BRAIN DRAIN IN NURSING

EFFECT ON HEALTHCARE

COLE, A.O.
(RN, RM, R.OPTH, BNSc., MSC, MBA FWACNM
OUTLINE

1 Brain Drain

2 Epidemiology

3 Causes & Effects

4 Retention Strategies

5 Recommendation & Conclusion

 1

WHAT IS BRAIN DRAIN?

 Brain Drain

The term ‘Brain Drain’ also known as the

“human capital flight” is the large scale
migration of highly educated, skilled and
talented people of less economically
advanced countries to highly rich and
developed countries of the world due to
conflicted issues, political instability and
lack of opportunities in the developing
countries. (UKessays, 2018)
Brain Drain

"Brain-drain‟ is a phenomenon where, relative to the

remaining population, a substantial number of more
educated or skilled individuals migrate to other places.
(Chiamaka&Chimereze, 2020)
Despite the negative effect of brain drain it also has
some positive impact to the migrants and as well their
home country and this is referred to as man capital
gains, a "brain gain", for the sending country in
opportunities for emigration. (Chiamaka&Chimereze,
2020)
 Brain Gain

• Brain Gain is a situation where a country gains or

benefits from its, vibrant, talented, skilled and
educated people who traveled abroad
• Instead of contributing to other nations’ development,
these people invest their skills, talent, education and
resources in their country, thereby growing it’s
economy and improving the standard of living overtime
(Chiamaka&Chimereze, 2020)
• The Nigerian music industry is a good example.
Brain Drain in Africa
 Brain Drain in Africa

• A 2013 United Nations report found that one in

nine Africans with tertiary education (roughly
13%) were living in developed countries in Asia,
Europe and North America suggesting that brain
drain in Africa is worse than Latin America and the
Caribbean (one in 13); Europe (one in 20) and Asia
(1 in 30). (Brooks, 2017).
• Data from the World Economic Forum (WEF) in
2014 also revealed how African nations stack up
against each other
 Brain Drain in Nigeria

• According to a poll measuring the desire to

emigrate in 2008-2010, the Organization for
Economic Co-operation and Development
found that 44% of Nigerians sampled would
permanently move if they had the opportunity
to do so.
• The results for the higher educated, women and
youth age 15 to 24 reported were 43%, 42% and
53% respectively (Organization for Economic
Co-operation and Development, 2012; Joyce,
2018).
 Brain Drain in Nigeria

No fewer than 7,000 Nigerian nurses left the country in 2021 seeking greener
pasture abroad.
 Brain Drain in Nigeria

• The WHO estimates that a density of less NUMBER OF DOCTORS, NURSES AND MIDWIVES
PER 1000 PEOPLE

than 23 healthcare workers (HCWs) per

1000 habitants is not compatible with a
viable health system.

• Since nurses and midwives constitute half

of the HCWs, it can be assumed that a
density of less than 11.5 nurses and
midwives per 1000 population is not
compatible with the standard of quality
sought by WHO. source: ICIR MDCN WORLBANK
Epidemiology

The British
government revealed It was recently
that Nigerian medics In a 2007 study, reported that no
constitute 3.9 12, 579 nurses fewer than 5,405
percent of the trained in Nigeria Nigerian trained
137,000 foreign staff or 12% of the total doctors and nurses
of 202 nationalities number of nurses are currently working
working alongside in the country, had with the National
British doctors and emigrated as at Health Service (NHS)
Nurses. (Chiamaka & the year 2000 in the United
Chimereze, 2020) (Chiamaka & Chimereze, Kingdom (UKEssays, 2018)
2020)
 2

WHY BRAIN DRAIN?

(CAUSES)
BRAIN DRAIN CAUSES

Economic factors Social amenities

Political Instability Professional growth/career

advancement opportunities

Health
factors Conflict and war
BRAIN DRAIN CAUSES

• The causes of brain drain are further grouped into two major
parts;

• The Push factors: that prompts the skilled workforce from a

developing (low or middle-income) country to emigrate from
their home countries to seek greener pastures

• The Pull factors: These are factors inherent in the foreign

(developed) country, that attract the skilled workforce to
immigrate over there.
 FACTORS

Lack of research Under-utilization of skilled and

Substandard living conditions, facilities semi- skilled personnel (poor
dearth of conveyance, work condition/no career
accommodation development

PUSH
FACTORS Lack of freedom and
Deteriorating excellence of
autonomy
educational system

Low and corroding

Social unrest, Political wages
instability, conflicts and wars Discrimination in recruitments
and promotions
FACTORS

P Healthier working conditions; career advancement opportunities

U
L Sophisticated standard of living
L
Employment opportunity

F greater income and Higher wages

A
C availability of experienced support workforce
T
O
Political stability & foreigner secured policies
R
S
 FACTORS

Modern educational schemes; prestige of ‘foreign training’

P
U
L Meritocracy, transparency
L
Scholarly &Intellectual autonomy

F
A Appreciation & rewards/honorary recognition
C
T Extensive resources for research
O (UKEssay, 2018)
R
S
 3

EFFECTS ON HEALTHCARE
IMPACT OF BRAIN-DRAIN

Increase workload High chances of

(More pressure on the 1 2 mistakes, misdiagnosis,
available workforce) malpractices and errors

Poor patient care Inadequate home-

3 4 trained specialists

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KEY FACTS
NURSING TRAINING IN NIGERIA

• Nurses in Nigeria achieve professional licensure

through the NMCN after undergoing rigorous
training and exams.

• There are three main pathways:

• School of Nursing (three years, RN
certification),
• School of Basic Midwifery (three years, phased
out),
• Universities (five years, RN/RM/RPH
certification plus a bachelor's degree).
NURSING TRAINING IN NIGERIA

• After graduation, a one-year internship is

mandatory.

• A new four-year pathway includes

midwifery/public health and awards an HND
degree (RN/RM/RPH/HND), followed by a one-
year clinical attachment for licensure.

• Post-basic programs now offer postgraduate

diplomas and Master's degrees in specialized
nursing fields.
NURSING ATTRITION IN LAGOS STATE

• About 600 nurses exited the Lagos State Health

Service Commission from 2020 to 2023,
through voluntary retirement and abscondence

• About 3000 nurses(single, double qualified and

graduate nurses) responded to the recent
global recruitment advert by the Lagos State
Government into the LSHSC, via online
application
(Cristiano, 2023)
 NURSING ATTRITION IN LAGOS STATE

• In an attempt to curb brain drain by addressing

nurses’ needs, The Lagos State Government now
pays nurses retention allowance

• The hazard allowance has also been reviewed

upwards based on national recommendation

• The entry level for graduate nurses has also been

reviewed to level 10 or Conhess 9 in alignment with
current national recommendations
 NURSING ATTRITION IN LAGOS STATE

• Freshly graduated nurses from the Lagos State

College of Nursing Igando, interested in working
with LSHSC are being absorbed into service

• Retired nurses from LSHSC who are still able and

willing to serve, and who possess special
qualifications of need, are being considered for
contract appointments
 NURSING ATTRITION IN LAGOS STATE

• The LSHSC conducts quarterly exit

replacement recruitment exercises for health
professionals and interns, to augment the
hospital workforce
 4

RETENTION STRATEGIES
MANAGEMENT

TRANFORMATIONAL STRUCTURAL
LEADERSHIP EMPOWERMENT

Healthcare managers must Involve nurses as key players in

have vision, influence, clinical developing and updating
knowledge and a strong institutional policies to improve
expertise in nursing practice, practice and the patient
according to the ANCC. experience and outcomes
MANAGEMENT
EXEMPLARY
PROFESSIONAL
PRACTICE
Equip nurses with a clear
understanding of the role of
nursing and how it applies to
working with patients, families,
communities and on
interdisciplinary teams
NEW
KNOWLEDGE,
INNOVATION AND
IMPROVEMENTS
Display a commitment to evolving
the future of patient care and
nursing practice, using existing
evidence, new research and
innovative contributions to
advance the science of nursing
(ANCC)
MANAGEMENT

EMPIRICAL
QUALITY
RESULTS

Equip nurses with the relevant tools in data

collection and regular review of statistics in
order to empower them as change agents and
promote evidence-based Nursing practice.
(ANCC)
TASK SHIFTING

Task shifting is a process of delegation whereby tasks

are moved appropriately to less specialised health
workers to make better use of workforce and ease
bottlenecks in the system. (Obinna, 2012)

In LSHSC, carers/Health Assistants are trained

personnels hired to carry out menial tasks delegated
and supervised by the charge nurses.

Their roles are limited but eases the workload of nurses

 FORCES OF MAGNETISM/RETENTION

• High-quality nursing leadership

• Flat organisational structure
• Open management style
• Supportive, individual personnel policies and processes
• High-quality care
• Professional models of care
• High level professional autonomy for nurses (Umar, et al, 2014)
FORCES OF MAGNETISM/RETENTION

• Quality assurance initiatives;

• Positive relationships between community and
hospital;
• Project a positive image of nursing;
• Positive nurse–physician relationship;
• Professional career development. (Umar, et al, 2014)
 5

RECOMMENDATION
AND CONCLUSION
 RECOMMENDATIONS
• Governments and health agencies/administrators in Nigeria should
adopt international nursing standards to ensure that nurses are job-
satisfied, motivated and encouraged to grow where they are planted
and contribute immensely to the development of the Nigerian health
sector.

• Nurses’ salaries should be reviewed upwards to further motivate nurses

to stay in the country.

• Government should look into the creation of social amenities, and

invest largely in developing the Nigerian health sector up to
International standards
RECOMMENDATIONS
• Further research should be conducted on Nursing brain drain in Nigeria, and
the results should be regularly reviewed and communicated to appropriate
authorities.

• Government and employers should consider adopting and integrating the

“PULL FACTORS” into the health system/facility to ensure their Nurses are
not attracted to overseas health facilities;Conscious retention efforts should
be infused into critical stages of the employee lifecycle (i.e; attraction,
recruitment, onboarding and development)

• All impediments to automatic career advancements and promotions should

be removed
 RECOMMENDATIONS

• Govt./Employers should provide mid-level or advanced training

sponsorships to willing employees

• Extension of retirement age for healthy and willing employees to 65 or 70

years.

• Provision of incentives (i.e; career or training incentives, professional

incentives, living incentives, automobile incentives) and welfare packages
(i.e; Decent accomodation, car and housing soft loans, Free health care for
nurses and their dependants), flexible rosters, creation of mentoring
opportunities.
 CONCLUSION

• Brain drain in Nigeria has been occurring since the late 1980s and lack of
adequate investment in the health sector is the root cause.

• This menace has created grevious impact on the health system and
quality of care rendered by the Nursing workforce which seems to only
continue to grow as more nurses are trooping outside the country in
search of what is missing in our health system.
 References
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• Daily Trust (18th Sept. 2022); Brain Drain: How shortage of Doctors, Nurses, Puts Your Life in Danger
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