Palliative care integration: a critical review of nurse migration effect in Jamaica

Background Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. Methods A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth’s methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. Results Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. ‘Push-factors’ such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. Conclusion Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.

Nurse migration in Australia, Germany and the UK: A rapid evidence assessment of primary research

Aim To examine existing primary research on nurse migration, including educational needs and initiativesBackground Nurse migration is a common strategy used to address nursing workforce needs.Introduction Agreements exist between countries to facilitate nurse migration, however, it is unclear how nurse migrants have contributed to developing the data on which these arrangements are based.Methods We conducted a rapid evidence assessment to review the available primary research data. The search strategy looked for sources that involve, was developed with or franchises migrant nurses. The papers included were assessed for methodological quality using the SRQR and CONSORT checklists.Findings The primary research data retrieved produced 4 main themes; migrant nurses are not clearly defined in research, discrimination is often reported by migrant nurses, language and communication competencies are important and structured integration programmes are highly valued by migrant nurses and destination healthcare employers.Discussion The findings show that migrant nurses are disenfranchised in primary research in healthcare and this is congrunent with wider reports of discrimination. Structured integration programmes improve the experience of migrant nurses.Conclusion There is a strong evidence for including migrant nurses in all aspects of research.Implications for Nursing Policy This has implications for policy because ethical and sustainable nurse migration relies on including nurse migrants in data.

Factors associated with the recruitment of foreign nurses in Japan: a nationwide study of hospitals

Background Nurse migration under bilateral agreements is a recent global trend, although lack of consultation with the health industries has led to challenges in the recruitment of foreign nurses by hospitals. To analyze the prevailing perception of hospitals on the Economic Partnership Agreement (EPA), under which Japan opened the doors to foreign nurses, we surveyed hospitals that are yet to employ foreign nurses. Methods An anonymous questionnaire was developed and distributed to eligible hospitals; it assessed managers’ perception of Japan’s policy on the recruitment of foreign nurses and their intentions to hire foreign nurses under the EPA (hereafter called EPA nurses). We randomly selected 1879 hospitals, or 22% of the hospitals in Japan (n = 8540), with more than 20 beds. We used descriptive statistics, a Chi-square test, and logistic regression analysis to identify the predictors and developed a model to predict the likelihood of their intention to recruit EPA nurses in the future. Results In total, 432 hospitals were eligible for further analysis (response rate: 22.9%). Half (50%) of the hospital managers were considerably interested in Japan’s policy on recruiting EPA nurses, although only 20% intended to recruit EPA nurses in the future. Willingness to recruit EPA nurses was associated with the degree of interest in the policy (OR 9.38; 95% CI 4.42–19.90) and managers’ perception of EPA nurses (OR 5.32, 95% CI 2.38–11.89). Conclusions To attract more hospitals to recruit foreign nurses, it is essential for the Japanese government and the sending countries to review their EPA systems. Utilizing returning nurses to assist language acquisition by the forthcoming EPA nurses could be a provisional solution. For a more fundamental solution, long-term provision, from prior to their migration until their return migration, is needed to encourage brain circulation, as opposed to brain drain, between sending and receiving countries.

Factors associated with the recruitment of foreign nurses in Japan: A nationwide study of hospitals

Background: Nurse migration under bilateral agreements is a recent global trend, although lack of consultation with the health industries has led to challenges in the recruitment of foreign nurses by hospitals. To analyze the prevailing perception of hospitals on the Economic Partnership Agreement (EPA), under which Japan opened the doors to foreign nurses, we surveyed hospitals that are yet to employ foreign nurses. Methods: An anonymous questionnaire was developed and distributed to eligible hospitals; it assessed managers’ perception of Japan’s policy on the recruitment of foreign nurses and their intentions to hire foreign nurses under the EPA (hereafter called EPA nurses). We randomly selected 1,879 hospitals, or 22% of the hospitals in Japan (n = 8,540), with more than 20 beds. We used descriptive statistics, a Chi-square test, and logistic regression analysis to identify the predictors and developed a model to predict the likelihood of their intention to recruit EPA nurses in the future. Results: In total, 432 hospitals were eligible for further analysis (response rate: 22.9%). Half (50%) of the hospital managers were considerably interested in Japan’s policy on recruiting EPA nurses, although only 20% intended to recruit EPA nurses in the future. Willingness to recruit EPA nurses was associated with the degree of interest in the policy (OR 9.38; 95% CI 4.42–19.90) and managers’ perception of EPA nurses (OR 5.32, 95% CI 2.38–11.89). Conclusions: To attract more hospitals to recruit foreign nurses, it is essential for the Japanese government and the sending countries to review their EPA systems. Utilizing returning nurses to assist language acquisition by the forthcoming EPA nurses could be a provisional solution. For a more fundamental solution, long-term provision, from prior to their migration until their return migration, is needed to encourage brain circulation, as opposed to brain drain, between sending and receiving countries.

Nurse migration in Germany, the UK, and Australia: a comparative situation analysis

Background Nurse migration is increasingly seen as an appropriate response to address nursing shortages in overburdened health systems. This paper aims to analyse the situation in Germany, the UK and Australia and identify similarities and differences in the dimensions, perceptions and processing of nurse migration in different health systems. Methods A rapid evidence assessment and comparative situation analysis of routine data obtained from public health, education and labour market reporting systems, and academic and grey literature were carried out in Jan-Feb 2020. Primary outcome measures were key data of nurse population and migration, barriers and opportunities, and educational initiatives to support migrating nurses to meet the requirements to work in the destination country. Results Germany, the UK and Australia are confronted with an ageing and increasingly chronically ill population and severe nursing shortages. Skilled migration is seen as an opportunity to address these problems, but each country is faced with different contextual conditions and requirements. Data on the nurse workforce obtained from public health, educational and labour market reporting systems are more differentiated and extensive in the UK and Australia than in Germany. Furthermore, there is a substantial amount of published literature in the UK (n = 65) and Australia (n = 87) on nurse migration and on how the countries address challenges in this area; in comparison to the German context, where such research is limited (n = 7). Available research focuses on the economic, epidemiological and geographical impact and distribution of nurse migration. Qualitative dimensions and educational requirements are less well discussed. Conclusions Evidence on nursing migration is strongly based on quantitative factors and may not reflect current needs. More information about qualitative aspects of nurse migration is required to develop recommendations that support enhanced nursing workforce migration. Key messages Nurse Migration presents many challenges that have not yet been fully researched. Results of a comparative analysis of three countries offer the opportunity to highlight missed opportunities.