Background: While nurse migration has received considerable political attention since the EU enlargements in 2004 and 2007, most research concentrated on the specific migration motives and the impact on health care systems, while little research focused on the experiences of nurses abroad or combined these experiences with research on working conditions in hospitals.
Objectives: To test whether the combination of qualitative and quantitative data on motives to migrate and to leave the current hospital, respectively, provides sufficient information (1) to analyse working conditions in Germany compared to five destination and three source countries, (2) to verify or falsify the assumption that working conditions in destination countries are better than in source countries, and (3) to identify sound strategies for workforce planning.
Design and data sources: (a) Relevant push factors for migrating from Germany were identified via an online survey, focus groups, and telephone interviews. (b) Eight factors were operationalised using items selected from the revised Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI). (c) The impact of these push factors on the stated "intention-to-leave" of 1508 hospital nurses in Germany was assessed using multivariate data analysis. (d) Descriptive statistics were used to illustrate comparisons across all countries using a total sample of 27,451 nurses from 328 hospitals.
Results: (1) All push factors show a positive association with the risk for nurses to leave their current jobs, with "poor working environment" having the most pronounced relationship (OR 3.235, 95% CI 2.434-4.301). (2) On average, four out of five destination countries receive better ratings than Germany (with 5/5 for "sufficient nursing staff", "recognition", "decision-making power", and "collaboration between nurses and physicians" but only 1/5 for "advanced training prospects"), while two out of three source countries receive worse ratings than Germany. (3) Results suggest that the way to retain and attract nurses on the short-term is to invest in better working environments.
Conclusions: By successfully linking qualitative and quantitative research, new insights about factors for the movement of nurses can be gained. German nurses would indeed find more satisfying conditions abroad in most cases-findings which encourages a revision of work-related aspects in German hospitals.
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