Nurse migration in Europe—Can expectations really be met? Combining qualitative and quantitative data from Germany and eight of its destination and source countries

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Abstract

Background

While nurse migration has received considerable political attention since the EU enlargements in 2004 and 2007, most research concentrated on the specific migration motives and the impact on health care systems, while little research focused on the experiences of nurses abroad or combined these experiences with research on working conditions in hospitals.

Objectives

To test whether the combination of qualitative and quantitative data on motives to migrate and to leave the current hospital, respectively, provides sufficient information (1) to analyse working conditions in Germany compared to five destination and three source countries, (2) to verify or falsify the assumption that working conditions in destination countries are better than in source countries, and (3) to identify sound strategies for workforce planning.

Design and data sources

(a) Relevant push factors for migrating from Germany were identified via an online survey, focus groups, and telephone interviews. (b) Eight factors were operationalised using items selected from the revised Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI). (c) The impact of these push factors on the stated “intention-to-leave” of 1508 hospital nurses in Germany was assessed using multivariate data analysis. (d) Descriptive statistics were used to illustrate comparisons across all countries using a total sample of 27,451 nurses from 328 hospitals.

Results

(1) All push factors show a positive association with the risk for nurses to leave their current jobs, with “poor working environment” having the most pronounced relationship (OR 3.235, 95% CI 2.434–4.301). (2) On average, four out of five destination countries receive better ratings than Germany (with 5/5 for “sufficient nursing staff”, “recognition”, “decision-making power”, and “collaboration between nurses and physicians” but only 1/5 for “advanced training prospects”), while two out of three source countries receive worse ratings than Germany. (3) Results suggest that the way to retain and attract nurses on the short-term is to invest in better working environments.

Conclusions

By successfully linking qualitative and quantitative research, new insights about factors for the movement of nurses can be gained. German nurses would indeed find more satisfying conditions abroad in most cases–findings which encourages a revision of work-related aspects in German hospitals.

Section snippets

Background

Since an increasing number of nurses cross borders every year in search of better working and living conditions, career prospects, or even just new experiences, they have become important actors in a growing, competitive global labour market. Due to the EU enlargements in 2004 and 2007 and the accession of less wealthy countries, such as Poland, Romania or Bulgaria, which created greater socio-economic diversity, the movement of nurses between European countries has grown significantly and has

Objectives

Since attracting young people to join the nursing workforce is an insufficient means of meeting future workforce challenges, the interest in both decreasing outbound nurse migration and increasing inbound migration is expected to grow, which demands a careful analysis of working conditions in both attractive destination countries and source countries. So far, most research on European nursing migration has largely concentrated on the specific migration motives and the impact migration has on

Methods

The methodology includes two major steps. First, a relevant database has been identified by linking and validating the research results of two large EU studies using multivariate data analysis. Second, descriptive statistics have been used to illustrate comparisons across countries.

Data source: Two EU workforce projects (PROMeTHEUS and RN4Cast).

The study is based on the research output of two recent EU projects funded through the Seventh Framework Programme (7FP), namely PROMeTHEUS (Health

Results

All eight explanatory variables show a positive association with the risk for nurses to leave the country, only with the predictors “decision-making power” and “remuneration” not being statistically significant (Table 3).

Discussion

Since the results of this study are based on subjectively measured data only, interpretation and discussion of the individual push factors should take differing country-specific aspects into careful consideration. For example, with respect to the satisfaction rates for “advanced training prospects”, it seems that Switzerland and Germany are among those countries with a rich infrastructure for advanced training prospects, since dissatisfaction is relatively low (23% and 30%), compared to

Conclusions/recommendations

The present study successfully linked qualitative and quantitative research results from two recent EU funded studies that had initial aims which were independent from each other. By linking the information gathered in both studies we were thus able to demonstrate how to make best use of both research results and public money spending. Furthermore, this study allowed us to introduce an innovative approach to current migration research, as we validated our assumption that push factors relevant

Acknowledgements

Both projects, RN4Cast (Registered Nurse Forecasting) as well as PROMeTHEUS (Health Professional Mobility in the European Union study). The authors are especially grateful to the following contributors: Diana Ognyanova (Technische Universität Berlin) from the PROMeTHEUS consortium and Anne Marie Rafferty (England, King's College London), Tomasz Brzostek, Maria Kózka (Poland, Jagiellonian University Medical College), Maria Schubert (Schweiz, UniversitätsSpital Zürich), Lindqvist Rikard (Sweden,

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