IJEPA: Gray Area for Health Policy and International Nurse Migration

Socio-cultural factors influencing Indonesian nurses to stay working in Indonesia: A qualitative study

AIM

To explore push, pull and retention factors affecting indonesian nurses decision to stay in the nursing profession.

INTRODUCTION

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.

BACKGROUND

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.

METHODS

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.

RESULTS

Five categories were developed: non-financial support, sense of togetherness, following the husband, social image and powerlessness.

DISCUSSION

Socio-cultural factors influence Indonesian nurses to stay working in their country despite their economic and career development difficulties.

CONCLUSION

Socio-cultural circumstances have become powerful factors affecting Indonesian nurses to stay working in Indonesia.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

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.

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.

Indonesian Nurses' Journey in Passing the Japan National Nursing Licensure Examination

Background

Despite the significant number of Indonesian nurses joining the Japanese National Nursing Licensure Examination (JNNLE), only a few of those were successful. Indonesian nurses as one of active migration player to Japan's market remain a critical support in supporting human resources for health in Japan. However, the successful nurses' perspectives have yet to be understood entirely. This study aimed to explore the experiences of Indonesian nurses who successfully passed the JNNLE.

Methods

This study used a descriptive qualitative approach. The participants were twenty Indonesian nurses who have passed the licensure examination. This study was carried out by semi-structured interviews conducted virtually. The data were analyzed using thematic content analysis.

Results

Five themes were discovered in this study: language ability as the key to succeeding in the exam, strategies to passing the exam, supporting resources as factors to increase the passing rate, understanding the nature of nursing exam, and internal motivation to be recognized as a professional nurse in a foreign country.

Conclusion

Indonesian nurses who passed the Japanese national nursing licensure examination tend to deploy planned strategies. Honing the language skills while working and living in Japan is very important, while structured support systems in the hospital, government, and social network are imperative to learning the new knowledge in the area of nursing care in Japan.

Ex-Migrant Nurses Empowerment after Recovery from Covid-19 Pandemic: An Analysis of Reflective Cycle Gibbs Model

During the Covid-19 outbreak, many ex-migrant nurses who had resigned and were living in Indonesia were unable to return to work. The objective of this study is to develop strategies for empowering ex-migrant nurses in the sustainable healthcare sector following the recovery from the Covid-19 pandemic. The Reflective Cycle Gibbs (RCB) model was employed during the research, which comprised six stages that began with a document review and PRISMA analysis. The PRISMA Analysis utilized Google search engines to filter documents from Google Scholar, Research Gate, and other sources. The RCB model examined 10 eligible journals and discovered records of nurses who returned to their home country due to inadequate pay, career development, workforce protection policy, and empowerment facilities. We concluded 4 problems encountered by returnee nurses i.e. lack of protection policy, poor wages, less career development, and lack of empowerment facilities.

Going Global: Insights of Indonesian Policymakers on International Migration of Nurses

Background

The Indonesian policymakers need to respond to the current challenges, particularly the excess of nurses and the increased demand for nurses in the global market.

Objective

This study aimed to present the perception of policymakers and stakeholders on the management of overseas migration of Indonesian nurses.

Methods

This study is a descriptive qualitative design where data were collected through structured interviews with key stakeholders representing the Indonesian government, namely the Ministry of Health (MOH), the Ministry of Labour (MOL), Ministry of Education (MOE) and the Indonesian Migrant Workers Protection Agency (BP2MI). The in-depth interviews involved participants who were responsible for managing Indonesian nurses' migration. The qualitative data were analyzed thematically using a content analysis approach.

Results

The issues involving nurses' migration policy are quite complex and sectoral. Themes emerging from this study include the move towards global market orientation, addressing challenges on international nurse migration, strengthening coordination among stakeholders and making the most of opportunities. All the themes reflect that the country should work hard to achieve the balance between quantity and quality of nursing resources for the international market.

Conclusion

As regulator and executor of Indonesian nurse migration, various government policies have responded to the low number of Indonesian nurses' migration overseas, emphasizing the three cycles of migration: pre-migration, migration and post-migration. The preparation of resources, regulations and placements for Indonesian nurses abroad open the opportunity to the international nursing labour market. Hence, the policies need to be strengthened from upstream to downstream to make Indonesian nurses more competitive and adaptive in global market.

Human Rights and Bioethical Considerations of Global Nurse Migration

There is a global shortage of nurses that affects healthcare delivery, which will be exacerbated with the increasing demand for healthcare professionals by the aging population. The growing shortage requires an ethical exploration on the issue of nurse migration. In this article, we discuss how migration respects the autonomy of nurses, increases cultural diversity, and leads to improved patient satisfaction and health outcomes. We also discuss the potential for negative impacts on public health infrastructures, lack of respect for cultural diversity, and ethical concerns related to autonomy and justice, including coercion and discrimination. This analysis is written from a rights-based ethics approach by referring to rights held by nurses and patient populations. Nurse migration highlights conflicts between nurses and between nurses and healthcare systems. Increased awareness of ethical challenges surrounding nurse migration must be addressed to enhance the well-being of nurses and patient populations.

Experiences of Healthcare Worker Returnees in Their Home Countries: A Scoping Review

Background

International migration of healthcare workers is a global phenomenon driven by growing demand in developed countries and expectations of healthcare workers from developing countries to have improved employment and lives. This migration has been understood to impact both the individuals and countries involved, with positive and negative consequences. However, little is known about returnees' experiences that could be used to address challenges and optimize benefits. The aim of this review was to understand what is known about experiences of migrant health workers after returning to their home countries.

Methods

A scoping review of primary research addressing experiences of migrant health workers upon their return to their homelands. A range of database were searched including Career and Technical Education Database via ProQuest, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education database via ProQuest, Excerpta Medica Care (EMCare) via Ovid, Education Resources Information Center (ERIC), Excerpta Medica database (EMBASE) via Ovid, MEDLINE and Scopus. A systematic process was performed guided by the work of Arksey and O'Malley. Eight databases were searched and 226 articles were retrieved. After screening articles and abstracts, 15 full-texts were assessed for eligibility, and finally seven studies were further analyzed and synthesized.

Results

Five qualitative studies, one quantitative study and one mixed methods study met inclusion criteria. Five themes emerged: (1) reasons to return, (2) upskilling and deskilling, (3) impact on human, financial, and social capital, (4) challenges and opportunities in the home country, and (5) facilitation supports.

Conclusion

Return migration is portrayed as a complex situation experienced by returnees. Structured policy and supports are required to help healthcare worker returnees prepare, and to adjust to life after their return. This study highlights the importance of comprehensive approach in return migration stage. Return migration policy should support healthcare worker returnees in their home country and facilitate utilization of their skills. Multi-stakeholder partnerships are vital to develop platforms for helping and facilitating returnees in the reintegration process at their home countries.

A Qualitative Study on Challenges Chinese Nurses Face while Working in Japanese Hospitals

Background:

Considering the increased numbers of Chinese nurses in Japan, we hypothesized that Chinese nurses in Japan are confronted with many difficulties, although few studies have been performed. Therefore, in-depth analyses of their experience to explore significant factors and aspects are required.

Objectives:

To clarify the problems and difficulties faced by Chinese nurses during their work and life in Japan and to address their future challenges.

Methods:

We performed semi-structured interviews with 13 Chinese nurses working at 2 Japanese hospitals with Chinese and Japanese registered nurse licenses in 2017. We analyzed data using a qualitative inductive method.

Results:

We found that Chinese nurses were motivated to work at Japanese hospitals for several reasons. Many Chinese nurses working in Japan had difficulties with the language barrier, interpersonal relationships related to cultural differences, and loneliness in their daily life, and also experienced fewer opportunities for promotion than Japanese nurses and insufficient support from Japanese hospitals. Many Chinese nurses were anxious about their future in Japan. More than half did not have a clear future direction for their working life in Japan.

Conclusion:

This study clarified the circumstances and difficulties of Chinese nurses working in Japan. One novel finding was that the main reason for their difficulties is due to their unknown career path and future workplace setting. Therefore, support for overcoming the language barrier and improving cultural understanding from hospitals is necessary to help nurses make better decisions based on their future plans.

Current trends in global nursing: A scoping review

Aim

This review aimed to elucidate research trends in global nursing in international literature.

Design

A scoping literature review of the PRISMA was used to guide the review.

Methods

PubMed was used to search for English articles published in academic journals between 2016–2018. The search keywords were “global/international/world nursing.” We used thematic synthesis to analyse and interpret the data and generated topics for global nursing literature.

Results

In total, 133 articles were analysed. Six topics emerged: (a) conceptualization of global nursing, (b) environmental health, (c) infectious diseases, (d) security efforts, (e) global shortage of nursing personnel and (f) diversification of study abroad programmes. The results of this review reflect today's serious international health, labour and global environmental issues. Based on these latest global nursing topics, it is necessary to develop new strategies, nursing models and environment‐related theories to create and maintain a healthy environment.

The Lived Experiences of Indonesian Nurses Who Worked as Care Workers in Taiwan

BACKGROUND

Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan.

PURPOSE

This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan.

METHODS

Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data.

RESULTS

Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry.

CONCLUSIONS

Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.

Determinants of nursing students' intention to migrate overseas to work and implications for sustainability: The case of Indonesian students

High graduation of nurses and limited job opportunities in Indonesia may lead to the emigration of nurses particularly through facilitated migration. This study aimed at identifying the prevalence of Indonesian nursing students with intention to work in Japan and predictors of their intention to migrate as well as having a definite plan to work in Japan. The study adopted cross-sectional design with a sample of 1,407 Indonesian nursing students. Factors associated with having migration intention, as well as a definite plan to work in Japan, were age, residence, and overseas experience. Other factors related to a definite plan to work abroad were family income, mastering a foreign language, knowledge about the nurse migration related to Indonesia-Japan cooperation, and their motivations to migrate to Japan. Sustainability of this international recruitment of nurses is possible by understanding the context of both source and destination countries. Maximizing benefits of migration of nurses for Indonesia and Japan requires structured policies targeting the educational sector and addressing the sustainability issues.

Examining the Potential of Blockchain Technology to Meet the Needs of 21st-Century Japanese Health Care: Viewpoint on Use Cases and Policy

Japan is undergoing a major population health transition as its society ages, and it continues to experience low birth rates. An aging Japan will bring new challenges to its public health system, highlighted as a model for universal health coverage (UHC) around the world. Specific challenges Japan’s health care system will face include an increase in national public health expenditures, higher demand for health care services, acute need for elder and long-term care, shortage of health care workers, and disparities between health care access in rural versus urban areas. Blockchain technology has the potential to address some of these challenges, but only if a health blockchain is conceptualized, designed, localized, and deployed in a way that is compatible with Japan’s centralized UHC-centric public health system. Blockchain solutions must also be adaptive to opportunities and barriers unique to Japan’s national health and innovation policy, including its regulatory sandbox system, while also seeking to learn from blockchain adoption in the private sector and in other countries. This viewpoint outlines the major opportunities and potential challenges to blockchain adoption for the future of Japan’s health care.

Japanese Language Interest on Nursing Students toward Intention to Work in Japan at Stikes Pemkab Jombang

Introduction: In Indonesia, the working prevalence of nurses was that 95% worked in the country and 5% were working abroad. The government provides opportunities for nurses who want to work in Japan through networking (Indonesia Japan Economic Partnership Agreement). However, there isn’t a lot of interest due to the lack of knowledge of the Japanese language. This study aimed to analyze the Japanese language related to the nursing students’ interest concerning working in Japan.Methods: The design of the study was correlational research with a cross-sectional approach which was conducted between May 31st and June 1st, 2016. The population consisted of nursing Bachelor’s program students and the population totaled 41; the samples totaled as many as 37. The data collection used Japanese observation test scores and questionnaires.Results: The results showed that most of the 75.6% got a good score (B). Nearly half (48.6%) of them were intending to work in Japan and 2.7% got great scores, also with the intent to work Japan. Based on the test results, the statistical value = 0.798 that the ρ value> α (0.05).Conclusion: This means that there is no correlation between the Japanese language and the nurse’s working interest related to Japan. The recommendation in this study is the implementation of an active Japanese language course. Further research should analyze the factors that affect the interests of Indonesian nurses when it comes to working in Japan.

Development of an empowerment model for burnout syndrome and quality of nursing work life in Indonesia

Objectives

This study aimed to develop an empowerment model for burnout syndrome and quality of nursing work life (QNWL).

Methods

This study adopted a mixed-method cross-sectional approach. The variables included structural empowerment, psychological empowerment, burnout syndrome and QNWL. The population consisted of nurses who have civil servant status in one of the regional hospitals in Indonesia. The participants were recruited using multi-stage sampling measures with 134 respondents. Data were collected using questionnaires, which were then analysed using partial least squares. A focus group discussion was conducted with nurses, chief nurses and the hospital management to identify strategic issues and compile recommendations.

Results

Structural empowerment influenced psychological empowerment (path coefficient = 0.440; t = 6.222) and QNWL (path coefficient = 0.345; t = 4.789). Psychological empowerment influenced burnout syndrome (path coefficient = −0.371; t = 4.303), and burnout syndrome influenced QNWL (path coefficient = −0.320; t = 5.102). Structural empowerment increased QNWL by 39.7%.

Conclusion

The development of a structural empowerment model by using the indicators of resources, support and information directly influenced the psychological empowerment of the sample of nurses. As an indicator of meaning, psychological empowerment decreased burnout syndrome. In turn, burnout syndrome, as the indicator of personal achievement, could affect the QNWL. Structural empowerment directly influenced the QNWL, particularly within the workplace context. Further studies must be conducted to analyse the effects of empowerment, leadership styles and customer satisfaction.

Nursing qualification and workforce for the Association of Southeast Asian Nations Economic Community

International nurse migration among Association of Southeast Asian Nations (ASEAN) countries has the potential to increase the effectiveness of health services and access for the ASEAN Economic Community. Providing equivalent nursing qualifications and licensure standards and increasing the availability of the nursing workforce has become a challenge for ASEAN members. The purpose of this study is: 1) to comparatively analyze information on nursing licensing examinations (NLE) across ASEAN countries; and 2) to present information on the human resources required for a successful nursing workforce. This study reviews all documents published on the subject within the ASEAN Economic Community. NLE systems exist in all ASEAN Member States (AMSs)s except Brunei, Vietnam, and Lao PDR. Nursing education systems also vary across ASEAN countries. Language as a means of general communication and nursing examinations also differs. The availability of a qualified health workforce at the regional level is above the threshold in some areas. However, at the national level, Indonesia, Myanmar, Cambodia, and Lao PDR fall below the threshold. Professional licensure requirements differ among ASEAN nurses as a part of the process to become a qualified nurse in host and source countries. Mutual Recognition Agreements on nursing services should address the differences in NLE requirements as well as the availability of nurses.

A deskilling and challenging journey: the lived experience of Indonesian nurse returnees

AIM

To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees.

BACKGROUND

The creation of bilateral agreements between Indonesia and Japan has facilitated the movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life.

METHOD

A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia's provinces between August and October 2015. Data were analysed thematically, supported by QSR NVIVO 10 software.

FINDINGS

Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; and (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin.

CONCLUSION

Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation.

IMPLICATION FOR NURSING AND HEALTH POLICY

The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees' expertise with the needs of the national labour market. The public-private partnership should be strengthened to utilize returnees in healthcare services.

Lived experience of Indonesian nurses in Japan: A phenomenological study

AIM

The movement of Indonesian nurses via a bilateral agreement with Japan has led to a substantial number of migrants to work as nurses in that nation's healthcare system. The purpose of this research was to develop a deeper understanding of the meaningful experiences of Indonesian nurses while working in Japanese hospitals.

METHODS

In this phenomenological study, sampling was purposive and was based on information shared by five Indonesian nurses. The data were collected in interviews; the analysis was thematic.

RESULTS

Six key themes were identified: (i) seeking better than before; (ii) communication challenges; (iii) the nursing examination as a culmination; (iv) differences in nursing practice; (v) cultural differences; and (vi) the benefits of living in developed country. Among these challenges, communication as the basis of shared meaning and understanding was viewed as a complex issue, by both patients and coworkers.

CONCLUSION

The results of this study call for further intervention in supporting Indonesian nurses living in Japan in their struggle with the issue of communication. The emphasis on language acquisition for personal and professional objectives, and the bridging of cultural differences as well, should be considered in an international context.