IDE Research Bulletin: International Migration of Nurses: The Cases of The Philippines and India

IDE Research Bulletin
Research project summary based on papers for academic journals

with the aim of contributing to the academic community
International Migration of Nurses:

The Cases of the Philippines and India
Project Leader
TSUJITA, Yuko
March 2019
Copyright (C) JETRO. All rights reserved.

http://www.ide.go.jp
International Migration of Nurses: The cases of the Philippines and India
Recently, the international migration of nurses has increased. In OECD countries,

14.5% of nurses were born abroad (OECD, 2015). There is a growing demand for
nurses in many OECD countries, arising from the increasing demand for better quality
of health services, the progressive aging population, the promotion of medical tourism,
and a shift from home care to institutional care, particularly regarding long-term care.
The Philippines and India are two major sources in exporting nurses. The number of
nurses who work in the OECD countries amounts to 221,344 from the Philippines and
70,471 from India. Moreover, for both countries sending nurses, the Gulf countries are
estimated to be the largest recipient countries, although there are no figures on how
many nurses from these countries work in the Gulf countries. English language
proficiency is one of their advantages in terms of working abroad.
Although the two countries “export” nurses, their domestic nurse labor market differs
somewhat. On the one hand, the Philippines had an excess supply of nurses particularly
in the early and mid-2000s, when the UK and USA opened their doors to foreign-trained
nurses. Many of those who were educated in the Philippines sought employment
opportunities abroad. On the other hand, India suffers from a shortage of nurses.
However, low salaries and benefits, particularly in private hospitals, are the main “push”
reasons why many nurses leave the country.
When registered nurses from the Philippines and India reach their destinations, they
face a wide range of obstacles, such as immigration policies, nursing practices, and
discrimination (for example, Cuban 2010; Yeats 2009; Moyce et al. 2016). According to
a study conducted in European countries, nurses from developing countries tend to be
engaged in simpler tasks than local nurses and those who are from developed countries
(Bruyneel et al. 2013). In Australia, foreign-trained nurses from non-English-speaking
countries lagged behind in terms of joining the nurse labor market (Hawthorne 2001).
One of the reasons why some nurses from developing countries face great obstacles at
their destinations is attributable to the fact that their nursing qualifications and
experiences are not automatically recognized at their destinations. This is mainly
because the quality of nursing education is polarized in these countries, as both
1
countries are seeing a mushrooming of nursing educational institutions.
With this background, three papers have been written in this research project.
Will they leave or will they stay? Occupation, migration policies and stepwise
migration of Philippine-educated nurses (PENs) in Singapore
The retention of foreign-educated nurses has emerged as an equally important issue as
their recruitment because of the tightening of the labor markets in both the destinations
and in some sending countries. We explored who among the foreign nurses leave the
current destination and why, within the framework of stepwise migration. Using sample
data from 264 Philippine-educated nurses (PENs) in Singapore, we carried out a
binomial regression analysis to determine the likelihood of leaving the destination and
found that nursing aides and health care attendants and older nurses were more likely to
plan to leave; while PENs working in publicly-funded facilities and those who have
been working in this country for a long time were more likely to plan to stay.
Our study contributes to the literature on foreign-educated nurses' retention on
two points. First, using the stepwise migration behavior as our framework, we
elaborated on who were likely to stay in a transit destination. Second, we highlighted
the relevance of the destination’s labour policies and programs that would improve the
foreign nurses’ work environment, in their stay-or-leave decision. The results present an
important implication on how Singapore and the emerging destinations such as Japan
can compete for scarce foreign-educated nurses. In cases where migration policies such
as family integration or citizenship are hard or costly to implement, labor policies and
programs, including the protection of workers’ rights, can be effective in securing a
qualified, skilled and stable foreign workforce.
An Examination of Nurses’ Intention to Migrate: Evidence from Nurses in Tamil

Nadu, India
This paper examined the relationship between nurses’ intention to migrate and their
characteristics based on our survey data from Tamil Nadu, India. Around 13% of the
sample nurses intended to migrate overseas, most of whom worked in private hospitals.
Due to the salary gap between public and private hospitals, nurses in private hospitals
possess incentives to go abroad in search of higher wages. Nurses who are also
experienced and single tend to plan to go abroad; in other words, younger, married
nurses who work in public hospitals typically do not intend to migrate overseas. The
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most frequently cited reason for non-migration is that nurses are simply not interested in
going abroad, which is true particularly among nurses who work for public hospitals.
They are relatively well paid, and their jobs are secured. The high opportunity cost of
overseas migration discourages these nurses from migrating. Nurses are generally
satisfied with their current occupation. The hypothesis that nurses who intend to migrate
feel unhappier than do nurses who do not intend to migrate has been rejected, as nurses
plan to migrate not because they are unhappy with their current occupation, but because
they wish to achieve more favorable working conditions and higher wages.
Deskilling of Foreign-trained Nurses at a Destination: A Mixed Methods Study of

Indian Nurses in Singapore
This paper demonstrated the factors, reasons, and processing of deskilling nurses from a
developing country in a destination country. The example is taken from Indian nurses in
Singapore. Deskilled nurses tended to be male, non-Christian, of rural origins and have
fathers with less formal education. They studied nursing in private institutions, likely
not at their own will. In the process of being deskilled in Singapore, Indian recruiters
play on the nurses’ desire and necessity to work overseas. Deskilled nurses often
decided to go to the destination very quickly, because Singapore was a less expensive
and easier destination than western countries. It is increasingly competitive for Indian
nurses to become licensed nurses in Singapore, as the number of positions is limited
particularly in nursing homes, and there are more foreign-trained, particularly Filipino
nurses. Deskilled nurses wait extended periods to receive employer recommendations to
take the licensing exam. Many unlicensed nurses wanted to go to another country, but
their migration prospects were limited because their work as unlicensed nurses in
Singapore was not recognized as nursing experience in developed countries, and costs
related to another migration were prohibitive. Therefore, it was unlikely that Singapore
served as the desired stepping stone to the preferred final destination. Many deskilled
nurses likely enjoyed the host country until their marriages were arranged by their
family in India.
＜References>
Bruyneel, L., B. Li, L. Aiken, E. Lesaffe, Koen van den Heede, and W. Sermeus. 2013.
“A Multi-country Perspective on Nurses’ Tasks below Their Skill Level: Reports
from Domestically Trained Nurses and Foreign Trained Nurses from Developing
3
Countries.” International Journal of Nursing Studies, 50, pp. 202-209.
Cuban, Sondra. 2010. “‘I Try Hard to Stay in England’: Itineraries, Routes, and Dead
Ends: An (im) Mobility Study of Nurses Who Became Corers.” Compare, 40 (2),
pp. 185-198.
Hawthorne, Lesleyanne. 2001. “The Globalization of the Nursing Workforce: Barriers
Confronting Overseas Qualified Nurses in Australia.” Nursing Inquiry, 8 (4), pp.
213-229.
Moyce, S., R. Lash, and M. Lou de Leon Siantz. 2015. “Migration Experiences of
Foreign Educated Nurses: A Systematic Review of the Literature.” Journal of
Transcultural Nursing, 27 (2), pp. 181-188.
OECD. 2015. International Migration Outlook 2015, Paris: OECD Publishing,
(http://dx/doi.org/10.1787/migr_outlook-2015-en) accessed on 20 Jan. 2018.
Yeates , N. 2009. Globalizing Care Economies and Migrant Workers, Basingstoke and
New York: Palgrave Macmillan.

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IDE Research Bulletin

Research project summary based on papers for academic journals

International Migration of Nurses:

Copyright (C) JETRO. All rights reserved.

Recently, the international migration of nurses has increased. In OECD countries,

An Examination of Nurses’ Intention to Migrate: Evidence from Nurses in Tamil

Deskilling of Foreign-trained Nurses at a Destination: A Mixed Methods Study of

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