Difficulties of Healthcare System Caused by Nurses'

Migration
Mark Joseph L. Silaroy
Shaira April E. Singpet
Mary Joy A. Murillo
Jsrahm M. Estrada
Jovelyn D. Arcia
Jinky A. Corpin

April G. Alap, PhD Ned.

Bachelor of Science in Nursing
July 2023

Abstract

The researcher conducted a study entitled "Difficulties of Healthcare System

Caused by Nurses' Migration." The migration of some nurses is an inevitable aspect of
globalization. A health system consists of all the organizations, institutions, resources,
and people whose primary purpose is to improve health. The researchers used a
descriptive cross-sectional design of quantitative research to determine the difficulties of
the healthcare system caused by nurses' migration. The study explicitly subjects the
difficulties of the Health Care System caused by Nurses' Migration which will take place
at the Urdaneta District Hospital, with 55 respondents. In collecting the data, the
researchers utilized a prepared questionnaire as their data-gathering tool to obtain
information from their respondents. The result of the study presented a correlation. As
for the values, "Quality of Care, Staffing, Patient Satisfaction & Age, Sex, Marital Status,
Employment Status, and Length of Employment" showed a P value more significant
than the alpha level of 0.05. As a result, the researchers accepted the null hypothesis.
They concluded that there is no meaningful association between the difficulties facing
the healthcare system by nurses' migration and respondent profile factors. However,
only "Monthly Family Income" showed a P value lesser than the alpha level of 0.05.
Thus, the researchers rejected the null hypothesis and concluded that a significant
relationship exists between difficulties in the healthcare system caused by nurses'
migration and respondent's profile variables in terms of monthly family income. The
researchers recommend that it be broadened to include the resistance and challenges
faced by the healthcare system, which influences nurses' relocation, and frequent
training to enhance one's capacity to gain new knowledge and skills in the healthcare
field. A brief technical learning session complements the orientation talks.

Keywords: nurses' migration, difficulties, healthcare system

INTRODUCTION

It is widely known that nurses are one of the largest sectors of the healthcare
workforce. Nurses are often the first health professional that individual sees on their
initial visit to a hospital. This made them central to primary health care. They are also
part of the local community that shapes and deliver effective interventions to meet the
needs of patients, families, and communities. However, most nurses, even newly
graduated nurses, migrate to developed countries to seek better opportunities and

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wages to provide for their family's needs back home. This phenomenon has
dramatically affected the healthcare system of the source countries.

An article by World Health Organization (2017). "Addressing the international

migration of health workers" as the international migration and mobility of health workers
are rapidly increasing and growing in complexity, health systems are challenged by both
the in and out flow of health workers across countries. Staffing in the healthcare system
is a process of assigning competent people to fulfill the roles designated for the
organizational structure through recruitment, selection and development, induction, and
orientation of the new staff of the goals, vision, mission, and philosophy. The notably
escalating international health workers' migration threatens the health emergency
response and the achievement of universal health coverage in several countries. The
Philippines is the largest exporter of nurses globally and has established international
nursing training – accounting for approximately 25 percent of all overseas nurses
worldwide. Roughly 20 percent of all registered nurses are Filipino in the United States,
specifically California. Approximately 85 percent of employed Filipino nurses work in
one of more than 50 countries worldwide. The Philippines exports more nurses than any
other country; many factors can significantly affect why most healthcare providers
migrate across countries. One factor is the push and pull factor. The push factor is the
factor that pushes an individual to move away from their home. In comparison, the pull
factor is the factor that makes an individual want to move to a new home.

In the article of Edward (2021), Palliative care is a team-based holistic approach

that aims to enhance the quality of life and lessen suffering in those with life-threatening
illnesses. Quality of care is how health services for individuals and populations increase
the likelihood of desired health outcomes. It is based on evidence-based professional
knowledge and is critical for universal health coverage. As countries commit to
achieving health for all, carefully considering the quality of care and health services is
imperative. It is widely accepted that palliative care should be included at the moment of
diagnosis or early during a severe illness. The World Health Organization has urged
governments to include primary palliative care in the continuum of care as part of
universal health coverage programs. The United Nations has recognized palliative care
to be a human right. In 72% of more prominent hospitals in the United States,
specialized teams offer palliative care. In comparison, only two specialists provide
palliative care in Jamaica at hospital-based clinics in three of the country's 24 public
hospitals.

In addition, the migration of healthcare professionals, particularly nurses, stands

out as a possible impediment. In efforts to integrate palliative care, it is crucial to
comprehend the phenomena of nurse migration and ensure that nurses with the
necessary skills are kept, especially considering the current COVID-19 epidemic. The
migration of health professionals occurs in the context of broader migration trends and
harms the effectiveness of the health systems of developing nations. However, the
statistics on international migration show that young women's migration level needs to
be improved, not only compared to male migration but also to the level of their desire to
migrate. In addition, although women are more likely to leave than their male
counterparts, their participation in economic migration remains relatively limited. Female
migration predominantly affects family reunion and marriage, while males migrate
mainly to secure employment or improve living conditions. For years, the migration
literature considered migration as a male phenomenon. The recognition of women's
migration has highlighted the effect of non-economic factors on the decision to migrate
and the reasons for migration.

According to Xesfingi (2016), it provides information on the provider's

performance in meeting the client's most critical expectations. It is a significant factor in
predicting patients' viewpoint behavioral intention; patient satisfaction is an essential

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indicator of healthcare quality. Patient satisfaction is a measure of the extent to which a
patient is content with the health care they receive from their health care provider, also
one of the most critical factors to determine the success of a health care facility. Patient
satisfaction is linked to significant results, including better compliance, a decline in the
use of medical services, fewer malpractice lawsuits, and better prognosis. Over the past
ten years, there have been an increasing number of surveys that only focus on patient
experience aspects of the care, like waiting times, the quality of basic amenities, and
communication with healthcare providers, all of which help identify concrete priorities for
quality improvement. This is due to the need for a solid conceptual foundation and
consistent measurement tool for consumer satisfaction.

Moreover, all healthcare service providers now place a high premium on

providing better patient care to maximize patient satisfaction. The potential to stand out
in a crowded market is also given to enterprises or public trusts by delivering superior
healthcare services compared to their competitors. Hospitals must provide patients with
excellent healthcare services and meet their wants due to the increased expectations
for standard services and customer needs. In the past, developing nations like Pakistan
have rarely covered healthcare services and related services in service studies. Despite
receiving a great deal of academic attention, the need for healthcare service
improvement has increased, posing difficulties for the service provider (i.e., technical or
non-technical staff) and making it a challenging task for academics, government
policymakers, therapeutic specialists, and hospital administrators to meet the needs of
patients and contribute to their satisfaction.Therefore, quality of care is central to quality
assurance and improvement initiatives in healthcare. Although the importance of quality
in the healthcare industry has long been understood, it has recently gained momentum
thanks to the creation of quality improvement initiatives, insurance, programs, and
patient agendas. Although the primary focus in healthcare is quality of care rather than
cost, it can be very challenging for a patient to assess the technical proficiency of the
service provider and the immediate effects of many therapies.

In the article of Sachdeva (2018), patient satisfaction affects clinical outcomes,

patient retention, and patient-centered delivery of quality health care. The study was
done in three emergency department units (medical, surgical, and trauma) on 150
patients using a random sampling method. The study focused on patient satisfaction
with treatment and care in the emergency department, which was further sub-grouped
into satisfaction with the admission process, physical environment, ongoing treatment,
and discharge process. For the admission process, the majority of the subjects reported
their satisfaction with the computerized admission process (51%) and examination done
by a doctor (47%) but also reported not being satisfied with the waiting time for the
review (57%) and delay in the start of treatment (53%) A similar findings were
suggested in a study where overall satisfaction was more strongly associated with the
perception of the physician wait interval (r= 0.37; p = 0.00001).

In the present study, most subjects reported satisfaction with the availability of
doctors and nurses in the emergency department (49%). This was contrary to the
findings of a previous study in teaching hospitals in India, highlighting the decreased
availability of healthcare staff, especially in the evening and night shifts. Continuing with
ongoing treatment, most subjects reported dissatisfaction with procedures like
maintaining privacy (41%), showing promptness to any emergency, and communicating
with patients by doctors and nurses (51%). These results are in contrast with a study
done in a district hospital in Iran, which reported that 94% of patients liked the nursing
practice of keeping the privacy of patients. The same study reported that 84% of
patients had negative experiences as they observed that nurses were not attentive to
their needs, particularly at night. In the present study, 47% of the subjects wanted more
from the clinical care by nurses. At the same time, another study on patient satisfaction
with nursing care at a national hospital in Sri Lanka reported that 81.8% of subjects

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were satisfied with interpersonal care and 89.7% with the efficiency and competency of
nursing staff.

However, another study in contrast on patient satisfaction regarding nursing care

revealed that 50% of the patients reported insufficient time spent by nursing staff, ten
which is very near to results obtained in the present research, in which 52% of subjects
stated that the nursing staff had no time to listen to their needs. This can be attributed to
the high workload and frequent turnover of patients in the emergency unit. The result of
this study showed that the majority of the subjects (45%) were uncertain regarding the
discharge/transfer process. The findings align with another study, where 43.6% of
patients reported that nurses needed to give more instructions on where to come for
follow-up and what to expect at home for the patients discharged from emergency.
Satisfaction was found more in patients admitted to the trauma unit (77%) than in
medical and surgical emergencies (24%). The increase in hospital stays for >24hrs
improved satisfaction among subjects which could be attributed to adjusting in hospital
setup and the start of patient treatment.

LITERATURE REVIEW
Two theoretical mechanisms are used to support our study on migration.
According to Smith (2017), poverty is the major push factor in migration. A push factor is
something negative about a person's local area that makes them want to leave (Everett
Lee, 2019). Nurses are being forced to migrate due to the "low pay, high risk"
environment in the Philippines. Lee defined a pull factor as one that draws someone
into a specific area. The main reason why nurses go abroad is that better career
opportunities are waiting abroad.

Everett Lee's Push-Pull Theory describes two factors that influence why people
migrate. Someone's existing neighborhood is a push factor, and the place they want to
go is a pull element since individuals are attracted there. For instance, many jobs are
vital, while high unemployment is frequently a push factor.

The same with Ernst George Ravenstein's Laws of Migration-2019. Under the
laws of migration, this theory posits three categories of migration. There must be a
"reason" for migrating, which is the first category. For instance, a nurse wishes to go to
the United Kingdom since there are better employment possibilities. The second
category is "distance," or how far the person is prepared to migrate. As an example,
Person A wishes to migrate only to Asian countries, whereas Person B wishes to
migrate to the Middle East. The final category is "migrant characteristics," including
gender, ethnicity, income, and educational background. For instance, moving to a new
location is always more challenging for females. On the other hand, some people find it
difficult to immigrate to specific areas where racism is prevalent.

In E.G Ravenstein's Laws of Migration-2018, Ravenstein discusses eleven laws,

nine still relevant today, and why they constitute the foundations of migration studies.
The first law is that most migrants go only short distances. The second law states that
migration occurs in steps, with workers moving from one location to another until they
settle somewhere. The third law proclaims that long-distance migrants typically choose
to travel to one of the major commercial or industrial areas. The fourth law declares that
every migratory current generates a counter-current to balance it. According to the fifth
law of migration, people from urban areas travel less than those from rural areas. The
sixth law says that females migrate more inside countries, but males travel more
globally. The seventh law affirms that families rarely migrate and that most migrants are
individuals. The 8th law states urban areas grow more by migration than by natural
increase. The ninth law claims that migration rises as transportation and economic

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opportunities advance. The tenth law says most migration occurs from rural to urban
areas. The last law is that individuals migrate mainly because of economic reasons.

The significance of these two theories is essential because migration is so

important in human life. It is critical to understand where and why people will migrate. It
could disrupt their migration patterns to keep them away from new settlements. These
studies not only promote economic growth and prosperity but also support the reduction
of poverty.

The study's conceptual framework consists of an independent variable: the

respondents' profile in terms of age, marital status, employment, monthly family income,
and working experience. At the same time, the dependent variables are the following:
(1) difficulties in the Health Care System caused by Nurses' Migration in terms of quality
of care, staffing, and patient satisfaction; (2) a significant relationship between the
difficulties in the Health Care System caused by Nurses Migration across their profile
variable. In this study, the profile of the respondents is considered an independent
variable since these are the factors that cause an impact on the dependent variables.
However, the dependent variables are affected by the independent variable
resulting in the challenges experienced by the healthcare system. Independent variable
1 is about the effects or changes to the quality of care, staffing, and patient satisfaction
based on the independent variable. Independent variable 2 is the healthcare system's
challenges due to nurses' migration. While dependent variable 3 is about the common
difficulties experienced by the health care system due to migration related to the
respondent's profile variables.

This study will examine the difficulties in the healthcare system caused by
nurses' migration along with its contributory factors, such as professional opportunities,
income, and professional skills to the healthcare system.

METHODOLOGY
This chapter presents the procedures and techniques the researcher used to
conduct the study. It contains the research design and strategy, the population and
locale of the study, the data gathering tools, the data gathering procedure, and the data
treatment.

Research Design and Strategy

The researchers used a descriptive cross-sectional design of quantitative
research to determine the difficulties of the Health Care System caused by Nurse's
Migration. The researchers would choose this method to gather the needed data for the
study and answer and describe a particular phenomenon; this method's relevance and
accuracy would benefit the study.

Population and Locale of the Study

The study explicitly subjects the difficulties of the Health Care System caused by
Nurses' Migration which would take place at the Urdaneta District Hospital, with 55
respondents. In addition, we will be distributing the questionnaire to the respondents
using a Likert scale.

Data Gathering Tool

In collecting the data, the researchers utilized a questionnaire as their data-
gathering tool to obtain information from their respondents. The participants' responses
are limited and expected to be precise, clearly identifiable, and readily classified
answers. While forming questions for respondents, the researcher is assisted by their
clinical research instructor.

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 Data Gathering Procedure
In gathering the needed data for the study, the preparation of communication
letters has been prioritized the Letter to the Dean, the Letter to the chief of Hospital, the
Letter to the chief nurse, and the Letter to the Respondents, followed by the
questionnaire's preparation. The researcher gave the questionnaire to the staff of
Urdaneta District Hospital after receiving permission to carry out the study.

They were informed that they had the right to confidentiality and declined
participation. The research did not involve any possible dangers. Data gathered should
be presented to the statistician for data analysis. The final output shall show in the
College of Health Sciences, Urdaneta City University, San Vicente West, Urdaneta City,
Pangasinan.

Treatment of Data
All the questions or statements in part I would be quantified; the statistical
analysis utilized in the study is the following:

1. Frequency and Percentage Distribution – It was used to determine the Frequency

and percentage distribution in the demographic profile of respondents, which contained
the Age, Sex, Marital Status, Employment Status, Monthly Family Income, and Length
of Employment.
Formula: 𝑓
𝑃= 𝑥 100
𝑛
Where:
P = Percentage (in %)
f = Frequency of each group of respondents in the sample size
n = Total sample of respondents

2. Weighted Mean - Weighted Mean was used to show the average responses of the
respondents to the difficulties of the Health Care System caused by Nurses’ Migration.
Formula:WM=Σ ¿ ¿
Where:
WM = Weighted ean
f x 1 , f x2 , … , f x k = Weight if responses in each of the questions being considered
N = Total number of observations

For part II, all the questions or statements would be quantified or measured
through a five (5) point Likert scale ranging from Not Encounter (1), Slightly Encounter
(2), Moderately Encounter (3), Encounter (4), Highly Encounter (5).

3. Chi-Square – this test is primarily used to examine whether two categorical are
independent in influencing the test statistics
Value Range Verbal Interpretation
5 4.50 – 5.00 Highly Encounter
4 3.50 – 4.49 Encounter
3 2.50 – 3.49 Moderately Encounter
2 1.50 – 2.49 Slightly Encounter
1 1.00 -1.49 Not Encounter

2
2 (O i−E i)
Formula: x = ∑
Ei
Where:
x 2 = chi-squared
O i = observe value

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 Ei = expected value

For part III, all the questions or statements would be quantified or measured
through a five (5) point Likert scale ranging from Not Encounter (1), Slightly Encounter
(2), Moderately Encounter (3), Encounter (4), Highly Encounter (5).
Value Range Verbal Interpretation
5 4.50 – 5.00 Highly Encounter
4 3.50 – 4.49 Encounter
3 2.50 – 3.49 Moderately Encounter
2 1.50 – 2.49 Slightly Encounter
1 1.00 -1.49 Not Encounter

RESULTS AND DISCUSSIONS

In this chapter, the content presents and discusses the results generated based
on the data gathered to answer the specific problems, which are to show the
Demographic Profile of the respondents and the difficulties of the health care system
caused by nurses’ migration. Finally, the relationship between the two (2) stated
variables.

1. Demographic Profile of the Respondents

Table 1 presents the respondent's Frequency and Percentage According to the
Demographic Profile of the respondents. As seen below, 55 respondents (29%) are 24
years old and below. On the other hand, (56%) aged 25-39 years old, and (15%) aged
40-49 years old, and lastly (0%) aged in Middle Adulthood and Late Adulthood were
involved in this study; there are 21 male respondents; on the other hand, there are 38
female respondents. More than half of the sampling population are Female
respondents. And then they are (55%) Single, (42%) Married, (4%) Separated, and
(0%) Widowed. For Employment Status, there are (16%) Permanent, (40%) Casual,
and (44%) Contractual. In Family Income, there are (11%) less than Php 9,520, (29%)
Php 9,520 – Php19, 040, (35%) Php19, 040 – Php 38, 080, (25%) Php 38, 080 – Php
66, 640, and the rest of choices has a percentage of (0%). For Length of Employment,
there are (33%) less than 1 year, (35%) 1-3 years, (13%) 3-6 years, and (20%) 7 years
and above. Hence, most of the respondents are young adult, female, single, work as
contractual, had a monthly family income of Php 19, 040 – Php 38, 080 and at 1-3 years
employed (beginners).

According to Camlin, Snow and Hosegood (2014), It was noted that nurses who
usually migrate were young, between the ages of 20 to 30 years, female and middle
class, and usually concern for the financial security. It has been said that migration has become
increasingly feminized because there are more women than men in the diaspora. This
guideline applies to nurse mobility as well. 90% of nurses in the world are female. In the
Philippines, women make up 74.1% of the nursing staff while men make up 25.9%.
Women can actively participate in migration, especially among healthcare professionals.
Most nurses in the globe are female. However, migrants who are women are more
susceptible to migration's "dark side." Given how strongly gendered migration is, it is
necessary to take a gender-responsive approach to better understand the mobility of
female nurses.

Moreover, Filipino labor migration was originally intended to serve as a

temporary measure to ease the tight domestic labor market. It was primarily intended to
stabilize the country’s balance of payments position and serve as an alternative
employment strategy for Filipinos. However, observations show that there has been a
growing dependence upon labor migration or international service provision to address
the problems of the domestic labor market over the years. Migrant health workers often

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feel constrained in making complaints about their employment conditions because of
their sense of vulnerability. They fear that employers will retaliate by dismissing them.
Without a job they will not be able to pursue their claim and will have forfeited their right
to remain in the country. The vulnerability of migrant health workers to exploitation is
reflected also in the degree to which internationally recruited nurses, report working
undesirable shifts with financial obligations and their precarious employment status
forcing them to comply.

2. Respondents’ difficulties in the healthcare system cause by nurses’ migration.

It was succeeding Table 2-5 presents the difficulties encountered in the

healthcare system caused by nurses' migration along with the quality of care. Table 2
revealed the average weighted Mean of 3.47, presenting the intermediate answers of
respondents regarding the difficulties of the healthcare system caused by nurses'
migration in terms of quality of care. It shows that the health care system encountered a
moderate level of it.

Difficulties in the health care system that caused nurses’ migration along quality
of care

The indicator "inability to instruct properly the health teaching before discharge"
has a weighted mean of 3.95, which implies that most respondents are encountered.
Over the past ten years, there have been an increasing number of surveys that only
focus on patient experience aspects of the care, like waiting times, the quality of basic
amenities, and communication with healthcare providers, all of which help identify
concrete priorities for quality improvement. This is due to the need for a solid conceptual
foundation and consistent measurement tool for consumer satisfaction (Xesfingi, 2016).

The indicator "incapable of improvement of knowledge and skills in providing

care" has a weighted mean of 3.05, which indicates that respondents are moderately
encountered about it. It has a significant role in forecasting patients' behavioral
intentions and viewpoints. It is a gauge of how satisfied a patient is with the medical
care they receive from their provider, and it is also one of the essential elements in
determining the success of a medical facility. Significant outcomes were associated with
it, such as improved compliance, decreased demand for medical services, fewer
malpractice claims, and better prognosis. As a result, efforts to ensure and improve the
quality of care in healthcare are centered on care quality. The emergence of quality
improvement efforts, insurance, programs, and patient agendas has recently given its
pace, even though the significance of quality in healthcare has long been acknowledged
(Xesfingi, 2016).

Difficulties in the health care system that caused nurses’ migration along staffing.

The following table presents the difficulties in the healthcare system that caused
nurses' migration along with staffing.

The average weighted Mean is 4.12, meaning most respondents are

encountered. Staffing in the healthcare system is a process of assigning competent
people to fulfill the roles designated for the organizational structure through recruitment,
selection and development, induction, and orientation of the new staff of the goals,
vision, mission, and philosophy. The notably escalating international health workers'
migration threatens the health emergency response and the achievement of universal
health coverage in several countries. Approximately 20 percent of all registered nurses
are Filipino in the United States, specifically California. Roughly 85 percent of employed
Filipino nurses work in one of more than 50 countries worldwide. The Philippines

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exports more nurses than any other country; many factors can significantly affect why
most healthcare providers migrate across countries (World Health Organization, 2017).

The indicator "staffing inadequacy" has a weighted mean of 4.40, implying that
most respondents are encountered about it. Since there is not enough employment in
the Philippines for nurses, many leave the country for more favorable working
conditions abroad. The nation has also grown dependent on labor migration to
strengthen the country's competitive domestic labor market. According to the general
agreement, remittances benefit the nation and raise the standard of living for individual
migrants and their families (Lorenzo, 2017).

The indicators "insufficient professional skills training and development" have a

weighted mean of 3.67, indicating that most respondents are encountered. The nation
has also grown dependent on labor migration to strengthen the country's competitive
domestic labor market. According to the general agreement, remittances benefit the
nation and raise the standard of living for individual migrants and their families. The
Philippine healthcare system, however, has been badly harmed by a scarcity of highly
skilled nurses brought on by inadequate professional skills training and the widespread
retraining of doctors to become nurses abroad, resulting in several hospital closures.
The World Health Organization has urged governments to include primary palliative
care in the continuum of care as part of universal health coverage programs. The United
Nations has recognized palliative care to be a human right. In 72% of more prominent
hospitals in the United States, specialized teams offer palliative care. In comparison,
only two specialists provide palliative care in Jamaica at hospital-based clinics in three
of the country's 24 public hospitals (Lorenzo, 2017).

Difficulties in the health care system that caused nurses’ migration along patient
satisfaction

The following table presents the difficulties in the healthcare system that caused
nurses' migration along with staffing.

The average weighted Mean is 3.49, which implies that most respondents are
encountered. It presents the difficulties in the healthcare system related to patient
satisfaction. Patient satisfaction affects clinical outcomes, patient retention, and patient-
centered delivery of quality health care (Sachdeva, 2018).

The indicator "insufficient time rendering patient needs and concerns" has a weighted
mean of 3.82, indicating that most respondents are encountered. Another study in contrast on
patient satisfaction regarding nursing care revealed that 50% of the patients reported insufficient
time spent by nursing staff, ten which is very near to results obtained in the present research, in
which 52% of subjects stated that the nursing staff had no time to listen to their needs. This can
be attributed to the high workload and frequent turnover of patients in the emergency unit
(Sachdeva, 2018).

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 The indicator "incompetent and inadequate healthcare services are provided" as a
weighted mean of 3.11, implying that most respondents are moderately encountered. It presents
a moderate level of difficulties related to patient satisfaction in the healthcare system. This was
in contrast to a study conducted in teaching hospitals in India that found fewer healthcare
professionals were available, particularly during the evening and night shifts. Regarding
continuous care, most subjects expressed unhappiness with practices such as protecting
patient privacy (41%), responding quickly to emergencies (51%), and interacting with patients
by doctors and nurses. These findings contrast with research conducted in an Iranian district
hospital, which found that 94% of patients approved the nurses' practice of maintaining patient
privacy. According to the same study, 84% of patients had unfavorable experiences because
they saw nurses not paying attention to their needs, especially at night. The results are
consistent with another study, where 43.6% of patients stated that nurses needed to provide
more instructions on where to come for follow-up and what to anticipate at home for patients
discharged from emergency (Xesfingi, 2017).

3. The significant relationship between the difficulties of the healthcare

system caused by nurses’ migration to their Profile Variable

Table 5 reveals the relationship between the dependent variable (profile of the
respondents) and independent variable (difficulties of nurses' migration in the health
care system). As for values mentioned above, the variables "Age, Sex, Marital Status,
Employment Status, and Length of Employment" showed a P value more significant
than the alpha level of 0.05. As a result, the researchers accepted the null hypothesis
and concluded that there is no meaningful association between the difficulties facing the
healthcare system by nurses' migration and respondent profile factors in terms of age,
sex, marital status, employment status, and length of employment. However, only
"Monthly Family Income" showed a P value lesser than the alpha level of 0.05. Thus,
the researcher rejected the null hypothesis and concluded that a significant relationship
exists between difficulties in the healthcare system caused by nurses' migration and
respondent's profile variables in terms of monthly family income.

According to Li et al. (2014), improved financial status is the most prevalent and
significant benefit migration has on nurses and their families. The vast majority of
migratory nurses probably make their decisions based on financial factors. In developed
and underdeveloped countries alike, nurses are generally underpaid. Although the
compensation for nurses is not favorable in industrialized nations, it is still substantial for
nurses from developed countries. On average, nurses from developing countries make
ten to twenty times more money than they would back home. By increasing their
income, nurses can better support their families and live back in their countries.

CONCLUSIONS AND RECOMMENDATIONS

The Conclusions and Recommendations section presents an interpretation of the
results of the study findings. This chapter will also conclude based on the analysis of the
result and then provide recommendations based on the analysis.

Conclusions
As presented in the findings, respondents are equally distributed among nurses
of Urdaneta District Hospital. The demographic profile shows that most respondents are
25 – 39 years old and female, meaning that most are young adults and are dominated
by female nurses. Of a total of 55 respondents, the majority of them are single. In
addition, most of the respondents are contractual employees who receive 19,040 –
38,080 pesos for monthly income and are in service for 1-3 years.

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 For difficulties in the healthcare system, due to nurses' migration, respondents
encounter difficulties in the quality of care in the healthcare system with a weighted
mean of 3.47 and verbal interpretation of moderately encountered. Furthermore, nurses’
migration has also significantly affected the patient's satisfaction and staffing of the
healthcare system; they both garnered a verbal interpretation of encountered.

According to the results and findings, difficulties in the healthcare system caused
by nurses' migration and the respondents' profile variable have no significant
relationship regarding their age, sex, marital status, employment status, and length of
employment. However, results and findings revealed a significant relationship between
difficulties in the healthcare system caused by nurses' migration and respondents'
profile variables regarding monthly family income.

Recommendations
The researchers recommend that the examination be broadened to look into the
reluctance and challenges of the healthcare system that lead to nurses' migration.
Regular training is recommended by the researchers in order to boost one's
ability to advance one's knowledge and abilities in healthcare delivery. It would be
possible to add a brief technical learning course to orientation lectures.
The researchers advise policymakers, the World Health Organizations, the
Department of Health, and other authorities to collaborate in order to address and
enhance the benefits, and opportunities for nurses in the Philippines, which can assist in
resolving issues with the healthcare system brought on by migration.
The researchers recommend this to future student nurses, to have a better
understanding of the situation and current trends of the nursing profession in the
Philippines, that despite the issues regarding the quality of care, staffing, and patient
satisfaction will improve, in that way, nursing students will realize that it is not just about
the monetary compensation but instead it is more on the heart to serve and the passion
to deliver safe and quality nursing care to all the people who are in need.

ACKNOWLEDGMENT
This study would not have been feasible without the direction and assistance of a
member of people who contributed and extended their valued aid in the preparation and
completion of this study in various ways. The researchers want to express their heartfelt
gratitude to:

To Mr. Roniel D. Aquino and Mr. Rudolf M. Tan, their respective panel
members, and to Ms. Stephanie B. Ladero, the chairman, the researcher express their
heartfelt gratitude for the adjuration and insightful comments for the betterment of this
study and recommendations for improving this research.

To Mr. Ricardo O. Estabillo Jr, their critic reader, who is open to new ideas and
who seeks out opposing viewpoints to those they previously held on a subject and
willingness to re-evaluate our research.

Dr. April G. Alap, their research adviser, they are always grateful for her
patience and for spending his valuable time evaluating our manuscripts and sharing her
knowledge and constructive criticism for the completion of this study.

Dr. Alyssa Ashley R. Diego, the Program Head of the College of Health and
Science, for her unending updates and guidance during the research proposal process.

Bachelor of Science in Nursing | 11

 Dr. Christopher R. Bañez, the Dean of the College of Health and Science, for
his steadfast assistance and direction throughout the study proposal writing process.

Above all, to our Almighty GOD, for giving His divine guidance while
accomplishing this study, for answering the researcher's prayers, and for giving them
the strength to go on despite all the struggles and threats of the pandemic.

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