Nurse migration from India: a literature review.

BACKGROUND A profound nursing shortage exists in India where nurses are increasingly outmigrating to practice nursing in surrounding countries and abroad. This is important globally because countries with the lowest nursing and healthcare workforce capacities have the poorest health outcomes. OBJECTIVE This review sought to synthesize and unify the evidence about nurse migration from India and includes a look at nurse retention within India. DESIGN A comprehensive literature review was performed to synthesize and unify both qualitative and quantitative research. DATA SOURCES Bibliographic databases searched included CINAHL, MEDLINE, PsycINFO, and EconLit using associated keywords for empirical and descriptive literature published between January 2004 and May 2014. Hand searches of the Nursing Journal of India from 2004 to February 2014 and the Journal of Nursing Research Society of India from its inception in 2007-February 2014 were also completed. REVIEW PROCESS 29 studies were selected and analyzed for the review. Data were appraised for quality; reduced through sub-categorization; extracted; and coded into a framework. Thematic interpretation occurred through comparing and contrasting performed by multiple reviewers. RESULTS Findings included an exponential growth in nurse recruitment efforts, nurse migration, and a concomitant growth in educational institutions within India with regional variations in nurse migration patterns. Decision-making factors for migration were based on working conditions, salience of family, and the desire for knowledge, skill, technology, adventure and personal enrichment. Challenges associated with migration included questionable recruiting practices, differing scopes of practice encountered after migration and experiences of racism and cultural differences. A shift toward a positive transformation of nursing status in India has resulted in an increased respect for individual nurses and the profession of nursing. This was attributed to the increased globalization of nursing. CONCLUSIONS Results from this review can be used to shape health policy and advocate for nursing reform in India. As India's healthcare infrastructure continues to evolve, effective programs to improve conditions for nurses and retain them in India are needed. Additionally, as the globalization of nurses increases, more research is needed to develop effective programs to aid in a smooth transition for nurses who migrate from India.