A concept model for understanding international nurse migration
Description of Theory: Nurse migration is a topic of interest for countries attempting to recruit internationally educated nurses, the institutions which hope to retain them, and the countries losing their workforce. Traditionally, the push-pull model, developed in 1979, has been used as a conceptual framework for understanding nurse migration. However, this model does not fully explain reasons nurses choose to stay in host countries despite barriers to nursing practice and safe patient care. The concept model introduced here provides a new context for understanding nurse migration, using a more complete analysis of various factors influencing nurses’ decisions. Adapted from Padarath et al’s (2003) model, this framework expands on the push-pull factors and includes stick and stay factors to further understand why nurses choose to migrate in the first place or to remain in their host countries. Stick factors seek to explain reasons nurses do not leave their countries of origin, such as the administrative barriers to migration or responsibilities to family at home. Stay factors relate to reasons nurses stay in their new countries, rather than returning home, including not wanting to interrupt their children’s education in the new country or feeling responsible for sending home remittances. This model adds block factors to explain the additional factors influencing a nurse’s decision to migrate.
Approach: A systematic review of the English-language literature exploring the lived experiences of internationally educated nurses yielded 44 quantitative and qualitative primary research articles. The authors reviewed articles to elicit themes of nurse migration not discussed in previous migration models.
Relation to Nursing Practice: Nurse managers attempting to maintain an internationally educated nursing staff can benefit from understanding the barriers nurses face once in the host country, and health care organizations can use the framework to improve nurse transitions and ultimately improve patient care and safety. Policy makers in countries attempting to recruit nurses and to retain and internationally educated nursing workforce can better address regulatory barriers facing migrating nurses. Finally, a new conceptual framework will streamline efforts to explore nurse migration, and research will benefit from a model which facilitates a thorough assessment of the influences of migration.
Conclusions: Nurse migration is a global issue, affecting both countries of origin who experience workforce shortages and host countries who assist nurses assimilate into a new culture. A comprehensive model which incorporates the myriad forces for nurse migration is essential for understanding motivations of nurses to migrate. The proposed conceptual model can be used by researchers, organizations and policy makers seeking to better understand the implications of nurse migration.