Migration of Lebanese nurses: A questionnaire survey and secondary data analysis

BACKGROUND: Nursing is becoming a mobile profession. Nurse migration is multifactorial and not limited to financial incentives. Non-economic factors that might lead to migration include poor recruitment and retention strategies, poor job satisfaction and working conditions, socio-political and economic stability, and the poor social image of the nursing profession. Lebanon is facing a problem of excessive nurse migration to countries of the Gulf, North America and Europe. No study has been conducted to understand the determinants and magnitude of the problem. OBJECTIVE: The objective of this study is to provide an evidence base for understanding the incidence of nurse migration out of Lebanon, its magnitude and reasons. DESIGN: A cross-sectional research design comprising both quantitative and qualitative methods was employed to achieve the stated objectives. This includes a survey of nursing schools in Lebanon, survey of nurse recruitment agencies, secondary data analysis and survey of migrant nurses. RESULTS: An estimated one in five nurses that receive a bachelors of science in nursing migrates out of Lebanon within 1 or 2 years of graduation. The majority of nurses migrate to countries of the Gulf. The main reasons for migration included: shift work, high patient/nurse ratios, lack of autonomy in decision-making, lack of a supportive environment, and poor commitment to excellent nursing care. Further, nurses reported that combinations of financial and non-financial incentives can encourage them to return to practice in Lebanon. The most recurring incentives (pull factors) to encourage nurses to return to practice in Lebanon included educational support, managerial support, better working conditions, utilization of best nursing practices and autonomy. CONCLUSION: Nurse migration and retention have become major health workforce issues confronting many health systems in the East Mediterranean Region. Our study demonstrated that nurse migration is a product of poor management and lack of effective retention strategies and sufficient knowledge about the context, needs and challenges facing nurses. Nurse migration in Lebanon underscores the importance of developing a monitoring system that would identify implications and help implement innovative retention strategies. Nurse migration out of Lebanon is likely to persist and even increase if underlying factors are not properly resolved.