Why Do Nurses Leave Their Home country?

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SOURCE: BMJ   

    It has been a phenomenon for decades, many nurses have left their home country despite many challenges and hurdles to adapt to the new country they chose to live in.  

For the context, I will share my nursing journey. I joined nursing education in 2002 not by choice but by chance, as I dropped studying engineering, and parents were not happy and they wanted me to pursue at least a graduate program where I can excel and lead an independent life. Education only meant for me to be independent and travel abroad to have a “quality life”, however, I was not sure what “quality life” meant. It so happened that I got admission into nursing in 2002 as recommended by a fellow nurse of my town and my parents started dreaming then, one day our son will be in Canada or the UK!

I was the only candidate to join nursing in my village and until joining nursing I was not aware of the profession which was almost 100 years old in India. Apparently, It was not so aspirational, then I met the classmates and seniors, mostly found that they were joined the nursing either to “fly abroad” or have “secured govt job” in the home country, nearly none have joined it by choice, mostly either they did not get the medical seats, not affordable to have the technical education, did not get the jobs (with their previous education) or recommended by the fellow nurses.

What it means to study nursing in an underdeveloped or developing country seems to me that we have been taught to be a robot, follow the orders, vocabulary sufficient to interact with the team,  and terminologies for smooth communication and few clinical skills, be resourceful (complete the task with available things or tools) and the whole course was taught in “English” foreign language, where patients spoke the colloquial. The objective was to complete the degree and pass the exam and get enrolled in the state nursing council, have 2 or 3 years of hands-on experience to expedite the process of “flying abroad”. Where the outcome of education and competencies and its utilization was not well defined, policy-making was visionless.

In the nursing practice, I have observed the huge gap in education and practice, no bridge courses were available to have an effective transition from college to the nursing practice, and remuneration and reward were not even equal to the minimum basic wages prescribed by the respective state governments. The living conditions were pathetic (even till today), the hospital used to provide the accommodation for 5 or 6 nurses, eat there, sleep there, and live there. If our wages were not fulfilling our basic needs and essentials of life, would anyone be content and deliver the expected? While enduring this, only sunshine of hope was/is “flying abroad”! 

Recruitment agencies started flourishing, as the middle-east was developing and started to hire overseas nurses. India, Pakistan, and Bangladesh became the best source for nurses. This was like a pair of wings for your dream of “fly abroad” and it is not too far from the home country and will be earning in the currency which is valued more than the home country! The recruitment agencies were started by tours and travel agencies, which still recruits the nurses for most middle-east countries, where nurses paid to these agencies to realize their dream to “fly abroad”! Still, it doesn’t make sense why the recruiting agencies need to be paid by fellow nurses?

This migration brought a lot of social changes in those families, economic stability has led and inspired many others to pursue nursing education, at the same time countries were strengthening healthcare and started hiring the nurses in great numbers, which fulfilled the dream of “secured government job” of many! This further led to the mushrooming of colleges, schools of nursing across India. 

In recent times, Nursing education though still not aspirational but has become a choice, and many fellow nurses have pursued the highest level of education and have the wheel of policymaking is moving now, and regulating and professional associations and institutions have started collaborating, and striving for change and shredding the status-quo is happening.

Hope, now you have the context, let us understand why nurses leave the home country?

Popularly people say better remuneration, and I would not agree completely with this popular notion. To say so, I would like to reflect on intra-country migration, there are a lot of fellow nursing professionals still choosing the home town as a workplace despite the wages being abysmal. I would like to list why nursing professionals are migrating intra-country and inter-country.

1. The dignity of Labour - where there’s no dignity in labor, there you can not expect people to be sane.

2. A better perspective of life  - would like to challenge themselves and have a comfortable life where their children’s education, healthcare, and social respect is. 

3. Quality of life - have a peaceful, responsible, and progressive life.

4. Progressive career - pursue higher education, pursue challenging roles, be leaders, and of course practice independently.

5. Community belongingness - involving in policy-making, decision-making processes. 

I recently joined the NHS UK, where I was really inspired, content, and welcomed. The HR team was so respectful and arrived at the airport to pick us, arranged for sponsored accommodation which shows the warmth and respect for the fellow nurses not just in spoken words but by their actions. Then they introduced and gave us an information pack which has detailed information on how we can avail the services of banking, telephone, transportation, payroll, where can avail the services? Whom we can reach to avail of the services? Well organized information will facilitate you, relieve the anxiety, and make you feel confident about yourself.

Further interesting was the community participation in welcoming us as nursing professionals and to facilitate the smooth transition,  the community transportation services gave us a one-month free-ride coupon. Hospital has arranged 30 food coupons worth 150 GBP. These sponsored services enabled us to adapt to the new world effectively without any ounce of anxiety, fear. We got into our shoes and started looking forward to becoming the Registered Nurse in the UK!

For this, there are two parts of exams other than the language test. The language test and the Part one Exam have cleared in the home country, and for part 2 exam, the hospital practice development team has prepared for 4 weeks, the exam is called OSCE (Observed Structured Clinical Exam), and the exam fee worth 900 GBP was again sponsored! Even the travel cost for the exam day was sponsored.

This support system enabled me to become a Registered Nurse at the desired time, and I'm abroad now!

To sum up, migration is a natural phenomenon of mankind, in our journey of life we keep traveling to preserve our dignity, strive for the quality of life, to have progressive incremental changes in life to have a better perspective of life. The intellectual ability not just empowers to be independent it also teaches us to make choices.