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MANAGEMENT: NURSING SHORTAGES
The impact on Asian
health care systems of
nursing migration
KHURSHID KHOWAJA, RN, RM, BSCN, PHD
ASSISTANT PROFESSOR AND DIRECTOR NURSING SERVICES, AGA KHAN UNIVERSITY HOSPITAL, PAKISTAN
Abstract
Nurses are precious resource in every corner of the world and hospitals are facing serious challenges in providing
high quality care with current nursing shortages. While the shortage of nurses is a worldwide issue, impacting
currently more on under developed countries, little literature is available on this aspect of the issue. Lots of job
opportunities are available for nurses in western countries, advertised on a daily basis, that attract nurses and
result in major nursing migration from Asian countries to the western world.
The nursing management group at the Aga Khan
University Hospital (AKUH) is highly stressed because
of the high turnover rate of nurses in this hospital. The
average annual turnover rate is calculated at 23% (see Figure
1), resulting in 60% of nurses having less than two years
experience.
Turnover rate and years of experience
The turnover rate is high in the first three years where 71% of
nurses resign with less than three years experience. Thirty-two
percent of nurses resign before completion of one year’s
service with AKUH as indicated in Figure 2. The major issue
associated with these resignations is that 50% of nurses resign
with a notice period of only 24 hours, where nursing
management require three to six months to replace their
positions and this time lapse impacts on the quality of care.
Reasons for turnover
The major reason for the high nursing turnover rate is the
migration of 66% of nurses to countries such as the United
States, the United Kingdom and Canada as indicated in Figure
3, where the working wages offered are quite high compared
to Pakistan. Out of these 66%, 70% migrate to the United
Kingdom, where nurses are not required to pass any type of
exam at entry level.
Relationship of nursing turnover to patient safety
The Institute of Medicine (2004) stated that nurses are
considered the largest component of the health care workforce
and their high turnover can have adverse consequences for
patient safety. The Institute of Medicine further stated that
leaner nurse staffing is associated with increased length of stay,
nosocomial infection (urinary tract infection, post operative
infection, and pneumonia), and pressure ulcers. These studies
taken together, provide substantial evidence that increased
nurse staffing is associated with better patient outcomes.
Subsequent studies have added to this evidence base and
substantiate the observation that greater numbers of patient
deaths are associated with fewer nurses to provide care (Aiken
et al., 2002) and less nursing time provided to patients is
30%
25%
20%
15%
17%
27%
21% 23%
10%
5%
0%
2000 2001 2002 2003
Figure 1: Turnover rate for nursing staff 2000-2003
Vol. 40 No. 4 | World Hospitals and Health Services | 19