South-East Asian Nurses' Experiences Under the Economic Partnership Agreement (EPA) in Japan: How Language Ability Affects Self-Confidence and Interpersonal Relationships.

INTRODUCTION: Since 2009, nurses have relocated to Japan from Indonesia, the Philippines, and Vietnam under the auspices of the Economic Partnership Agreement (EPA). We asked why some migrant nurses remain in Japan whereas others leave. METHOD: We applied the methodology of Constructivist Grounded Theory. All participants were internationally educated nurses (IENs) currently or formerly working in Japan after passing the National Nursing Examination. RESULTS: Difficulty in mastering the Japanese language was established as one of the main themes. Initial coding elicited two explanatory sub-categories: lack of confidence in communication and effects of language difficulty on workplace relationships. One explains how practical experience in the workplace affected nurses' confidence in communication. The other explains how levels of Japanese language attainment shaped relationships with colleagues. DISCUSSION: These findings suggest a need to regulate the working conditions of foreign nurses, and a need for training schemes to optimize IEN retention.

Investigation of the relationship between attitudes toward migration and life satisfaction of nurses working in Turkey.

BACKGROUND: Nurse migration contributes to the nursing shortage in developing countries. Understanding nurses' attitudes toward migration and related factors is crucial for policy-making and healthcare workforce planning in Turkey. AIM: This study aimed to investigate the relationship between nurses' attitudes toward migration and their life satisfaction in Turkey. METHODS: The study included working nurses with social media accounts on a social media platform in Turkey who followed nursing-related content. A sample of 423 nurses completed an online survey. Independent variables included nurses' sociodemographic characteristics and inclination toward migration, while dependent variables were life satisfaction and migration attitude levels. Data were collected via an online questionnaire, incorporating the Brain Drain Attitude Scale (BDAS) and Life Satisfaction Scale (LSS), between April and May 2023. RESULTS: The study found a negative correlation between nurses' life satisfaction levels and their attitudes toward migration (r = -.349, p < .001). Nurses dissatisfied with their profession (F = 6.575, p < .05), lacking professional support (F = 8.641, p < .05), and lacking social support (F = 6.307, p < .05) scored higher on the BDAS. Conversely, those satisfied with their profession (F = 31.455, p < .05), receiving professional support (F = 26.307, p < .05), and social support (F = 33.990, p < .05) scored higher on the LSS. CONCLUSION AND IMPLICATIONS FOR NURSING: The study revealed that decreased life satisfaction among nurses in Turkey correlates with increased migration attitudes. These results underscore the need for strategies to enhance nurses' job satisfaction and support systems to mitigate migration tendencies. This study contributes valuable insights into the high inclination of Turkish nurses toward emigration.

[Academically educated nurses from third countries: Professional self-concept versus working life in Germany. A qualitative study using the example of migrant nurses from the Philippines]. / Akademisiertes Pflegefachpersonal aus Drittstaaten: Professionelles Selbstverständnis vs. berufliche Realität in Deutschland? Eine qualitative Studie am Beispiel migrierter philippinischer Pflegefachpersonen.

BACKGROUND: The recruitment of internationally educated nurses is gaining relevance in Germany in response to the growing shortage of nurses. Differences in nursing qualifications and practices between the country of origin and of destination can irritate the professional self-concept and hinder professional integration. PURPOSE: The study objective was to examine the development of the professional scope of action to unfold the professional self-concept of academically qualified nurses in Germany. METHODS: In accordance with the episodic interview, eight guided interviews were conducted with Filipino nurses who had migrated to Germany. Data was analyzed by thematic coding. RESULTS: The analysis shows two dimensions that impact the professional scope of action: perceived systemic constraints in the transition process and perspectives on professional development. The recruitment and recognition process is associated with high financial and time-related uncertainties and professional devaluation experiences. Migrant nurses experience both a loss of competence and a sense of foreignness in their nursing role in Germany. In order to regain professional scope of action, strategies of continuing education and focusing on more technology-intensive nursing care areas are pursued; only a minority can adapt their self-concept to the circumstances of nursing practice in Germany. DISCUSSION: The study results demonstrate the importance of paying attention to both the competence profile and the professional self-concept of academically educated nurses in order to offer migrant nurses professional career prospects in Germany. Especially in long-term care, this has proved to be a structural problem. CONCLUSION: To provide an attractive destination for international academically qualified nursing professionals in Germany, the ratification of international standards, the provision of transparent and independent information, utilization of existing nursing expertise as well as the establishment of career opportunities are recommended.

Socio-cultural factors influencing Indonesian nurses to stay working in Indonesia: A qualitative study.

AIM: To explore push, pull and retention factors affecting indonesian nurses decision to stay in the nursing profession. INTRODUCTION: Identifying influencing factors that determine Indonesian nurses' decisions to remain working in Indonesia gives a better understanding of nurses' migration and therefore are necessry to explore. BACKGROUND: Studies examining nurse migration's push and pull factors have been carried out extensively. A study exploring factors that make nurses stay in their home countries, such as Indonesia needs to be conducted to provide different insights for related parties. METHODS: A qualitative descriptive study was conducted with 52 managers and 181 nurses from hospitals and community health centres across four different regions in Indonesia, including DKI Jakarta, Lampung, South Kalimantan and West Nusa Tenggara. A purposive sampling method was used. The data were collected online (via Zoom) and offline through semi-structured interviews and focus group discussions. A content analysis was performed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed. RESULTS: Five categories were developed: non-financial support, sense of togetherness, following the husband, social image and powerlessness. DISCUSSION: Socio-cultural factors influence Indonesian nurses to stay working in their country despite their economic and career development difficulties. CONCLUSION: Socio-cultural circumstances have become powerful factors affecting Indonesian nurses to stay working in Indonesia. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: There is a need for harmonisation of policies related to nursing migration between recipient and source countries. Moreover, policies should go beyond education, competency and credentialing regulations and include addressing social costs and needs, such as the possibility of migrating nurses' families to the recipient countries.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective.

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

Factors Related to Job Continuance of Nurses Who Migrated to Japan: A Cross-Sectional Study.

Japan has accepted nurses from Indonesia, the Philippines, and Vietnam under the Economic Partnership Agreement, but nearly half of them have already left the workforce. This study aimed to clarify the factors related to the job continuance of nurses who migrated to Japan under the Economic Partnership Agreement. Our goal was to explore factors specific to migrant nurses and to contribute to the development of support measures for them. This research was a cross-sectional study in which a web-based questionnaire and interview were conducted at a single point in time. Migrant nurses (n = 40) participated in the web-based questionnaire survey. Of those, nine nurses were also interviewed. Spearman's rank correlation coefficient was used to establish correlations, and qualitative descriptive analysis was used to analyse interviews. The questionnaire survey results revealed the content of work, human relationships in the workplace, the number of night shifts, and satisfaction with the balance between work and private life were significantly and negatively correlated with the Intention to Quit scale total score. All correlation coefficients were less than 0.5, indicating weak correlations. Three categories emerged from the interviews as positive factors related to job continuance: "generous support from the workplace", "beneficial nursing experience in Japan", and "determination to live in Japan". A good working environment, generous support from the supervisor and colleagues, high values of nursing in Japan, and desire to migrate to Japan were the factors that had a positive effect on migrant nurses' job continuance in Japan. Understanding the characteristics of migrant nurses and providing generous support will enable them to continue working in Japan. This study was not registered.

Nursing shortage in the Philippines: Dissecting an entanglement of issues

@#The banning of new nursing schools in the Philippines was imposed in 2010 to mitigate the failing compliance of schools with various competency standards set forth by the Professional Regulation Commission (PRC), in addition to the burden of students in paying their affiliations with hospitals. In the midst of the shortage of nurses in the country that was magnified by the COVID-19 pandemic, the Commission on Higher Education (CHED) decided to lift the moratorium. This paper draws on the narratives of nursing leaders and professionals on the phenomenon of nursing shortage and the issues that can arise with the reopening of nursing schools. The verbatims highlight the historical and contemporary entanglement of various issues that contributed to the problem of nursing shortage. In addressing these issues, this paper looks into some of the problems in Philippine nursing that may conform with the broad contemporary problems identified by philosopher Alain Badiou. Viable solutions may be found in the exploration of emerging research methodologies, consideration of systems thinking using technological advances, and incorporating political competency among Filipino nurses.

Guaranteeing dignity and decent work for migrant nurses and health care workers beyond the COVID-19 pandemic.

AIM(S): The main aim of this article is to outline the devastating aftereffects of COVID-19 in terms of ethical recruitment and the respect of dignity of nurses and health care professionals. BACKGROUND: Nations experience the ominous impacts of the COVID-19 pandemic in terms of an exacerbated shortage of nurses worldwide. In this situation, migration flows of nurses are skyrocketing and the respect of the migrant nurses' dignity as human beings should be guaranteed. EVALUATION: Data from reports elaborated by the International Centre on Nurse Migration (ICNM) were examined and outlined the central role of the respect of dignity of every nurse to prevent unethical exploitation of them. KEY ISSUE(S): The respect of human dignity is a complex concept. Human dignity denotes the inner nature of human beings but also their rights at work. CONCLUSION(S): In a post-COVID-19 world with increased flows of nurse migration, it is crucial to guarantee dignity at work for migrant nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should prioritize the ethical recruitment of health care workers and give a prominent role to the WHO 'Code of Practice on the International Recruitment of Health Personnel' which recognizes the ethical bedrocks of employment.

The Paradox of Surplus and Shortage: A Policy Analysis of Nursing Labor Markets in Indonesia.

Purpose: Resolving nursing resources constraints should rely on robust nursing labor market analysis; however, no current study analyzes the dynamics of nursing labor markets in Indonesia. This study aimed to investigate the production, inflow and outflow, maldistribution and inefficiencies, and private sector regulations of the nursing labor market in Indonesia. Patients and Methods: This study used descriptive qualitative and document analysis approaches via focus group discussion (FGD) among various stakeholders in Indonesia. The FGD was conducted once attended by representatives from various sectors, including health, education, manpower, professional associations, and private. Policies on training, inflow and outflow, maldistribution and efficiencies, and private sector regulation were analyzed. Document analysis was used to triangulate the qualitative data. Results: There is a structured policy regarding production, inflow and outflow, distribution, and involvement of the private sector. The number of nursing production shows an excess when entering the labor markets; however, the health-care providers reported a nursing workforce shortage. Policies on outflow encourage the deployment of Indonesian nurses overseas despite various challenges. Private sector involvement cannot be denied, especially in the placement of Indonesian nurses abroad. In addition, there is an absence of an integrated nursing labor market platform which may lead to inaccurate supply and demand. Conclusion: Establishing an integrated and comprehensive platform of the nursing labor market in Indonesia is imperative. Addressing the surplus and shortage of nursing workforce requires reliable data to inform the policy. These analyses highlight the need to understand how the existing environment affects the market for Indonesian nurses nationally and globally.

Reflections on whiteness: Racialised identities in nursing.

In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

Filipino nurses' perspectives of the clinical and language competency requirements for nursing registration in England: A qualitative exploration.

AIM: To understand Filipino nurses' experiences of the 'Test of Competence' process, alongside the additional competency requirements of their sponsor Trust. BACKGROUND: The Philippines has been a significant and sustained source of foreign trained nurses to the UK over the past twenty years. Since October 2014, the Nursing and Midwifery Council has required that all non-UK nurses pass a 'Test of Competence' prior to acquiring registration. However, there is limited evidence exploring how overseas nurses experience this process and the tests which comprise it. DESIGN: A qualitative study informed by pragmatism, using focus group discussions. METHODS: Focus groups were held with pre-departure nurses in Manila, the Philippines and with post-arrival Filipino nurses in the Southeast of England. A total of 21 male and female Filipino nurses participated. Qualitative data were analysed using Reflexive Thematic Analysis. RESULTS: Three themes were generated in relation to the competency process. Firstly, inappropriate preparation, Second, a competency/practice disparity and finally intergenerational and intra-professional support. CONCLUSION: Some aspects of the 'Test of Competence' process were seen as unnecessarily difficult, contradictory, repetitious and/or of little relevance to practice. Lack of support and insufficient information relating to how best prepare for the tests were mitigated to some extent by individual learning and informal support mechanisms. An evaluation of the impact that repeated changes to the Test of Competence process may have on the quality of support offered by NHS Trusts to overseas nurses is recommended.

Palliative care integration: a critical review of nurse migration effect in Jamaica.

BACKGROUND: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. METHODS: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. RESULTS: Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. CONCLUSION: Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.

Experiences of Healthcare Worker Returnees in Their Home Countries: A Scoping Review.

BACKGROUND: International migration of healthcare workers is a global phenomenon driven by growing demand in developed countries and expectations of healthcare workers from developing countries to have improved employment and lives. This migration has been understood to impact both the individuals and countries involved, with positive and negative consequences. However, little is known about returnees' experiences that could be used to address challenges and optimize benefits. The aim of this review was to understand what is known about experiences of migrant health workers after returning to their home countries. METHODS: A scoping review of primary research addressing experiences of migrant health workers upon their return to their homelands. A range of database were searched including Career and Technical Education Database via ProQuest, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education database via ProQuest, Excerpta Medica Care (EMCare) via Ovid, Education Resources Information Center (ERIC), Excerpta Medica database (EMBASE) via Ovid, MEDLINE and Scopus. A systematic process was performed guided by the work of Arksey and O'Malley. Eight databases were searched and 226 articles were retrieved. After screening articles and abstracts, 15 full-texts were assessed for eligibility, and finally seven studies were further analyzed and synthesized. RESULTS: Five qualitative studies, one quantitative study and one mixed methods study met inclusion criteria. Five themes emerged: (1) reasons to return, (2) upskilling and deskilling, (3) impact on human, financial, and social capital, (4) challenges and opportunities in the home country, and (5) facilitation supports. CONCLUSION: Return migration is portrayed as a complex situation experienced by returnees. Structured policy and supports are required to help healthcare worker returnees prepare, and to adjust to life after their return. This study highlights the importance of comprehensive approach in return migration stage. Return migration policy should support healthcare worker returnees in their home country and facilitate utilization of their skills. Multi-stakeholder partnerships are vital to develop platforms for helping and facilitating returnees in the reintegration process at their home countries.

Nursing workforce in the Philippines: Data and issues

@#<p style="text-align: justify;">This study was conducted to: (1) determine the profile of nurses in various work settings based on available databases; (2) describe the current nursing education and programs in the Philippines; and (3) identify national key issues affecting the nursing workforce. The study utilized descriptive, cross-sectional research design; and employed institutional survey, Delphi survey, and round table discussions. Results showed that the Department of Health has the current number of nurses working in hospitals and communities in the different regions, including information on age and sex distribution, employment characteristics, and type of hospital affiliations. The Professional Regulations Commission Board of Nursing has the results of the national licensure examinations. Commission on Higher Education has information on BSN curriculum and schools. Priority key issues identified are: (1) nursing leadership and nursing role clarity, (2) workplace safety and violence, and (3) shortage of nurses, (4) unjust compensation, and (5) skills mix and geographic maldistribution. PNA is thought to have a big role in helping address these key issues. </p>

Globalization of Health Service: Sharing of Best Practices in Perianesthesia Nursing Care, a Case Study of Cross-Border Institutional Collaboration.

Healthcare is a global concern among all nations and nursing is a global profession as evidenced by the flow of healthcare professionals across international boundaries. With English as the language of science and commerce and post-colonial influence in domestic healthcare practice and training, many former Anglo-speaking colonial settlements become parts of an expansive market for health human resources migration. The movement of health personnel mainly flows from low and medium income countries to high income countries to sustain their health systems. The resulting brain drain adversely impacts a source country's health system, leading the World Health Organization to declare global health migration as the biggest health threat of the 21st century. This report illustrates how an overseas health network achieves its goals of developing clinical and management excellence through an international exchange program. The provider institution also fulfills its mission of contributing to a more balanced, equitable and healthier world.

Downward occupational mobility of baccalaureate-prepared, internationally educated nurses to licensed practical nurses.

AIM: This study explored the experience of baccalaureate-prepared, internationally educated nurses who work as licensed practical nurses in Canada. BACKGROUND/INTRODUCTION: Internationally educated nurses experience several barriers to workforce integration on arrival in destination countries. Given these barriers, evidence suggests that internationally educated nurses sometimes experience downward occupational mobility and deskilling in destination countries. Some baccalaureate-prepared, internationally educated nurses work as licensed practical nurses in destination countries, but there is minimal research on this population. METHODS: We used an exploratory transnational feminist qualitative research design. Following ethics approval, a total of 14 baccalaureate-prepared, internationally educated nurses who currently or recently worked as practical nurses in Canada were interviewed for the study. Data were thematically analysed with the aide of NVivo 11 data software. RESULTS: Our results revealed four key themes related to the experiences of this group of nurses: they migrate to Canada with hope for a better personal and professional life; they experience barriers to workforce integration as registered nurses and discover an easier path in the licensed practical nurse registration process; they experience deskilling and ambivalent skill recognition; and they feel dissatisfied as a licensed practical nurse in Canada. DISCUSSION/CONCLUSION: There is a need for policy to support the upward mobility of baccalaureate-prepared, internationally educated nurses who work as practical nurses. IMPLICATIONS FOR NURSING POLICY: Implications for policymakers include the need to address the barriers to becoming registered nurses, including application processing times and lack of adequate access to educational programmes.

Exploring migration intention of nursing students in Nepal: A mixed-methods study.

The objective of this study was to assess the migration intention of students enrolled in pre-registration nursing programs in Nepal, and to explore factors influencing this intention. Using an embedded mixed methods design, 799 nursing students were surveyed, followed by 12 semi-structured face-to-face interviews. The result showed that the majority (92.5%) expressed some intention to migrate, with three quarters of these listed furthering their study abroad as the primary reason. In the multiple regression analysis, those with lower professional identity, and those who reported nursing was not their first choice were likely to express migration intention. Interview data identified low salaries, unemployment, poor working conditions, insufficient postgraduate education, and a lack of professional autonomy in Nepal as reasons for their intention to migrate. Increasing opportunities for nurses to undertake postgraduate education in Nepal, promoting a positive image of nursing, and facilitating a supportive learning environment during undergraduate nursing education could help address the potential loss of nurses from Nepal.

The global Filipino nurse: An integrative review of Filipino nurses' work experiences.

AIM: To understand the work-related experiences of Philippine-trained nurses working globally. BACKGROUND: The Philippines is a major source country of foreign-trained nurses located globally. However, there is paucity of research on professional factors and career related issues affecting foreign-trained nurses' work experiences. METHODS: An integrative review through a comprehensive search of literature was undertaken from November 2015 and was repeated in August 2016. Seven articles satisfied the selection criteria. RESULTS: Filipino nurses experienced differences in the practice of nursing in terms of work process, roles and autonomy. Moreover, they encountered challenges such as work-related discrimination and technical difficulties within the organisation. CONCLUSION: A clear understanding of Filipino nurses' work experiences and the challenges they have encountered suggests identification of important constructs influencing effective translation of nursing practice across cultures and health systems, which then form the basis for support strategies. IMPLICATION FOR NURSING MANAGEMENT: It is critical to recognize foreign-trained nurses' experience of work-related differences and challenges as these foster favorable conditions for the management team to plan and continually evaluate policies around recruitment, retention and support offered to these nurses. Furthermore, findings suggest internationalization of nursing framework and standards integrating a transcultural paradigm among staff members within a work organisation.

Trends and issues in international nurse migration: A Canadian perspective

@#<p style="text-align: justify;">This paper explores the issues surrounding international nurse migration to Canada. Within the context of Karl Marx's idea of a "disposable industrial reserve army [of labor]" (Magdoff & Magdoff, p. 20; Marx, 1887, p. 438), this paper posits that internationally educated nurses (IENs) are viewed as disposable labour who have the potential to assume different labour requirements needed by the receiving nation state (Magdoff & Magdoff, p. 26). This paper provides a brief background of international nurse migration in history and literature. It proceeds to explore the issue of gendered and racialized labour, and a more focused discussion of the current state and pathways of IEN migration to, and the plight of IENs in Canada.</p>

Indian nurses in Italy: a qualitative study of their professional and social integration.

AIMS AND OBJECTIVES: To investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration. BACKGROUND: To study the worldwide, nursing flux is a health priority in the globalised world. The growth in migration trends among nurses, not only from Philippines or India, has proliferated in recent years. The research on nurses' mobility for Southern European countries is underexplored, and in Italy, the out-migration flows of Indian nurses were never analysed. DESIGN: Qualitative methodological approach. METHODS: Semi-structured interviews (n = 20) were completed with Indian clinical nurses working in Italy for more than one year mainly in private organisations. A purposive sampling technique was used for recruitment. The data were then content-analysed using an inductive method. RESULTS: The findings were categorised into four themes: (1) aspects of professional integration and working experience, (2) intra- and interprofessional relationships and perceptions of the IPASVI Regulatory Nursing Board, (3) initial nursing education and continuous professional development and (4) perceptions of social integration. CONCLUSION: The results show that for Indian nurses in Italy emigration is important to gain opportunities to expand economic and social privileges as well as escape from historical assumptions of stigma associated with nursing work, especially for women. However, these conclusions have to be seen in wider socio-cultural complexities that are at the basis of transnational fluxes (Prescott & Nichter ). RELEVANCE TO CLINICAL PRACTICE: The research offers an insight into the complicated reasons for Indian nurses out-migration to Italy. Without comprehending the interwoven textures of the political and social relations that are continually constructed and re-constructed among different nations, it is difficult to understand nurses out-migration and consequently have a better and safer collaborative teamwork in the host countries.