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Return migration of nurses: A concept analysis

Article  in  Indian Journal of Public Health Research and Development · September 2018

DOI: 10.5958/0976-5506.2018.00994.4

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Ferry Efendi Anna Kurniati

Airlangga University Ministry of Health, Indonesia
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University College Cork Airlangga University
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 DOI Number: 10.5958/0976-5506.2018.00994.4

Return Migration of Nurses: A Concept Analysis

Ferry Efendi1, Anna Kurniati2, Eileen Savage3, Nursalam Nursalam4, Ah. Yusuf5, Kusnanto Kusnanto5
1
Lecturer, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia; 2Health planner specialist,
Center for Planning and Management of Human Resources for Health, BPPSDMK, Ministry of Health,
Indonesia; 3Professor, School of Nursing, University College Cork, Ireland; 4Professor, 5Lecturer, Faculty
of Nursing, Universitas Airlangga, Surabaya, Indonesia

ABSTRACT
Background: 5HWXUQPLJUDWLRQLVDFRPSOH[FKDOOHQJLQJSKHQRPHQRQDQGWRGDWHLWUHPDLQVDFRQFHSWWKDW
is not well understood. A concept analysis would help to clarify what is meant by return migration. This
paper aims to report on an analysis of the concept of return migration of nurses.
Design: &RQFHSWDQDO\VLVXVLQJWKH:DONHUDQG$YDQWDSSURDFK
Data Sources: *RRJOH 6FKRODU 3XEPHG (%6&2 -6725 DQG:HE RI 6FLHQFH GDWDEDVHV ZHUH VHDUFKHG
ZLWKRXWDWLPHIUDPH7ZHQW\RQHDUWLFOHVPHHWLQJWKHLQFOXVLRQFULWHULDZHUHLQFOXGHG
Method:7KLVVWXG\HPSOR\VHLJKWVWHSVRI:DONHUDQG$YDQW¶VPHWKRGWRFRQGXFWWKHFRQFHSWDQDO\VLV
Results:5HWXUQPLJUDWLRQRIQXUVHVFDQEHGH¿QHGE\¿YHDWWULEXWHVWKHPRWLYDWLRQDQGGHFLVLRQVRIPLJUDQW
nurse, return as human right, resource mobilisation, reintegration and return itineraries. Antecedents of
return migration include the economic, social, geographical, political, family and life cycle that comprise the
FDXVHDQGH൵HFWIUDPHZRUN:LWKUHJDUGVWRUHWXUQPLJUDWLRQWKHFRQVHTXHQFHVDUHEHQH¿FLDORUGHWULPHQWDO
depend on the point of view migrant nurses, source country, receiving country, nursing profession and
FRXQWU\KHDOWKV\VWHP(PSLULFDOUHIHUHQWVKDYHEHHQLGHQWL¿HGDQGVXSSRUWSRWHQWLDODUHDWRXQGHUWDNHD
research on return migration.
Conclusion:7KLVFRQFHSWDQDO\VLVKDVFODUL¿HGFXUUHQWXQGHUVWDQGLQJVDQGHQKDQFHWKHFODULW\RIUHWXUQ
migration concept. It recognises the centrality of return as a component in migration stage that needs a
comprehensive approach.

Keywords: concept analysis, return migration, nurse migration, brain gain.

INTRODUCTION
Migration of skilled health workers in a global
FRQWH[W KDV LQFUHDVHG VLJQL¿FDQWO\ RYHU WKH ODVW WZR
decades.1,2 Nurses as a large part of professional health
FDUHZRUNIRUFHKDYHFRQWULEXWHGWRWKHVLJQL¿FDQWÀRZV
of this migration movement.3–5 Migration has long been
assumed as a one direction process,6 such that migrants
who emigrated would permanently stay in the destination
FRXQWU\+RZHYHUWKHUHLVLQFUHDVLQJHYLGHQFHVKRZLQJ
2UJDQL]DWLRQIRU0LJUDWLRQ,20DOVRVXSSRUWWKLVLGHD
by emphasising on the need for comprehensive and
cooperative approaches to managing return as a part of
the human movement.11 The issue of return has become
LQFUHDVLQJO\ VLJQL¿FDQW DPRQJ LPPLJUDQWV DOWKRXJK LQ
the absence of statistical data. The study pointed out the
need for global attention on the nurses’ return migration
WKDW LV KLJKO\ FRPSOH[ DQG QHHGV IXUWKHU DFWLRQ IURP
nursing profession.10
that the migrants are returning to their country of origin
known as return migration.7–9
Acknowledging the importance of return migration,
The International Centre of Nurse Migration recognised
WKLVPRYHPHQWDVDPHDQVRIEHQH¿WLQJWKHFRXQWULHVRI
origin and called for serious attention.10 The International
&RQFHSW DQDO\VLV DV :DONHU DQG $YDQW  KDV
argued can provide a knowledge base to get a clear picture
RISKHQRPHQRQREMHFWRULGHD12 The aim of this concept
DQDO\VLVZDVWRH[DPLQHWKHFRQFHSWRIUHWXUQPLJUDWLRQDV
it is used in global nurses’ migration, to provide a brighter
understanding of the phenomenon and suggestion for
future study can be developed and measured.
 200 Indian Journal of Public Health Research & Development, September 2018, Vol.9, No. 9

Data sources: An electronic search using the keyword 5HVRXUFHVIRU+HDOWK.DPSDOD?X0DUFK

“return migration nurse”, “return emigrant nurse”, Back to the past, referring to the article 13 section 2 of
“return immigrants nurse” was undertaken using 7KH8QLYHUVDO'HFODUDWLRQRQ+XPDQ5LJKWVVWDWHGWKDW
databases relevant to nursing, medicine and social “Everyone has the right to return to his country”.20 The
VFLHQFHV3XEPHG(%6&2-6725:HERI6FLHQFHDQG positions statement by International Council of Nurses
Google Scholar.
Data Selection and Analysis: 7KH ¿QDO VDPSOH RI 
documents was selected with inclusion criteria for
UHFRJQLVHWKHSRWHQWLDOEHQH¿WRIPLJUDWLRQDQG
call for support to nurse who wishes to return home by
putting the nurses right on priority.
Resource mobilization: Bringing resources back to
WKH VHOHFWLRQ RI SDSHUV ZHUH D UHSRUWHG RQ PLJUDQWV
the countries of origin marked the character of return
returning or having returned to their country of origin;
migration. Nurse returnees not only bringing the
DQGEIRFXVHGRQTXDOL¿HGQXUVHV
RESULTS
Uses of the concept in literature: There is no available
GH¿QLWLRQ RI UHWXUQPLJUDWLRQIURPFRPPRQO\ UHIHUUHG
GLFWLRQDULHV 2[IRUG DQG 0HUULDP:HEVWHU GLFWLRQDU\
7KH ¿UVW GH¿QLWLRQ RI UHWXUQ PLJUDWLRQ SURSRVHG E\
¿QDQFLDO FDSLWDO EXW DOVR KXPDQ DQG VRFLDO FDSLWDO10 It
LV XQGHQLDEOH WKDW WKH ÀRZ RI UHPLWWDQFHV WR WKH ORZ
DQG PLGGOH LQFRPH FRXQWULHV SOD\V D VLJQL¿FDQW UROH
in the nation’s development.21 Even though we are a
lack of data on the impact of remittances from nursing
workforce, evidence showed that in Philippine as a
source country of nurses share 10% remittances of
*URVV'RPHVWLF3URGXFWIRU-DPDLFDDQGIRU
%RYHQNHUNZKLFKGH¿QHDVWKHUHWXUQRISHRSOH Uganda.22 %UDLQ JDLQ LV WKH PRVW H[SHFWHG RI UHWXUQHG
DIWHU HPLJUDWLQJ WR RULJLQ FRXQWU\ IRU WKH ¿UVW WLPH13 migrants which brings new skill, knowledge and idea to
$ERYHWHUPVKDYHYDULRXVLQWHUSUHWDWLRQV)RUH[DPSOH contribute to the advancement of their origin’s country.23
with regards to the movement, Dumont and Spielvogel 6WXGLHVRIUHWXUQPLJUDWLRQLQ-DPDLFDDQG3DFL¿F,VODQG
GH¿QHWKHPRYHPHQWDVWKHLQLWLDOPLJUDWLRQRQO\
to be called return migration.14
'H¿QLQJDWWULEXWHV
Motivation and decisions of nurse migrant: Individual
motivation and decision for going back to the country
of origin is one of key distinctive associated with return
nurse migration. It has been argued that individual
decision to return home as a response of personal factor,
career path and others.15,10 Individual initiatives to return
has been decided on the early stage of migration or
during they stay in foreign country.16,17 Motivation to
UHWXUQKRPHZDVUHSRUWHGLQÀXHQFHGWKHZLOOLQJQHVVDQG
readiness of migrant which consider the circumstances
in both, home and host countries.18
Return as human right: Freedom of return under the
umbrella of migration was described in the literature
RQ UHWXUQ KRPH 5HFRJQLVLQJ WKH VLJQL¿FDQW PRELOLW\
RQ KHDOWK SURIHVVLRQDO WKH :+2 LVVXHG WKH JOREDO
code by recommending the Member States to take
into account individual right to migrate and leave any
country.195HFDOOLQJUHVROXWLRQ:+$LQZKLFKWKH
:RUOG+HDOWK$VVHPEO\UHTXHVWHGWKH'LUHFWRU*HQHUDO
to develop a voluntary code of practice on the international
recruitment of health personnel in consultation with all
relevant partners; Responding to the calls of the Kampala
'HFODUDWLRQDGRSWHGDWWKH)LUVW*OREDO)RUXPRQ+XPDQ
countries described that most returnees have gained new
or additional capabilities.21,16
Reintegration: Return migration was characterised by
reintegration phase into the family, group and society in
KLVRUKHUFRXQWU\5HLQWHJUDWLRQIRXQGTXLWHFRPSOH[
dynamic and challenging aspect of return migration.11
5HLQWHJUDWLRQWREHLQÀXHQFHGE\VLWXDWLRQDQGFRQGLWLRQ
in both countries.24:KHQ PLJUDQWV IHHO WKDW WKH\ KDYH
achieved their goals, they are more ready to reintegrate
into the home country.18 &RPSOH[ UHLQWHJUDWLRQ
problems have been investigated by Arowolo for
LQVWDQFH MREOHVVQHVV VRFLDO PDODGMXVWPHQW ERUHGRP
DQGIUXVWUDWLRQDPRQJQRQQXUVHVPLJUDQWV25 This study
consistent with research of nurses migrant who returns
WR ,QGRQHVLD WKH PDMRULW\ RI QXUVHV ZHUH XQHPSOR\HG
DQGIDFHGGL൶FXOW\LQEXLOGLQJDFDUHHU26
Return itineraries: 7KH MRXUQH\ RI UHWXUQ ZDV
FRPSOH[ ZKLFK JHQHUDOO\ GLYLGHG LQWR YROXQWDULO\
DQG LQYROXQWDULO\ 7KHVH W\SHV ZHUH H[SODLQHG LQ WKH
OLWHUDWXUH RI UHWXUQ PLJUDWLRQ RI QXUVHV 0DMRULW\ WKH
VWXGLHV VXSSRUW WKH EHQH¿WV RI YROXQWDULO\ UHWXUQ DV D
form to contribute in the nation development.27 Voluntary
return due to the completion of work contract, and goals
achievement was reported by another study.16+RZHYHU
some study also noted that forced return migration might
become the push factor from country of residence to
make them back home.10
 Indian Journal of Public Health Research & Development, September 2018, Vol.9, No. 9 201

Model case of return migration of nurses: In the
:DONHUDQG$YDQWPHWKRGPRGHOFDVHZDVFRQVWUXFWHG
to further clarify the concept. The case may be derived
from our real life, invented or found in published
document.12 A model case adapted from return migration
VWXG\LQZKLFKH[LVWLQUHDOOLIHFRQWH[W
'HQLDV 3VHXGRQ\P ZDV OHIW KLV MRE WR PLJUDWH
to Australia because of the war happened in his home
FRXQWU\$IWHUDUULYLQJLQ$XVWUDOLDWKHLPPLJUDWLRQR൶FH
found him without a legal document. Only two months
ahead of his arrival date, the Australian government has
decided to deport him back to his country of origin.
6XPLDWL 3VHXGRQ\P LV D  \HDUV ROG ZKR KROG
a bachelor’s degree in nursing. She has been working Denias case only has one attribute, his return
LQ -DSDQ IRU WKUHH \HDUV DV IRUHLJQ QXUVHV:RUNLQJ DV LWLQHUDU\ ZDV IRUFHG E\ WKH VWDWH WR H[SHO IURP WKH
QXUVHVLQ-DSDQDOORZVKHUWRHDUQDURXQG86'SHU
PRQWK HLJKW WLPHV KLJKHU WKDQ ,QGRQHVLD +DYLQJ WKLV
wage, she was thinking to return home after she reaches
her personal goals. She also sent the money back to
home country for her family. After Tsunami disaster hit
-DSDQLQKHUIDPLO\ZDVZRUULHGDERXWKHUVDIHW\
and tried to persuade her for return. Even though she has
SDVVHGWKH-DSDQHVH1XUVLQJ([DPLQDWLRQDQGHOLJLEOHWR
VWD\LQ-DSDQIRUXQOLPLWHGSHULRGV¿QDOO\VKHGHFLGHG
WR JR EDFN WR ,QGRQHVLD DQG WULHG WR ¿QG D QHZ MRE
:KLOHZDLWLQJIRUWKHMRELQWHUYLHZVKHZDVUXQQLQJD
VPDOOEXVLQHVVIURPWKHVDYLQJPRQH\LQ-DSDQ6KHZDV
VKRFNHGWR¿QGRXWWKDWOLYLQJLQKHUFLW\ZDVFKDOOHQJLQJ
DQG GL൶FXOW WR ¿QG D MRE 6KH WKRXJKW WKDW VKH PXVW
rebuild her career from zero as a new nurse.
All attributes arise in this case describe the
FRPSOH[LW\ RI WKH FRQFHSW 6XPLDWL GHPRQVWUDWHG
individual motivation in her decision to return home.
+HU UHWXUQ ZDV LQÀXHQFHG E\ WKH DFKLHYHPHQW RI KHU
personal goals, crisis, and her family. Financial capital
was obviously observed from her situation to support
KHU IDPLO\ DQG KHUVHOI DW KRPH FRXQWU\ /DVWO\ UHWXUQ
KRPHSRVLWLRQHGKHURQWKHGL൶FXOW\¿QGLQJDMREDQG
struggles to seek a new vacancy for her future.
Additional cases: related case: There is one case
related to return migration concept of which have some
DWWULEXWHV RI UHWXUQ PLJUDWLRQ EXW DFWXDOO\ GL൵HUHQW
)ROORZLQJLVDQH[DPSOHRIUHODWHGFDVH
Table 1: Concept on return migration of nurse: antecedent, attributes and consequences
Antecedents Attributes
'ULYHUVLQÀXHQFLQJPRWLYDWLRQWR Motivation and decisions of nurse
KRVW FRXQWU\ LQYROXQWDU\ UHWXUQ PLJUDWLRQ 7KLV W\SH
of return repeatedly showed by refugees and asylum
VHHNHUVWKDWÀRZWRGHYHORSHGFRXQWULHV
Antecedents: 7KH FDXVH DQG H൵HFW PRGHO LV WKH PRVW
SUHYDOHQWIUDPHZRUNIRUH[SODLQLQJUHWXUQPLJUDWLRQRI
nurses.10 The antecedents for return migration of nurses
are social, economic, geographical, political, family or
life cycle.6&DXVHDQGH൵HFWIDFWRUVGULYHQXUVHVWRUHWXUQ
WRWKHFRXQWU\RIRULJLQZKLFKD൵HFWHGE\FLUFXPVWDQFHV
in the host and home country.6 Economic motives for
H[DPSOHZKHQWKHMREDUUDQJHPHQWUHDFKHVWKHHQGRIWKH
contract, it might be a cause factor to leave host country.8
On the other side, enough saving in country of origin
PLJKW EHFRPH DQ H൵HFW IDFWRU WR UHWXUQ KRPH 1RQ
HFRQRPLFFRQVLGHUDWLRQDOVRKDYLQJPRUHLQÀXHQFHGIRU
return home than economic reason.6
Consequences: Mount evidence showed the positive
and negative impact of return migration on various
players on this movement.10 The players include migrant
nurses, nursing profession, host and home country. For
instance, developing countries who have a surplus of
QXUVLQJ ZRUNIRUFH FRXOG JDLQ EHQH¿W IRU WKH UHWXUQ RI
PLJUDQWQXUVHV7KHEUDLQJDLQLVPXFKPRUHH[SHFWHG
WKDQEUDLQGUDLQSDUWLFXODUO\IURPWKHPLGGOHDQGORZ
income countries.
Consequences
%HQH¿FLDODQGGHWULPHQWDO
UHWXUQFDXVHDQGH൵HFW migrant depending on:
Social Return as human right Individual
Economic Resource mobilization Source country
Geographical Reintegration Receiving country
Political Return itineraries Nursing profession
)DPLO\/LIH&\FOH National health system
 202 Indian Journal of Public Health Research & Development, September 2018, Vol.9, No. 9

Empirical referents: Measuring return migration can be &RQÀLFWRI,QWHUHVW Authors declared that we have no
FKDOOHQJLQJ DV WKHUH LV VWLOO FRQIXVLRQ RQ WKH GH¿QLWLRQ FRQÀLFWRILQWHUHVW
and data availability as well.28+RZZDVFRXQWU\GHDOLQJ
with this issue by lack of system to track the returnee Acknowledgment: None
obviously appeared on the published literature.29 Mostly Source of Funding: NA
country relies on the census, survey, population registries,
labour force survey, country social survey, and data from Ethical Clearance: NA
employment services.28 A study from most developed
countries conveys a message that there is a need of REFERENCES
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 &RQQHOO- %XFKDQ-7KHLPSRVVLEOHGUHDP"
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DQGSUDFWLFH$FFRUGLQJWRWKLVDQDO\VLVZHQHHGDVSHFL¿F
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 (IHQGL)&KHQ&01XUVDODP1,QGDUZDWL
5 8O¿DQD(/LYHGH[SHULHQFHRI,QGRQHVLDQ
QXUVHVLQ-DSDQ$SKHQRPHQRORJLFDOVWXG\Japan
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This article provides an analysis of the concept of
return migration of nurses found in published literature.
17,±
 .XUQLDWL$&KHQ&00(IHQGL) 2JDZD
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H[SHULHQFH RI ,QGRQHVLDQ QXUVH UHWXUQHHV Int.
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 Indian Journal of Public Health Research & Development, September 2018, Vol.9, No. 9 203

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