INTRODUCTION:

Migration of health workers ‘Brain drain’ is defined as the movement of health personnel in search of the better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide.[1]

The migration of highly skilled workers from less-developed nations to industrialized nations is an inevitable part of the process of globalization and has positive and negative aspects. Those potentially advantaged often include the individuals who move and the source, or home, country that receives capital in the form of remittances from those who have moved. At the same time, major disadvantages are incurred if departures impair a country’s ability to deliver vital services in local communities.[2] Trained health professionals are needed in every part of the world. However, better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in the developed countries attract talent from less developed areas. The majority of migration is from developing to developed countries. This is of growing concern worldwide because of its impact on the health systems in developing countries. These countries have invested in the education and training of young health professionals. This translates into a loss of considerable resources when these people migrate, with the direct benefit accruing to the recipient states who have not worked out the cost of educating them. The intellectuals of any country are some of the most expensive resources because of their training in terms of material cost and time, and most importantly, because of lost opportunity. In 2000 almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for more than a year. Of these, about 65 million were economically active[3]. Some of the factors that pull professionals to developed countries may include: availability of information, easy access to communication and technology, making it easy to find jobs or complete visa applications and process; aggressive targeted recruitment to fill vacancies in richer countries; availability of employment opportunities; better remunerations and working conditions, secure and conducive living conditions; and opportunities for intellectual growth. [4] There are various reasons for the brain drain in India. The reasons usually include two aspects which respectively come from countries and individuals. In terms of countries, the reasons may be social environment (in source countries: lack of opportunities, political instability, economic depression, health risks, etc.; in host countries: rich opportunities, political stability and freedom, developed economy, better living conditions, etc.). In terms of individual reasons, there are family influence, and personal preference: preference for exploring, ambition for an improved career, etc. Keeping all these in mind we can identify some causes for the brain drain among nurses in India. [5]

STATEMENT OF PROBLEM:

A descriptive study on factors intend to brain drain among staff nurses of selected hospitals of district Ludhiana, Punjab.

OBJECTIVES:

· To assess factors intend to brain drain among staff nurses of selected hospitals of district Ludhiana, Punjab.

· To find out the relationship of factors intend to brain drain with selected variables.

MATERIALS AND METHODS:

A quantative research approach and descriptive design was adopted to accomplish the objectives of the study. The present study was conducted in Guru Teg Bahadur hospital and Deep hospital of Ludhiana, Punjab. Total sample consisted of 100 staff nurses and selection was done by convenient sampling technique. Out of 100 staff nurses, 60 were from Guru Teg Bahadur hospital and 40 were from Deep hospital of Ludhiana, Punjab. Tool consisted of self structured interview schedule which had two parts socio-demographic data and rating scale to assess factors intend to brain drain among staff nurses. Rating scale was including the four contributing factors intended to brain drain i.e. professional factors, economical factors, personal factors and psychological factors. There were 15 items in professional factors, 4 items in economic factors, 8 items in personal factors and 3 items in psychological factors. The tool was rated as strongly agreed, agreed and disagreed and was scored 3, 2, and1 respectively. A try out of the tool was done for clarity and relevance of conducting the study. Pilot study was conducted to ensure the reliability of the tool and feasibility of the study. The content validity of the tool was determined by the expert’s opinions and suggestions on the relevance of items. The reliability of rating scale to assess factors intend to brain drain was 0.99. Written consent was taken from the staff nurses who were willing to participate in the study. Data collection procedure was carried out from 8^th April to 13^th April, 2013. The data was analyzed by using descriptive and inferential statistics.

RESULTS:

Out of 100, maximum (94) of staff nurses were females and only 6 were male. About 79% of staff nurses were in age group 20-30 years, and 65 were unmarried whereas 34 were married. Regarding education, 71 staff nurses were GNM, 21 were B. Sc. Nurses and very few i.e. 7 were post Basic B. Sc. Nurses and only one was M. Sc. Nurse. In case of children, majority (81) had no children. While considering the area of residence, more than half (53) belongs to rural area and near to half (47) were from urban area. As per years of experience, 38% were having <1 year of experience, 35% had 1-5 years, 14% had 5-10 years and 13% were having >10 years of experience. Regarding family income, 44% had >15000 Rs/month, 26% had 10000-15000 Rs/month and 25% of staff nurses had 5001-10000 Rs/month. More than half (65%) of staff nurses were from nuclear families. Maximum (92%) of them had not visited the abroad. All (100%) the staff nurses want to go abroad and more than half (67%) want to go Canada, 20% stated America and 6% desired to go New Zealand. While considering the reason for migration, more than Half (52%) stated that they want to go for employment, 25% for family reason and 20% for the education purposes.

Fig.1 depicts that majority of staff nurses (98%) were having more contributing factors intend to brain drain and very few (2%) were having less contributing factors intend to brain drain.

Contributing Factors

Fig. 1 Frequency percentage distribution of staff nurses according to levels of contributing factors

Table 1 Mean, Mean percentage and Rank order of contributing factors intend to brain drain among staff nurses

Contributing factors		Professional factor score
A. Professional factors		Mean	Mean %age		Rank order
1.	Better job opportunities	2.81	93.66		1
2.	Professional advancement	2.81	93.66		1
3.	Improved quality care	2.77	92.33		2
4.	Career advancement	2.75	91.66		3
5.	Career expectation	2.68	89.33		4
6.	Better training facilities	2.68	89.33		4
7.	Working conditions	2.67	89.00		5
8.	Continuing education	2.65	88.33		5
9.	Job security	2.64	88.00		6
10.	Management system	2.64	88.00		6
11.	Favorable laws	2.59	86.33		7
12.	Gaining wider experience	2.58	86.00		8
13.	Effective leadership	2.55	85.00		9
14.	Awareness regarding consumer protection	2.55	85.00		9
15.	Retention of nurses	2.44	81.33		10
B. Economic factors		Economic factors score
1.	High wages	2.86	95.33		1
2.	Bonuses	2.74	91.33		2
3.	Benefit packages	2.50	83.33		3
4.	Financial constraints	2.50	83.33		3
C. Personal factors		Personal factors score
1.	Better lifestyle	2.69	89.66		1
2.	Self improvement	2.68	89.33		2
3.	No political interference	2.58	86.00		3
4.	Self environment	2.55	85.00		4
5.	Lure for freedom	2.49	83.00		5
6.	Craze of overseas	2.43	81.00		6
7.	Family abroad	2.38	79.33		7
8.	Better family relations	2.01	70.00		8
D. Psychological factors		Psychological factors score
1.	Dignified job	2.66		88.66	1
2.	Less violence and crime	2.34		78.00	2
3.	Less workload	2.08		69.33	3

Table 1 shows that mean percentage and rank order of professional factor score was high in better job opportunities and professional improvement (93.66% and rank 1^st) and lowest in retention of nurses (81.33% and rank 10^th). Among economical factors, mean percentage and rank order of economical factor score was high in high wages (95.33% and rank 1^st) and lowest in benefit packages and financial constraints (83.33% and rank 3^rd). In case of personal factors, mean percentage and rank order was high in better lifestyle (89.66% and rank 1^st) and lowest in better family relation (70.00% and rank 8^th) among staff nurses. Among psychological factors, mean percentage and rank order was high in dignified job (86.66% and rank 1^st) and lowest in less workload (69.33% and rank 3^rd).

Table 2 Frequency and percentage distribution of staff nurses according to levels of contributing factors with significant variables

Variables

Professional factors

More

contributing

(n)

Less

contributing

(n)

Chi-square

& df

Reason for migration

For education

For employment

For family

Any other…

12.42

P= 0.005

Personal factors

Type of family

Nuclear

Joint

Extended

10.68

P=0.004

Psychological factors

Having children

Yes

4.97

P=0.025

Reason for migration

For education

For employment

For family

Any other…

8.378

P= 0.038

Table 2 depicts that professional factors had statistical significant relationship with reason for migration (chi-square=12.42, p=0.005) for brain drain among staff nurses, personal factors had statistical significant relationship with type of family (chi-square=10.68, p=0.004) and psychological factors had statistical significant relationship with having children (chi-square=4.97, p=0.025) and reason for migration (chi-square=8.378, p=0.038) for brain drain among staff nurses.

DISCUSSION:

The findings of the present study revealed that 98% of staff nurses had more contributing factors intend to brain drain whereas only 2% of staff nurses had less contributing factors intend to brain drain. The relationship of brain drain with contributing factors showed that professional factor, economical factor and personal factors were more contributing among 95% of staff nurses and less contributing among very few i.e. 5% of staff nurses while the psychological factor was more contributing to brain drain among 68% of nurses and less contributing in 32% of staff nurses. Statistically significant relationship was found in factor score with staff nurses who had previously visited abroad at p< 0.05 level of significance. Statistically significant association was found in contributing factors intend to brain drain among staff nurses with having children, type of family and reason for migration among staff nurses.

Our study among 100 staff nurses revealed that among professional factors; lack of better job opportunities and professional advancement in India were the contributing factors intend to brain drain among staff nurses (Mean %age= 93.66) followed by lack of quality care (Mean %age=92.33), career advancement (Mean %age= 91.66) and among economical factors; lack of high wages (Mean %age=95.33) was the main contributing factor intend to brain drain among staff nurses. Whereas in case of personal factors; better life style (Mean %age = 89.66) and among psychological factors; lack of dignified job (Mean %age = 88.66 were the main factors intend to brain drain among staff nurses. The findings were consistent with R Baral and S Sapkota. Their study revealed that lack of training and educational opportunities in Nepal was the main cause of respondents to migrate abroad (Mean: 2.67) followed by lack of job and career opportunities in Nepal (Mean: 3.57), personal ambitions (Mean: 3.70), economical factors (Mean: 3.72), job dissatisfaction (Mean: 4.90), married to the man living there (Mean: 5.31), political conflicts (Mean: 5.94), lack of modern facilities (Mean: 6.06). [6] Another research published on 2009 stated that 63% of Nurses of India intended to immigrate because of dissatisfaction with working condition and also other main factor for immigration was better in-come. [7] Study done by Lipuke in 2013 stated that five main causes of migration are poor remuneration, lack of professional development in home country, poor health care and system, easy availability of jobs in developed countries.[8] In our study, the respondents had given their reasons of migration as economic factors and job dissatisfaction in India. Also research published by Connel (2008) states that the economic factors and the better working environment with more technological facilities are the main causes of migration among doctors and nurses. [9]

CONCLUSION:

The factors intend to brain drain are complex with no simple strategic measures to mitigate the phenomenon. This study has been able to confirm role of contributing factors on brain drain among staff nurses. From the findings of this study it can be concluded that the major contributing factors for nurses’ brain drain were lack of better job opportunities, no professional development, low wages, lack of better life style and lack of job dignity in India.

ACKNOWLEDGEMENT:

The researchers would like to express their special thanks to all participants of this study, for their valuable responses.

REFERENCES:

1. Yusuf Abdu Misau, Nabilla Al-Sadat, Adamu Bakari Gerei. Brain drain and health care delivery in developing countries. Journal of Public Health in Africa 2010; 1:e6.

2. Patricia Pittman, Linda H. Aiken, and James Buchan. International Migration of Nurses. Health service research March 2007; 42:3p2.

3. Sunita Dodani and Ronald E LaPorte. Brain drain from developing countries: how can brain drain be converted into wisdom gain? J R Soc Med. 2005 Nov; 98(11): 487–491.

4. Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Poz MD. Migration of health-care workers from developing countries: strategic approaches to its management. Bulletin of the World Health Organization. 2004, 82 (8): 595-600.

5. Raveesh S. Brain Drain: Socio-Economic Impact on Indian Society. International Journal of Humanities and Social Science Invention May 2013, 5(2):12-17.

6. R Baral, S Sapkota. Factors influencing migration among nepalese nurses. Journal of Chitwan Medical College 2015; 5(12): 25-29.

7. Hawkes M, Kolenko M, Diwakar K. Nursing brain drain from India. Human resources for health.2009;7(5). DOI:10.1186/1478-4491-7-5.

8. Likupe G. The skills and brain drain what nurses say. Journal of clinical nursing 2013; 22(910):1372-1381. DOI:10.1111/jocn.2013.22.issue 9 pt10/issuetoc.

9. Connel J. Migration of health-care workers from developing countries: strategic approaches to its management. The international migration of health workers 2008; 0(1):11-14. DOI: 10.1016/S0140-6736(10)62035-.

Received on 24.06.2016 Modified on 17.07.2016

Int. J. Adv. Nur. Management. 2016; 4(4): 327-330.

DOI: 10.5958/2454-2652.2016.00073.1