Volume 22, Issue 1 (2025)
ioh 2025, 22(1): 168-193 |
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Ethics code: IR.TUMS.SPH.REC.14010289
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Mosaddeghrad A M, Fazaeli A A, Zahmatkesh M, Ebadi A, Moghaddasi F. Strategies for Managing Nurse Migration from Iran: A Qualitative Study. ioh 2025; 22 (1) :168-193
URL: http://ioh.iums.ac.ir/article-1-3740-en.html
URL: http://ioh.iums.ac.ir/article-1-3740-en.html
Ali Mohammad Mosaddeghrad 
, Ali Akbar Fazaeli , Maryam Zahmatkesh , Abbas Ebadi , Farinaz Moghaddasi *
, Ali Akbar Fazaeli , Maryam Zahmatkesh , Abbas Ebadi , Farinaz Moghaddasi *
Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences , farinazmoghaddasi@gmail.com
Abstract: (1546 Views)
Background and aims: In recent years, the migration of nurses from Iran has become a significant challenge for the country’s healthcare system. The continuation of this trend may have adverse consequences on the quality and sustainability of health services and lead to a reduction in an efficient workforce. Therefore, identifying effective strategies to manage nurse migration is of critical importance.
Methods: This qualitative study, utilizing a content analysis approach, was conducted through semi-structured interviews with 57 participants, including 25 migrant nurses, 17 nurses planning to migrate, and 15 senior managers and faculty members of nursing departments at the Ministry of Health and universities in 2024. Purposeful and snowball sampling was used, continuing until data saturation was achieved. Data analysis was conducted using Braun and Clarke’s thematic analysis approach, supported by the MAXQDA software.
Findings: Strategies for managing nurse migration were identified in 10 key themes, including increasing salaries and benefits, creating appropriate and sustainable employment opportunities, developing educational and empowerment programs, managing workload, improving nursing management, promoting workplace justice, cooperating with destination countries, adopting strategies to strengthen nurse retention, systematic management of the nurse migration process, and managing return migration and circular migration.
Conclusion: Nurse migration from Iran poses a significant challenge to the country’s healthcare system. Improving working conditions, including increasing salaries and benefits, and implementing effective programs to enhance nurse retention are essential. By providing appropriate occupational support, negative consequences of migration can be mitigated, thereby improving the quality of healthcare services.
Methods: This qualitative study, utilizing a content analysis approach, was conducted through semi-structured interviews with 57 participants, including 25 migrant nurses, 17 nurses planning to migrate, and 15 senior managers and faculty members of nursing departments at the Ministry of Health and universities in 2024. Purposeful and snowball sampling was used, continuing until data saturation was achieved. Data analysis was conducted using Braun and Clarke’s thematic analysis approach, supported by the MAXQDA software.
Findings: Strategies for managing nurse migration were identified in 10 key themes, including increasing salaries and benefits, creating appropriate and sustainable employment opportunities, developing educational and empowerment programs, managing workload, improving nursing management, promoting workplace justice, cooperating with destination countries, adopting strategies to strengthen nurse retention, systematic management of the nurse migration process, and managing return migration and circular migration.
Conclusion: Nurse migration from Iran poses a significant challenge to the country’s healthcare system. Improving working conditions, including increasing salaries and benefits, and implementing effective programs to enhance nurse retention are essential. By providing appropriate occupational support, negative consequences of migration can be mitigated, thereby improving the quality of healthcare services.
Keywords: Nurse migration, Iranian nurses, migration management, health policy, health human resources
Type of Study: Research |
Subject:
Health Economics
Received: 2025/04/3 | Accepted: 2025/06/11 | Published: 2025/03/30
Received: 2025/04/3 | Accepted: 2025/06/11 | Published: 2025/03/30
References
1. Anand S, Bärnighausen T. Health workers at the core of the health system: framework and research issues. Health Policy. 2012;105(2-3):185-91. [DOI:10.1016/j.healthpol.2011.10.012] [PMID]
2. Ramjan LM, Maneze D, Salamonson Y, Zugai J, Bail K, Liu XL, et al. Undergraduate nursing students challenge misconceptions towards men in nursing: A mixed‐method study. Journal of Advanced Nursing. 2024;80(4):1638-51. [DOI:10.1111/jan.15914] [PMID]
3. Baumann A, Crea-Arsenio M. The crisis in the nursing labour market: Canadian policy perspectives. Healthcare. 2023;11(13):e1954. [DOI:10.3390/healthcare11131954] [PMID] []
4. Tamara AT, Mohammadnezhad M. A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open. 2023;10(3):1247-57. [DOI:10.1002/nop2.1434] [PMID] []
5. Buchan J. Nurse migration and international recruitment. Nursing Inquiry. 2001;8(4):203-4. [DOI:10.1046/j.1440-1800.2001.00112.x] [PMID]
6. Beady A, Khalil R. Nursing staff shortage in Iran: a serious challenge. Hayat. 2014;20(1):1-5. [Persian]
7. Iranian Nursing Organization. Nurse shortage: An ongoing challenge in healthcare systems. [Internet]. 2022. Available at: http://ino.ir/1/1578/1316.
8. Hamshahrionline News Agency. The immigration demand of Iranian nurses increased 6 times. Tehran: Hamshahrionline. [Internet]. 2021. Available at: http://hamshahrionline.ir/x7kkM.
9. Kamali M, Zandi KN, Ilkhani M, Shakeri N, Rohani C. The relationship between job satisfaction and desire to emigrate among the nurses of public hospitals in Tehran. Journal of Health Administration. 2020;23(3):11-16. [Persian] [DOI:10.29252/jha.23.3.11]
10. Heidari A, Shah Bahrami M, Koochak F, Khatirnamani Z. Desire for emigration and its relationship with social capital among nurses working in teaching hospitals in Golestan, Iran. Payesh. 2023;22(3):301-12. [Persian] [DOI:10.61186/payesh.22.3.301]
11. Nabob M, Abdullah S, Nares S, June MH. Brain-drain phenomenon among healthcare workers. International Journal of Public Health and Clinical Sciences. 2019;6(3):90-103. [DOI:10.32827/ijphcs.6.3.90]
12. Sass L, Bagasse A, Catania G, Panini M, Aloe G, Watson R, et al. Push and pull factors of nurses' intention to leave. Journal of Nursing Management. 2019;27(5):946-54. [DOI:10.1111/jonm.12745] [PMID]
13. Ajayi P, Ajayi O, Ogunleye T. Determinants of brain drain among health workers in public teaching hospitals in Ekiti State, Nigeria. International Journal of Health and Pharmaceutical Research. 2022;7(1):45-55. [DOI:10.56201/ijhpr.v7.no1.2022.pg45.55]
14. Pretorius CM. A phenomenological study of South African nurse migration and workplace reintegration upon return. [Thesis]. Stellenbosch University; 2018.
15. Abdu HR, Harass Ø. Nurses' awareness about brain drain and its determinants factors at Main Mansoura University Hospital. International Egyptian Journal of Nursing Sciences and Research. 2024;5(1):36-51. [DOI:10.21608/ejnsr.2024.275721.1364]
16. Mokoena MJ. Perceptions of professional nurses on the impact of shortage of resources for quality patient care in a public hospital: Limpopo Province [Thesis]. University of South Africa; 2017.
17. Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A. The cost of health professionals' brain drain in Kenya. BMC Health Serv Res 2006; 6(1): 1-10. [DOI:10.1186/1472-6963-6-89] [PMID] []
18. International Organization for Migration. Glossary on Migration. Switzerland: International Organization for Migration; 2021.
19. Geiger M, Pécoud A. The politics of international migration management. In: The Politics of International Migration Management. London: Palgrave Macmillan; 2010: 1-20. [DOI:10.1057/9780230294882_1]
20. Sajjadpour SMK. Conceptual and operational frameworks in the management of international migration: a case study of Iran. Geographical Research 2005; 20(78): 9-30. [Persian].
21. Yeates N. The globalization of nurse migration: Policy issues and responses. Int Labour Rev 2010; 149(4): 423-40. [DOI:10.1111/j.1564-913X.2010.00096.x]
22. World Bank. The nurse labor and education markets in the English-speaking CARICOM: Issues and options for reform. Report No. 48988-LAC. Washington, DC; 2009. Available at: http://siteresources.worldbank.org/INTJAMAICA/Resources/The_Nurse_Labor_Education_Market_Eng.pdf.
23. Pope C, Ziebland S, Mays N. Analysing qualitative data. BMJ 2000; 320(7227): 114-6. [DOI:10.1136/bmj.320.7227.114] [PMID] []
24. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101. [DOI:10.1191/1478088706qp063oa]
25. Padarath A, Chamberlain C, McCoy D, Ntuli A, Rowson M, Loewenson R. Health personnel in Southern Africa: confronting maldistribution and brain drain. Durban: Health Systems Trust; 2003: 1-41.
26. Agba AM, Ushie EM. Wage differentials and industrial disputes in Nigerian hospitals. J Bus Manag. 2013;11(5):1-12. [DOI:10.9790/487X-1150112]
27. Tessema M. Causes, challenges and prospects of brain drain: The case of Eritrea. Int Migr. 2010 Jun;48(3):131-57. [DOI:10.1111/j.1468-2435.2009.00585.x]
28. Attah FM, Angioha PU. Examining the level of relationship between working condition predictor variables; remuneration, working hours, office design, job security and workers wellbeing and productivity in commercial banks. Int J Sci Res Publ. 2019;9(5):552-7. [DOI:10.29322/IJSRP.9.05.2019.p8967]
29. Kingma M. Nurses on the move: Migration and the global health care economy. Ithaca, NY: Cornell University Press; 2018. [DOI:10.7591/9781501726590]
30. 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. Hum Resour Health. 2004;2(1):1-4. [DOI:10.1186/1478-4491-2-3] [PMID] []
31. Cometto G, Tulenko K, Muula AS, Krech R. Health workforce brain drain: from denouncing the challenge to solving the problem. PLoS Med. 2013;10(9):e1001514. [DOI:10.1371/journal.pmed.1001514] [PMID] []
32. Dovlo D. Migration of nurses from Sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;42(3p2):1373-88. [DOI:10.1111/j.1475-6773.2007.00712.x] [PMID] []
33. Lorenzo FM, GalvezTan J, Icamina K, Javier L. Nurse migration from a source country perspective: Philippine country case study. Health Serv Res. 2007;42(3p2):1406-18. [DOI:10.1111/j.1475-6773.2007.00716.x] [PMID] []
34. 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. Hum Resour Health. 2017;15(1):1-8. [DOI:10.1186/s12960-017-0199-y] [PMID] []
35. Thupayagale-Tshweneagae G. Migration of nurses: is there any other option?. Int Nurs Rev. 2007;54(1):107-9. [DOI:10.1111/j.1466-7657.2007.00526.x] [PMID]
36. Khadria B. Migration of highly skilled Indians: case studies of IT and the health professionals. New Delhi: Oxford University Press; 2004.
37. Van Eyck K. Women and international migration in the health sector. Ferney-Voltaire: Public Services International; 2004. p. 18.
38. Mudihanselage HS, Chamaru AA. The nursing shortage impact on job outcome (the case in Sri Lanka). J Competitiveness. 2015;7(3):64-73. [DOI:10.7441/joc.2015.03.06]
39. Sapkota TN, Van Teijlingen E, Simkhada PP. Nepalese health workers' migration to the United Kingdom: a qualitative study. Health Sci J. 2014;8(1):57.
40. Simoens S, Villeneuve M, Hurst J. Tackling nurse shortages in OECD countries. OECD Health Working Papers, No. 54. Paris: Organisation for Economic Co-operation and Development; 2005.
41. Bach S. Human resources and new approaches to public sector management: improving human resources management capacity. Stud Health Serv Policy. 2003;21(1):105-46.
42. 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. Glob Health Sci Pract. 2015;3(1):85-96. [DOI:10.9745/GHSP-D-14-00170] [PMID] []
43. Hashish EA, Ashour HM. Determinants and mitigating factors of the brain drain among Egyptian nurses: a mixed-methods study. J Res Nurs. 2020;25(8):699-719. [DOI:10.1177/1744987120940381] [PMID] []
44. Boafo IM. Ghanaian nurses' emigration intentions: The role of workplace violence. Int J Africa Nurs Sci. 2016;5(1):29-35. [DOI:10.1016/j.ijans.2016.11.001]
45. Opoku DA, Ayisi-Boateng NK, Osarfo J, Sulemana A, Mohammed A, Spangenberg K, et al. Attrition of nursing professionals in Ghana: an effect of burnout on intention to quit. Nurs Res Pract. 2022;2022:3100344. [DOI:10.1155/2022/3100344] [PMID] []
46. Salmon ME, Yan J, Hewitt H, Guisinger V. Managed migration: the Caribbean approach to addressing nursing services capacity. Health Serv Res. 2007;42(3p2):1354-72. [DOI:10.1111/j.1475-6773.2007.00708.x] [PMID] []
47. Thomas P. The international migration of Indian nurses. Int Nurs Rev. 2006;53:277-83. [DOI:10.1111/j.1466-7657.2006.00494.x] [PMID]
48. El-Jardali F, Dumit N, Jamal D, Mouro G. Migration of Lebanese nurses: a questionnaire survey and secondary data analysis. Int J Nurs Stud. 2008;45(10):1490-500. [DOI:10.1016/j.ijnurstu.2007.10.012] [PMID]
49. Connell J, Buchan J. The impossible dream? Codes of practice and the international migration of skilled health workers. World Med Health Policy. 2011;3(3):1-7. [DOI:10.2202/1948-4682.1175]
50. Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health-care workers from developing countries: strategic approaches to its management. Bull World Health Organ. 2004;82(7):595-600.
51. Stewart J, Clark D, Clark PF. Migration and recruitment of healthcare professionals: causes, consequences and policy responses. Policy Brief Focus Migra. 2007;7:1-8.
52. Dovlo D. The brain drain and retention of health professionals in Africa. In: Regional training conference on improving tertiary education in Sub-Saharan Africa: things that work; 2003; Accra.
53. Chikanda A. Nurse migration from Zimbabwe: analysis of recent trends and impacts. Nurs Inq. 2005;12(3):162-74. [DOI:10.1111/j.1440-1800.2005.00273.x] [PMID]
54. Sodzi-Tettey S. Opportunity for Ghana to train more nurses for her needs and for export. 2010 [cited 2015 Feb 27]. Available at: http://www.modernghana.com/news/278181/1/opportunity-for-ghana-to-train-more-nurses-for-her.html
55. Diallo K. Data on the migration of health-care workers: sources, uses, and challenges. Bull World Health Organ. 2004;82(8):601-7.
56. 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. Hum Resour Health. 2017;15(1):1-8. [DOI:10.1186/s12960-017-0199-y] [PMID] []
57. Government of the District of Columbia Department of Health. Nurse Staffing Agencies Licensing. Available at: http://doh.dc.gov/service/nurse-staffing-agencies-licensing. 2014.
58. Alonso-Garbayo Á, Maben J. Internationally recruited nurses from India and the Philippines in the United Kingdom: the decision to emigrate. Hum Resour Health. 2009;7(1):1-1. [DOI:10.1186/1478-4491-7-37] [PMID] []
59. Nair M, Webster P. Health professionals' migration in emerging market economies: patterns, causes and possible solutions. J Public Health. 2013;35(1):157-63. [DOI:10.1093/pubmed/fds087] [PMID]
60. Tung RL. Brain circulation, diaspora, and international competitiveness. Eur Manag J. 2008;26(5):298-304. [DOI:10.1016/j.emj.2008.03.005]
61. Ray KM, Lowell BL, Spencer S. International Health Worker Mobility: Causes, Consequences, and Best Practices. Int Migr. 2006;44(2):181-203. [DOI:10.1111/j.1468-2435.2006.00368.x]
62. Haour-Knipe M, Davies AA. Return Migration of Nurses. Geneva: The International Centre on Nurse Migration; 2008.
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