Employment goals, expectations, and migration intentions of nursing graduates in a Canadian border city: A mixed methods study

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Abstract

Background

Internationally, nurse migration in border cities has received little attention. Nurses who graduate from nursing programs in Canadian border communities have the option of working in Canada or the United States. They are able to cross the international border each day as commuter migrants returning to their home country after work. Despite recent investment by Canada to increase the number of nursing students, the migration intentions of graduating nurses and the factors influencing their decision making has not been explored.

Objectives

The objective of this study is to explore the migration intentions of a graduating class of baccalaureate nursing students in a Canadian border community and the factors influencing their decision making.

Methods

An explanatory sequential mixed methods design was used. In the first quantitative phase, data was collected by a web-based self-report survey. In the qualitative phase, semi-structured interviews were conducted. Data collection took place between February and July 2011.

Results

The response rate to the survey was 40.9% (n = 115). Eighty-six percent of graduates preferred to work in Canada although two thirds identified that they were considering migrating for work outside of Canada. Knowing a nurse who worked in the US (Michigan) influenced intention to migrate and living in a border community was a strong predictor of migration. Migrants had significantly higher expectations that their economic, professional development, healthy work environment, adventure and autonomy values would be met in another country than Canada. Evidence from the interviews revealed that clinical instructors and clinical experiences played a significant role in framing students’ perceptions of the work environment, influencing their choice of specialty, and where they secured their first job.

Conclusion

The value–expectancy framework offered a novel approach to identifying job factors driving migration intentions. The study offered a snapshot of the graduates’ perception of the work environment before entering the workforce. The graduates doubted that their future work environment would meet many of their job expectations, a troubling finding requiring further investigation. Expectations influenced their migration intentions and may be relevant to their integration and retention in the workforce.

Section snippets

Background

Migration has had a long tradition in the nursing profession beginning with Florence Nightingale but the current trends and effects of nurse migration differ greatly from what was observed in the past (Habermann and Stagge, 2010). Globally, there is a shortage of Registered Nurses (RN) and almost every country in the world predicts needing more nurses than they will produce or retain (Aiken et al., 2004, Buchan and Calman, 2004, Kline, 2003). As a result of underinvestment in nursing, developed

Design and methods

For the purpose of this study, a migrant was defined as a graduate who is considering working in nursing in another country. The migrant may move from Canada (e.g., North Carolina or Australia) or live in Canada but commute (commuter migrant) for work across an international border (e.g., Windsor and Detroit border). Non-migrants were defined as graduates who were only considering working in Canada.

An explanatory sequential mixed methods design was used (Creswell and Plano Clark, 2011). In

Quantitative analysis

Quantitative analysis was performed using IBM® SPSS® Statistics 19 (Somers, NY). Prior to data analysis, the data was explored for accuracy of entries, missing data, and statistical assumptions such as normal distribution and outlier data points (El-Masri and Fox-Wasylyshyn, 2005, Field, 2005, Hazard Munro, 2005). Descriptive statistics were used to describe the sample characteristics and the value and expectations mean scores. Ordinal variables (Likert-scales) were treated as continuous

Survey response

The response rate to the survey was 40.9% (n = 115). The majority of the survey was completed (n = 107) in its entirety with few missing responses. Eight (7.0%) surveys were only partially completed. These cases were not deleted to preserve the sample size and allowed completed responses to be included in the analysis. Missing responses were excluded from the analysis accounting for differences in the reported number of participants’ responses. The fact that at any given point the largest per cent

Migration intentions of new graduates

This research provides insights into the migration intentions of recently graduated Canadian nurses, where two thirds considered migrating. Nurse migration has been identified as a symptom of a failing health system and “not the primary disease” (Kingma, 2008) and these findings suggest that these graduates are aware of symptoms of problems in the nurse's work environment before entering the workforce. The majority preferred to work in Canada, but because of a perceived absence of valued jobs

Conclusion

Reports have been produced to address the nursing shortage in Canada (Canadian Nurses Association, 2009), but the important issue of the loss of nurses through migration, has been absent. The lack of full time positions pushing nurses from Canada has been well documented but it has been unclear whether other valued job factors and personal characteristics of these nurses also contributed to this movement. This study explored the use of a value expectancy framework and additional factors which

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