Nursing in Sri Lanka: Situating a Study of Nurses' Intent to Leave or Stay in an Organization within the Contexts of Professional Issues and Nurse Migration

  • Author / Creator
    Aluwihare-Samaranayake, Dilmi S
  • ABSTRACT Retention of nursing staff is a worldwide concern. Inadequate workforce planning, resource constrained undersupply of new nurses, underdeveloped recruitment, retention and return policies, poor incentive and career support structures and complex quality of work-life environments compete with forces supporting nurse out-migration to influence on nurses’ intentions to leave or stay in their profession, organization and/or country. Nurse retention influences current and future delivery of healthcare. It also affects the quality and quantity of the nursing workforce. Importantly, nurse out-migration contributes to strengthening the domestic economy through remittances. In Sri Lanka, leadership decisions based on assumptions about nurses’ decisions to stay or leave their positions (including out-migrate) are based on little or no evidence-based knowledge of the associated negatives (costs) or positives (benefits) of nurses staying, leaving or migrating. In this country there is little research on nurse migration at either the macro or micro levels of analysis. Thus the aim of this research was to begin addressing gaps in research, policy development and knowledge regarding nurse turnover and nurse migration. Multiple methods were used to develop knowledge in this area. The context for this exploration was set through first-hand knowledge of healthcare and nursing in Sri Lanka and a scholarly analysis of published and unpublished literature (including analysis of academic publications, reports and other grey literature) about the nursing profession and issues and challenges faced by nurses in Sri Lanka (Chapter 1). This critical analysis also informed the overarching study as it set the stage for an empirical study of nurses’ turnover intentions. Then an integration of turnover research and commitment theory, published between 1958 and 2016 and contextualized to the Sri Lankan context, was utilized to develop a Contextual Work-Life Experiences model. This model is intended to guide research into micro level concepts shaping nurses’ intentions and decisions to stay or leave, while holding attention to the macro context ambiance (Chapter 2). An initial testing of the model was conducted using a cross sectional survey with 679 nurses at an urban hospital in Sri Lanka to examine nurses’ work-life contexts, commitments and turnover intentions (Chapter 3). This limited scope study showed that nurses’ decisions are complex, influenced by their immediate work contexts, personal contexts and commitments to the profession, organization, family and country. Drawing on the findings from the initial literature exploration, the limited scope study, and an exploration of the migration literature an analysis of the macro context of nurse migration in Sri Lanka is presented (Chapter 4). This contributed to developing a research agenda and policy framework to situate nurse migration within a nurse workforce-planning framework. This dissertation makes significant contributions as it identifies some of the gaps in research, policy development and knowledge. It highlighted the need for internal strengthening of the nursing profession through stricter regulation and standardization of competencies, research consciousness, policy and action to promote systematic processes for evidence-based practice, and to address nurse turnover and migration, education, professionalization, research, leadership, and information systems. It emphasized the importance of analyzing factors most proximal to the nurses (factors in nurses’ work contexts and personal contexts, including professionalism and transformational leadership skills, opportunities for education and professional development and support for nurses to fulfill their commitments to family, profession and organization) that influence their core motivations. These factors are vital for researchers, policy makers, educators and clinicians in the development of evidence-based strategies to maximize organizational efficiency and effectiveness. It also highlighted the need for researchers and policy makers to take into consideration multiple contexts at multiple levels involving multiple stakeholders and discourse for meaningful research agendas and policy planning. Finally, the dissertation highlighted that a collaborative evidence and policy-based approach to increase professionalism in nursing enhance nurses’ work-life experiences, manage nurse turnover and migration driven by an evidence based policy framework is imperative to the sustainability of Sri Lanka’s health care system.

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  • Degree
    Doctor of Philosophy
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    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.