Nurse migration is a pressing issue that is surprisingly not being discussed, being taken lightly and kept in the dark. Loss of health care workforce means a weakened health care system and inability to meet the basic health care needs of the population. This further prompts more nurses to migrate away from their home country.
Whilst remaining in one’s country to work used to be the norm and persons did not think of emigrating. Now, it seems to be a matter of when one will migrate. Thinking of leaving my loved ones behind and the place I call home is saddening and heart-breaking.
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What influences a nurse’s decision to move? Is health care not a major priority by the government? What does it mean for a country to have no nurses? How will the health care system be affected if there are no nurses? How will the economy and economic output and productivity be affected with limited to no nurses?
Nurse migration
Nursing is a mobile profession so nurses could work anywhere they choose to. Nurses are leaving their home country for personal and professional development, better pay, better quality of life and personal safety. Some nurses seek adventure, novelty and change.
It surprises me that one’s own country does not see the advantages of its nurses yet there is a war for nurses in industrialized countries. Many countries are competing in this competitive global market as they seek nurses from different countries.
The packages offered from the industrialized countries look lucrative and show enhanced opportunities for both the nurse and their family. There are incentives for nurses, facilitated immigration process and open entry to countries. Nurses are also given preferential treatment plus they could move with their families.
Rippling effect
Nurses who migrate further affect the already disadvantaged health care system. This worsens working conditions for nurses left behind as they suffer from heavier workloads.
Heavier workload could cause reduced work satisfaction, low morale, high levels of absenteeism and burnout which all impact quality of care.
Reasons nurses leave
Can you imagine working within an organization for years and remaining at the same level? Or seeing nurses who came after you get promoted? Furthering your education and still not getting a salary increase?
Nurses are leaving due to limited upward mobility and diversity, limited career opportunities, lack of resources to get the job done effectively, slow or lack of promotion and no future.
Nurses suffer from poor and unstable working conditions, lack of workplace safety, limited staffing, heavy workload and high nurse to patient ratio.
Nurses have low salary in their home country and lack of social and retirement benefits. There is no overtime pay but lots of work “overload” and a stressful working environment.
Nurses are limited! Limited opportunities for employment or job advancement, limited to no say in work schedule and working hours and limited chance to upgrade nursing skills.
Yes, that too! Talk about hostility in the workplace. Non-involvement in decision making, lack of support from supervisors and constant blame, bullying, bashing and targeting.
Nurses perform loads of non-nursing tasks including that of a doctor, orderly, health aid and cleaner. Nurses have suffered for too long silently and are emotionally exhausted.
Nurses are frustrated from the low recognition from management and undervaluation and appreciation by the public and government.
Many nurses have left as a direct result of an unsatisfactory and unstable political environment which caused fear and uncertainty of jobs.
Catch that package
Packages offered from other countries show that nurses have access to career advancement. There is recognition of professional expertise, attractive salaries and social and retirement benefits. A professional work environment with sensitive employment policies are also highlighted.
Understaffing
Overworked nurses can suffer from fatigue and burnout and feel overwhelmed. This could impair the nurse’s ability to focus on tasks and pay attention to details, increase medical errors and cause missed nursing care. This could affect the patient as they may experience lack of engagement, neglect, high risk of infection, complications and falls and increased risk of mortality.
Understaffing means the same amount of work for fewer nurses. This increases the nurse to patient ratio and causes breakdown in mental, emotional and physical health. When nurses become sick, tired or injured from the chronic staffing limitations they will miss work.
This further compounds the staffing problems. Nurses who face constant stress at work can develop health issues including depression, anxiety, exhaustion, hypertension and even suicidal thoughts. Understaffing significantly affects relationship with loved ones as nurses are usually too tired from work to engage in fun, homebased activities.
Patients
Understaffing could increase negative patient and family perceptions of nursing care. This causes the patient to distrust the health care system especially if they feel like they received inadequate or rushed care and decreased explanation of medication, diagnosis and procedures.
Overall, inadequate staff on duty could jeopardize patient and worker safety.
Keep nurses
Organizations need to focus on keeping nurses and improving staff. Nurses employed now may become disgruntled later and leave, so, how can organizations retain nurses?
Create an environment that is desirable to stay because employing nurses is not enough. A strong workplace and culture should be enforced. Trust should be developed between staff and management.
Nurses could be provided with flexible work schedules. Nurses are selfless and often put their patients and co-workers needs ahead of their own.
Allow nurses to work with each other to create flexible working and staffing schedules for their units in a way that meet the needs of everyone.
Nurses input should be valued. Nurses should be able to freely air their views and their voices heard without being labelled or their comments used against them on their appraisals.
Health care studies can be subsidized or provided free for nurses. Phlebotomy, basic life support and advanced life support courses could be provided free. Nurse renewal license could also be free.
Schooling could be paid for nurses or a tuition reimbursement program be put in place. Nurses could then sign bonds for at least two or three years once employment has begun.
Nurses should be given career advancement opportunities so they could feel like they have a future within the organization. Nurses should be able to transition from their RN certificate to BSN or other areas of interest.
Nurses need opportunities to float on different units and shadow other people.
How about recognizing nurse’s degrees and increasing nurse’s salaries after completion of their degree. How about promoting nurses to nurse manager quicker.
Yes, rally for nurses to have reduction in vehicle and telephone rates.
A nonbiased method to reward high performers could be developed to demonstrate appreciation for staff efforts so nurses can feel appreciated for the work they do. Motivated nurses will go the extra mile and provide exceptional patient care.
Pay
Nurses need overtime pay, more risk allowance pay, severance pay, more night duty pay, charge nurse pay and preceptor pay.
You think nurses want to leave and experience the barriers to migration?
The process of transfer and migration can be overwhelming and costly. The immigration process too can be costly. Nurses need to learn new technology and terminology and adapt to the language.
Nurses have to adjust to different clinical practices, procedures, equipment and a new work environment.
Leaving one’s family, friends, country and establishing oneself in a new country can be emotionally taxing. Disappearance of one’s social support system can be very difficult.
Adjusting to a new culture and environment can be challenging. Double standards, exposure to racism and discrimination are other key elements.
Tell me what can cause the nurses to stay!
Thank you for reading our findings on our survey carried out on why nurses are migrating across the Caribbean!
Visit categories on the main page and click on the “Health Care” section for more on health care!
Reems Sonson
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Wow.. need I say more!!
Well written. This highlights very well what goes unaddressed. Added to the issues associated with migration most times you find the senior nurses in the profession who have gained the experience and can be in charge on the units are the ones leaving. The issue created when this happens is that the younger nurses are left to take up roles they may not necessarily be ready to. Whilst they do possess the knowledge for the roles the experience that comes with it may not be developed adequately.
I have always had that question lingering ..would a nurse who works in favorable conditions with adequate financial compensation want to uproot themselves from the comfort of their homes surrounded by their families to work abroad?
The fact that the highly skilled nurses with many years of experience are leaving pose a problem for the health sector and the country. What happens when only junior and inexperienced nurses are left to take charge of critically ill patients!? I do not think that nurses would leave their country behind if they were being respected by both the managers, government and public, being paid fairly without saying “nurses make money”, getting gratuity, favorable risk allowance along with all the added benefits as provided overseas Janel. I think that the role of a nurse is taken for granted in Saint Lucia. Since we lack proper representation we are not respected and our importance not seen. Nurses are afraid to speak on the pressing issues affecting them daily so things are not changing.
Well said Reems
I dont understand it either that this issue of nurses migrating is not addressed. It is clearly burdensome on the remaining nurses and it has a ripple effect on patients and the general public.
We now have better working conditions , alteast better than VH. But we still need to see more appreciation for staff. I would appreciate a “thank you, job well done” from my employer/ managers, but my sole purpose for working and spending thousands towards my education is to have a better life. which comes from making more money. So as much as some persons believe nurses are making ‘ a lot’ of money, we know differently and the pay really does not compensate for the work, deprived sleep and sacrifices done for this job. So I will support any nurse who desires to leave for a better life and career opportunities.
When the same mindset and people are placed in a new building then things remain the same Katie. Same old same old.
Well expressed Reems. The situation may not be an easy fix but, a change in the working environment could start off by acknowledging and appreciating nurses worth by a simple awards of recognition whether every month or quarterly in the respective units. A change of attitude and culture by management can be reflected by having frequent walk in on the units, interface with nurses, build a healthy rapport with nurses, have a first hand experience of the day to day challenges they encounter and how they go about them. Strengthen such systems like the appraisal process. Note to Unit Managers,refrain from recommending or promoting as a result of friendship and select the individuals who have the right background of study,experience and among the soft
skills, the right attitude. Provide avenues to incorporate potential nurses with excellent leadership skills and who may have furthered their education in the most needed specialties like public health/infection control, Administrative Management,Intensive Care Nursing which can be contributive to quality management. Making available a wide range of outdoor activities whether adventurous or educational, from climbing the pitons, a day at the waterfalls and other nature spots. Providing the opportunity to staff who may volunteer their service in creative activities like, cake decorating, sewing , massaging and so many more. These activities promote healthy life style, creative ways to earn a separate income and most importantly, strong social networking among all levels of staff. There are so many innovative ways in
making a difference by management to provide and maintain a healthy environment to nurses and overall staff.
Thank you for your response Jojo. I agree that simple awards of recognition could show appreciation of the nurses. I think that we need to develop a culture of togetherness where nurses could feel apart of a team. When persons feel like they are apart of something greater than themselves then they feel a sense of belonging, desire to give their input, make things work and ensure the betterment of the entire team. It is almost like feeling like they are a family. I too agree that the appraisal process needs to be strengthened because most times it is not a fair indicator of the skills and competencies of the nurse. It is typically bias and nurses tend to be marked down because of their character and not their work output or anything to do with how they are/perform on the unit. If nurses and management could have a discussion on ways to improve the mental state and attitude of nurses, ways nurses could feel supported by management and make nurses be priority then the health care system will be much improved. It should be both about the patient and the nurse, none should be more important than the other. Until we develop a system of equilibrium then things will not change. Nurses suffer traumatic experiences at work everyday so their psychological wellbeing should be paramount.
Job well done…highlighted all the important issues etc
Well said Reema
Great post Reems . Its normal for nurses to migrate because we cant compete with the metropolitan countries when it comes to benefits. However shortage of nursing staff is a global problem so this should not be a reason for migrating. And your are right the problem of nurse migration needs to be addressed. I know right now management are seeking solutions to this problem but certainly its not an easy fix.
Nurses have been migrating from eons but now they are leaving in large numbers Janice. The global shortage of nurses have caused other countries to come shopping for nurses in our country and the offers are very appealing. I agree that it is not an easy fix at all.