Volume 25, Issue 3 (May-June 2026)
Payesh 2026, 25(3): 319-334 |
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Ethics code: IR.TUMS.SPH.REC.14010289
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Mosaddeghrad A, Fazaeli A, Ebadi A, Moghaddasi F. Analysis of push and pull factors in nurse migration: A scoping review. Payesh 2026; 25 (3) :319-334
URL: http://payeshjournal.ir/article-1-2704-en.html
URL: http://payeshjournal.ir/article-1-2704-en.html
1- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2- Nursing Care Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
3- School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
2- Nursing Care Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
3- School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
Abstract: (98 Views)
Objective(s): In recent decades, the migration of nurses has escalated significantly, reaching a critical juncture. This trend, primarily observed in the movement from developing to developed countries, presents a formidable challenge to enhancing health systems in the countries of origin. Understanding the underlying causes of nurse migration is a crucial first step toward effectively managing this phenomenon.
Methods: This study was conducted as a scoping review. Relevant literature regarding the causes of nurse migration was gathered from reputable databases such as PubMed, Web of Science, and Scopus. The search employed specific keywords within the timeframe of January 2000 to May 2024. Ultimately, 73 pertinent studies were selected, and the data were analyzed using thematic analysis.
Results: Findings indicate that the reasons behind nurses' migration can be categorized into two main groups: push and pull factors. Push factors include inadequate salaries and benefits, a mismatch between income and living expenses, unemployment and limited job opportunities, lack of personal security, and heavy workloads. Political instability and limited opportunities for career advancement are also significant contributors in this category.Pull factors involve higher and timely salaries and benefits, a higher standard and quality of life, educational and career advancement opportunities, and a safe working environment with proper care standards.
Conclusion: The migration of nurses, influenced by both push and pull factors, poses a significant challenge for health systems worldwide. To address this issue, it is essential to enhance working conditions, which include improving salaries and benefits, adjusting nurse-to-patient ratios, and ensuring safe working environments. Furthermore, providing educational opportunities can boost nurses' motivation to stay in their home countries. Ensuring political stability and implementing cultural reforms to elevate the social standing of nurses are also vital in mitigating the adverse effects of migration.
type of study: Systematic Reviw |
Subject:
Helath Services Management
Received: 2024/10/23 | Accepted: 2025/06/3 | ePublished ahead of print: 2026/04/26 | Published: 2026/05/6
Received: 2024/10/23 | Accepted: 2025/06/3 | ePublished ahead of print: 2026/04/26 | Published: 2026/05/6
References
1. Anand S, Bärnighausen T. Health workers at the core of the health system: framework and research issues. Health Policy 2012;105:185-91 [DOI:10.1016/j.healthpol.2011.10.012]
2. Anand S, Bärnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet 2007;369:1277-85 [DOI:10.1016/S0140-6736(07)60599-6]
3. Ramjan LM, Maneze D, Salamonson Y, Zugai J, Bail K, Liu XL, Montayre J. Undergraduate nursing students challenge misconceptions towards men in nursing: a mixed-method study. Journal of Advanced Nursing 2024;80:1638-51 [DOI:10.1111/jan.15914]
4. Baumann A, Crea-Arsenio M. The crisis in the nursing labour market: Canadian policy perspectives. Healthcare 2023;11:1-9 [DOI:10.3390/healthcare11131954]
5. Das T, Holland P, Ahmed M, Husain L. Sustainable Development Goal 3: Good Health and Well-being. In: Das T, Nayar PD, editors. South-East Asia Eye Health: Systems, Practices, and Challenges. 1st Edition, Springer: Singapore, 2021 [DOI:10.1007/978-981-16-3787-2_4]
6. Bakibinga P. Africa can and must do more to support nurses and midwives. The Conversation. Available at: https://theconversation.com/africa-can-and-must-do-more-to-support-nurses-and-midwives-135722 [Access date: 07/10/2023]
7. Chirico F, Khabbache H, Rizzo A, Nucera G, Yildirim M, Batra K, et al. Bridging ethics and spirituality in healthcare policies for a holistic response to climate change, new pandemics and global health challenges: a call to action. Advances in Medical Psychology and Public Health 2024;1:170-3
8. Achieve CE. Nursing shortage: economic and financial implications to nurses. Available at: https://achievece.com/blog/nursing-shortage-economic-and-financial-implications-to-nurses [Access date: 05/10/2024]
9. Tamata AT, Mohammadnezhad M. A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open 2023;10:1247-57 [DOI:10.1002/nop2.1434]
10. Buchan J. Nurse migration and international recruitment. Nursing Inquiry. 2001;8:203-204 [DOI:10.1046/j.1440-1800.2001.00112.x]
11. World Health Organization. State of the World's Nursing 2020: Investing in Education, Jobs and Leadership. Geneva: WHO; 2020. Available at: https://apps.who.int/iris/handle/10665/331677 [Accessed: 07/9/2024]
12. Kaelin L. A question of justice: assessing nurse migration from a philosophical perspective. Developing World Bioethics 2011;11:30-9 [DOI:10.1111/j.1471-8847.2010.00284.x]
13. Peer N. The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: a focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases. Tropical Diseases, Travel Medicine and Vaccines 2015;1:1-8 [DOI:10.1186/s40794-015-0007-4]
14. Ezeonwu M. The role of African nurse diaspora in addressing public health priorities in Africa. Global Qualitative Nursing Research 2021;8:23333936211031501 [DOI:10.1177/23333936211031501]
15. Mokoena MJ. Perceptions of professional nurses on the impact of shortage of resources for quality patient care in a public hospital: Limpopo Province. [Master's thesis]. Pretoria: University of South Africa; 2017. Available at: https://uir.unisa.ac.za/bitstream/handle/10500/22928/dissertation_mokoena_mj.pdf [Access date: 08/11/2024]
16. Joshi R, Yakubu K, Keshri VR, Jha V. Skilled health workforce emigration: its consequences, ethics, and potential solutions. Mayo Clinic Proceedings 2023;98:960-5 [DOI:10.1016/j.mayocp.2023.02.035]
17. Stievano A, Caruso R, Shaffer F. Navigating the health professional migration tsunami in the era of COVID-19 and globalization: a call to action for a collective and coordinated response from government and non-government organizations. Healthcare (Basel). 2023;11:931 [DOI:10.3390/healthcare11070931]
18. Nolen S. Rich countries lure health workers from low-income nations to fight shortages. The New York Times. 2022 Jan 24. Available at: https://www.nytimes.com/2022/01/24/health/health-workers-migration.html [Access date: 05/10/2024]
19. Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A. The cost of health professionals' brain drain in Kenya. BMC Health Services Research 2006;6:1-10 [DOI:10.1186/1472-6963-6-89]
20. Diallo K. Data on the migration of health-care workers: sources, uses, and challenges. Bulletin of the World Health Organization 2004;82:601-7
21. World Health Organization. WHO Global Code of Practice on the International Recruitment of Health Personnel. Geneva: WHO; 2010. Available at: https://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R16-en.pdf [Access date: 01/05/2025]
22. Najib M, Abdullah S, Narresh S, Juni MH. Brain-drain phenomenon among healthcare workers. International Journal of Public Health and Clinical Sciences 2019;6:90-103 [DOI:10.32827/ijphcs.6.3.90]
23. Walton-Roberts M, Runnels V, Rajan SI, Sood A, Nair S, Thomas P, et al. Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human Resources for Health 2017;15:1-8 [DOI:10.1186/s12960-017-0199-y]
24. Thapa B, Shrestha K. Factors influencing brain drain among Nepalese nurses. Kathmandu University Medical Journal 2017;15:35-9
25. Kabbash I, El-Sallamy R, Zayed H, Alkhyate I, Omar A, Abdo S. The brain drain: why medical students and young physicians want to leave Egypt. Eastern Mediterranean Health Journal 2021;27:1102-1108 [DOI:10.26719/emhj.21.050]
26. Sasso L, Bagnasco A, Catania G, Zanini M, Aleo G, Watson R, et al. Push and pull factors of nurses' intention to leave. Journal of Nursing Management 2019;27:946-54 [DOI:10.1111/jonm.12745]
27. Ajayi PO, Ajayi OM, Ogunleye TS. Determinants of brain drain among health workers in public teaching hospitals in Ekiti State, Nigeria. International Journal of Health and Pharmaceutical Research 2022;7:45-55 [DOI:10.56201/ijhpr.v7.no1.2022.pg45.55]
28. Ogaboh AAM, Udom HT, Eke IT. Why brain drain in the Nigerian health sector? Asian Journal of Applied Sciences 2020;8:95-104 [DOI:10.24203/ajas.v8i2.5990]
29. Pretorius CM. A phenomenological study of South African nurse migration and workplace reintegration upon return [Master's thesis]. Stellenbosch: Stellenbosch University; 2018. Available at: https://scholar.sun.ac.za/handle/10019.1/103671 [Access date: 01/05/2025]
30. Smith R, Hanefeld J. Globalization, trade, and health economics. Oxford Research Encyclopedia of Economics and Finance. Oxford: Oxford University Press; 2018. Available at:https://oxfordre.com/economics/display/10.1093/acrefore/9780190625979.001.0001/acrefore-9780190625979-e-35 [Accessed: 07/6/2024] [DOI:10.1093/acrefore/9780190625979.013.35]
31. Wibulpolprasert S, Pachanee CA, Pitayarangsarit S, Hempisut P. International service trade and its implications for human resources for health: a case study of Thailand. Human Resources for Health 2004;2:1-2 [DOI:10.1186/1478-4491-2-10]
32. Abdou HR, Hagrass Ø. Nurses' awareness about brain drain and its determinants factors at Main Mansoura University Hospital. International Egyptian Journal of Nursing Science Research 2024;5:36-51 [DOI:10.21608/ejnsr.2024.275721.1364]
33. Neyazi N, Mosadeghrad AM, Afshari M, Isfahani P, Safi N. Strategies to tackle non-communicable diseases in Afghanistan: a scoping review. Front Public Health 2023;11:1-15 [DOI:10.3389/fpubh.2023.982416]
34. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005;8:19-32 [DOI:10.1080/1364557032000119616]
35. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77-101 [DOI:10.1191/1478088706qp063oa]
36. Mensah K, Mackintosh M, Henry L. The 'skills drain' of health professionals from the developing world: a framework for policy formulation. London: Medact; 2005. Available at: https://www.medact.org/app/uploads/2014/03/2.-the-skills-drain-of-health-professionals.pdf [Accessed: 05/5/2024]
37. Likupe G. The skills and brain drain what nurses say. Journal of Clinical Nursing 2013;22:1372-81 [DOI:10.1111/j.1365-2702.2012.04242.x]
38. George G, Rhodes B. Is there a financial incentive to immigrate? Examining the health worker salary gap between India and popular destination countries. Human Resources for Health 2017;15:1-0 [DOI:10.1186/s12960-017-0249-5]
39. Dimaya RM, McEwen MK, Curry LA, Bradley EH. Managing health worker migration: a qualitative study of the Philippine response to nurse brain drain. Human Resources for Health 2012;10:1-8 [DOI:10.1186/1478-4491-10-47]
40. Kadel M, Bhandari M. Factors intended to brain drain among nurses working at private hospitals of Biratnagar, Nepal. Bibechana 2019;16:213-20 [DOI:10.3126/bibechana.v16i0.21642]
41. Ross SJ, Polsky D, Sochalski J. Nursing shortages and international nurse migration. International Nursing Review 2005;52:253-262 [DOI:10.1111/j.1466-7657.2005.00430.x]
42. Simoens S, Villeneuve M, Hurst J. Tackling nurse shortages in OECD countries. OECD Health Working Papers, No. 19. Paris: Organisation for Economic Co-operation and Development; 2005. Available at:
https://doi.org/10.1787/172102620474 [DOI:10.1787/172102620474 [Accessed: 07/10/2023]]
43. Oda H, Tsujita Y, Irudaya Rajan S. An analysis of factors influencing the international migration of Indian nurses. Journal of International Migration and Integration 2018;19:607-24 [DOI:10.1007/s12134-018-0548-2]
44. Liese B, Dussault G. The state of the health workforce in sub-Saharan Africa: evidence of crisis and analysis of contributing factors. Africa Region Human Development Working Paper Series, No. 75. Washington, D.C.: World Bank; 2004. Available at: https://documents1.worldbank.org/curated/en/412051468002680722/pdf/328040Health0workforce0AFHD0No175.pdf [Accessed: 02/10/2024]
45. McGillis Hall L, Pink GH, Jones CB, Leatt P, Gates M, Peterson J. Is the grass any greener? Canada to United States of America nurse migration. International Nursing Review 2009;56:198-205 [DOI:10.1111/j.1466-7657.2008.00706.x]
46. Singh JA, Nkala B, Amuah E, Mehta N, Ahmad A. The ethics of nurse poaching from the developing world. Nursing Ethics 2003;10:666-70 [DOI:10.1191/0969733003ne655oa]
47. Beaton M, Walsh J. Overseas recruitment: experiences of nurses immigrating to Newfoundland and Labrador, 1949-2004. Nursing Inquiry 2010;17:173-83 [DOI:10.1111/j.1440-1800.2009.00471.x]
48. Vujicic M, Zurn P, Diallo K, Adams O, Dal Poz MR. The role of wages in the migration of health care professionals from developing countries. Human Resources for Health 2004;2:1-4 [DOI:10.1186/1478-4491-2-3]
49. Tregunno D, Peters S, Campbell H, Gordon S. International nurse migration: U-turn for safe workplace transition. Nursing Inquiry 2009;16:182-90 [DOI:10.1111/j.1440-1800.2009.00448.x]
50. El-Jardali F, Dumit N, Jamal D, Mouro G. Migration of Lebanese nurses: a questionnaire survey and secondary data analysis. International Journal of Nursing Studies 2008;45:1490-500 [DOI:10.1016/j.ijnurstu.2007.10.012]
51. Alonso-Garbayo Á, Maben J. Internationally recruited nurses from India and the Philippines in the United Kingdom: the decision to emigrate. Human Resources for Health. 2009;7:37 Available at: https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-7-37 [Access date: 01/05/2025] [DOI:10.1186/1478-4491-7-37]
52. Maslow AH, Frager R. Motivation and Personality. 3st Edition, Harper & Row: New York, 1987
53. Raghuram P. Caring about 'brain drain' migration in a postcolonial world. Geoforum 2009;40:25-33 [DOI:10.1016/j.geoforum.2008.03.005]
54. Tjadens F. Health care shortages: where globalization, nurses and migration meet. Eurohealth 2002;8:33-5
55. Choy CC. Empire of care: nursing and migration in Filipino American history. 1st Edition, Duke University Press: Durham, 2003 [DOI:10.1215/9780822384410]
56. International Labour Organization. Towards a fair deal for migrant workers in the global economy. International Labour Conference, 92nd Session, Geneva, 2004. Available at: https://webapps.ilo.org/public/english/standards/relm/ilc/ilc92/pdf/rep-vi.pdf [Accessed: 07/11/2023]
57. Massey DS, Arango J, Hugo G, Kouaouci A, Pellegrino A, Taylor JE. Theories of international migration: a review and appraisal. Population and Development Review 1993;19:431-66 [DOI:10.2307/2938462]
58. Khadria B. Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals. OECD Science, Technology and Industry Working Papers, No. 2004/6. Paris: OECD Publishing; 2004. Available at:
https://doi.org/10.1787/381236020703 [DOI:10.1787/381236020703 [Accessed: 17/11/2023]]
59. de Veer A, den Ouden DJ, Francke A. Experiences of foreign European nurses in the Netherlands. Health Policy 2004;68:55-61 [DOI:10.1016/j.healthpol.2003.08.006]
60. Buchan J. The impact of global nursing migration on health services delivery. Policy, Politics, & Nursing Practice 2006;7:16S-25S [DOI:10.1177/1527154406291520]
61. Buchan J, Parkin T, Sochalski J. International nurse mobility: trends and policy implications. Geneva: World Health Organization; 2003. Available at: https://apps.who.int/iris/handle/10665/68061 [Accessed: 07/8/2024]
62. Friedman EA. An action plan to prevent brain drain: building equitable health systems in Africa. Boston: Physicians for Human Rights; 2004. Available at: https://phr.org/our-work/resources/an-action-plan-to-prevent-brain-drain [Accessed: 07/10/2023]
63. Shapiro RL. Drawing lines in the sand: the boundaries of the HIV pandemic in perspective. Social Science & Medicine 2002;55:2189-99 [DOI:10.1016/S0277-9536(01)00363-X]
64. Ekingen E, Teleş M, Yıldız A, Yıldırım M. Mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions. Archives of Psychiatric Nursing 2023;42:97-105 [DOI:10.1016/j.apnu.2022.12.027]
65. Mudihanselage HS, Chamaru AA. The nursing shortage impact on job outcome (the case in Sri Lanka). Journal of Competitiveness 2015;7:64-73
66. Sapkota TN, van Teijlingen E, Simkhada PP. Nepalese health workers' migration to the United Kingdom: a qualitative study. Health Science Journal 2014;8:57-74
67. Bach S. Human resources and new approaches to public sector management: improving human resources management capacity. In: Ferrinho P, Dal Poz MR, editors. Towards a Global Health Workforce Strategy. 1st Edition, ITG Press: Antwerp, 2003
68. Schmiedeknecht K, Perera M, Schell E, Jere J, Geoffroy E, Rankin S. Predictors of workforce retention among Malawian nurse graduates of a scholarship program: a mixed-methods study. Global Health: Science and Practice 2015;3:85-96 [DOI:10.9745/GHSP-D-14-00170]
69. Chikanda A. Nurse migration from Zimbabwe: analysis of recent trends and impacts. Nursing Inquiry 2005;12:162-74 [DOI:10.1111/j.1440-1800.2005.00273.x]
70. Kingma M. Nursing migration: global treasure hunt or disaster-in-the-making? Nursing Inquiry 2001;8:205-12 [DOI:10.1046/j.1440-1800.2001.00116.x]
71. Hashish EA, Ashour HM. Determinants and mitigating factors of the brain drain among Egyptian nurses: a mixed-methods study. Journal of Research in Nursing 2020;25:699-719 [DOI:10.1177/1744987120940381]
72. Ibrahim AF, Akel DT, Alzghoul HW. Image of nursing profession as perceived by Egyptian and Jordanian undergraduate male nursing students: a comparative study. Journal of Education and Practice 2015;6:24-36
73. Thomas P. The international migration of Indian nurses. International Nursing Review 2006;53:277-83 [DOI:10.1111/j.1466-7657.2006.00494.x]
74. Garner SL, Conroy SF, Bader SG. Nurse migration from India: a literature review. International Journal of Nursing Studies 2015;52:1879-90 [DOI:10.1016/j.ijnurstu.2015.07.003]
75. Larsen JA, Allan HT, Bryan K, Smith P. Overseas nurses' motivations for working in the UK: globalization and life politics. Work, Employment & Society 2005;19:349-68 [DOI:10.1177/0950017005053177]
76. Sanders D, Lloyd B. Human resources: international context: human resources. South African Health Review 2005;2005:76-87
77. Bou-Karroum L, Daou KN, Nomier M, El Arnaout N, Fouad FM, El-Jardali F, et al. Health care workers in the setting of the "Arab Spring": a scoping review for the Lancet-AUB Commission on Syria. Journal of Global Health. 2019;9:010402 [DOI:10.7189/jogh.09.010402]
78. Kalipeni E, Semu LL, Mbilizi MA. The brain drain of health care professionals from sub-Saharan Africa: a geographic perspective. Progress in Development Studies 2012;12:153-71 [DOI:10.1177/146499341101200305]
79. Fong T, Hassan Z. Factors contributing to brain drain in Malaysia. International Journal of Education, Learning and Training 2017;2:14-31
80. Cristian ER, Baragan GL. Identification of main economic and social causes of Romanian migration. Ecoforum Journal 2015;4:7-13
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