Health Workforce at a Crossroads: A Qualitative Study on Migration and Retention Among Sri Lankan Nurses

Abstract

The migration of healthcare workers, particularly the nurses, from low- and middle-income countries like Sri Lanka has emerged as a critical issue. It is aggravating workforce shortages and straining healthcare systems. This study explores the factors influencing Sri Lankan nurses’ decisions to either remain in the country or to migrate abroad. The aim of this study is to understand the push and pull factors that shape these decisions, focusing on the common critical period of indecision among new nursing graduates.This study adapts a mixed-methods approach, combining surveys and in-depth interviews. Two separate batches of participants were involved in this study: the surveys were collected from 25 Sri Lankan nurse graduates who graduated during the years of 2010 to 2014, and in-depth interviews were conducted with 20 recent graduates who graduated during the years of 2021 to 2023 that are currently working in Sri Lanka. This study uses thematic analysis to identify key themes related to the nurses' migration decisions.The findings reveal that while financial incentives and better working conditions abroad are strong pull factors, personal and familial responsibilities, and a sense of duty to the country, are significant factors in retention. Nurses express a desire to remain in Sri Lanka but are hindered by heavy workloads, low salaries, and limited career advancement opportunities. The results also emphasize that the government of Sri Lanka has a window of opportunity to intervene during a period of indecision by addressing these systemic challenges through policy changes. Policy suggestions based on the findings of the study include increasing nurses’ salaries, improving career development pathways, and reducing workloads. The study also calls for greater international collaboration to regulate and monitor the global recruitment of healthcare workers to prevent further brain drain. The research contributes to a deeper understanding of the dynamics of nurse migration and retention, offering insights for policymakers to retain the Sri Lankan skilled workforce and to strengthen Sri Lanka’s healthcare system.