An integrative review of the role of remittances in international nurse migration

Figures & data

Figure 1 Search strategy for the literature review.

Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Table 1 Articles included in the integrative review

Author and date	Sending country or region	Receiving country	Purpose	Methods and analysis	Sample
Adams and Stilwell, 2004^Citation58	NA	NA	This article introduces the special issue from the Bulletin of the World Health Organization that focused on international nurse migration.	Editorial introduction	NA
Adlung and Carzaniga, 2001^Citation59	NA	NA	It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context.	Report	NA
Ahmad, 2004^Citation60	40-country study	Australia, Canada, Germany, UK, USA	Discusses the context of international health worker migration at the time of publication.	Opinion	NA
Alonso-Garbayo and Maben, 2009^Citation41	India, Philippines	UK	This paper compares the diverse motivations of nurses from different countries to migrate as well as those of nurses with previous migratory experience and first-time migrants.	Qualitative	6 (India) 15 (Philippines)
No author listed, Australian Nursing Journal, 2006^Citation61	Africa, Philippines	Australia, Canada, USA, UK	To briefly report on the impact of health worker migration on developing countries.	Report	NA
Brown and Connell, 2004^Citation50	Fiji, Samoa, Tonga		This paper seeks to examine the rationale for the migration of skilled health professionals from a group of three Pacific island countries – Fiji, Samoa and Tonga – in each of which there has been a considerable international skill drain from the health sector.	Cross-sectional	182
Buchan et al, 2006^Citation51	Jamaica, Mauritius, Zambia, Kenya, India, Ghana, Australia/ New Zealand, Zimbabwe, South Africa, Nigeria, Philippines	UK	The paper reports on a survey of recently arrived international nurses working in London to assess their demographic profile, motivations, experiences, and career plans.	Quantitative	380
Chanda, 2002^Citation62	NA	NA	To provide an examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care.	Policy analysis	NA
Chandra and Willis, 2005^Citation84	NA	US	To explore the current and projected shortage of nursing professionals in the USA, as well as some of the reasons for this shortage.	Report	NA
Christmas and Hart, 2007^Citation63	NA	NA	To review results, recommendations, and actionable items generated from a consortium of international organizations that focused on the worldwide shortages of health care workers and the migration patterns of health care workers from developing nations to the first world.	Report	NA
Cutcliffe and Yarbrough, 2007^Citation64	NA	NA	This two-part article examines the mass transplantation of nurses within the context of globalization.	Report	NA
Diallo, 2004^Citation65	NA	NA	This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers.	Report	NA
Dimaya et al, 2012^Citation42	Philippines	NA	This study examines how the development of brain drain-responsive policies is driven by the effects of nurse migration and how such efforts aim to achieve mind-shifts among nurses, governing and regulatory bodies, and public and private institutions in the Philippines and worldwide.	Qualitative	10
Dwyer, 2007^Citation85	NA	NA	To consider the right of the individual in migration and the social and international justice of health worker migration.	Report	NA
Dywili et al, 2013^Citation43	NA	NA	To identify the reasons why nurses continue migrating across international borders.	Integrative review	17 (articles)
El-Jardali et al, 2008^Citation52	Lebanon	Gulf, North America, Europe	The objective of this study is to provide an evidence base for understanding the incidence of nurse migration out of Lebanon, its magnitude, and reasons.	Cross-sectional	6,026
Fleck, 2004^Citation66	NA	NA	To explore the factors, such as remittances, that influence health care workers to migrate.	Report	NA
Francis et al, 2008^Citation48	India, Zimbabwe, the Netherlands, Singapore, Malaysia, UK	Australia	This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and nontraditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria.	Qualitative	18
Harrington, 2005^Citation86	Africa, Asia, and Central/ South America	NA	Jan Harrington spoke with Dr Kingma about her research for the book and her findings.	Interview	NA
Harrington, 2010^Citation87	NA	NA	Jan Harrington, International Nursing Review news editor, spoke with Dr Kingma about her efforts with International Council of Nurses over 25 years to improve working conditions for nurses.	Interview	NA
Humphries et al, 2009^Citation44	NA	Ireland	This paper presents data on the remittances sent by migrant nurses to their families “back home.”	Mixed methods	21 (qualitative) 336 (quantitative)
Johnson et al, 2014^Citation81	India	NA	To explore nurses’ accounts of entry into nursing in the context of the globalization of the nursing profession in India, and the salience of “migration” for nurses’ individual careers.	Qualitative	56
Jones et al, 2009^Citation45	Caribbean	UK	Based on the migration of nurses from the English-speaking Caribbean region to the UK, this paper explores the significance of gender at both the macro and micro levels.	Integrative review	15 (studies)
Walker, 2008^Citation79	Philippines	NA	To highlight the exploitation of Filipino workers and the challenges associated with international nurse migration.	Report	NA
Kingma, 2001^Citation67	NA	NA	To present the major motivators and barriers to international nurse migration, possible consequences of migration trends, and a number of recent government policies addressing related issues.	Policy analysis	NA
Kingma, 2007^Citation68	NA	NA	To look at nurse migration flows in the light of national nursing workforce imbalances, examine factors that encourage or inhibit nurse mobility, and explore the potential benefits of circular migration.	Policy analysis	NA
Kirby and Siplon, 2012^Citation69	NA	NA	To argue in favor of a variety of policy and development assistance measures that are grounded in an orientation of nonindifference toward others.	Opinion	NA
List, 2009^Citation70	Sub-Saharan Africa	NA	To examine ways in which destination countries and source countries can minimize incentives for health care worker emigration, while encouraging social responsibility in others by highlighting current policy and activism efforts that seek to reverse the brain drain through infrastructure and capacity-building in sub-Saharan Africa.	Policy analysis	NA
Lorenzo et al, 2007^Citation71	Philippines	NA	To describe nurse migration patterns in the Philippines and their benefits and costs.	Case study	NA
McGillis Hall et al, 2009^Citation53	Canada	USA	The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA.	Secondary data analysis	706
Muula et al, 2006^Citation54	Malawi	NA	To attempt to quantify the financial losses from the investment in training due to the migration from the developing nations.	Economic analysis	NA
Ntlale and Duma, 2012^Citation46	Lesotho	NA	The purpose of this study, which was exploratory, descriptive, and qualitative, was to investigate and describe the experiences of family members of migrant nurses from the Maseru district of Lesotho about the costs and benefits of nurse migration.	Qualitative	10
Parish, 2005^Citation72	Africa	UK	To highlight political attempts to stabilize health care recruitment and analyze it in the context of migration.	Report	NA
Perrin et al, 2007^Citation55	Philippines	Not specific	To assess the current registered nurse-staffing situation in Philippine hospitals.	Cross-sectional	NA
Record and Mohiddin, 2006^Citation73	Malawi	Not specific	This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world: Malawi.	Case study	86 (surveys; not just nurses)
Reinhard et al, 2009^Citation88	Not specific	USA	To examine how the USA can ensure an adequate supply of health care professionals and paraprofessionals to meet the needs of an aging population.	Report	NA
Ryan and Couglan, 2009^Citation47		Ireland	The aim was to explore the experience of the key stakeholders and individuals who had relocated to Ireland to work in the health and social care sector.	Qualitative	NA
Sapkota et al, 2014^Citation49	Nepal	UK	This study explored the reasons why a group of Nepalese health workers migrated to the UK.	Qualitative	6 (doctors) 9 (nurses)
Saravia and Miranda, 2004^Citation74	NA	NA	This article seeks to raise questions, identify key issues, and provide examples of policies that can be used to manage migration and the asymmetric distribution of highly educated and skilled people.	Report	NA
Schmid, 2004^Citation75	NA	NA	To review the large impact of temporary and permanent migration of the health care workforce.	Report	NA
Shaffer and Dutka, 2013^Citation76	NA	NA	This article presents the challenges and regulatory implications of nurses entering the USA on an occupational visa and in applying for a license to practice.	Report	NA
Stilwell et al, 2004^Citation77	NA	NA	The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.	Policy analysis	NA
Thupayagale-Tshweneagae, 2007^Citation78	NA	NA	To examine reasons behind migration and to argue that there are greater incentives for migrating than staying.	Report	NA
Walker, 2008^Citation79	New Zealand	NA	The aim of this paper was to understand the scope and scale of problems facing other migrant nurses and to highlight the current and long-term implications for health care services in New Zealand.	Report	NA
Winkelmann-Gleed and Seeley, 2002^Citation56	NA	UK	This article, based on research carried out in 2002/2003, examines the experiences of recently internationally qualified migrant nurses to the UK and explores their stories with the aim of understanding aspects of their work-related identities.	Mixed methods	140
World Health Organization, 2006^Citation2	NA	NA	To explore possible solutions and steps of the World Health Assembly to address the brain drain.	Report	NA
Xu and Zhang, 2005^Citation89	NA	NA	This theoretical study examines the ethics of international nurse recruitment from the conceptual framework of stakeholder interests.	Qualitative	NA
Zivotofsky and Zivotofsky, 2009^Citation80	NA	NA	To argue for greater latitude in defining country of origin, personal autonomy, and contribution to society in the context of international health worker migration.	Opinion	NA

Abbreviations: GATS, General Agreement on Trade in Services; NA, not available.

Figure 2 Carling’s 2008 conceptual model for microlevel analyses of remittances. Copyright © 2008. Reproduced from Carling J. The determinants of migrant remittances. Oxf Rev Econ Policy. 2008;24(3):581–598, by permission of Oxford University Press.⁴

Adams O, Stilwell B. Health professionals and migration. Bull World Health Organ. 2004;82(8):560.

 Web of Science ®Google Scholar

Adlung R, Carzaniga A. Health services under the General Agreement on Trade in Services. Bull World Health Organ. 2001;79(4):352–364.

 Web of Science ®Google Scholar

Ahmad OB. Brain drain: the flight of human capital. Bull World Health Organ. 2004;82(10):797–798.

 PubMed Web of Science ®Google Scholar

Alonso-Garbayo A, Maben J. Internationally recruited nurses from India and the Philippines in the United Kingdom: the decision to emigrate. Hum Resour Health. 2009;7:37.

 PubMed Web of Science ®Google Scholar

Migration threatens health systems in developing countries. Aust Nurs J. 2006;13(6):10.

 Google Scholar

Brown RPC, Connell J. The migration of doctors and nurses from South Pacific island nations. Soc Sci Med. 2004;58(11):2193–2210.

 Web of Science ®Google Scholar

Buchan J, Jobanputra R, Gough P, Hutt R. Internationally recruited nurses in London: a survey of career paths and plans. Hum Resour Health. 2006;4:14.

 Google Scholar

Chanda R. Trade in health services. Bull World Health Organ. 2002;80(2):158–163.

 PubMed Web of Science ®Google Scholar

Chandra A, Willis WK. Importing nurses: combating the nursing shortage in America. Hosp Top. 2005;83(2):33–37.

 Google Scholar

Christmas K, Hart KA. Workforce shortages are a global issue. Nurs Econ. 2007;25(3):175–177.

 Web of Science ®Google Scholar

Cutcliffe JR, Yarbrough S. Globalization, commodification and mass transplant of nurses: Part 1. Br J Nurs. 2007;16(15):926–930.

 Google Scholar

Diallo K. Data on the migration of health-care workers: sources, uses, and challenges. Bull World Health Organ. 2004;82(8):601–607.

 PubMed Web of Science ®Google Scholar

Dimaya RM, McEwen MK, Curry LA, Bradley EH. Managing health worker migration: a qualitative study of the Philippine response to nurse brain drain. Hum Resour Health. 2012;10(1):47.

 Google Scholar

Dwyer J. What’s wrong with the global migration of Health Care Professionals? Individual rights and international justice. Hastings Cent Rep. 2007;37(5):36–43.

 PubMed Web of Science ®Google Scholar

Dywili S, Bonner A, O’Brien L. Why do nurses migrate? – a review of recent literature. J Nurs Manag. 2013;21(3):511–520.

 Web of Science ®Google Scholar

El-Jardali F, Dumit N, Jamal D, Mouro G. Migration of Lebanese nurses: a questionnaire survey and secondary data analysis. Int J Nurs Stud. 2008;45(10):1490–1500.

 Web of Science ®Google Scholar

Fleck F. Should I stay or should I go? Bull World Health Organ. 2004; 82(8):634.

 Web of Science ®Google Scholar

Francis K, Chapman Y, Doolan G, Sellick K, Barnett T. Using overseas registered nurses to fill employment gaps in rural health services: quick fix or sustainable strategy? Aust J Rural Health. 2008;16(3):164–169.

 Web of Science ®Google Scholar

Global ICN Report says supply of nurses affects health care outcomes. Int Nurs Rev. 2005;52(1):4–5.

 Web of Science ®Google Scholar

Three countries launch projects to promote healthy workplaces. Int Nurs Rev. 2010;57:155–157.

 Google Scholar

Humphries N, Brugha R, McGee H. Sending money home: a mixed-methods study of remittances by migrant nurses in Ireland. Hum Resour Health. 2009;7:66.

 Web of Science ®Google Scholar

Johnson SE, Green J, Maben J. A suitable job?: A qualitative study of becoming a nurse in the context of a globalizing profession in India. Int J Nurs Stud. 2014;51(5):734–743.

 PubMed Web of Science ®Google Scholar

Jones AD, Bifulco A, Gabe J. Caribbean nurses migrating to the UK: a gender-focused literature review. Int Nurs Rev. 2009;56(3):285–290.

 PubMed Web of Science ®Google Scholar

Walker L. A mixed picture: the experiences of overseas-trained nurses in New Zealand. Nurs N Z. 2008;14(11):18–19.

 Google Scholar

Kingma M. Nursing migration: global treasure hunt or disaster-in-the-making? Nurs Inq. 2001;8(4):205–212.

 PubMedGoogle Scholar

Kingma M. Nurses on the move: a global overview. Health Serv Res. 2007;42(3 Pt 2):1281–1298.

 PubMed Web of Science ®Google Scholar

Kirby KE, Siplon P. Push, pull, and reverse: self-interest, responsibility, and the global health care worker shortage. Health Care Anal. 2012; 20(2):152–176.

 Web of Science ®Google Scholar

List JM. Justice and the reversal of the healthcare worker ‘brain-drain’. Am J Bioeth. 2009;9(3):10–12.

 PubMed Web of Science ®Google Scholar

Lorenzo FM, Galvez-Tan J, Icamina K, Javier L. Nurse migration from a source country perspective: Philippine country case study. Health Serv Res. 2007;42(3 Pt 2):1406–1418.

 Web of Science ®Google Scholar

McGillis Hall L, Pink GH, Jones CB, Leatt P, Gates M, Peterson J. Is the grass any greener? Canada to United States of America nurse migration. Int Nurs Rev. 2009;56(2):198–205.

 Web of Science ®Google Scholar

Muula AS, Panulo B, Maseko FC. The financial losses from the migration of nurses from Malawi. BMC Nurs. 2006;5:9.

 Google Scholar

Ntlale ME, Duma SE. The costs and benefits of nurse migration on families: A Lesotho experience. Curationis. 2012;34(1):E1–E8.

 Google Scholar

Parish C. Nurses and doctors unite in call for an end to African skills drain. Nurs Stand. 2005;19(41):5.

 Google Scholar

Perrin ME, Hagopian A, Sales A, Huang B. Nurse migration and its implications for Philippine hospitals. Int Nurs Rev. 2007;54(3):219–226.

 Web of Science ®Google Scholar

Record R, Mohiddin A. An economic perspective on Malawi’s medical “brain drain”. Global Health. 2006;2:12.

 PubMed Web of Science ®Google Scholar

Reinhard S, Redfoot D, Cleary B. Health and Long-Term Care: Are Immigrant Workers Indispensable? Am Soc Aging. 2009;32:24–30.

 Google Scholar

Ryan D, Couglan D. Inward labour mobility in the Irish health- and social-care sector. Br J Nurs. 2009;18(3):192–197.

 Google Scholar

Sapkota TN, van Teijlingen E, Simkhada PP. Nepalese health workers’ migration to the United Kingdom: a qualitative study. Heal Sci J. 2014;8(1):57–74.

 Google Scholar

Saravia NG, Miranda JF. Plumbing the brain drain. Bull World Health Organ. 2004;82(8):608–615.

 PubMed Web of Science ®Google Scholar

Schmid K. Strategies to manage migration of health professionals to protect national health systems will be successful only if all stake-holders are involved in the process. Bull World Health Organ. 2004;82(8):621–622.

 Google Scholar

Shaffer FA, Dutka JT. Global mobility for internationally educated nurses: challenges and regulatory implications. J Nurs Regul. 2013;4(3):11–16.

 Google Scholar

Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health-care workers from developing countries: strategic approaches to its management. Bull World Health Organ. 2004;82(8):595–600.

 PubMed Web of Science ®Google Scholar

Thupayagale-Tshweneagae [webpage on the Internet]. Migration of nurses: is there any other option? Int Nurs Rev. 2007;54(1):107–109.

 Web of Science ®Google Scholar

Winkelmann-Gleed A, Seeley J. Strangers in a British world? Integration of international nurses. Br J Nurs. 2005;14(18):954–961.

 Google Scholar

World Health Organization. Working Together for Health: The World Health Report 2006. Geneva: World Health Organization; 2006. Available from: http://www.who.int/whr/2006/whr06_en.pdf?ua=1. Accessed January 31, 2014.

 Google Scholar

Xu Y, Zhang J. One size doesn’t fit all: Ethics of international nurse recruitment from the conceptual framework of stakeholder interests. Nurs Ethics. 2005;12:571–581.

 PubMed Web of Science ®Google Scholar

Zivotofsky AZ, Zivotofsky N. Are healthcare workers chained to their country of origin? Am J Bioeth. 2009;9(3):16–18.

 PubMed Web of Science ®Google Scholar

Carling J. The determinants of migrant remittances. Oxf Rev Econ Policy. 2008;24(3):581–598.

 Web of Science ®Google Scholar