Explore the realities of nurse migration through international case studies, ethical recruitment, and actionable lessons for healthcare migration and workforce sustainability.
Introduction
The worldwide migration of nurses is reshaping healthcare systems, spotlighting both promise and challenge. The World Health Organization reports that, by 2030, there could be a global shortage of up to nine million nurses and midwives. This crisis has accelerated international nurse mobility, with thousands of health professionals moving from countries like Nigeria, the Philippines, and Türkiye to fill urgent gaps in the UK, the US, Canada, and beyond. While nurse migration supports workforce sustainability in destination countries, it raises concerning questions about nurse retention, healthcare migration policies, staff shortages, and the long-term health of source country systems. Understanding the scope of nurse migration—and learning from global case studies—can inform fair, effective, and ethical solutions for all stakeholders.
Why Are Nurses Migrating? Key Drivers and Firsthand Realities
Nurse migration is driven by a complex mix of push and pull factors, with motivations deeply rooted in both professional aspirations and practical challenges.
Economic and Professional Motivations
Economic incentives rank among the strongest forces driving nurse migration. According to a recent survey of Turkish nurses, 76.9% identified low salary as their primary reason for seeking work abroad. Similarly, Filipino and Nigerian nurses have consistently pursued higher pay, better contracts, and more stable employment in countries with high demand for their skills. These pull factors are especially persuasive in times of economic downturn or inflation in source countries.
Professional growth is another major consideration. Many nurses encounter limited opportunities for career advancement at home, with unsupportive managers, stagnating roles, and outdated infrastructure stymieing potential. Some report that state-run health systems offer little chance for specialization, training, or access to new technologies. Conversely, destination countries frequently promise ongoing education, state-of-the-art facilities, and clearer career pathways.
Social, Political, and Cultural Factors
Beyond career and pay, social networks and family reunification powerfully shape migration decisions. African nurse migrants, for example, often rely on informal networks of colleagues and relatives already established abroad. These networks provide vital information on job prospects, visa processes, and life in the destination country.
Political instability and public attitudes toward nursing also play a role. In some countries, diminishing public respect, discriminatory work environments, and rising political uncertainty make nurses feel undervalued or even unsafe. This “push” effect motivates skilled professionals to seek respect and recognition elsewhere.
Case in Point:
A study in Iran found that many nurses attribute their desire to migrate not only to professional or monetary concerns, but also to the lack of public prestige and recognition for their vital work.
The Impact on Healthcare Systems: Case Studies From Around the World
Examining nurse migration through case studies reveals both the broad patterns and the human consequences of large-scale workforce shifts.
Nigeria: Severe Workforce Shortages and Rising Health Concerns
Nigeria has experienced one of the most dramatic nurse outflows in recent years. According to the Nigerian health ministry and professional nurse associations, more than 13,000 nurses and other healthcare workers emigrated to the UK in a single year. In another striking figure, over half of Nigeria’s newly registered nurses sought official documentation in 2023 to enable overseas employment.
Impacts:
The ramifications are profound. Nigeria’s nurse-to-population ratio continues to fall, exacerbating nursing shortages and straining the country’s fragile healthcare system. The loss of experienced professionals results in fewer skilled attendants for mothers and infants, contributing to one of the highest maternal mortality rates globally. Hospitals face staff burnout, overcrowding, and reduced patient care quality.
Remittances from migrant nurses—while valuable to the national economy—cannot compensate for the loss in healthcare capacity and expertise.
The Philippines: A Major Exporter and Policy Innovator
The Philippines stands as the single largest exporter of nurses worldwide, with over a quarter million working abroad in more than 50 countries. The Philippine government has formalized nurse migration as an economic strategy, partnering with destination countries through bilateral agreements and promoting nurse education with an eye towards international standards.
Impacts:
Migrant nurses provide significant remittances, often supporting entire families and communities at home. However, the exodus sometimes leaves domestic hospitals understaffed, forcing less experienced nurses or recent graduates into advanced roles with minimal preparation. This, in turn, has led to concerns about patient safety and the maintenance of care quality. The country’s proactive approach to nurse migration policies and ethical recruitment, however, has helped balance some domestic demands with international opportunities.
TĂĽrkiye: Workforce Dissatisfaction and Patterns of Mobility
Turkish nurses have increasingly participated in global nurse migration. In a recent study, the most frequently cited reasons for emigration were salary inadequacies (76.9%) and poor working conditions (68.5%). Only 10% felt fully satisfied with their professional environment.
Impacts:
Türkiye faces a dual challenge: retaining trained nurses and modernizing domestic health infrastructure to better match global standards. The departure of experienced staff not only creates a brain drain in nursing but also poses risks during periods of high demand, such as the COVID-19 pandemic.
Destination Country Perspectives: UK, US, and Iceland
Destination countries like the UK, US, and Canada have strategically relied on international nurse recruitment to bridge workforce gaps. For instance, the UK’s National Health Service (NHS) has run targeted campaigns in countries like India and the Philippines, offering competitive salaries, relocation support, and development opportunities.
Professional Integration:
While these efforts benefit stretched health systems, migrant nurses often report challenges related to credential recognition, cultural adjustment, and career progression. Filipino nurses in Iceland, for example, have cited difficulties with language, professional practice differences, and social integration, even as their skills are vital to local care.
Policy, Ethics, and International Agreements: Setting Standards for Migration
Migration policy analysis highlights the need for coordinated, ethical, and evidence-based approaches in managing international nurse mobility.
The WHO Global Code of Practice
A landmark framework, the WHO Global Code of Practice on the International Recruitment of Health Personnel urges countries to:
- Promote ethical recruitment, avoiding practices that exploit migrants or destabilize source country systems
- Increase transparency in recruitment and employment contracts
- Encourage investment in local health worker retention to reduce dependency on international staffing
Implementation Examples
- The UK and Philippines have established formal agreements ensuring that recruitment is voluntary, transparent, and aligned with both parties’ needs.
- The European Union’s cross-border healthcare workforce policies incentivize member states to recognize foreign credentials and facilitate smoother mobility for healthcare professionals.
Ethical Recruitment and Workforce Planning
Ethical nurse recruitment is now recognized as essential for both protecting human rights and sustaining healthcare service delivery. Policies that penalize exploitative agencies, require fair contracts, and mandate social support for migrant nurses are being adopted in both source and destination countries.
Support for Credential Recognition
Many destination countries are refining processes for recognizing international qualifications and providing bridging programs. This helps migrant nurses adapt more quickly while maintaining care standards and patient safety.
Lessons Learned: Sustainable Nurse Recruitment and Retention Strategies
Successful nurse migration policies and practices depend on a dual commitment to protecting source country health systems and meeting global healthcare needs.
Improving Retention in Source Countries
Retention strategies are crucial. Policymakers in Nigeria, Türkiye, and other affected nations increasingly view increased salaries, improved workplace safety, and professional recognition as core retention tools. Offering clear career paths, ongoing education, and mentorship enables nurses to grow their expertise without seeking opportunities abroad.
Public recognition and efforts to elevate the status of nursing also boost morale. Public campaigns, awards, and professional associations can foster a sense of pride and accomplishment, counteracting social or cultural devaluation.
Ethical and Collaborative Recruitment
Adhering to international guidelines, such as the WHO Code, ensures that nurse migration can benefit all parties. Bilateral agreements—whereby destination and source countries negotiate recruitment terms and invest in training—provide a model for ethical, mutually supportive migration.
Supportive onboarding programs in destination countries, including cultural orientation, language training, and peer mentorship, enable migrant nurses to thrive, reducing attrition and maximizing their contributions.
Workforce Planning and International Cooperation
Long-term solutions require international coordination. Investing in nurse education, expanding training capacities, and harmonizing standards between countries help balance workforce flows with the healthcare needs of populations worldwide.
Case Highlight:
The UK-Philippines agreement includes “return pathways” and options for temporary migration, allowing Philippine nurses to gain international experience before returning home and sharing new skills—an example of workforce sustainability in practice.
The Double-Edged Sword: Navigating Opportunities and Risks
Nurse migration, when managed proactively and ethically, can address workforce shortages and build cross-cultural expertise. However, without balanced policies, the risk of nurse drain is significant, particularly where already-stretched health systems lose their most skilled professionals.
- For individuals: Migration can be life-changing—offering financial stability, personal growth, and fulfillment.
- For source countries:Â Nurse migration risks weakening the healthcare infrastructure, deterring future talent from entering nursing, and worsening public health outcomes.
- For destination countries:Â The inflow of skilled nurses strengthens systems but also requires investment in integration, credentialing, and cultural competence.
Nurse Migration
Nurse migration is a defining reality for health systems everywhere—one that brings hope, challenge, and opportunity in equal measure. By studying case examples, upholding ethical recruitment, improving retention at home, and supporting integration abroad, nations can foster a global nursing workforce that is both resilient and sustainable. Investing in nurses is investing in public health. The lessons learned from nurse migration underscore the need for international collaboration and smart workforce planning to protect both patients and professionals now and in the future.
