Migration of nurses and the perceived impact on the public health care system in Zambia.

Abstract

The subject of international migration has become an important social issue and feature of globalized labour market in health care. International migration of nurses has increasingly become a concern and the volumes are reported to be increasing particularly from the developing world where, in some countries, is a leading cause of attrition and subsequent shortage of nurses as a human resource. This has implications on the capacity of health systems to respond to the challenge of health care delivery to populations considering that nurses form the largest health workforce in most countries. In Zambia, nurse migration has equally been a concern including the absence of relevant studies with evidence to inform policy direction, planning and management of nursing human resource. The purpose of this study was to determine the extent of nurse migration, the reasons why nurses resign their employment positions and leave the country, why other nurses do not migrate and to further determine the perceived nurse migration impact on the public health care system. The study was a non-experimental descriptive survey design that used both quantitative and qualitative approaches to data collection and data analysis. A triangulation approach was used in data collection involving various methods; multistage, stratified and systematic sampling; purposive and snowball with a range of data collection instruments; semi-structured for focused interviews of nurse migrants, nurses seeking verifications and policy makers; self-administered questionnaire that enlisted data from clinical nurses and nurse educators on the perceived impact of nurse migration on the public health care system and topic guides for focus group discussions. Computer software were used to code and analyze data; SPSS version 11.0 for quantitative data and NVivo7 for qualitative data. A total of 309 clinical nurses and 23 nurse educators responded to the self administered questionnaire. Thirty three key informants participated in focus group discussions conducted in four health facilities situated in four districts. There were five directors at provincial, district and national levels and 13 nurse migrants interviewed. Data on nurses with verification of qualifications sent to countries were collected from a total of 1,142 records; 931 for RNs and 211 for ENs. The study was guided by a conceptual framework developed from two migration theories namely the World Systems Theory and the Push and Pull Theory. The World Systems Theory structured the world into three zones of Periphery (poor countries), Semi-Periphery (Transitional economies) and the Core (industrialized wealthy countries). Push factors caused people to leave the Periphery to the Semi-periphery and to the Core where the Pull factors attracted those from the Periphery and Semi-periphery. Major findings of the study showed dissatisfaction with work conditions, poor living conditions, lack of professional recognition and autonomy and lack of access to professional development as being among the push factors while the pull factors included attractive work conditions, conducive work environment and access to professional development, among others. The perceived impact included nurse shortage, excessive workload, long working hours and poor quality of patient care. Findings on issues for policy on managing nurses leaving for greener pastures were in the form of interventions that would address the push factors and formed the basis for recommendations from the study.