Among other important issues, this literature review has confirmed that migration is a very difficult step, one which would rather be avoided, just as Kingma stated in 2006. Each potential nurse-migrant in any country around the world most probably carefully weighs the pros and cons of such a move, attempting to maximize her/his opportunities in a global society.
In terms of the overall review of literature on migration in general, and the migration of nurses, one main finding is that the majority of nurses who migrate are moving from low income countries to higher income ones. The number of migrants has been increasing world- wide, while the CR has a low migrating potential. Only about 11% of Czech citizens consider working abroad, they prefer temporary migration, and it seems that even less Czech nurses have similar plans. Interestingly, during the economic downturn in 2008, the Czech Republic had the biggest relative reduction in migratory flows. Considering the facilitating policies, intra-European migration is rather small compared with the migratory flows of non-EU citizens, while the monitoring of these flows is not very exact.
The migration of nurses is currently a global political theme because of its relation to the general shortage of health care professionals and the provision of safe care. Self- sustainability in the production of nurses, improved working conditions, better remuneration of nurses, better health care workforce planning and recruiting are all well- known solutions to the shortage problems. The consequences of brain gain, brain drain, brain circulation and brain wasting are more researched and understood today.
An increased migration very often points to serious problems within the system; and since health care professionals´ migration is a global phenomenon, the causative problems must
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be global as well. The financial aspect of migration is almost always the deciding factor and the other aspects of migration are usually less important. Migrating nurses very often pair their financial motivation with another motive such as the wish to improve their language skills, experience something new or learn something new.
The current evidence demonstrates the often negative and exceedingly difficult initial experiences of migrating nurses who typically struggle with achieving efficient levels of communication skills, with fundamental differences in nursing practice and with discriminatory practices in the destination country. The nature of the nursing profession - the need to communicate very exactly with the clients about very sensitive topics - necessitates a deep understanding and a very proficient active usage of the language at an almost native level, as well as an understanding of the sociocultural background. A lack of such fluency will leave nurses feeling “like outsiders” and might influence the quality of care. The different nursing practices in the destination countries which the migrating nurses had to adapt to mainly included the differently viewed role of the nurse with more autonomous functions, more responsibilities (especially in the area of physical assessment of clients and risk assessment), critical thinking of the nurse, as well as their ability to be assertive and delegate tasks efficiently. Furthermore, the knowledge of the health care system, using modern technologies and respecting the clients´ autonomy, were other problematic areas for migrating nurses. Some authors suggested other topics to be included in a longer and specific orientation period of migrating nurses (e.g. cultural issues, local policies on confidentiality and discrimination). Apart from orienting the internationally educated nurses in certain topics, a mentor who previously was a migrating nurse seems to facilitate the transition, as does placing the migrating nurse in a specialty department in which she/he has professional experience.
While there is not much published research on Czech migrating nurses, it seems that they have to be first transformed by the recruiting agency to be successful in the global market. They will later be inevitably transformed further by the migration, especially towards an increase in their self-confidence and self-respect. The search for respect, which the Czech
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nurses do not receive in the Czech health care system, could be another motivator for migration.
Based on my review of the available literature, it seems that only two articles about certain aspects of Czech nursing migration (e.g. job satisfaction and the intention to migrate) were published internationally (in 2006 and 2013). Further, the Czech Republic did not participate in any of the recently completed EU-wide studies on the migration of health care workers. Four recent academic theses exploring the topic of Czech nursing migration were publicly available for my review, and all of them involved the use of non-random sampling of approximately thirty participants. The only indicator used for the national monitoring of nursing migration is the annual number of requests for the recognition of professional qualification. Therefore, for a conceptual framework for this study, a more robust approach was suggested. I used mixed methods research and attempted to collect more quantitative data on all of the known aspects of nursing migration, which I identified in the reviewed literature. Research questions (listed below) reflected the knowledge identified on different populations, as well as the call for testing the newly developed theory on nursing migration. A larger and more heterogeneous sample of Czech nurses was targeted by cooperating with a national professional organization and an established recruiting agency. However, due to the lack of other options, the sample remained non-randomized. The resulting qualitative strand explored and validated the previously collected data.
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