Journal of Nursing Management, 2016, 24, 893–901

Job satisfaction, work environment and intention to leave among

migrant nurses working in a publicly funded tertiary hospital
1,2 1,2
YONG-SHIAN GOH PhD, MN, BHSN and VIOLETA LOPEZ PhD, MNA, BSN

1
Senior Lecturer, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of
Singapore and 2Professor, Alice Lee Centre for Nursing Studies, National University Health System, Singapore

Correspondence (2016) Journal of Nursing Management 24, 893–901.

GOH Y.-S. & LOPEZ V.
Yong-Shian Goh Job satisfaction, work environment and intention to leave among migrant
Alice Lee Centre for Nursing nurses working in a publicly funded tertiary hospital
Studies
National University of Singapore, Aim(s) This study sought to explore the job satisfaction level of migrant nurses
Singapore working in a multicultural society and, more specifically, the relationship between
Clinical Research Centre (MD 11) their job satisfaction levels, work environment, their intentions to leave and the
10 Medical Drive predictors of their intentions to leave.
Singapore 117597
Background Nursing shortages have led to the increasing trend of employing
E-mail: shawn_goh@nuhs.edu.sg
migrant nurses, which necessitated studies examining nurses’ migration.
Evaluation A cross-sectional, correlational design using a stratified random
sample was conducted on 495 migrant nurses working in a tertiary public-funded
hospital in Singapore.
Results The results showed that migrant nurses were satisfied with their jobs;
with job satisfaction negatively correlated with work environment. Interestingly,
pre-existing groups of Chinese migrant nurses did not help newly arrived Chinese
migrant nurses to assimilate better. Predictors of migrant nurses’ intentions to
leave included having supportive nurse managers and nursing practice
environment.
Conclusions The presence of a supportive work environment is essential to retain
migrant nurses.
Implications for nursing management Health administrators need to empower
nursing managers with skills to implement career development plans as part of
hospitals’ retention strategies for migrant nurses. Information should also be provided
during recruitment campaigns to enable migrant nurses to make informed choices.
Keywords: intention to leave, job satisfaction, work environment, migrant nurses,
Singapore

Accepted for publication: 4 April 2016

2007, Beaton & Walsh 2010) and reducing the overall

Background
Over the past decade, a worldwide nursing shortage
has continued to plague the health-care industry. Sev-
eral countries, including European countries, have
expressed concern about the future of their health-care
workforce, particularly given the growing demand for
nurses (Tregunno et al. 2009, Campbell 2014). Strate-
gies such as recruitment of migrant nurses, (Aiken
turnover rate of nurses (Ujvarine et al. 2011) have
been implemented to alleviate this shortfall. With an
increasing trend for global migration and international
recruitment campaigns, this have led to many studies
being conducted on the issues related to nurses’ migra-
tion (Brown 2004, Omeri 2006).
If the nursing shortage continues to be unad-
dressed, it has been predicted that by 2020, the

DOI: 10.1111/jonm.12395
ª 2016 John Wiley & Sons Ltd 893
Y. -S. Goh and V. Lopez
United States (US) will require the staggering number
of one million nurses (Juraschek et al. 2012). Despite
aggressive recruitment campaigns directed at migrant
nurses that seek to address this chronic shortage, the
problem has not abated (Aiken 2007). In some coun-
tries, the number of migrant nurses comprises up to
20% of the total nursing population and, in 2015,
many hospitals indicated an intention to increase the
employment of migrant nurses 3.2 fold (Campbell
2014). Despite a large number of migrant nurses
being employed in various health-care systems, nurs-
ing shortages persist because of high turnover rates
within the profession (Buerhaus 2008, Donelan et al.
2008).
Under the push–pull theory of migration, individuals
migrate seeking better social environments, economic
opportunities (Bach 2004, Kingma 2007, 2008),
higher wages and better living conditions (Interna-
tional Council of Nursing 2007, Djukic et al. 2010).
However, many migrant nurses face work-related
stressors (Kingma 2008) that create challenging rela-
tionships with their colleagues (Ea et al. 2010, Liou
& Cheng 2011, Newton et al. 2012). Many studies
have shown that there is a link between job satisfac-
tion and employees’ intentions to leave (Hegney et al.
2006, Hayne et al. 2009). Thus, it is important to
conduct studies that explore the factors related to job
satisfaction among migrant nurses (Cohen et al.
2009).
Job satisfaction is based on the two-factor theory
of Herzberg (1987) that includes both intrinsic fac-
tors (i.e. motivators) and extrinsic factors (i.e. de-
motivators). Intrinsic factors include achievement,
recognition, assuming more responsibilities and
opportunities for career advancement. Conversely,
extrinsic factors include supervision, interpersonal
relationships, physical working conditions, salary and
perceived job security. Some studies have shown that
teamwork, adequate staffing and autonomy in deci-
sion making strongly affect job satisfaction (Ran-
dolph 2005, Hegney et al. 2006, Rodwell et al.
2009). To reduce turnover rates among migrant
nurses, it is important that health-care administrators
explore why nurses leave their positions and develop
effective strategies to prevent further attrition (Arslan
Yurumezoglu & Kocaman 2015). This study sought
to conceptualise the phenomenon of job satisfaction
among migrant nurses working in the Asian region.
To date, very few studies have been conducted
exploring job satisfaction and the intention of
migrant nurses to leave. This research was particu-
larly important, as the majority of migrating nurses
894
originate from countries with homogenous popula-
tions and, upon migrating to Singapore, must
face the challenges of working in a multicultural
environment.
Methods
Aim and objective
The research objectives of this study were to: (i)
explore the levels of job satisfaction of migrant nurses
working in a multicultural environment; (ii) examine
the relationship between job satisfaction levels, prac-
tice environments and nurses’ intentions to leave; and
(iii) identify the predictors of migrant nurses’ inten-
tions to leave.
Study design
A cross-sectional study was conducted between June
and December 2012 using a stratified random
sample of migrant nurses that were selected based
on the nationality distribution of nurses registered
with the Singapore Nursing Board (Singapore Nurs-
ing Board 2012). The inclusion criteria included
non-Singaporean nurses employed for at least one
year at the site of study. The sample size was calcu-
lated based on a power analysis for the regression
model. A total of 429 nurses was required to
achieve 90% power at a 5% level of significance
(nQuery Advisor, 2001). Based on an anticipated
non-response rate of 30%, the total number of par-
ticipants required was 600.
Outcome measures
The research instrument comprised three parts: a
demographic sheet, the job satisfaction questionnaire
(JSQ) and the practice environment scale–nursing
work index–revised (PES-NWI-R). All instruments
were in English, as English literacy is a prerequisite
for registration as a nurse in Singapore (Singapore
Nursing Board 2012).
Demographic sheet
The demographic sheet collected information related
to participants’ age, gender, citizenship, religion, mari-
tal status, highest nursing qualification, work experi-
ence in other countries, nursing experience, nursing
practice environments, nursing ranks, intentions to
leave and living arrangements.
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 893–901
 Migrant nurses, job satisfaction, work environment, intention to leave

regression was used to examine the predictors of

Job satisfaction questionnaire (JSQ) migrant nurses’ intentions to leave.
A 37-item JSQ was used to explore the following five
domains of job satisfaction: (i) pay and benefits (10
items); (ii) support (seven items); (iii) autonomy and Results
professional opportunities (10 items); (iv) scheduling
Sample characteristics
(six items); and (v) relationships and interaction (four
items). Participants were asked to rate each item on a A total of 495 migrant nurses participated in the study,
scale of 5, ‘very satisfied’ to 1, ‘very dissatisfied’ resulting in an overall response rate of 82.5%. The
(higher scores indicated positive job satisfaction). The
Table 1
internal consistency reliability of the JSQ in this study Characteristics of the study population (n = 495)
was Cronbach’s alpha 0.82.
Characteristics n (%)

Age (years)
Practice environment scale–nursing work index– <30 243 (49.1)
revised (PES-NWI-R) 31–40 201 (40.6)
41–50 43 (8.7)
A 36-item PES-NWI-R was used to explore the follow- >50 8 (1.6)
Marital status
ing six domains of work environment: (i) hospital Single 246 (49.7)
affairs (nine items); (ii) quality of care (10 items); (iii) Married 239 (48.3)
nurse manager’s ability (five items); (iv) staffing and Divorced 2 (0.4)
Separated 6 (1.2)
resource adequacy (four items); (v) good nurse–physi- Widowed 1 (0.2)
cian relationships (three items); and (vi) nursing infor- Others 1 (0.2)
mation technology (five items). Participants were asked Religion
Christianity 229 (46.3)
to rank each item on a scale of 1, ‘strongly agree’ to 4, Other Christian 94 (19.0)
‘strongly disagree’ (a lower score indicated that the par- Buddhist/Taoism 69 (13.9)
Free Thinker (No religion) 57 (11.5)
ticipant strongly agreed that an organisational charac-
Hindu 36 (7.3)
teristic was present) (Lake 2002, Liou & Cheng 2009). Islam 10 (2.0)
The internal consistency reliability of the PES-NWI-R Years of working experience as a nurse
<8 years 280 (56.6)
in this study was Cronbach’s alpha 0.93. >8 years 215 (43.4)
Nursing practice environment
General medical surgical 162 (32.7)
Data collection and analysis Intensive care 151 (30.5)
Perioperative 88 (17.8)
Ethical approval was obtained from the Institutional Emergency 51 (10.3)
Review Board of the participating institution. The par- Oncology 24 (4.8)
Nephro-urology 19 (3.8)
ticipants were provided with an information sheet Gender
explaining the study’s purpose. Participation was vol- Female 485 (98)
Male 10 (2.0)
untary and participants were given 2 weeks to com-
Citizenship
plete the questionnaire. Once completed, participants Filipino 202 (40.8)
were told to place their questionnaires and signed con- Malaysian 113 (22.8)
Chinese PRC 81 (16.4)
sent forms into two separate sealed self-adhesive Indian national 45 (9.1)
envelopes and to deposit these envelopes into boxes at Myanmar national 23 (4.6)
the nurses’ station. The collected data were coded and Others 31 (6.3)
Highest nursing qualification
entered into the IBM SPSS Statistics for Windows, Ver- Certificate 4 (0.8)
sion 23.0 (IBM Corp 2013). Diploma 150 (30.9)
Advanced Diploma 27 (5.5)
Normality on the dependent variable (i.e. job satis-
Bachelor Degree 309 (62.4)
faction level) was determined using a histogram prior Master Degree 4 (0.8)
to data analysis (Chan 2003). Descriptive statistics Doctor of Philosophy 1 (0.2)
Have you worked in any other country other than Singapore before?
were used to describe the sample characteristics. Yes 232 (48.1)
Means and standard deviations (SD) were used to No 257 (51.9)
quantify the variables in the study. A Pearson correla- Any intention to leave?
Yes 82 (16.6)
tion coefficient analysis (r) was used to test the rela- No 413 (83.4)
tionships between the study variables and logistic

ª 2016 John Wiley & Sons Ltd

Journal of Nursing Management, 2016, 24, 893–901 895
Y. -S. Goh and V. Lopez

Table 2
Job satisfaction level of different nationality groups of migrant Job satisfaction level
nurses (n = 495)
The migrant nurses surveyed were moderately satis-
95% CI for Mean
fied with their job (mean = 3.43, SD = 0.43) (see
Mean SD Lower bound Upper bound Table 2). Indian nurses reported the highest levels of
Job satisfaction level 3.43 0.43 3.39 3.46
job satisfaction followed by Malaysian, Filipino,
Malaysian 3.46 0.39 3.39 3.53 Myanmar and Chinese nurses. A post-hoc test using
Filipino 3.47 0.42 3.41 3.53 Bonferroni correction showed that the job satisfac-
Mainland Chinese 3.22* 0.43 3.12 3.32
Indian national 3.49 0.44 3.36 3.62
tion levels of Indian nurses were higher than that of
Myanmar national 3.37 0.42 3.19 3.55 Chinese nurses (mean difference 0.269, 95% CI,
Other 3.52 0.44 3.36 3.68 0.40 to 0.50, P < 0.05). Overall, Indian nurses
F = 5.07; job satisfaction level range 1–5.
reported higher levels of job satisfaction than other
Post-hoc analysis *P < 0.05 significant between groups. nationality groups of migrant nurses surveyed in this
study.

majority of participants were female (i.e. 98%) and

less than 40 years of age (i.e. 89.7%) (see Table 1).
The study population comprised a group of well-edu-
cated individuals, more than half of the participants
(i.e. 62.4%) had a college degree or higher level of
education. Over half of the migrant nurses (i.e. 56.6%)
had less than 8 years’ work experience and almost half
of the nurses (i.e. 48.1%) had previously worked in
countries other than Singapore. Of the study popula-
tion, approximately 16.6% of the migrant nurses
expressed intentions to leave their jobs.
Relationship between job satisfaction and work
environment
A negative correlation was found between job satisfac-
tion and each of the domains of the practice environ-
ment scale: nurse participation in hospital affairs
(r = 0.539, n = 495, P < 0.01), quality of care
(r = 0.472, n = 495, P < 0.01), nurse manager abil-
ity (r = 0.525, n = 495, P < 0.01), staffing adequacy
(r = 0.538, n = 495, P < 0.01), nurse–physician rela-
tionship (r = 0.372, n = 495, P < 0.01) and nursing

Scale 1 2 3 4 5 6 7 Table 3
Pearson product-moment correla-
1 Total job satisfaction 1.00 0.538** 0.472** 0.525** 0.538** 0.372** 0.329** tions between total job satisfaction
2 PES-NWI-R: nurse 1.00 0.698** 0.609** 0.671** 0.518** 0.375** and work environment (n = 495)
participation
3 PES-NWI-R: quality of 1.00 0.526** 0.516** 0.357** 0.377**
care
4 PES-NWI-R: nurse 1.00 0.518** 0.364** 0.340**
manager ability
5 PES-NWI-R: staffing 1.00 0.372** 0.287**
6 PES-NWI-R: nurse 1.00 0.279**
physician
7 PES-NWI-R: 1.00
information technology

n = 495 for all analyses.

**P < 0.01 (2-tailed).

Intention to leave Table 4

t-Test table on intention to leave and
Yes No t Mean difference (95% CI) P value job satisfaction

Pay and benefit 2.98 (.569) 3.24 (.524) 3.97** 0.255 ( 0.381, 0.129) 0.000
Support 3.177 (.505) 3.33 (.501) 2.52** 0.154 ( 0.274, 0.033) 0.013
Autonomy and professional 3.52 (.588) 3.71 (.441) 2.77** 0.190 ( 0.325, 0.054) 0.007
Scheduling 3.21 (.683) 3.46 (.610) 3.34** 0.250 ( 0.397, 0.102) 0.001
Relationship and interaction 3.41 (.490) 3.62 (.497) 3.53** 0.212 ( 0.329, 0.094) 0.000

n = 495 for all analysis.

**P < 0.05.

ª 2016 John Wiley & Sons Ltd

896 Journal of Nursing Management, 2016, 24, 893–901
 Migrant nurses, job satisfaction, work environment, intention to leave

information technology (r = 0.329, n = 495, model. When demographic characteristics and other
P < 0.01) (see Table 3). These results suggest that domains in the outcome variables of the model were
lower job satisfaction levels were associated with controlled, the strongest predictor of nurses’ intention
lower reported perceptions of work environment to leave was the ability of nurse managers (odds
among migrant nurses working in Singapore. ratio = 1.152, P < 0.05) followed by nursing practice
environments (odds ratio = 0.876, P < 0.05).
Mean difference between intention to leave and
job satisfaction Discussion and implications for nursing
management
Table 4 shows the mean difference for migrant nurses
between intention to leave and the domains in JSQ. The This study explored job satisfaction, practice envi-
mean difference was significant in relation to both pay ronments and the intentions of migrant nurses in
and benefits (mean difference = 0.255, 95% CI Singapore to leave their jobs. Overall, the study
0.381 to 0.129, P < 0.05); support (mean differ- found that the job satisfaction level of migrant
ence = 0.154, 95% CI 0.274 to 0.033, P < 0.05); nurses was high. This may be because the availabil-
autonomy and professional (mean difference = 0.190, ity of stable jobs fulfilled migrant nurses’ initial
95% CI 0.325 to 0.054, P < 0.05); scheduling intentions to migrate (Atri et al. 2006, Kingma
(mean difference = 0.250, 95% CI 0.397 to 2008, Djukic et al. 2010). Compared with Filipino,
0.102, P < 0.05); and relationship and interaction Malaysian and Indian migrant nurses, Chinese
(mean difference = 0.212, 95% CI 0.329 to migrant nurses had the lowest levels of job satisfac-
0.094, P < 0.05). The magnitude of the mean differ- tion. There is a large population of Chinese migrants
ence showed a small effect size (eta squared = 0.02). in Singapore (Suryadinata, 2009); however, it should
be noted that this did not translate to higher levels
of job satisfaction among Chinese migrant nurses.
Predictors of intention to leave
This may be because Chinese migrant nurses view
Table 5 shows the predictors of migrant nurses’ inten- themselves as members of an ancient civilisation with
tions to leave. A reduced model was presented con- a rich historical and cultural background and thus
taining the demographic variables (i.e. age, gender, wish to maintain their own cultural perspective (Yan
citizenship, marital status, religion, nursing qualifica- & Berliner 2011). Further, given the large number of
tions, work experience outside Singapore, years of Chinese migrant nurses present in the current work-
nursing experience and nursing practice environ- force, the new Chinese migrant nurses may have the
ments). Only two independent variables made a impression that they can retain their own cultural
unique statistically significant contribution to the perspective in Singapore (Lu et al. 2011, Taras et al.
2012). Another plausible explanation could relate to
the language issues faced by Chinese migrant nurses
Table 5
Logistic regression analysis of intention to leave (n = 495) in their work environment (Goh & Lopez 2016).
Further, differences in their socio-cultural life expec-
95% CI for
odds ratio tations may have affected their perspectives of work-
Odds ing in a new environment (Ea et al. 2010). Finally,
Variable ratio Lower Upper P
these nurses may have experienced difficulties in hav-
Age 0.764 0.489 1.192 0.236 ing their Chinese nursing qualifications recognised in
Gender 3.751 0.746 18.86 0.109
Citizenship 0.834 0.656 1.061 0.140
Singapore and this may have resulted in a deskilling
Marital status 1.071 0.596 1.923 0.819 or downgrading of their roles and, consequently, led
Religion 0.983 0.818 1.180 0.851 to lower levels of job satisfaction (Kingma 2007).
Nursing qualification 1.297 0.922 1.826 0.136
Work experience out of 0.779 0.431 1.408 0.408
In this study, Indian migrant nurses reported the
Singapore highest levels of job satisfaction compared with other
Years of experience 1.133 0.789 1.625 0.499 nationality groups. This could be attributed to the use
Nursing practice environment 0.876 0.791 0.970 0.011**
PES2_quality care 1.095 0.976 1.229 0.123 of English as a teaching medium in India nursing
PES3_nurse manager ability 1.152 1.008 1.316 0.037** schools (Khadria 2007). Many Indian migrant nurses
C3_Autonomy/professionalism 0.561 0.305 1.034 0.064
in Singapore migrated from Kerala (are Malayalam
Constant 0.114
speaking) and have one religious faith (i.e. Christian-
**P < 0.05. ity) (Thomas 2006). Thus, a strong support system

ª 2016 John Wiley & Sons Ltd

Journal of Nursing Management, 2016, 24, 893–901 897
Y. -S. Goh and V. Lopez
may already be in place that provides new Indian
migrant nurses with the necessary social support
(Royal College of Nursing 2003, Kingma 2008).
Another study showed that the majority of Indian
migrant nurses were unhappy and held low societal
attitudes towards nursing in India which prompted
them to consider migration (Thomas 2006) Further, in
countries such as the Philippines and India (where
excess numbers of nurses are being trained) many
nurses migrate so that they can send money home to
support their impoverished homelands (Afram 2012).
Thus, many migrant nurses may hold goals related to
successfully assimilating into their new work
environments.
Compared with Chinese migrant nurses, Filipino
and Malaysian migrant nurses were more satisfied
with their jobs. This may be because Filipino nurses
are more resilient and have a strong commitment to
working in another country as their salaries enable
them to send remittances to their families back home
(Ball 2004). Further, it has become normal for Filipino
nurses to migrate following graduation. Thus, many
Filipino nurses will have prepared themselves to perse-
vere in spite of any obstacles that they may face in
their new environment (Brush & Sochalski 2007,
Enrile & Agbayani 2007). Presently, there is already a
large number of Filipino nurses working in Singapore
and thus Filipino nurses have a large network of social
support upon migrating (Beechinor & Fitzpatrick
2008). Singapore’s geographical proximity with
Malaysia, its similarity in population diversity and
shared cultural heritage could also explain the higher
job satisfaction levels of Malaysian migrant nurses
(Wang 2004, Tan 2014). A phenomenological study
conducted by Koh (2010) showed that while
Malaysian migrants prefer their Malaysian identity,
some like to perceive themselves as Singaporeans
and are willing to adopt Singaporean values and
characteristics.
Many studies have shown that job satisfaction is
directly related to the work environments in which the
jobs are being performed (Emerson et al. 2008, Probst
et al. 2010). This study identified a negative correla-
tion between job satisfaction and work environment.
These results reflected the findings of previous studies
in which the primary reasons for lower levels of job
satisfaction related to low promotional opportunities,
poor job fit, management and bureaucracy (van der
Doef et al. 2012, Siow & Ng 2013, Wilson 2015).
This study also identified a relationship between lower
levels of job satisfaction and the use of nursing infor-
matics in the clinical area. This may have contributed
898
to nurses’ levels of dissatisfaction, as nurses reported
having to learn how to use the new technology while
trying to adapt to a new work environment (Emerson
et al. 2008, Ward 2013, Liu et al. 2015).
Finally, this study identified two predictors of
migrant nurses’ intentions to leave; that is, the ability
of nurse managers to lead a ward and the practice
environments. Under the social exchange theory
(Cropanzano & Mitchell 2005) and the leader–mem-
ber exchange theory (Dulebohn et al. 2012, Mattal
et al. 2015), it is beneficial for both supervisors and
employees to have healthy interactions when sharing
resources and information and providing support, as
such interactions reduce workplace stress and employ-
ees’ intentions to leave (Rodwell et al. 2009, Thomas
& Lankau 2009). Further, according to Herzberg’s
two-factor theory, providing adequate supervision also
helps to prevent job dissatisfaction and thus reduces
employees’ intentions to leave (Maidani 1991, Collins
et al. 2000). A recent study showed that a lack of sup-
port from management and a lack of communication
with managers were the main reasons employees chose
to leave an organisation (Wilson 2015). High quality
working relationships between nurse managers and
migrant nurses could result in better group cohesion
and create positive social climates, resulting in team-
work, resolving problems in the workplace and ulti-
mately benefit both individuals and the organisation
(Rodwell et al. 2009, Duffield et al. 2010).
Nursing practice environments were a predictor of
the intentions of migrant nurses to leave their jobs.
Prior to migrating, migrant nurses may assume that
they will be able to work in a specialty similar to
that in which they had worked previously; however,
when they migrate, these nurses may find that they
cannot choose the specialty areas in which they work
(Allan & Larsen 2003, Smith et al. 2006). Migrant
nurses are usually not given the opportunity to work
in their area of specialisation or interest. This may
contribute to their intention to leave (Wilson 2015).
Many studies have shown that practice environments
are important in relation to job satisfaction and
retention and having a positive work experience is
most favourable for migrant nurses (Laschinger
2008, Patrician et al. 2010, Li et al. 2012, Choi &
Boyle 2014).
Limitations of the study
The use of a cross-sectional questionnaire limited the
ability of this study to establish cause–effect relation-
ships. However, this limitation was reduced by a high
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 893–901

response rate of 82.5% that allowed all the factors
under investigation to be measured (Polit & Beck
2011). Allowing participants a 2-week period to
return their self-report questionnaires may have
reduced participants’ recall bias and minimised the
possibility of obtaining social desirability response
biases (Burns et al. 2008, Polit & Beck 2011). Finally,
generalising the results of this study to all migrant
nurses may be an issue, as the target population were
primarily hospital nurses. Future studies should be
undertaken in different settings to address this issue.
Conclusion
The study found a significant relationship between the
intrinsic and extrinsic factors affecting job satisfaction
and the intention of migrant nurses to leave their jobs.
A supportive work environment is critical to ensure
that migrant nurses are given the opportunity to par-
ticipate in the decision-making processes that affect
their professional development. The results showed
that nurse managers play an important role in migrant
nurses’ acculturation to their new environment and
affect migrant nurses’ levels of job satisfaction and
their intentions to stay.
Implications for policy, education, practice
and research
Health-care institutions should adopt recruitment poli-
cies that provide information on nursing practice envi-
ronments to potential applicants who wish to migrate
to enable them to make more informed choices. This
could be particularly important for migrant nurses
who wish to work in a particular specialty. Health-
care institutions should also adopt a workplace policy
that provides an orientation programme to migrant
nurses and offers support systems (similar to the
‘buddy’ approaches that have been found to be effec-
tive in other countries) (Smith & Ho 2014). Further,
nurse managers need be cognisant of the needs of
migrant nurses and maximise the knowledge and skills
related to their specialties to ensure that migrant
nurses feel needed and valued (Wilkes & Bartley
2007). Continuing education programmes should be
tailored to address the knowledge and skills that
migrant nurses’ need to learn and develop when work-
ing in new environments such as the use of new tech-
nologies and to decrease migrant nurses’ anxieties and
uncertainties. Future qualitative research should be
conducted among migrant nurses to further explore
the problems that migrant nurses face as a new
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 893–901
Migrant nurses, job satisfaction, work environment, intention to leave
migrant and determine their views as to any appropri-
ate strategies that could be implemented to assist and
support migrant nurses settling into their adopted
workplaces.
Acknowledgements
The authors would like to thank Dr Aye Aye Cho and
Ms Alice Lee for data collection and data entry; Dr
Wilson Tam for statistical consultation, Dr Chan
Moon Fai and Professor Chan Wai Chi for their
supervision during the initial phase of this PhD study.
Ethical approval
National Healthcare Group Domain Specific Review
Board (DSRB 2011/02051).
Sources of funding
This study was funded by the Ministry of Health Sin-
gapore, MOHNRC Nursing Research Grant FY01-01
(R-545-000-041-290).
References
Afram G.G. (2012). The remittance market in India: Opport-
unities, challenges, and policy options. Available at: https://
openknowledge.worldbank.org/bitstream/handle/10986/2228/
9780821389720.pdf?sequence=4, accessed 2 March 2016.
Aiken L.H. (2007) US nurse labor market dynamics are key to
global nurse sufficiency. Health Services Research, 42 (3, Pt
2) , 1299–1320.
Allan H. & Larsen J.A. (2003) We need respect: experiences of
international recruits in the UK. European Institute of Health
and Medical Sciences: University of Surrey, 1–147.
Arslan Yurumezoglu H. & Kocaman G. (2016) Predictors of
nurses’ intentions to leave the organisation and the profession
in Turkey. Journal of Nursing Management 24 (2), 235–243.
Atri A., Sharma M. & Cottrell R. (2006) Role of social support,
hardiness, and acculturation as predictors of mental health
among international students of Asian Indian origin. Interna-
tional Quarterly of Community Health Education 27, 59–73.
Bach S. (2004) Migration pattern of physician and nurses: still
the same story. Bulletin of the World Health Organization 82
(8), 624–625.
Ball R. (2004) Divergent development, racialised rights: glob-
alised labour markets and the trade of nurses: the case of the
Philippines. Women Studies International Forum 27 (2), 119–
133.
Beaton M. & Walsh J. (2010) Overseas recruitment: experiences
of nurses immigrating to Newfoundland and Labrador, 1949–
2004. Nursing Inquiry 17 (2), 173–183.
Beechinor L.A.V. & Fitzpatrick J.J. (2008) Demands of immi-
gration among nurses from Canada and the Philippines. Inter-
national Journal of Nursing Practice 14 (2), 178–187.
899
Y. -S. Goh and V. Lopez
Brown R. (2004) The migration of doctors and nurses from
South Pacific Island Nations. Social Science & Medicine 58
(11), 2193–2210.
Brush B.L. & Sochalski J. (2007) International nurse migration:
lessons from the Philippines. Policy, Politics & Nursing Prac-
tice 8 (1), 37–46.
Buerhaus P. (2008) Current and future state of the US nursing
workforce. Journal of the American Medical Association 300
(20), 2422–2424.
Burns K.E., Duffett M., Kho M.E. et al. (2008) A guide for the
design and conduct of self-administered surveys of clinicians.
Canadian Medical Association Journal 179 (3), 245–252.
Campbell D. (2014). NHS nurse shortage forces health service
to recruit overseas. The Guardian. Available at: http://
www.theguardian.com/society/2014/dec/17/nhs-nurse-short-
age-health-service-overseas, accessed 23 February 2016.
Chan Y.H. (2003) Biostatistic 101: data presentation. Singapore
Medical Journal 44 (6), 280–285.
Choi J.S. & Boyle D.K. (2014) Differences in nursing practice
environment among US acute care unit types: a descriptive
study. International Journal of Nursing Studies 51, 1441–
1449.
Cohen J., Stuenkel D. & Nguyen Q. (2009) Providing a healthy
work environment for nurses: the influence on retention. Jour-
nal of Nursing Care Quality 24, 308–315.
Collins K., Jones M., McDonnell A., Read S. & Cameron A.
(2000) Do new roles contribute to job satisfaction and reten-
tion of staff in nursing and professions allied to medicine?
Journal of Nursing Management 8, 3–12.
Cropanzano R. & Mitchell M. (2005) Social exchange theory:
an interdisciplinary review. Journal of Management 31 (6),
874–900.
Djukic M., Kovner C., Budin W.C. & Norman R. (2010) Physi-
cal work environment: testing an expanded model of job sat-
isfaction in a sample of registered nurses. Nursing Research
59 (6), 441–451.
Donelan K., Buerhaus P., DeRochers C., Dittus R. & Dutwin
D. (2008) Public perceptions of nursing careers: the influence
of the media and nursing shortages. Nursing Economics 26
(3), 143–151.
Duffield C.M., Roche M.A., Blay N. & Stasa H. (2010) Nurs-
ing unit managers, staff retention and the work environment.
Journal of Clinical Nursing 20, 23–33.
Dulebohn J.H., Bommer W.H., Liden R.C., Brouer R.L. & Fer-
ries G.R. (2012) A meta-analysis of antecedents and conse-
quences of Leader-Member Exchange integrating the past
with an eye toward the future. Journal of Management 38
(6), 1715–1759.
Ea E.E., Itzhaki M., Ehrenfeld M. & Fitzpatrick J. (2010)
Acculturation among immigrant nurses in Israel and the Uni-
ted States of America. International Nursing Review 57, 443–
448.
Emerson E.E., Griffin M.Q., L’Eplattenier N. & Fitzpatrick J.J.
(2008) Job satisfaction and acculturation among Filipino reg-
istered nurses. Journal of Nursing Scholarship 40 (1), 46–51.
Enrile A. & Agbayani P.T. (2007) Differences in attitudes
towards women among three groups of Filipinos: Filipinos in
the Philippines, Filipino American immigrants, and U.S. Born
Filipino Americans. Journal of Ethnic And Cultural Diversity
in Social Work 16 (1–2), 1–25.
900
Goh Y.S. & Lopez V. (2016) Acculturation, quality of life and
work environment of international nurses in a multi-cultural
society: a cross-sectional, correlational study. Applied Nursing
Research 30, 111–118.
Hayne A.N., Gerhardt C. & Davis J. (2009) Filipino nurses in
the United States: recruitment, retention, occupational stress,
and job satisfaction. Journal of Transcultural Nursing 20 (3),
313–322.
Hegney D., Plank A. & Parker V. (2006) Extrinsic and intrinsic
work values: their impact on job satisfaction in nursing. Jour-
nal of Nursing Management 14, 271–281.
Herzberg F. (1987) One more time: How do you motivate
employees. Harvard Business Review 65, 109–120.
I.B.M. Corp. (2013) IBM SPSS Statistics for Windows. IBM
Corp, Armonk, NY.
International Council of Nursing. (2007). Nurse Retention and
Migration, pp. 1–6. International Council of Nursing Position
Statement, Geneva.
Juraschek S.P., Zhang X.M., Ranganathan V.K. & Lin V.W.
(2012) United States registered nurse workforce report card
and shortage forecast. American Journal of Medical Quality
27 (3), 241–249.
Khadria B. (2007) International nurse recruitment in India.
Health Services Research 42 (3), 1429–1436.
Kingma M. (2007) Nurses on the move: a global overview.
Health Services Research 42 (3), 1281–1298.
Kingma M. (2008) Nurses on the move: diversity and the work
environment. Contemporary Nurse 28, 198–206.
Koh S.E. (2010) Towards a Theory of ‘Skilled Diasporic Citi-
zenship’: Tertiary-Educated Chinese Malaysian in Singapore
as Citizens, Diasporas and Transnational Migrants Negotiat-
ing Citizenship and Migration Decisions. London School of
Economics and Political Science, London.
Lake E. (2002) Development of the practice environment scale
of the nursing work index. Research in Nursing & Health 25
(3), 176–188.
Laschinger H.K.S. (2008) Effect of empowerment on profes-
sional practice environments, work satisfaction, and patient
care quality: further testing the nursing worklife model. Jour-
nal of Nursing Care Quality 23 (4), 322–330.
Li B., Bruyneel L., Sermeus W. et al. (2012) Group-level
impact of work environment dimensions on burnout
experiences among nurses: a multivariate multilevel probit
model. International Journal of Nursing Studies 50 (2),
281–291.
Liou S.R. & Cheng C.Y. (2009) Using the Practice Environment
Scale of the Nursing Work Index on Asian Nurses. Nursing
Research 58 (3), 218–225.
Liou S.R. & Cheng C.Y. (2011) Experiences of a Taiwanese
nurse in the United States. Nursing Forum 46, 102–109.
Liu C.-H., Lee T.-T. & Mills M.E. (2015) The experience of
informatic nurses in Taiwan. Journal of Professional Nursing
31, 158–164.
Lu Y., Samaratunge R. & H€ artel C.E.J. (2011) Acculturation
strategies among professional Chinese immigrants in the Aus-
tralian workplace. Asia Pacific Journal of Human Resources
49, 71–87.
Maidani E. (1991) Comparative study of Herzberg’s two factors
theory of job satisfaction among public and private sector.
Public Perspective Management 20, 49–68.
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 893–901

Mattal F.K., Scott B.A., Koopman J. & Conlon D.E. (2015) Does
seeing ‘eye to eye’ affect work engagement and organizational
citizenship behavior? A role theory perspective on LMX agree-
ment. Academy of Managment Journal 58 (6), 1686–1708.
Newton S., Pillay J. & Higginbottom G. (2012) The migration
and transitioning experiences of internationally educated
nurses: a global perspective. Journal of Nursing Management
20 (4), 534–550.
nQuery Advisor. (2001) Statistical Solutions. nQuery Advisor,
Belfast, North Ireland.
Omeri A. (2006) Workplace practices with mental health impli-
cations impacts on recruitment and retention of overseas
nurses in the context of nursing shortages. Contemporary
Nurse 21, 56–61.
Patrician P.A., Shang J. & Lake E.T. (2010) Organizational
determinants of work outcomes and quality care ratings
among Army Medical Department registered nurses. Research
in Nursing and Health 33, 99–110.
Polit D.F. & Beck C.T. (2011) Nursing Research: Generating
and Assessing Evidence for Nursing Practice. Lippincott Wil-
liams & Wilkins, Philadelphia.
Probst J., Baek J. & Laditkia S. (2010) The relationship
between workplace environment and job satisfaction among
nurse assistants. Journal of the American Medical Directors
Association 11, 246–252.
Randolph S.D. (2005) Predicting the effect of extrinsic and
intrinsic job satisfaction factors on recruitment and retention
of allied health professionals. Journal of Healthcare Manage-
ment 50, 49–60.
Rodwell J., Noble A., Demir D. & Steane P. (2009) The impact
of the work conditions of allied health professionals on satis-
faction, commitment and psychological distress. Healthcare
Management Review 34, 273–283.
Royal College of Nursing. (2003) We Need Respect. Royal Col-
lege of Nursing, London.
Singapore Nursing Board. (2012) Singapore Nursing Board:
Annual Report 2011. Singapore Nursing Board, Singapore.
Siow E. & Ng J. (2013) Internal migration of nurses in the Uni-
ted States: migratory prompts and difference in job satisfac-
tion between migrants and non-migrants. Nursing Economics
31 (3), 128–136.
Smith C.D. & Ho J.O. (2014) How to positively integrate inter-
nationally educated nurses. Nursing Management 45 (6), 30–
36.
Smith P.A., Allan H., Henry L.W., Lawsen J.A. & Mackintosh
M.M. (2006) Valuing and Recognising the Talents of a
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 893–901
Migrant nurses, job satisfaction, work environment, intention to leave
Diverse Workforce: Report From the REOH Study. Depart-
ment of Health, National Health System, London.
Suryadinata L. (2009) Chinese migration in the globalizing
world: A brief comparison between developed and developing
countries. CHC Bulletin Issues: A Publication of Chinese
Heritage Centre (13 & 14), 1–7.
Tan W.Z. (2014) Highlighting bilateral ties, KL food outlet
Agrobazaar opens in S’pore. In Today Online. Mediacorp,
Singapore.
Taras V., Rowney J. & Steel P. (2013) Work-related accultura-
tion: change in individual work-related cultural values follow-
ing immigration. The International Journal of Human
Resource Management 24 (1), 130–151.
Thomas P. (2006) The international migration of Indian nurses.
International Nursing Review 53, 277–283.
Thomas C. & Lankau M. (2009) Preventing burnout: the effects
of LMX and mentoring on socialization, role stress, and
burnout. Human Resource Management 48 (3), 417–432.
Tregunno D., Peters S., Campbell H. & Gordon S. (2009) Inter-
national nurse migration: U-turn for safe workplace transi-
tion. Nursing Inquiry 16 (3), 182–190.
Ujvarine A.S., Zrinyi M., Toth H., Zekanyne I.R., Szogedi I. &
Betlehem J. (2011) Intent to stay in nursing: internal and
external migration in Hungary. Journal of Clinical Nursing
20, 882–891.
van der Doef M., Mbazzi F.B. & Verhoeven C. (2012) Job con-
ditions, job satisfaction, somatic complaints and burnout
among East African nurses. Journal of Clinical Nursing 21,
1763–1775.
Wang G. (2004) Nation-Building: Five Southeast Asian Histo-
ries. Institute of Southeast Asian Studies, Singapore.
Ward R. (2013) The application of technology acceptance and
diffusion of innovation models in healthcare informatics.
Health Policy and Technology 2, 223–228.
Wilkes R.C. & Bartley S.J. (2007) A model for career planning
in healthcare: investing in a career development program will
retain workers for growth. Online Journal for Workforce
Education and Development 2 (3), 1–33.
Wilson N.A. (2015) Factors that affect job satisfaction and
intention to leave of allied health professionals in a
metropolitan hospital. Australian Health Review 39, 290–
294.
Yan K. & Berliner D.C. (2011) Chinese international students
in the United States: demographic trends, motivations, accul-
turation features and adjustment challenges. Asia Pacific Edu-
cational Review 12, 173–184.
901
 本文献由“学霸图书馆-文献云下载”收集自网络，仅供学习交流使用。

学霸图书馆（www.xuebalib.com）是一个“整合众多图书馆数据库资源，

提供一站式文献检索和下载服务”的24 小时在线不限IP 图书馆。

图书馆致力于便利、促进学习与科研，提供最强文献下载服务。

图书馆导航：

图书馆首页 文献云下载 图书馆入口 外文数据库大全 疑难文献辅助工具