking, speaking and listening: Nursing practices and professional identities among Polish nurses in Norway

This article explores the lived experiences of Polish nurses' transition into the Norwegian healthcare system and analyses the emerging differences in nursing practices and professional identities between Poland and Norway. It draws on ethnographic findings and argues that nursing is a complex practice, which involves not only nursing knowledge, but also less obvious and often taken for granted nursing imaginaries and actions. In doing so, the article looks at different ways of walking, speaking and listening, which are not merely nurses' daily habits, but also the embodiments of hierarchical relations, agency and empowerment in healthcare settings. This kind of analytical perspective of the existing differences in nursing practices and professional identities between Poland and Norway raises crucial questions about transitional contexts of nurse migration and shows that nursing is not static, but rather a dynamic and processual way of conduct.

Overseas recruitment activities of NHS Trusts 2015-2018: Findings from FOI requests to 19 Acute NHS Trusts in England

Migrant nurses form an increasing proportion of the nursing workforce, with the United Kingdom (UK) being the third most popular destination for overseas nurses in the world. The migrant nurse workforce is highly susceptible to policy changes at the macro or professional level of the donor and recipient countries. Freedom of information requests were issued to 19 National Health Service [NHS] Trusts in England to determine their involvement in overseas nurse recruitment activity from 1998 onwards. These indicate a notable shift away from active European Union (EU) recruitment and towards overseas countries particularly the Philippines and India. Reasons given were as follows: diminishing returns from EU sources, high attrition among EU nurses and the introduction of English language tests for EU nurses in July 2016. This led to Trusts revisiting their recruitment strategies by increasing more direct/less resource-intensive methods and expanding their focus outside of the EU. Trusts frequently utilised private recruitment companies for their recruitment drives, including consulting and influencing the Trusts' workforce strategies. Policy adjustments have numerous influences on the composition of the overseas nursing workforce. While the NHS continues its efforts in expanding its international nursing workforce, this should not be at the expense of ethical and sustainable recruitment practices, which may be compromised indirectly as a result.

Global nurse shortages-the facts, the impact and action for change

INTRODUCTION

Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. This scoping review investigated: what is known about current nurse workforces and shortages and what can be done to forestall such shortages?

SOURCES OF DATA

Published documents from international organisations with remits for nursing workforces, published reviews with forward citation and key author searches.

AREAS OF AGREEMENT

Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. It requires evidence informed policy and resource allocation at national, subnational and organisation levels.

AREAS OF CONTROVERSY

The definition in law, type of education, levels and scope of practice of nurses varies between countries raising questions of factors and evidence underpinning such variation. Most policy solutions proposed by international bodies draws on data and research about the medical workforce and applies that to nurses, despite the different demographic profile, the work, the career options, the remuneration and the status.

GROWING POINTS

Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensure sustainable health systems.

AREAS TIMELY FOR DEVELOPING RESEARCH

Research is needed on: the nursing workforce in low income countries and in rural and remote areas; on the impact of scope of practice and task-shifting changes; on the impact over time of implementing system wide policies as well as raising the profile of nursing.

Traveling health-promoting infrastructures: A meta-ethnographic analysis

In recent years, it has become increasingly important to understand the global circulation of healthcare innovations in nations' attempts to solve contemporary health challenges. This article is a systematic review and meta-ethnography-inspired analysis that explores the global circulation of health-related standards, protocols, procedures, and regulations, or what we term health-promoting infrastructures (HPIs). The notion of HPIs is defined as built networks that allow for the circulation of health expertise with the intention of promoting solutions that address global health problems. We conducted systematic searches in six relevant electronic databases and ended up with a set of 13 studies. The review shows that it takes arduous work to prepare and facilitate the travel of HPIs and to mold them into meaningful local forms. In conclusion, we argue that HPIs can helpfully be thought of as scripted forms, which are globally available in always sited efforts to address specific problems.

The consequences of Ireland's culture of medical migration

BACKGROUND

In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system.

METHODS

This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data-registration and migration data from source and destination countries-and qualitative data-in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland.

RESULTS

Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions-that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad.

CONCLUSION

In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes.

Indian nurses in Italy: a qualitative study of their professional and social integration

AIMS AND OBJECTIVES

To investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration.

BACKGROUND

To study the worldwide, nursing flux is a health priority in the globalised world. The growth in migration trends among nurses, not only from Philippines or India, has proliferated in recent years. The research on nurses' mobility for Southern European countries is underexplored, and in Italy, the out-migration flows of Indian nurses were never analysed.

DESIGN

Qualitative methodological approach.

METHODS

Semi-structured interviews (n = 20) were completed with Indian clinical nurses working in Italy for more than one year mainly in private organisations. A purposive sampling technique was used for recruitment. The data were then content-analysed using an inductive method.

RESULTS

The findings were categorised into four themes: (1) aspects of professional integration and working experience, (2) intra- and interprofessional relationships and perceptions of the IPASVI Regulatory Nursing Board, (3) initial nursing education and continuous professional development and (4) perceptions of social integration.

CONCLUSION

The results show that for Indian nurses in Italy emigration is important to gain opportunities to expand economic and social privileges as well as escape from historical assumptions of stigma associated with nursing work, especially for women. However, these conclusions have to be seen in wider socio-cultural complexities that are at the basis of transnational fluxes (Prescott & Nichter ).

RELEVANCE TO CLINICAL PRACTICE

The research offers an insight into the complicated reasons for Indian nurses out-migration to Italy. Without comprehending the interwoven textures of the political and social relations that are continually constructed and re-constructed among different nations, it is difficult to understand nurses out-migration and consequently have a better and safer collaborative teamwork in the host countries.

The development of the nursing profession in a globalised context: A qualitative case study in Kerala, India

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. The phenomenon that enabled our analysis, by showing these forces at work in a particular time and place, was an outbreak of strikes by nurses working in private hospitals in Kerala in 2011-2012.

Does migration 'pay off' for foreign-born migrant health workers? An exploratory analysis using the global WageIndicator dataset

BACKGROUND

This study used the global WageIndicator web survey to answer the following research questions: (RQ1) What are the migration patterns of health workers? (RQ2) What are the personal and occupational drivers of migration? (RQ3) Are foreign-born migrant health workers discriminated against in their destination countries?

METHODS

Of the unweighted data collected in 2006-2014 from health workers aged 15-64 in paid employment, 7.9 % were on migrants (N = 44,394; 36 countries). To answer RQ1, binary logistic regression models were applied to the full sample. To answer RQ2, binary logistic regression was used to compare data on migrants with that on native respondents from the same source countries, a condition met by only four African countries (N = 890) and five Latin American countries (N = 6356). To answer RQ3, a multilevel analysis was applied to the full sample to take into account the nested structure of the data (N = 33,765 individual observations nested within 31 countries).

RESULTS

RQ1: 57 % migrated to a country where the same language is spoken, 33 % migrated to neighbouring countries and 21 % migrated to former colonizing countries. Women and nurses migrated to neighbouring countries, nurses and older and highly educated workers to former colonizing countries and highly educated health workers and medical doctors to countries that have a language match. RQ2: In the African countries, nurses more often out-migrated compared to other health workers; in the Latin American countries, this is the case for doctors. Out-migrated health workers earn more and work fewer hours than comparable workers in source countries, but only Latin American health workers reported a higher level of life satisfaction. RQ3: We did not detect discrimination against migrants with respect to wages and occupational status. However, there seems to be a small wage premium for the group of migrants in other healthcare occupations. Except doctors, migrant health workers reported a lower level of life satisfaction.

CONCLUSIONS

Migration generally seems to 'pay off' in terms of work and labour conditions, although accrued benefits are not equal for all cadres, regions and routes. Because the WageIndicator survey is a voluntary survey, these findings are exploratory rather than representative.

Working with difference: Thematic concepts of Japanese nurses working in New Zealand

The purpose of this study was to compare the differences experienced by Japanese nurses working in New Zealand from an organizational and personal perspective, using a qualitative approach. Interview data was analyzed using a thematic method to abstract increasing levels of themes until one main theme explained the data: finding a voice. This core theme demonstrated that Japanese nurses had to learn to accommodate difference while learning to speak up. Moreover, this needed to occur through a number of cultural filters. The principal conclusion was that migrant nurses face multiple personal and organizational challenges when working in a new environment. Finding a voice is the method in which nurses learn to communicate and work within new healthcare settings. Nurses use a number of filters to manage the transition. The host country needs to recognize these differences and accommodate them through orientation modules.

Nurse migration from India: a literature review

BACKGROUND

A profound nursing shortage exists in India where nurses are increasingly outmigrating to practice nursing in surrounding countries and abroad. This is important globally because countries with the lowest nursing and healthcare workforce capacities have the poorest health outcomes.

OBJECTIVE

This review sought to synthesize and unify the evidence about nurse migration from India and includes a look at nurse retention within India.

DESIGN

A comprehensive literature review was performed to synthesize and unify both qualitative and quantitative research.

DATA SOURCES

Bibliographic databases searched included CINAHL, MEDLINE, PsycINFO, and EconLit using associated keywords for empirical and descriptive literature published between January 2004 and May 2014. Hand searches of the Nursing Journal of India from 2004 to February 2014 and the Journal of Nursing Research Society of India from its inception in 2007-February 2014 were also completed.

REVIEW PROCESS

29 studies were selected and analyzed for the review. Data were appraised for quality; reduced through sub-categorization; extracted; and coded into a framework. Thematic interpretation occurred through comparing and contrasting performed by multiple reviewers.

RESULTS

Findings included an exponential growth in nurse recruitment efforts, nurse migration, and a concomitant growth in educational institutions within India with regional variations in nurse migration patterns. Decision-making factors for migration were based on working conditions, salience of family, and the desire for knowledge, skill, technology, adventure and personal enrichment. Challenges associated with migration included questionable recruiting practices, differing scopes of practice encountered after migration and experiences of racism and cultural differences. A shift toward a positive transformation of nursing status in India has resulted in an increased respect for individual nurses and the profession of nursing. This was attributed to the increased globalization of nursing.

CONCLUSIONS

Results from this review can be used to shape health policy and advocate for nursing reform in India. As India's healthcare infrastructure continues to evolve, effective programs to improve conditions for nurses and retain them in India are needed. Additionally, as the globalization of nurses increases, more research is needed to develop effective programs to aid in a smooth transition for nurses who migrate from India.

African Female Physicians and Nurses in the Global Care Chain: Qualitative Explorations from Five Destination Countries

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

Global Worker Migration

In an attempt to alleviate the shortage of nurses practicing within the United States (US), hospitals and other health care organizations have begun to recruit nurses from outside America’s borders. While these efforts may yield increased staffing levels in the US, they have also raised questions as to whether it is ethical to create nurse shortages in poor countries so that richer countries can enjoy full employee rosters. This recruitment of nurses serves to create what has been labelled as ‘brain drain’ for many developing countries. Within the US, professional nursing and hospital organizations and governmental legislation are attempting to address the issues of nursing shortages and help relieve some of the issues created by brain drain. Using game theory as a theoretical foundation, this article proposes the development of a win-win environment that may support adequate nursing levels in both developed and developing countries.