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Massouh A, Skouri H. Ventricular Assist Devices During an Economical Collapse: Challenges and Outcomes. J Card Fail 2024:S1071-9164(24)00188-X. [PMID: 38815707 DOI: 10.1016/j.cardfail.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Affiliation(s)
| | - Hadi Skouri
- University of Balamand Medical School, Beirut, Lebanon.
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2
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Villamin P, Lopez V, Thapa DK, Cleary M. Retention and turnover among migrant nurses: A scoping review. Int Nurs Rev 2023. [PMID: 37467162 DOI: 10.1111/inr.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
AIM To map and explore primary research about factors related to retention, turnover and turnover intention among migrant nurses. BACKGROUND Understanding retention and turnover among migrant nurses is essential, especially in the context of nursing shortage. There is a range of factors motivating nurses to emigrate; however, factors related to retention and turnover among migrant nurses in the host country are unclear. METHODS This review utilised Arksey and O'Malley's methodological framework for scoping reviews, and is reported with the PRISMA-ScR checklist. Four electronic databases were searched-CINAHL, PsycINFO, ProQuest and PubMed-to identify primary research published between January 2000 and May 2022. Titles and abstracts were reviewed against the inclusion and exclusion criteria, and then full-text versions were reviewed. Data extracted were summarised, and results synthesised. RESULTS Fifteen studies were included, with studies mainly from the Middle East, the United Kingdom and the United States. Personal, organisational, financial, political and environmental factors were found to influence retention and turnover among migrant nurses. CONCLUSION Retention and turnover rates among migrant nurses vary among host countries. The factors identified are related to each other; hence, retention and turnover among migrant nurses are best understood in the context of their source country, host country and individual circumstances. IMPLICATIONS FOR NURSING POLICY, SOCIAL POLICY, AND HEALTH POLICY: Host countries must promote strategies that foster retention, such as reviewing immigration policies to support long-term immigration and family unity. Organisations employing migrant nurses need to consider the presence of a social network to facilitate adaptation and integration. It is also recommended that source countries address the reasons for emigration and initiate policies encouraging return migration, including providing merit to overseas experience. International nursing organisations should call for an examination of the conditions of migrant nurses to ensure equality across all source countries.
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Affiliation(s)
- Princess Villamin
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia
| | - Deependra Kaji Thapa
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Australia
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Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F, Gbejewoh EO, Odogu U, Akhirevbulu ICG, Kwarshak YK, Wariri O. Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review. BMJ Glob Health 2023; 8:bmjgh-2023-012338. [PMID: 37156560 PMCID: PMC10174016 DOI: 10.1136/bmjgh-2023-012338] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs. METHODS We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers. RESULTS We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions. CONCLUSION Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.
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Affiliation(s)
- Patience Toyin-Thomas
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Paul Ikhurionan
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Avwebo O Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic, Edmonton, Alberta, Canada
| | - Ukachi C Nnawuihe
- Department of Clinical Services, Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Murataj N, Syla B, Krasniqi Y, Bahtiri S, Bekaj D, Beqiri P, Hoxha IS. Migration Intent of Health Care Workers during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11122. [PMID: 36078833 PMCID: PMC9518021 DOI: 10.3390/ijerph191711122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The migration of healthcare workers from developing countries to more economically developed countries is a long-standing and ongoing trend. Loss of qualified staff due to migration can negatively impact healthcare systems. Understanding factors that drive migration is essential to identifying and managing health system needs. Our study explored factors related to the migration intent of healthcare staff in Kosovo, particularly after the COVID-19 pandemic. We carried out a cross-sectional survey of healthcare workers from public and private institutions. The survey analysed the prevalence of willingness to migrate and whether willingness was affected by the pandemic, and calculated crude and adjusted odds ratios for variables which may influence migration willingness. 14.43% of healthcare workers reported aspiration to migrate, and 23.68% reported an increased chance of migrating after the pandemic. Dissatisfaction with wages and working conditions, higher education and private sector engagement were associated with increased odds of migration willingness. After the pandemic, factors related to interpersonal relationships and state response gave lower odds of migration intent. These findings point to potential factors associated with the migration of healthcare workers, which can help policymakers address gaps in national health system strategy.
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Affiliation(s)
- Nora Murataj
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Blerim Syla
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Yllka Krasniqi
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Shegë Bahtiri
- Institute of South East Europe for Health and Social Policy, 10000 Prishtina, Kosovo
| | - Dardan Bekaj
- Institute of South East Europe for Health and Social Policy, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Advanced Nursing Practices Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir S. Hoxha
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
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What made Lebanese emigrant nurses leave and what would bring them back? A cross-sectional survey. Int J Nurs Stud 2019; 103:103497. [PMID: 31884331 DOI: 10.1016/j.ijnurstu.2019.103497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/25/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The nursing workforce is critical for the provision of quality health-care and positive patient outcomes. There is a global trend of migration of nurses from under-developed to developed countries due to attractive job offers in the host countries. Lebanon presents such a case where nurses are migrating abroad, leading to shortages in the nursing workforce in their home country. OBJECTIVES The aim of this study was to investigate reasons for the migration of Lebanese nurses, and incentives that would attract them back to their home country in order to enhance the nursing workforce in Lebanon. DESIGN This study is a cross-sectional survey of emigrant Lebanese nurses. SETTINGS Recipient countries where Lebanese nurses emigrated. PARTICIPANTS 440 Emigrant Lebanese nurses were identified through the registration database of the Order of Nurses in Lebanon. The survey was sent to all of them via email; 153 responses were received. METHODS Data were collected from November 2017 to March 2018. Analysis included univariate and bivariate tests to present descriptive statistics of the respondents, and to examine region of residence and gender in relation to their current job satisfaction, reasons for leaving Lebanon, intention to return to Lebanon, and aspects that would attract them back to their home country. Logistic regression analysis was used to determine the socio-demographic and work-related characteristics associated with the odds of returning to practice nursing in Lebanon. RESULTS A total 136 completed responses were considered. Emigrant Lebanese nurses were highly educated, with more years of work experience, and older than nurses remaining in their home country. Top reasons for nurses to leave Lebanon included unsatisfactory salary or benefits, better work opportunities in other countries, and lack of professional development or career advancement. The majority of surveyed nurses (59%) expressed willingness to return to practice nursing in Lebanon. Aspects that would attract emigrant Lebanese nurses back to their home country include attractive salary or better benefits and opportunities for professional development, career advancement, or continuing education. Emigrant Lebanese nurses residing in the Gulf, staff nurses, and nurses with more years of work experience were more likely to return to practice nursing in Lebanon. CONCLUSION Highly educated and experienced nurses are departing from Lebanon. This presents a challenge for the less experienced nurses remaining in the country, who could benefit from the mentorship and experience of their migrating peers. Creating an environment that could enhance the professional development of nurses in Lebanon, with financial incentives could retain the nursing workforce in the country.
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Grafton K, Gordon F. The motivations and aspirations of Indian physiotherapists who migrate overseas to study and work: a grounded theory study. Physiotherapy 2019; 105:385-395. [PMID: 30922596 DOI: 10.1016/j.physio.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 11/04/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore why Indian physiotherapists seek to migrate overseas for study and work. DESIGN Qualitative research using Constructivist Grounded Theory (CGT) methodology. SETTING Individual interviews and focus groups were conducted in the UK and India, at university, clinic or hotel locations convenient to the participants. PARTICIPANTS Nineteen physiotherapists from across India. Thirteen had studied or worked in the UK, Australia or Kuwait, and six had no overseas experience. FINDINGS The participants desired a 'better life' due to factors perceived as less favourable in India: pay levels, professional respect and professional development. These elements were inter-dependent and their importance varied between participants and according to gender. Indian societal values amplified the importance of pay for male physiotherapists, whereas females prioritised professional development. Migrant physiotherapists aspired to professional autonomy through the development of knowledge, skills and experience. Respect was important, but there were different perspectives on its achievement and the relevance of titles. For those studying overseas, work was sought to recoup the cost of that study, and, importantly to consolidate learning and experience of autonomous physiotherapy practice. They all planned to return to India and wished to transfer their knowledge and skills back into practice in India. CONCLUSION Pay, respect and professional development are all motivators for Indian physiotherapists to study and work overseas. An ability to practise physiotherapy autonomously is a key factor underpinning the achievement of each of these elements and thus the ultimate aspiration to have a 'better life'.
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Affiliation(s)
- Kate Grafton
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, UK.
| | - Frances Gordon
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, UK
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Grafton K, Gordon F. A grounded theory study of the narrative behind Indian physiotherapists global migration. Int J Health Plann Manage 2019; 34:657-671. [PMID: 30657206 DOI: 10.1002/hpm.2725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/06/2022] Open
Abstract
It is estimated that an additional 6.4 million allied health professionals are required to address India's health challenges. Physiotherapy is amongst the largest of these professions. Over the last decade, thousands of Indian physiotherapists have sought to study and work overseas. In this study, 19 physiotherapists from across India were interviewed. Data were collected and analysed using construct+ivist grounded theory methods. The findings indicate that the Indian physiotherapy profession faces many political and clinical hierarchical challenges within the Indian healthcare infrastructure. The profession's education provision has developed, and the private clinical sector has grown, but there are significant disparities in quality and standards across the sector. The profession in India has variable autonomy, is not nationally regulated, is poorly paid, and the leadership has been divided. The political, educational, and clinical context in Indian physiotherapy impacts upon physiotherapists' ability to practise effectively to their professional satisfaction. Individual physiotherapists are frustrated by their workplace and travel overseas where they hear that the physiotherapy profession and practice is different. Whilst the disjunctures influencing these factors continue, and overseas physiotherapy practice is perceived as different and superior, Indian physiotherapists will continue to seek to migrate overseas, and facilitating their return will be challenging.
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Affiliation(s)
- Kate Grafton
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Frances Gordon
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Gea‐Caballero V, Castro‐Sánchez E, Díaz‐Herrera MÁ, Sarabia‐Cobo C, Juárez‐Vela R, Zabaleta‐Del Olmo E. Motivations, Beliefs, and Expectations of Spanish Nurses Planning Migration for Economic Reasons: A Cross‐Sectional, Web‐Based Survey. J Nurs Scholarsh 2019; 51:178-186. [DOI: 10.1111/jnu.12455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Vicente Gea‐Caballero
- La Fe Nursing School (University of Valencia)Valencia, Spain; La Fe GREIACC Research Institute Valencia Spain
| | - Enrique Castro‐Sánchez
- Wellcome Trust ISSF Faculty FellowNational Institute for Health ResearchHealth Protection Research Unit in Healthcare Associated Infection and Antimicrobial ResistanceImperial College London London England
| | - Miguel Ángel Díaz‐Herrera
- Primary Care Nursing Team Sant Ildefons‐Cornella 2Catalan Institute of HealthKnowledge Mobilisation Unit Hospital Universitari General de Catalunya Barcelona Spain
| | | | - Raúl Juárez‐Vela
- Faculty of Health SciencesUniversity of Salamanca Salamanca Spain
| | - Edurne Zabaleta‐Del Olmo
- Institute of Research in Primary Care Jordi Gol, Barcelona, Spain; Primary Care Management Barcelona Ciutat, Catalan Institute of Health, Barcelona, SpainAutonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), SpainFaculty of Nursing, Girona University Girona Spain
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Faremi FA, Olatubi MI, Adeniyi KG, Salau OR. Assessment of occupational related stress among nurses in two selected hospitals in a city southwestern Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Efendi F, Nursalam N, Kurniati A, Gunawan J. Nursing qualification and workforce for the Association of Southeast Asian Nations Economic Community. Nurs Forum 2018; 53:197-203. [PMID: 29359337 DOI: 10.1111/nuf.12243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
International nurse migration among Association of Southeast Asian Nations (ASEAN) countries has the potential to increase the effectiveness of health services and access for the ASEAN Economic Community. Providing equivalent nursing qualifications and licensure standards and increasing the availability of the nursing workforce has become a challenge for ASEAN members. The purpose of this study is: 1) to comparatively analyze information on nursing licensing examinations (NLE) across ASEAN countries; and 2) to present information on the human resources required for a successful nursing workforce. This study reviews all documents published on the subject within the ASEAN Economic Community. NLE systems exist in all ASEAN Member States (AMSs)s except Brunei, Vietnam, and Lao PDR. Nursing education systems also vary across ASEAN countries. Language as a means of general communication and nursing examinations also differs. The availability of a qualified health workforce at the regional level is above the threshold in some areas. However, at the national level, Indonesia, Myanmar, Cambodia, and Lao PDR fall below the threshold. Professional licensure requirements differ among ASEAN nurses as a part of the process to become a qualified nurse in host and source countries. Mutual Recognition Agreements on nursing services should address the differences in NLE requirements as well as the availability of nurses.
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Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - N Nursalam
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Anna Kurniati
- Center for Planning and Management of Human Resources for Health, BPPSDMK, Ministry of Health, Jakarta, Indonesia
| | - Joko Gunawan
- Akademi Keperawatan Pemerintah Kabupaten Belitung, Tanjungpandan, Bangka Belitung, Indonesia
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Alameddine M, Chamoun N, Btaiche R, El Arnaout N, Richa N, Samaha-Nuwayhid H. The workforce trends of nurses in Lebanon (2009-2014): A registration database analysis. PLoS One 2017; 12:e0182312. [PMID: 28800618 PMCID: PMC5553929 DOI: 10.1371/journal.pone.0182312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Analysis of the nursing registration databases is a highly informative approach that provides accurate and reliable information supporting evidence based decisions relevant to the nursing workforce planning, management and development. This study presents the first systematic analysis of the nursing registration database in Lebanon. It Reports on the workforce distribution and trends using an updated version of the Order of Nurses in Lebanon (ONL) databases. METHODS This study presents a secondary data analysis of a de-identified subset of the updated ONL registration database. The workforce participation status of ONL registered nurses was categorized as active and eligible. For active nurses sectors and sub-sectors of employment were defined. Eligible nurses were categorized as unemployed, working outside nursing and working abroad. SPSS was used to conduct descriptive analysis to present workforce trends of Lebanese nurses for year 2009-2014 as frequencies, percentages and percentage changes. RESULTS Increases in the size of the Active (35%) and Eligible (86%) nurses were observed over the past six years. The majority of nurses fell in the below 35 years age group (60% in 2014). The hospital sector remained the principle employer, with 87% of Lebanese nurses working in hospitals in 2014. A 173% increases was reported for nurses working abroad. DISCUSSION Despite the growth of the Active nursing workforce, the skewed distribution of nurses in the below 35 age group and the growth in the Eligible category, especially for nurses living abroad, raise concerns on the longevity of nurses in the profession and the reasons for their attrition from the workforce. CONCLUSION There is a need to investigate the push and pull factors that are affecting nurses and the design of policies and interventions that would encourage nurses to remain active in Lebanon. Furthermore, policies and interventions that would create employment opportunities outside hospitals, especially in the Community sector, are recommended.
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Affiliation(s)
- Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nariman Chamoun
- Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon
| | - Rachel Btaiche
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Castro Lopes S, Guerra-Arias M, Buchan J, Pozo-Martin F, Nove A. A rapid review of the rate of attrition from the health workforce. HUMAN RESOURCES FOR HEALTH 2017; 15:21. [PMID: 28249619 PMCID: PMC5333422 DOI: 10.1186/s12960-017-0195-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/23/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Attrition or losses from the health workforce exacerbate critical shortages of health workers and can be a barrier to countries reaching their universal health coverage and equity goals. Despite the importance of accurate estimates of the attrition rate (and in particular the voluntary attrition rate) to conduct effective workforce planning, there is a dearth of an agreed definition, information and studies on this topic. METHODS We conducted a rapid review of studies published since 2005 on attrition rates of health workers from the workforce in different regions and settings; 1782 studies were identified, of which 51 were included in the study. In addition, we analysed data from the State of the World's Midwifery (SoWMy) 2014 survey and associated regional survey for the Arab states on the annual voluntary attrition rate for sexual, reproductive, maternal and newborn health workers (mainly midwives, doctors and nurses) in the 79 participating countries. RESULTS There is a diversity of definitions of attrition and barely any studies distinguish between total and voluntary attrition (i.e. choosing to leave the workforce). Attrition rate estimates were provided for different periods of time, ranging from 3 months to 12 years, using different calculations and data collection systems. Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres. CONCLUSION Attrition, and particularly voluntary attrition, is under-recorded and understudied. The lack of internationally comparable definitions and guidelines for measuring attrition from the health workforce makes it very difficult for countries to identify the main causes of attrition and to develop and test strategies for reducing it. Standardized definitions and methods of measuring attrition are required.
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Affiliation(s)
| | | | - James Buchan
- Queen Margaret University, Edinburgh, Scotland United Kingdom
- University of Technology, Sydney, Australia
| | - Francisco Pozo-Martin
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 1SH United Kingdom
| | - Andrea Nove
- ICS Integrare, calle Balmes 30,3-1a, 08007 Barcelona, Spain
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Pozo-Martin F, Nove A, Lopes SC, Campbell J, Buchan J, Dussault G, Kunjumen T, Cometto G, Siyam A. Health workforce metrics pre- and post-2015: a stimulus to public policy and planning. HUMAN RESOURCES FOR HEALTH 2017; 15:14. [PMID: 28202047 PMCID: PMC5312527 DOI: 10.1186/s12960-017-0190-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/09/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. METHODS Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. RESULTS There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. CONCLUSIONS There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.
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Affiliation(s)
- Francisco Pozo-Martin
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain.
| | - Sofia Castro Lopes
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - James Campbell
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - James Buchan
- School of Nursing Midwifery and Health, University of Technology Sydney, Sydney, Australia
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teena Kunjumen
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
| | - Giorgio Cometto
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - Amani Siyam
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
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Sagherian K, Clinton ME, Abu-Saad Huijer H, Geiger-Brown J. Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses. Workplace Health Saf 2016; 65:304-312. [DOI: 10.1177/2165079916665398] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.
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de Vries DH, Steinmetz S, Tijdens KG. Does migration 'pay off' for foreign-born migrant health workers? An exploratory analysis using the global WageIndicator dataset. HUMAN RESOURCES FOR HEALTH 2016; 14:40. [PMID: 27342146 PMCID: PMC4920982 DOI: 10.1186/s12960-016-0136-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/06/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND This study used the global WageIndicator web survey to answer the following research questions: (RQ1) What are the migration patterns of health workers? (RQ2) What are the personal and occupational drivers of migration? (RQ3) Are foreign-born migrant health workers discriminated against in their destination countries? METHODS Of the unweighted data collected in 2006-2014 from health workers aged 15-64 in paid employment, 7.9 % were on migrants (N = 44,394; 36 countries). To answer RQ1, binary logistic regression models were applied to the full sample. To answer RQ2, binary logistic regression was used to compare data on migrants with that on native respondents from the same source countries, a condition met by only four African countries (N = 890) and five Latin American countries (N = 6356). To answer RQ3, a multilevel analysis was applied to the full sample to take into account the nested structure of the data (N = 33,765 individual observations nested within 31 countries). RESULTS RQ1: 57 % migrated to a country where the same language is spoken, 33 % migrated to neighbouring countries and 21 % migrated to former colonizing countries. Women and nurses migrated to neighbouring countries, nurses and older and highly educated workers to former colonizing countries and highly educated health workers and medical doctors to countries that have a language match. RQ2: In the African countries, nurses more often out-migrated compared to other health workers; in the Latin American countries, this is the case for doctors. Out-migrated health workers earn more and work fewer hours than comparable workers in source countries, but only Latin American health workers reported a higher level of life satisfaction. RQ3: We did not detect discrimination against migrants with respect to wages and occupational status. However, there seems to be a small wage premium for the group of migrants in other healthcare occupations. Except doctors, migrant health workers reported a lower level of life satisfaction. CONCLUSIONS Migration generally seems to 'pay off' in terms of work and labour conditions, although accrued benefits are not equal for all cadres, regions and routes. Because the WageIndicator survey is a voluntary survey, these findings are exploratory rather than representative.
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Affiliation(s)
- Daniel H. de Vries
- />Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie Steinmetz
- />Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kea G. Tijdens
- />Amsterdam Institute for Advanced Labor Studies (AIAS), University of Amsterdam, Amsterdam, The Netherlands
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Alameddine M, Khodr H, Mourad Y, Yassoub R, Abi Ramia J. Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:353-362. [PMID: 25754443 DOI: 10.1111/hsc.12210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 06/04/2023]
Abstract
The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.
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Affiliation(s)
- Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hiba Khodr
- Department of Political Studies and Public Administration, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Yara Mourad
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Jinane Abi Ramia
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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17
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Zhou Y, Roscigno C, Sun Q. Why do China-educated nurses emigrate? A qualitative exploration. Int J Nurs Stud 2016; 53:163-72. [DOI: 10.1016/j.ijnurstu.2015.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
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18
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Alameddine M, Mourad Y, Dimassi H. A National Study on Nurses' Exposure to Occupational Violence in Lebanon: Prevalence, Consequences and Associated Factors. PLoS One 2015; 10:e0137105. [PMID: 26355686 PMCID: PMC4565636 DOI: 10.1371/journal.pone.0137105] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare institutions have commonly reported exposure of employees, particularly nurses, to high levels of occupational violence. Despite such evidence in the Middle East Region, there is a dearth of national studies that have systematically investigated this phenomenon. This study investigates the prevalence, characteristics, consequences and factors associated with nurses’ exposure to occupational violence in Lebanon. Methods A cross-sectional design was utilized to survey a nationally representative sample of 915 nurses registered with the Order of Nurses in Lebanon. Stratified random sampling by governorate was utilized. Individually-mailed questionnaires collected information on exposure to violence, degree of burnout and demographic/professional background. The main outcome variables were exposure to verbal abuse (never, 1–3, 4–9 and 10+ times) and physical violence (never, ever) over the past 12-months. Descriptive statistics were used to estimate prevalence of violence. Multivariable, binomial and multinomial regression models were carried out to investigate the correlates of exposure to verbal abuse and physical violence, respectively. Results Response rate was 64.8%. Over the last year, prevalence of nurses’ exposure to verbal abuse was 62%, (CI: 58–65%) and physical violence was 10%, (CI: 8–13%). Among respondents, 31.7% of nurses indicated likelihood to quit their jobs and 22.3% were undetermined. Furthermore, 54.1% reported high levels of emotional exhaustion and 28.8% reported high levels of depersonalization. Compared to nurses with no exposure to verbal abuse, nurses reporting high exposure had high levels of emotional exhaustion (OR:6.4; CI:1.76–23.32), depersonalization (OR:6.8; CI: 3–15) and intention to quit job (OR:3.9; CI: 1.8–8.3). They further reported absence of anti-violence policies at their institutions (OR: 3; CI: 1.5–6.3). Nurses that were ever exposed to physical violence were more likely to be males (OR: 2.2; CI: 1.1–4.3), working day and night shifts (OR: 2.8; CI: 1.4–5.5) and subject to ten or more incidents of verbal abuse per year (OR: 46.7; CI: 10.1–214). Conclusions An alarming two-thirds of respondents reported exposure to verbal abuse which was found to be a significant predictor of the three subscales of burnout, intention to quit and exposure to physical violence. The prevalence of exposure to physical violence is disconcerting due to its severe consequences. Policy and decision-makers are urged to use study findings for policy and practice interventions to create safe work environments conducive to nurses’ productivity and retention.
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Affiliation(s)
- Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El-Solh, Beirut
- * E-mail:
| | - Yara Mourad
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El-Solh, Beirut
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
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19
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Deek H, Newton P, Inglis S, Kabbani S, Noureddine S, Macdonald PS, Davidson PM. Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease. Collegian 2015; 22:333-9. [DOI: 10.1016/j.colegn.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Santric-Milicevic M, Matejic B, Terzic-Supic Z, Vasic V, Babic U, Vukovic V. Determinants of intention to work abroad of college and specialist nursing graduates in Serbia. NURSE EDUCATION TODAY 2015; 35:590-6. [PMID: 25623630 DOI: 10.1016/j.nedt.2014.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/01/2014] [Accepted: 12/24/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND In a country with a poor economy and limited job opportunities, the outmigration of students is not commonly perceived as a problem but rather is perceived as a solution to the high unemployment facing young health professionals. OBJECTIVES Study objectives were to identify the prevalence of intention to work abroad of nursing graduates to point to the predictors of intention to work abroad and predictors of having a firm plan to work in a foreign country. DESIGN Descriptive study, a survey. SETTINGS College and specialist nursing schools, Serbia. PARTICIPANTS 719 nursing graduates from the 2012/2013 school year. METHODS Voluntarily completed a questionnaire that was designed with regard to similar surveys administered in EU-candidate countries during the pre-accession period. Data were analysed with descriptive and multivariate regression analyses. RESULTS Almost 70% (501) of respondents indicated an intention to work abroad. Of the nurses, 13% already had established a firm plan to work abroad. Single graduates and those with a friend or relative living abroad were more likely to consider working abroad than were their counterparts (odds ratios were 2.3 and 1.7, respectively). The likelihood of considering working abroad decreased by 29% when the individuals' financial situation was improved. Factors associated with having a firm plan were previous professional experience in a foreign country, having someone abroad and financial improvement (5.4 times, 4.8 times and 2 times greater likelihood, respectively). CONCLUSIONS The high prevalence of intention to work abroad suggests the need to place the issue of the out-migration of nursing graduates on the policy agenda. College and specialty nursing graduates and health technicians are prepared to work abroad in search of a better quality of life, better working conditions and higher salaries.
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Affiliation(s)
- M Santric-Milicevic
- Institute of Social Medicine, Medical Faculty, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia; Centre - School of Public Health, Medical Faculty, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia.
| | - B Matejic
- Institute of Social Medicine, Medical Faculty, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia; Centre - School of Public Health, Medical Faculty, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - Z Terzic-Supic
- Institute of Social Medicine, Medical Faculty, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia; Centre - School of Public Health, Medical Faculty, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - V Vasic
- Department of Statistics and Mathematics, Faculty of Economics, University of Belgrade, Kamenicka 6, 11000 Belgrade, Serbia
| | - U Babic
- Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - V Vukovic
- High School for Health Vocational Studies in Belgrade, Cara Dusana 254, 11000 Belgrade, Serbia
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21
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Moyce S, Lash R, de Leon Siantz ML. Migration Experiences of Foreign Educated Nurses. J Transcult Nurs 2015; 27:181-8. [DOI: 10.1177/1043659615569538] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Global nurse migration has a recognized impact on host and source countries, but the lived experience of foreign educated nurses is an important aspect of the success of this migration. A systematic review of the literature was conducted to understand the lived migration and acculturation experiences of foreign educated nurses. Design: A systematic review of the literature, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted. Primary research articles or secondary analyses were selected based on keyword and citation-based searches ( n = 44). Findings: Nurses’ experiences included migration and licensing barriers, difficulty with communication, racism and discrimination, skill underutilization, acculturation, and the role of the family. Conclusions: Barriers encountered in host countries may impede acculturation and successful nursing practice, resulting in circular migration and poor patient safety outcomes. Implications for Practice: Social support systems and cultural orientation programs can mitigate the impacts of social isolation and racism. Addressing common barriers can help minimize deskilling and allow safe and effective transitions to host countries.
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Affiliation(s)
- Sally Moyce
- University of California, Sacramento, CA, USA
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22
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Abdulrahim S, Ajrouch KJ, Antonucci TC. Aging in Lebanon: Challenges and Opportunities. THE GERONTOLOGIST 2014; 55:511-8. [PMID: 25326343 DOI: 10.1093/geront/gnu095] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/03/2014] [Indexed: 11/13/2022] Open
Abstract
This spotlight offers a unique window into factors affecting aging in Lebanon. As a bridge between east and west, both geographically and culturally, Lebanon has the fastest growing older adult population in the Arab region, but few societal resources to address its needs. In a country with a history of political instability and war, but also a culture with strong family values, aging adults in Lebanon are vulnerable in some ways and advantaged in others. Outmigration of youth is an important determinant of the wellbeing of the elderly. While often advantaged by remittances sent by their children, older Lebanese adults have less access to instrumental social and personal support previously provided by young adults in the family. How Lebanon manages these challenges is likely to foreshadow the future aging experience for much of the Arab region.
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Affiliation(s)
- Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, Ypsilanti, Michigan.
| | - Toni C Antonucci
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
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23
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The making of nursing practice law in Lebanon: a policy analysis case study. Health Res Policy Syst 2014; 12:52. [PMID: 25193112 PMCID: PMC4163164 DOI: 10.1186/1478-4505-12-52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process. METHODS This study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson's "Policy Triangle Framework" as themes were categorized into content, actors, process, and context. RESULTS Findings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations. CONCLUSIONS This policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our findings are relevant in local and regional context as policymakers and other stakeholders can benefit from this experience when drafting laws and at the global context, as international organizations can consider this case study when developing global guidance and recommendations.
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24
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Alexis O, Shillingford A. Internationally recruited neonatal nurses' experiences in the National Health Service in London. Int J Nurs Pract 2014; 21:419-25. [DOI: 10.1111/ijn.12284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Obrey Alexis
- Faculty of Health and Life Sciences; Oxford Brookes University; Swindon UK
| | - Adeline Shillingford
- Neonatal Unit; Queen Charlotte's and Chelsea Hospitals; Imperial College Healthcare NHS Trust; London UK
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25
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El-Jardali F, Alameddine M, Jamal D, Dimassi H, Dumit NY, McEwen MK, Jaafar M, Murray SF. A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon. HUMAN RESOURCES FOR HEALTH 2013; 11:49. [PMID: 24079458 PMCID: PMC3851251 DOI: 10.1186/1478-4491-11-49] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/09/2013] [Indexed: 05/16/2023]
Abstract
BACKGROUND Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. METHODS This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. RESULTS A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses' reported job satisfaction and their intent to stay. CONCLUSION This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses' job satisfaction and retention in rural settings.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Diana Jamal
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Nuhad Y Dumit
- Rafic Hariri School of Nursing, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mary K McEwen
- Alaska Department of Health and Social Services, Division of Public Health, Section of Health Planning and Systems Development, Juneau, Alaska
| | - Maha Jaafar
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Susan F Murray
- Department of Health Policy & Management, Florence Nightingale School of Nursing & Midwifery, King’s College London, London, UK
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Kaddourah BT, Khalidi A, Abu-Shaheen AK, Al-Tannir MA. Factors impacting job satisfaction among nurses from a tertiary care centre. J Clin Nurs 2013; 22:3153-9. [DOI: 10.1111/jocn.12261] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 01/05/2023]
Affiliation(s)
| | - Aziza Khalidi
- Islamic University of Beirut; Higher Institute of Management; Beirut Lebanon
| | - Amani K Abu-Shaheen
- Research and Scientific Publication Center; King Fahad Medical City Hospital; Riyadh Saudi Arabia
| | - Mohamad A Al-Tannir
- Research and Scientific Publication Center; King Fahad Medical City Hospital; Riyadh Saudi Arabia
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27
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El-Jardali F, Murray SF, Dimassi H, Jamal D, Abualrub R, Al-Surimi K, Clinton M, Dumit NY. Intention to stay of nurses in current posts in difficult-to-staff areas of Yemen, Jordan, Lebanon and Qatar: a cross-sectional study. Int J Nurs Stud 2013; 50:1481-94. [PMID: 23545140 DOI: 10.1016/j.ijnurstu.2013.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The nursing workforce shortages in difficult-to-staff areas have implications not only for quality of care but also for population health outcomes. An understanding of attrition and of retention is important to inform policies on the nursing workforce. OBJECTIVES This paper draws on questionnaire survey data from nurses working in difficult-to-staff areas in four countries in the Eastern Mediterranean Region (Yemen, Jordan, Lebanon and Qatar). It aims to identify the specific and common factors associated with nurses' intention to stay in their current post for the coming 1-3 years in three countries with an internally trained nursing workforce and in a fourth where the workforce is externally recruited. METHODS Nurses working in 'difficult to staff' areas in Yemen, Jordan, Lebanon and Qatar were surveyed. A conceptual model composed of 6 dimensions based on that of the World Health Organization was constructed with 'intent to stay' (Career Decisions) as the main outcome. Regression models were constructed for each of the dimensions in the conceptual model with 'intent to stay' as the dependent variable for each of the study countries. Subsequently, a collective model that combined Lebanon, Jordan and Yemen was constructed to identify common factors that are associated with intent to stay. RESULTS Factors associated with intent to stay differed for study countries. Marriage was positively associated with intent to stay in Lebanon and Jordan whereas years of experience were positively significant for Lebanon and Yemen. Shorter commuting time was significantly associated with intent to stay in Jordan whereas a preference for village life was significant for Lebanon. Job satisfaction was significantly associated with intent to stay in all study countries. Nurses in Lebanon, Jordan and Qatar who indicated that they would choose nursing if they had the opportunity to choose a career all over again were significantly more likely to intend to stay in their current post. CONCLUSIONS Studies of nurses working in these areas can help national policymakers and local nursing directors better manage the sparse nursing workforce in these localities and to provide them with appropriate incentives and support to encourage them to stay.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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The challenges of working in underserved areas: A qualitative exploratory study of views of policy makers and professionals. Int J Nurs Stud 2013; 50:73-82. [DOI: 10.1016/j.ijnurstu.2012.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/09/2012] [Accepted: 08/24/2012] [Indexed: 11/22/2022]
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29
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Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N. Burnout among Lebanese nurses: Psychometric properties of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Health (London) 2012. [DOI: 10.4236/health.2012.49101] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Zittel B, Ezzeddine S, Makatjane M, Graham I, Luangamornlert S, Pemo T. Divergence and convergence in nursing and health care among six countries participating in ICN's 2010 Global Nursing Leadership Institute. Int Nurs Rev 2011. [DOI: 10.1111/j.1466-7657.2011.00952.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Alameddine M, Kazzi A, El‐Jardali F, Dimassi H, Maalouf S. Occupational Violence at Lebanese Emergency Departments: Prevalence, Characteristics and Associated Factors. J Occup Health 2011; 53:455-64. [DOI: 10.1539/joh.11-0102-oa] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mohamad Alameddine
- Health Management and Policy, Faculty of Health SciencesAmerican University of Beirut
| | - Amin Kazzi
- Department of Emergency MedicineAmerican University of Beirut Medical Center
| | - Fadi El‐Jardali
- Health Management and Policy, Faculty of Health SciencesAmerican University of Beirut
| | - Hani Dimassi
- School of Pharmacy, Lebanese American UniversityLebanon
| | - Salwa Maalouf
- Health Management and Policy, Faculty of Health SciencesAmerican University of Beirut
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DYWILI SOPHIA, BONNER ANN, O’BRIEN LOUISE. Why do nurses migrate? - a review of recent literature. J Nurs Manag 2011; 21:511-20. [DOI: 10.1111/j.1365-2834.2011.01318.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ravari A, Bazargan M, Vanaki Z, Mirzaei T. Job satisfaction among Iranian hospital-based practicing nurses: examining the influence of self-expectation, social interaction and organisational situations. J Nurs Manag 2011; 20:522-33. [PMID: 22591154 DOI: 10.1111/j.1365-2834.2010.01188.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The influence of self-expectation, social interaction, and organisational situation on job satisfaction among nurses is examined. BACKGROUND Understanding determinants and correlates of job satisfaction are important factors that help to reduce the problem of nurse attrition. METHODS Utilizing the Hybrid Model of concept development, job satisfaction was examined in three phases: (1) the theoretical phase, a working definition and the dimensions of job satisfaction were established; (2) the fieldwork phase, a qualitative semi-structured interview was employed to capture participants' perceptions of the concept; and (3) the analytical phase, the experiences of nurses were evaluated using the conceptual model. RESULTS The results indicate that personal beliefs, rather than social interaction or organisational situation, constitute the core of job satisfaction. CONCLUSIONS Despite the variety of dissatisfaction factors rooted in social interaction and organisational situation, participants achieved the highest job satisfaction when trusting in self-value systems and the spiritual value of their job objectives. IMPLICATIONS Intervention is needed to increase organisational and professional support for nurses. However, highlighting the sacred and spiritual value of the nursing profession, which is rooted in religious values and culture, provides additional reinforcement for enhancing the job satisfaction among this segment of health care providers.
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Affiliation(s)
- Ali Ravari
- School of Nursing and Midwifery, Rafsanjan Medical Sciences University, Rafsanjan, Iran
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Hendel T, Kagan I. Professional image and intention to emigrate among Israeli nurses and nursing students. NURSE EDUCATION TODAY 2011; 31:259-262. [PMID: 21129827 DOI: 10.1016/j.nedt.2010.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 10/21/2010] [Accepted: 11/04/2010] [Indexed: 05/30/2023]
Abstract
Under globalization, nurse migration has become an increasingly widespread phenomenon. One factor motivating it might be nurses' perception of the profession's image. The purpose of this study was to examine the connection between Israeli working nurses' and student nurses' perceptions of nursing's professional image and their intention to emigrate. One hundred thirty-two nurses and students participated in this cross-sectional study, the data collected by means of a structured questionnaire. Fifty-five percent of the sample were considering emigration or definitely intended to emigrate. Significantly more participants under the age of 35 were considering or had decided to emigrate than older participants. No statistically significant correlation was found between intention to migrate and perception of the profession's image. However, perceived professional image, as a component of professional reasons for emigrating (to get a better salary, working conditions, etc.), did contribute to the intention to emigrate.
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Affiliation(s)
- Tova Hendel
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Badr L, Rizk U, Farha R. The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon. J Nurs Manag 2011; 18:182-93. [PMID: 20465746 DOI: 10.1111/j.1365-2834.2010.01052.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace. BACKGROUND There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings. METHOD Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses. RESULTS Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted. CONCLUSIONS/IMPLICATIONS Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.
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Affiliation(s)
- Lina Badr
- Azusa Pacific University, Azusa, CA, USA.
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Nurses' work environment and intent to leave in Lebanese hospitals: implications for policy and practice. Int J Nurs Stud 2010; 48:204-14. [PMID: 20932524 DOI: 10.1016/j.ijnurstu.2010.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND The dual burden of nursing shortages and poor work environments threatens quality of patient care and places additional pressures on resource-stretched health care systems, particularly in the Eastern Mediterranean Region (EMR). There is a paucity of research in the EMR examining the quality of nurses' work environment and its association to nurses' intent to leave their jobs/countries. OBJECTIVES Systematically examine the characteristics of nurses' work environment and their relation to nurses' intent to leave their jobs within the context of Lebanon. A secondary objective is to assess the utility and validity of the NWI-R within the context of the EMR. METHODS A cross-sectional survey design was utilized to survey a total of 1793 registered nurses in 69 Lebanese hospitals. The survey instrument included questions on nurses' background, hospital characteristics, intent to leave, and the Revised Nurse Working Index (NWI-R). Data analysis included descriptive statistics for demographic characteristics, t-test and ANOVA to assess differences in agreement scores, and a multinomial logistic regression model to predict intent to leave. Thematic analysis of open-ended questions was utilized to extract themes that fit under issues relating to nurses' work environment in Lebanese hospitals. RESULTS The NWI-R subscale with the lowest mean score related to control. Younger nurses had lower scores on organizational support and career development. Regression analysis revealed that for every 1 point score decrease on career development there was a 93% increase in likelihood of reporting intent to leave country. Likewise, for every 1 point score decrease on participation there was an observed 51% and 53% increase in likelihood of reporting intent to leave country and hospital, respectively. Findings show that hospital characteristics (size, accreditation status and presence of a recruitment and retention strategy) were significantly associated with NWI-R subscales. CONCLUSIONS Participation, control and career development were key work environment challenges contributing to the attrition on nurses from Lebanese hospitals. Although some of the issues identified are country specific, others would certainly be relevant to other countries in the EMR. Addressing these challenges would require a strong and coordinated action from governments, professional bodies, policy makers and health managers.
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EL-JARDALI FADI, MERHI MIRVAT, JAMAL DIANA, DUMIT NUHAD, MOURO GLADYS. Assessment of nurse retention challenges and strategies in Lebanese hospitals: the perspective of nursing directors. J Nurs Manag 2009; 17:453-62. [DOI: 10.1111/j.1365-2834.2009.00972.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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El-Jardali F, Dimassi H, Dumit N, Jamal D, Mouro G. A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nurs 2009; 8:3. [PMID: 19284613 PMCID: PMC2667438 DOI: 10.1186/1472-6955-8-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/12/2009] [Indexed: 11/21/2022] Open
Abstract
Background Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country. Methods A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country. Results An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility. Conclusion Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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