The migration of nurses is stimulating international debate around globalisation, ethics, and the effects on health systems. This thesis examines this phenomenon through nurses trained in Nepal who migrate to the UK. Since 2000, increasing numbers of Nepali nurses have started crossing national borders to participate in the global healthcare market, particularly in the affluent west. By using qualitative multisited research and in-depth interviews with key stakeholders in both Nepal and the UK, this thesis explores why nurses aspire to migrate, how they fulfil these aspirations, and their experience of living and working in the UK. The thesis begins by examining the historical development of nurse training in Nepal, particularly from the mid 1950s. This period saw profound socio-political transformations, including in the position of women in Nepali society and in the perception of nursing in Nepal. Previously, many families were very reluctant to send their daughters into nursing. By the late 1990s, middle-class women and their families were increasingly attracted to nursing, both as a vocation and as a means to migrate. The thesis explores the rise of private training colleges to meet the increased demand for nurse training, and the new businesses that have grown up around the profession to facilitate nurse recruitment and migration. Around one thousand nurses have migrated to the UK since 2000, and the second part of the thesis presents their experiences of the migration process and of working and settling in the UK. Nurses have faced complex bureaucratic and professional hurdles, particularly after UK nurse registration and work-permit policies changed in 2006. The thesis also highlights how highly qualified nurses with many years of work experience in Nepal have become increasingly deskilled in UK. Frequently sent to rural nursing-homes by recruiting agencies, they create and join new diasporic support networks. Further, many have left their loved ones behind, and experience homesickness and the pain of family separation. Often, they plan for their husbands and children to join them after several years, and the research explores this and the issues faced by their families, as they relocate and adapt to life in the UK. Finally, the thesis makes some important policy recommendations. For Nepal, these relate to greater regulation of nurse training and the brokering of nurses abroad. In the UK, they relate to increasing the flexibility of registration and visa regulations to assist in supporting Nepali nurses' work choices, and to value and utilise their professional skills in the UK better.

Yes / An exploratory qualitative study design was adopted for this study and underpinned by Rex’s migrant workers framework (Rex, 1999). Semi-structured interviews were conducted with ten ward managers from four NHS trusts in the north-east of England to gain an insight into their experiences of working with black African nurses with regard to equal opportunities in accessing professional development and promotion. Managers reported that black African nurses experienced racism from patients, racism from colleagues, discrimination and lack of equal opportunities. A unique finding of the study was that managers stereotyped black African nurses as lacking motivation for professional development and promotion. The authors recommend that NHS ward managers receive training in implementing antidiscrimination policies and valuing equality and diversity.

Despite evidence that suggests that nurses migrate to Ontario through the Live-in Caregiver Program, no research has been conducted on this group of nurses in Ontario. This study addresses that gap utilizing the transnational feminist concept of “global care chains” in a single holistic case study design to explore the experience of nurses who migrate to Ontario through the Live-in Caregiver Program (2001-2011), and examine the diverse perspectives of stakeholders on issues of rights and obligations of these nurses. Fifteen live-in caregivers and nine policy stakeholders were interviewed, and an analysis undertaken of immigration and nursing policy documents. Findings indicate that familial discourses and perspectives on global social status shape these women’s decision to migrate from the Philippines to Canada, often via a second country (especially Saudi Arabia), as well as their subsequent Canadian experiences. Results are consistent with Rhacel Parrenas’ idea of ‘contradictory class mobility’ that describes the phenomenon of decrease in social status coupled with an increase in financial status among immigrant care workers. As professional women undertaking unskilled work, the nurses’ contradictory class status was reinforced by the emotional labour and domestic work they were required to perform. Furthermore, as temporary workers on a path to permanent residency, their professional integration as nurses was complicated by Canada’s immigration policy and the paradox between the government’s stated short-term goal (to address labour force shortage of live-in caregivers) versus its long-term goal (to ensure the integration of permanent residents). Within this policy paradox immigration policy makers emphasized the short-term obligation of fulfilling labour needs, while live-in caregivers and advocacy groups emphasized the long-term obligations of the Canadian government related to gaining permanent residence status. The lack of congruence between the Live-in Caregiver Program policy and nursing policy concerning internationally educated nurses, as well as prioritization of their familial obligations complicated the process of professional integration for this group of women. Recommendations arising from the study concern the need to bridge these policy gaps and address the shortcomings of the Live-in Caregiver Program to leverage the integration of this group of internationally educated nurses in Canada.

<p><strong>Background.</strong> The nursing profession has a long tradition of migration. The migration of nurses from Canada has received little attention.</p> <p><strong>Objective.</strong> The purpose of this sandwich thesis was to understand the migration intentions of nurse graduates in a Canadian border city, their intention to become commuter migrants, and to explore the factors influencing these intentions.</p> <p><strong>Methods.</strong> Two qualitative studies of the migration literature included an analysis of the concept of migration and an integrative review of case study methodology in the study of nurse migration. A mixed methods study, guided by the Value-Expectancy framework, explored the migration intentions of nurse graduates in a Canadian border city and the factors influencing these intentions.</p> <p><strong>Results.</strong> The concept of nurse migration was found to be multifaceted. Its attributes, antecedents and consequences were defined. The mixed methods study provided insights into the migration intentions of recently graduated Canadian nurses. The majority preferred to work in Canada, but because of a perceived absence of valued jobs factors, were willing to migrate. Two thirds considered migrating and sixteen percent were interested in becoming commuter migrants. The findings supported the hypothesis that nurses weigh employment values (goals) against the expectation of achieving them, thus influencing intentions to migrate or stay.</p> <p><strong>Conclusion.</strong> The value-expectancy framework offered a novel approach for identifying the job factors that were driving migration intentions. There is a need for more primary research employing different methodologies to explore the characteristics, causes, and consequences of nurse migration that were identified through this research.</p> / Doctor of Philosophy (PhD)