Professional problems: The burden of producing the “global” Filipino nurse

"We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong

Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.

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.

Clocking out: Nurses refusing to work in a time of pandemic

Social science research has long critiqued how professional ideals of public service can ignore chronic problems within the healthcare industry, placing unfair burden on the "heroism" of individual workers. Yet, fewer studies investigate how healthcare professionals actively negotiate such demands for service, amidst increasing workplace pressures and risks. This paper studies Filipino nurses' response to a government policy that banned them from working overseas in order to channel their labor to local hospitals during the COVID-19 pandemic. Based on 51 in-depth interviews, we argue that nurses' willingness to serve in the Philippines' COVID-19 hospitals hinged on the point at which the deployment ban interrupted their emigration trajectories. Specifically, nurses' decision to heed their government's call to service depended on whether they saw local hospital experience as valuable for their plans of working abroad. We introduce the concept of "clocking out" to describe how aspiring nurse migrants set limits to the time they devote to local service, as they pursue a career pathway beyond national borders. We discuss how this concept can inform scholarship on nurse retention and professional values, especially for developing nations in times of crisis.

Filipino nurse migration to the UK: Understanding migration choices from an ontological security-seeking perspective

The Philippines remains the world's largest exporter of nurses, with over 22,000 employed in the NHS (Baker, 2020). In this article, we analyse the migratory rationales and choices of Filipino nurses either about to embark or already working in the UK's National Health Service (NHS), through an ontological security framework. Qualitative interviews and focus groups were undertaken with 24 nurses in the Philippines and UK one element of which set out to understand why, in the context of high global demand for overseas nurses the nurses had chosen the UK as their destination. Findings highlight how collective imageries of 'home' and of different overseas destinations are rooted in shared understandings of underlying social structures, and their perceived capacity to generate ontological security for their citizens. Social and institutional pressures in the Philippines engendered a generalised insecurity that was corrosive to the nurses' identity and sense of agency and undermined the ability to meet cultural norms of family support. The nurses favoured the UK due to the comparative ease of moving there; a prevailing perception of social stability and of its political and institutional structures as being based on transparency and meritocracy, facilitating professional development and social mobility. The findings extend 'culture of migration' perspectives by illuminating why nurses migrate to where they do by emphasising place as a source of ontological security, with migratory preferences influenced by the perceived capacity of different national systems to minimise social risks. This also implies that as global social risks and volatilities intensify, plugging nursing gaps in the economically developed world with nurses from the developing world will become increasingly unpredictable as the ability of governments in destination countries to guarantee ontological security becomes more uncertain.

Understanding International Immobility through Internal Migration: “Left behind” Nurses in the Philippines

Migration scholars have tended to portray internal mobility as a step toward broader cross-border movement, reinforcing the notion of ongoing progress toward international migration. This article argues for a need to recognize how internal mobility can also explain international immobility, or why people do not move across national borders. Using the case of Filipino nurses, we argue that while internal migration does allow aspiring migrants to build the potential ability to emigrate, individual trajectories are much more diverse and multi-directional, often prolonging or reinforcing their international immobility. As a result, and in our case study, the costs and burdens of constant internal movement can also alter nurses’ migration aspirations, prompting them to either alter their original goals or acquiesce to their inability to leave their origin countries. This article calls for migration scholarship to address not only a “mobility bias” within the field but also the over-focus on international migration, rather than internal mobility, as a subject of study.

A 15-Year Trend Study of Internationally Educated Nurses' NCLEX-RN Performance

AIM

The aim of the study was to describe trends in internationally educated nurses' (IEN) National Council Licensure Examination-Registered Nurses (NCLEX®-RN) performance from 2003 to 2017 and to determine the odds of passing the exam based on country of nursing education.

BACKGROUND

IEN comprise 5.6 percent of US nurses; more than half come from the Philippines. There is a lack of research on IEN NCLEX-RN performance.

METHOD

Correlational research was used to determine the performance and likelihood of passing the NCLEX-RN based on country of nursing education using secondary data analysis. Odds ratios were estimated to express the odds of passing.

RESULTS

IEN NCLEX-RN applications and pass rates are decreasing. The odds of passing the NCLEX-RN among Philippine-educated nurses are lower compared to all other IEN. The odds of passing the Canadian NCLEX-RN are higher for all IEN.

CONCLUSION

The low NCLEX-RN pass rate of IEN reflects differences in nursing education and practice across countries.

Pre-acculturation as a risk factor for obesity: Findings from the Health of Philippine Emigrants Study (HoPES)

Immigrants to the United States may have an advantage in terms of healthier weight, but tend to gain excessive weight after arrival, and may suffer from obesity and related health conditions. Acculturation theory suggests that this increase in obesity risk is due to adoption of unhealthy western dietary behaviors, and assumes that "eastern/traditional" dietary behaviors prior to migration are healthier. While this assumption is supported by studies conducted several decades ago, the phenomenon of globalization that has risen since the 1990s has increased exposure to western ideas and behaviors in communities worldwide. Hence, today's immigrants are more likely to have already adopted less healthy behaviors that increase obesity risk prior to their arrival in the U.S., a phenomenon we term "pre-acculturation." The present study investigates the role of pre-acculturation in obesity development among immigrants from the Philippines. Data come from the Health of Philippine Emigrants Study, fielded in 2017 (n = 1632). Pre-acculturation was measured with English proficiency, preparation to migrate, receiving care packages, texting, telephone, or internet contact with friends/family in the U.S. Outcomes included the body mass index (BMI, kg/m2), waist circumference (WC, cm), waist-to-height ratio (WHtR) and waist-to-hip-ratio (WHR). Covariates included age, gender, education, financial strain, physical activity, and diet. Migrants reported greater English proficiency, preparation, and a slightly lower WHtR than non-migrants, but did not differ on BMI, WC, or WHR. Preparation was associated with greater BMI, WC, and WHtR, and the effects of preparation status differed by migration status. Among migrants, more preparation was associated with greater BMI, WC, and WtHR. Further, among non-migrants, texting and telephone communications was related to lower BMI, WC, and WHR. In summary, pre-acculturation may be a risk factor for obesity in the Philippines, suggesting that binary notions of "Western" versus "eastern/traditional" cultures may be too simplistic.

Nurses' use of mobile instant messaging applications: A uses and gratifications perspective

AIM

To explore how and why mobile instant messaging applications are used by Filipino nurses as part of their work.

METHODS

Guided by the uses and gratifications theory, in-depth interviews with 20 staff nurses working in 9 hospitals (ie, 4 private and 5 public hospitals) in the Philippines were conducted in July 2015. Interview data were analysed through a phenomenological perspective to thematic analysis.

RESULTS

Results show that mobile instant messaging applications such as Facebook Messenger and Viber were mostly used by staff nurses and these were accessed using their own smartphones. Thematic analysis indicates that they were used to meet staff nurses' need for information exchange, socialization, and catharsis. Moreover, user interactions vary depending on members within a chat group. For instance, communication via mobile instant messaging applications are much formal when superiors are included in a chat group.

CONCLUSION

In general, the results show that mobile instant messaging applications are routinely used by Filipino staff nurses not only for clinical purposes (ie, information exchange) but also for non-clinical purposes (ie, socialization and catharsis). This paper ends with several practical and theoretical implications including future research directions.

The Life Story Experience of "Migrant Dentists" in Australia: Potential Implications for Health Workforce Governance and International Cooperation

BACKGROUND

The migration of dentists is a major policy challenge facing both developing and developed countries. Dentists from over 120 countries migrate to Australia, and a large proportion are from developing countries. The aim of the study was to assess the life story experience (LSE) of migrant dentists in Australia, in order to address key policy challenges facing dentist migration.

METHODS

A national survey of all migrant dentists resident in Australia was conducted in 2013. Migrant experiences were assessed through a suite of LSE scales, developed through a qualitative-quantitative study. Respondents rated experiences using a five-point Likert scale.

RESULTS

A total of 1022 migrant dentists responded to the survey (response rate = 54.5%). LSE1 (health system and general lifestyle concerns in home country), LSE2 (appreciation towards Australian way of life) and LSE3 (settlement concerns in Australia) scales varied by migrant dentist groups, sex, and years since arrival to Australia (chi-square, P < .05). In a logistic regression model, migrants mainly from developing countries (ie, the examination pathway group) faced greater health system and general lifestyle concerns in their home countries (9.32; 3.51-24.72) and greater settlement challenges in Australia (5.39; 3.51-8.28), compared to migrants from well-developed countries, who obtained direct recognition of qualifications. Migrants also are more appreciative towards the Australian way of life if they had lived at least ten years in Australia (1.97; 1.27-3.05), compared to migrants who have lived for less than ten years.

CONCLUSION

Migrant dentists, mainly from developing countries, face challenges both in their home countries and in Australia. Our study offers evidence for multi-level health workforce governance and calls for greater consensus towards an international agenda to address dentist migration. Better integration of dentist migration with the mainstream health workforce governance is a viable and opportunistic way forward.

Global Nursing-a literature review in the field of education and practice

Aim

To describe key findings of Global Nursing in empirical nursing studies.

Design

A literature review using descriptive data synthesis of peer‐reviewed articles in the field of nursing education and practice.

Methods

This review of Cinahl Complete, PubMed, PsycINFO and Scopus was undertaken using the search strategy “global nursing”. Independent title/abstract and full‐text screening was undertaken, identifying original articles written in English.

Results

A total of 472 titles and 170 abstracts were read through. Seventy‐three articles were included for full‐text review. Twenty published studies of Global Nursing with multiple research methodologies fulfilled the inclusion criteria. Findings were described with five categories. Global Nursing Arena, Global Nursing Working Environments, Global Nursing Workforce Management, Global Nursing Competencies and Global Nursing Networking were shown to be crucial when Global Nursing was addressed in the literature.

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.

The international migration of dentists: directions for research and policy

In 2010, the World Health Organization Global Code of Practice for International Recruitment of Health Personnel (the WHO Code) was adopted by the 193 Member States of the WHO. The WHO Code is a tool for global diplomacy, providing a policy framework to address the challenges involved in managing dentist migration, as well as improving the retention of dental personnel in source countries. The WHO Code recognizes the importance of migrant dentist data to support migration polices; minimum data on the inflows, outflows and stock of dentists are vital. Data on reasons for dentist migration, job satisfaction, cultural adaptation issues, geographic distribution and practice patterns in the destination country are important for any policy analysis on dentist migration. Key challenges in the implementation of the WHO Code include the necessity to coordinate with multiple stakeholders and the lack of integrated data on dentist migration and the lack of shared understanding of the interrelatedness of workforce migration, needs and planning. The profession of dentistry also requires coordination with a number of private and nongovernmental organizations. Many migrant dentist source countries, in African and the South-Asian WHO Regions, are in the early stages of building capacity in dentist migration data collection and research systems. Due to these shortcomings, it is prudent that developed countries take the initiative to pursue further research into the migration issue and respond to this global challenge.