Job Satisfaction, Work Environment and Intention to Leave Among Migrant Nurses in a Multi-Cultural Society

Purpose: Over the past decade, nursing shortage has continued to plague the healthcare industry affecting the delivery of care worldwide. Acknowledging that human resource shortage in the healthcare sector is an issue not constrained by international boundaries, the World Health Organization (WHO) has warned of serious consequences such as the decrease in quality of patient care, the time on care delivery as well as collaboration among with healthcare team members posed serious implications on patient safety (Aiken, Xue, Clark, & Sloane, 2007; Buerhaus, 2008; World Health Organisation, 2006). With several countries worldwide expressing their concerns about the future of their healthcare workforce, particularly about the growing demand for nurses (Campbell, 2014; Tregunno, Peters, Campbell, & Gordon, 2009). One way that many nations used to alleviate this shortfall was via the recruitment of migrant nurses (Aiken et al., 2007; Baumann, Blythe, & Ross, 2010; Beaton & Walsh, 2010) as well as trying to reduce their resignation rate (Ujvarine et al., 2011). The purpose of this study is to explore the job satisfaction level of migrant nurses working in a multicultural society; the relationship between their job satisfaction level, work environment and the intention to leave; the predictors towards intention to leave. 

Methods: A cross-sectional, correlational design using a stratified random sampling technique based on the nationality distribution of migrant nurses registered with the Singapore Nursing Board. A total of 495 migrant nurses working in a tertiary public-funded hospital were recruited for this study achieving 90% power at a 5% level of significance (Elashoff, 2012).  Outcome measures for this study includes: a demographic sheet, job satisfaction questionnaire (JSQ), and Practice Environment Scale –Nursing Work Index – Revised (PES-NWI-R).   All instruments were in English language as the English literacy is a prerequisite for registration as a nurse in Singapore (Singapore Nursing Board, 2013).  

Results: An overall response rate of 82.5% was obtained in this study with the migrant nurses’ demographic characteristics being similar to other parts of the world. A descriptive analysis showed that migrant nurses working in the hospital were moderately satisfied with their job (mean=3.43, SD=0.43) with Indian nurses reporting the highest mean job satisfaction.  A post-hoc test using Bonferroni correction indicated that the job satisfaction level of Indian migrant nurses was higher compared with the Chinese nurses (mean difference 0.269, 95% CI 0.40 to 0.50,   p<.05). Pearson Product-moment Correlation showed that there is a negative correlation between job satisfaction and all the domains of the practice environment scale: nurse participation in hospital affairs. The mean difference was also present between the intention to leave and all domains in JSQ. Finally, according to the logistic regression analysis, the strongest predictor for intention to leave was nurse manager ability (odds ratio= 1.152, p < .05) followed by nursing practice environment (odds ratio= 0.876, p < .05) while controlling for demographic characteristics and other domains in the outcome variables in the model. 

Conclusion: Overall, our results showed that the mean job satisfaction level of migrant nurses was high with the plausible explanation resulting from the initial intention to migrate was to seek out a stable job, which led to an overall  improvement in their quality of life (Baumann et al., 2010; Djukic, Kovner, Budin, & Norman, 2010). However, it was interesting to note that Chinese migrant nurses reported the lowest satisfaction with their job as compared with all other nationalities where this could be due to several plausible explanations. Firstly, Chinese migrants may see themselves as an ancient civilisation with rich historical and cultural background thus increasing their desire to maintain their own cultural perspective towards life and its changes (Yan & Berliner, 2011). Secondly, with a predominantly Chinese population in Singapore (Government of Singapore, 2014), together with the large number of pre-existing Chinese migrant nurses might have given the impression to the newly migrated Chinese nurses that they can retain their  perspective here as Singapore will allow them to do so (Y. Lu, R. Samaratunge, & C.E.J. Härtel, 2011; Taras, Rowney, & Steel, 2012). Thirdly, language issue faced by Chinese migrant nurses in their work environment (Goh & Lopez, 2015), difference in cultural expectation in social life (Blythe, Baumann, Rheaume, & McIntosh, 2008), and preference of retaining their cultural belief system (Y. Lu, R.  Samaratunge, & C.E.J.  Härtel, 2011) will in turn affect their perspectives towards working in a new environment (Ea, Itzhaki, Ehrenfeld, & Fitzpatrick, 2010). Finally, the difficultly in receiving recognition of their nurse education obtained in their homeland (Kingma, 2007) which caused deskilling and downgrading of job roles resulting in a poorer reported job satisfaction level among the Chinese migrant nurses.

Results from our study also showed that a negative correlation was found between job satisfaction and the work environment. Our results concurred with many studies where the key reasons for lower job satisfaction were related to low promotional opportunities, unsure of job fit, and management and bureaucracy (Thomas & Lankau, 2009; Wilson, 2015). Our study also showed that there is a relationship seen between lower job satisfaction and the use of nursing informatics in the clinical area where the plausible explanation can be due to the stressors arising from the need  in learning to use health care informatics in their daily work which was not available in their homeland (Liu, Lee, & Mills, 2015; Ward, 2013).

Finally in our study, two predictors of the intention to leave were identified among the migrant nurses’ population. The first identified predictor was the nurse managers’ ability to lead the ward. According to the Social Exchange Theory, it is important to have healthy interactions, sharing of resources, information and support (Rodwell, Noble, Demir, & Steane, 2009) among employers and employees as it reduce the intention to leave.  A recent study further showed that 39.3% of their respondents indicated that their main reasons for leaving was the lack of support from management and lack of communication with their manager (Wilson, 2015). With high quality working relationship from the presence of a good nurse manager, migrant nurses will experience group cohesion and positive social climate that promotes teamwork, resolve problems in the workplace where it benefits both the individual and the organisation (Duffield, Roche, Blay, & Stasa, 2010; Rodwell et al., 2009) by curtailing the migrant nurses’ intention to leave.

The second predictor towards intention to leave among migrant nurses was the nursing practice environment that they were working in. This knowledge is unique within the field of nursing management as there is a paucity in literatures exploring the job satisfaction among migrant nurses working in different specialisation and its impact towards the intention to leave. The plausible explanation for this phenomenon might be due to the lack of choice in the speciality area where the migrant nurse can chose to work in when they came over. They eventually may not work in their area of specialisation or interest and thus limiting  their opportunities for professional development (Wilson, 2015). The practice environment is important for nurses’ job satisfaction and retention, as a positive work environment favourable to the migrant nurses will significantly increase their job satisfaction and lower intention to leave (Choi & Boyle, 2014; Li et al., 2012; Patrician, Shang, & Lake, 2010). With the shortage in nursing workforce among many OECD (Organisation for Economic Co-operation and Development) countries (Cohen, 2006)  it is important for us to understand the benefits of maximising retention of the current healthcare workforce. Our results confirmed there is a significant relationship between some intrinsic and extrinsic job satisfaction factors and the intention to leave among this population if migrant nurses. International nursing migration will continue to increase as seeking for opportunities to pursue improved pay in the wake of economic globalization. One main contribution of this study was to identify the importance of workplace relationships in retaining migrant nurses. This information can assist healthcare administrators in implementing strategies to improve retention rates of migrant nurses in the workforce. Health-care organisations will also need to encourage open communication and provide a participative management style as part of good human resource practice. When implementing change in health-care organisations, Human resource managers can also use results from this study and take note of the importance to develop front-line nurse managers’ leadership skills required for their positions.