Expectations of international migration in nursing students in Mexico

Expectations of international migration in nursing students
in Mexico, Distrito Federal
Migration expectations among nursing students in Mexico City
Yetzi Rosales-Martínez, M in CS; Gustavo Nigenda PhD; Omar Galárraga, PhD; José
Arturo Ruiz-Larios, Lic in Soc.
Center for Health Systems Research, National Institute of Public Health. Cuernavaca,
Morelos, Mexico
Overdubs request
Summary
OBJECTIVE: To analyze the factors associated with the expectation of migrating abroad in
undergraduate students in public school nursing in Mexico City, Mexico City.
MATERIAL AND METHODS: A cross-sectional study was conducted with a nonprobabilistic
sample of 420 students. A multivariate logistic model was built.
RESULTS: 69% of the informants expressed the intention to migrate to work (65%) or
study (26%).50% would choose as destination Canada, followed by Spain and the United
States. The variables associated with the expectation of migrating were: age, income,
having relatives abroad and perceiving poor working conditions / wages in Mexico.
CONCLUSIONS:The results agree with the international literature. Low salaries, poor
working conditions and few possibilities to develop professionally in Mexico contribute to
generate the expectation of migrating in the study population. Additionally, the students'
optimistic perception of the foreign market and the labor demand of developed countries
help to emphasize this phenomenon.
Keywords: nursing students; intention; job; international migration; Mexico

ABSTRACT
OBJECTIVE: To analyze the factors associated with the expectations to migrate abroad
among nursing students in Mexico City.
MATERIAL AND METHODS: A cross-sectional study was conducted with a non-random
sample of 420 students. A logistic regression model was estimated.
RESULTS: A total of 69% of the informants expressed their intention to move abroad, to
look for employment (65%) and / or to continue their studies (26%). Of those, 50% would
choose Canada as their destination, followed by Spain and the United States. The variables
associated with migration expectations were: age, income, having relatives abroad, and
perception of poor labor conditions and low wages in Mexico.
CONCLUSIONS:Results are consistent with international literature. Low wages, poor labor
conditions and the limited possibilities for professional development in Mexico are factors
that contribute to generate migration expectations among nursing students. Additionally,
optimistic perceptions about the job market and labor demand in more developed countries
heighten expectations to migrate.
Keywords: Students, nursing; intention; employment; emigration and immigration; Mexico
The migration of nursing personnel from developing countries to industrialized countries is a
well-known and documented phenomenon. In Mexico, the volume of nurses who manage to
migrate to other countries to work in the field of their training is not known. However, there
are indications that this phenomenon could increase quantitatively in an important way,
given the demographic and epidemiological tendencies of the traditional recipient countries
and the control that exists in them about the training of specialized health personnel. one
In the international sphere, the migratory flow of nurses has responded to the need to
correct the deficit of these personnel in industrialized countries. Among the main attraction
factors, as with other population groups, the prevailing wages in the recipient countries
stand out. two
What is documented in the international literature offers an idea of the magnitude of the
problem. In 2002, 85% of nurses born and trained in the Philippines were employed in the
international market. 3 On the other hand, in 2003 43% of the nurses who worked in the
United Kingdom had been trained in other countries. 4
In Latin America, nurses from Costa Rica, Honduras, Nicaragua, Panama, Cuba, Puerto Rico,
Argentina, Peru and Paraguay are attracted to the health market in the US, Canada, Italy
and Spain. These countries stimulate this migratory flow through international recruitment

agencies that offer attractive work packages for personnel recently graduated from this
career. The percentages of migration in this region are very varied. In 2005, it was reported
that 2.3% of the total Argentine nursing staff migrated to another country, as well as staff
from Brazil (2.8%), Guatemala (34%), Peru (15%) and Panama (46.8%). 5
In Mexico, records on the subject refer to migratory flows of nursing personnel since the
early 1990s, with the United States, Spain and the United Kingdom as the main
destinations. 6 Another study revealed that the State of Mexico and Chihuahua reported in
2003 the migration of 150 and 500 people with nursing studies respectively, in response to
a shortage of personnel in Texas, California, Florida and New York. 7
Among the main implications of migration of nurses for provider countries are, on the one
hand, the relationship between insufficient staff, the performance of the health system and
the effect on the health of the population 8 and, on the other , the loss of public investment
made in the training of nurses who may work in another country.
The empirical evidence on the determinants of the decision to migrate in this staff indicates
the relevance of income and incentives. In poor countries, the low remuneration and the
lack of consistency between the salary, the assigned work functions and the academic
degree achieved constitute a reason for dissatisfaction that contributes to generating the
expectation of migrating. 9 The above characteristics are present in the Mexican health labor
market and are also intertwined with aspects such as unemployment, underemployment
and long working days. 10
Also, some studies conducted on the expectation of international migration in nursing
personnel provide figures to measure this phenomenon. In Zimbabwe, 71% of respondents
said they intend to migrate in the immediate future, projecting the United Kingdom (30%),
South Africa (24%) and the rest to Australia, the United States, New Zealand and
Canada. 11 Similar findings were disseminated from other research conducted in six
countries in Africa with different professional categories, of which 49.8% had nursing as a
profession. The resulting proportion of professionals who expressed the expectation to
migrate was in the range of 26% in Uganda and 68% in Zimbabwe. 12
In view of the growing worldwide trend in the recruitment of nursing personnel, its
repercussions on the health systems of the countries that are expelling them and the lack of
knowledge about what is happening in Mexico on this subject, this study seeks to know and
analyze some of the factors that explain the expectation of international migration of a
group of nursing students in the last year of the degree in three public schools in the
Federal District. The importance of knowing this expectation consists of the opportunity to
have a diagnosis about the phenomenon in a particular context and to promote research on
this at the national level based on the results obtained.
Among its contributions, this study will enrich the analysis related to the strategic planning
of health workers in Mexico and will contribute to justify, based on evidence, the
formulation of policies for the retention and distribution of human resources at the regional,
national and international.
Material and methods
A cross-sectional study was conducted with a non-probabilistic sample of 420 students. The
field work was carried out in mid-2007 in the Federal District. The unit of analysis was the

undergraduate students in nursing enrolled in three selected schools that were studying the
last year of the career and were present on the day of the data collection. The only
exclusion criterion was to not show interest in participating. The choice of this population
group responded to the relevance of their condition as future health professionals and to the
methodological feasibility that represented having them gathered in a delimited physical
space.
A survey was carried out using a previously tested instrument in a pilot form with nursing
students from the Autonomous University of the State of Morelos. The questionnaire
consisted of six sections that investigated: sociodemographic data, academic performance,
sources of information on international migration, perception of labor market conditions in
Mexico, expectation of migration and perception of international labor market
conditions. For the design of the questions, the testimonies collected in a focus group with
nursing students and the results of a bibliographic review were taken as reference.
For the selection of schools and informants, sampling by criteria was used. It was sought
that schools were public control and that according to the statistical yearbook of the
National Association of Universities and Institutions of Higher Education (ANUIES) registered
the largest number of graduates of this degree in the Federal District. Based on these
criteria, the National School of Nursing and Obstetrics (ENEO) of the National Autonomous
University of Mexico (UNAM) was elected; the Division of Biological and Health Sciences
(DCBS) of the Autonomous Metropolitan University (UAM); and the Higher School of Nursing
and Obstetrics (ESEO) of the National Polytechnic Institute (IPN), which together annually
graduate around 72% of graduates in nursing in this entity.
Regarding the informants, we worked with a sample of voluntary subjects. The application
of the questionnaire was carried out during events organized by the schools where students
of the last semesters were invited for induction into social service. Only in the case of the
ENEO, students were specifically invited to participate in this study. The instrument was
answered by the students without intermediation of an interviewer. On average, the
percentage of participation in the survey with respect to the total enrollment of the last
semesters of the career in the three schools was 77.6%.
In logistic terms, authorities of the three schools were contacted through the institutional
office and the attached research protocol. Their approval and support for fieldwork was
requested. In addition, the project was approved by the Ethics Committee of the National
Institute of Public Health. To comply with the considerations
In the research ethics, an informed consent letter was attached to the questionnaires where
the objectives of the study were made known to the students and the confidentiality of their
answers was guaranteed.
Data analysis
A multivariate logistic regression was performed to estimate the association between a
series of independent variables and a dichotomous response related to the presence or
absence of the expectation to migrate. The socioeconomic characteristics and the perception
of working conditions in Mexico and abroad were compared from the dependent variable
using the chi 2 test . Finally, a multivariate model was constructed with variables selected
from the theory reported and those with a statistically significant association.
The number of observations in the multivariate model was 403 and the probability of the set
of independent variables was significant ( p

ji 2 test of Hosmer-Lemeshow was used, concluding with a p > 0.05 that the model is useful
to explain the studied phenomenon, as the estimated probabilities are equal to the observed
probabilities. The diagnosis of collinearity of the variables was applied with the tolerance
test and variance inflation factor (VIF) to verify that the independent variables did not show
a high correlation between them. The statistical package Stata was used to process the
data. * Although no differences were found by sex, this variable was included in the adjusted
model because its presence increased the statistical significance of the rest of the
variables. Additionally, a difference index (ID) was constructed from two closed questions
designed with identical response options and, therefore, comparable to each other. In the
questionnaire, four options were placed to answer the questions: Is it possible to obtain
employment in a health institution (in Mexico or abroad) for a recently graduated bachelor's
degree? a) easy, b) complicated, c) impossible, d) does not know. The ID was created by
subtracting the observations included in each question about "opportunities in
Mexico" vs."opportunities abroad". A positive value in the ID indicates that the perception of
the employment situation in Mexico is better (or higher) than that abroad. Conversely, a
negative ID value implies that opportunities abroad are perceived as higher (or
higher). Finally, a value of zero implies that employment opportunities in both countries are
perceived as equivalent.
Results
The questionnaire was answered by 420 nursing students of whom 85.5% were
women. 78% were in the age range of 20 to 24 years. The main place of origin reported
was the Federal District (80%), followed by the State of Mexico (10%). The majority of
informants (82%) stated that they were single and only 16% mentioned having economic
dependents. Regarding the average monthly income in the home, 53% declared receiving
up to two minimum wages, while 21% reported an income of six minimum wages and
above. In terms of their activity, in addition to studying, 23% were working. Of the latter,
73% received an average monthly income that did not exceed two minimum wages. Finally,
55% of respondents reported having relatives abroad.
Significant differences were found ( p

Regarding the sources and type of information on international migration of nursing
personnel, 84% reported having information on this. Of these, 33% obtained it on their own
initiative. 52% said they were informed about employment conditions in other countries and
half pointed to at least one requirement to be hired abroad. Among these requirements, the
most mentioned were to know the language of the receiving country, be titled and have the
immigration documents in order.
35% reported having had three different sources of information related to working
conditions in other countries and 27% reported having up to four sources. In Figure 2 can
be seen the information sources mentioned. The two main ones were professors (25%) and
Internet (16%). Also, 54% said they had relatives living outside of Mexico, mostly uncles
and cousins; Of these, 12% recognized these relatives as a source of information on
international migration.

In table IISome characteristics related to the perception of working conditions in Mexico and
abroad are presented. When comparing the frequencies of those who said they had and did
not have the expectation of migrating, statistically significant differences were found. Within
the group of students with the expectation of migrating, there was a higher proportion of
students who perceived greater opportunity to get employment abroad. Also, in the group
that rated the working conditions and wages in Mexico as poor, the percentage of students
with the expectation of migrating was higher. By last,
In Table III the adjusted variables that were significantly associated with migration
expectations shown.It was estimated that the possibility of having this expectation occurs in
students belonging to the youngest age group (20-24 years old), with an average household
income above five minimum wages and with family members living in other
countries. Likewise, this possibility increases when students perceive poor working
conditions in Mexico together with considering the salaries offered to nursing personnel
abroad better.
Discussion
In general, the results obtained on the determinants of the expectation to migrate found
correspondence with the international literature. Among the sociodemographic factors
associated with this phenomenon was age 13 and admission to the home. A generational
tendency was observed to present greater intention to migrate in the groups of younger

informants. This suggests that age is a factor of decreasing the expectation of migration
given that young people have lower aversion to risk compared to the adult
population. 14 Regarding household income, it was observed that socioeconomic stratification
within the union profiles different aspirations in terms of education and / or work, which is
expressed in the search for better employment conditions, in this case outside of
Mexico. The higher the family is on the socioeconomic scale, the clearer this preference is
on the part of the students.
A possible explanation of this phenomenon arises from the best alternatives offered by the
professional markets in terms of income and benefits unlike the non-specialized markets
where the majority of Mexican migrants seek to locate themselves. The nursing staff plans
the migration after evaluating the employment alternatives both in their country and
abroad. This evaluation involves two important factors. On the one hand, the professional
status achieved after obtaining a university degree and, on the other, the specific demand
of nurses by developed countries. These aspects are intensified in students whose families
have higher incomes since migrating will only make sense if they can maintain or surpass
the status of life achieved in their country of origin. fifteen
This can be reinforced by the correlation between the family's socioeconomic income and
the opportunities for access to the educational system identified by Fernández. 16 This author
points out that as progress is made in the degrees and levels of the education system, it
tends to become more discriminatory for students whose families belong to lower social
strata. Our study shows that even within professional schools, the level of family income
plays a role in the development of the expectation to migrate not as a desperate measure,
but as a planned process of investment in human capital that allows finding a labor niche.
high income, or continue with specialized training, even in the international market. In this
sense, it should be noted that 26% of the informants with the expectation of migrating
indicated as their main reason to continue studying in another country since they perceived
this opportunity in their country of origin to be less promising.
A factor strongly associated with the expectation of migrating is the expectation of wages
and working conditions in the international market. Although the literature first mentions
the economic reasons for this phenomenon, it also provides evidence of the influence of
other aspects. Some authors point to dissatisfaction in professional life as a powerful
predictor in planning to migrate abroad. 17,18 In general, in addition to an attractive salary,
better hiring conditions and non-financial incentives are sought, as well as opportunities for
professional development, management at work, positive work environments and access to
benefits. 19
The nursing labor market in Mexico offers conditions that motivate university graduates to
migrate.Mexico has distinguished itself by offering precarious working conditions to health
professionals that have not improved with the sector reforms promoted since the
1980s. One of the main trends in the labor market has been the replacement of stable and
protected employment relationships with flexible hiring schemes and incentive systems
based on cost containment strategies. 20 In this context, health professionals face an
uncertain work future in the face of the suppression of social benefits, the deterioration of
salaries and a weak regulation of their rights as workers by the State. twenty-one
In addition, the economic differences between regions, the shortage of nursing personnel in
developed countries and the consequent international demand for it exacerbate the
expectation of migration. 22 In this way, the globalization of labor markets becomes a
survival option that transfers labor and professional demands not addressed in the countries
of origin to other regions.

From a cultural approach, these social and economic processes are internalized by the
subjects, generating in them a set of expectations about the opportunities to perform in
other countries. 23 This gradually leads to a collective acceptance of the phenomenon. In this
scenario, the possibility of executing adequate policies to regulate the migration process of
health workers becomes urgent.
The study of migration expectations among Mexican nurses allows us to have a first
indicator about the possibility of this phenomenon increasing in the country. To date,
migration has maintained a relatively low proportion for Mexican nursing personnel as a
work option. However, the predicted deficits of these personnel in the US and other
industrialized countries, together with the aging processes of their population, generate a
scenario of high migration probability in the coming years. To this must be added the
unattractive labor conditions existing in Mexico. In terms of your professional practice, The
nursing staff constitutes an important human resource because of the coverage of care they
provide and their consequent contribution in the improvement of the health conditions of
the populations. It has been documented that the improvement of obstetric care and the
reduction of maternal mortality are largely attributed to the performance of these
personnel. 24
In the case of accentuating this migration, Mexico would face social and economic
impacts. One of them would be the loss of public investment made in the training of these
personnel. 25 Another would be the negative effect on the health of the population due to
insufficient personnel and poor performance of health institutions. 26 The methodologies
used to evaluate the performance of health systems consider the number of human
resources as an indicator of care capacity. 27 According to the OECD, the availability of
nursing personnel in Mexico is 2.2 per thousand inhabitants, while the average of the
countries that make up this organization is 8.0 per thousand. 28
Given that the volume of migrant nursing personnel is still low, this is a time for the
competent authorities to design and implement a policy that regulates the eventual growth
of migrants in order to guarantee respect for labor and human rights. the people who decide
to take this option and who protect the national health institutions in case they have to do
without such a valuable resource.
In the logic of regulating migration, strategies in the field of work can be aimed at
expanding the systems of financial and non-financial incentives, in such a way that they
benefit all personnel with a bachelor's degree in nursing regardless of the public institution
that employs them. the contracting scheme.
Another strategy could be focused on disseminating reliable information from official sources
to balance the effect of sources of information on international migration on
students. Assuming the influence of these, it would be worth reorienting messages in the
media to provide reliable information about working conditions for nursing personnel
abroad. Likewise, the use of existing information systems is a resource that can be
complemented with indicators that allow knowing the number of nurses who migrate
through the authorized route, as well as the time they remain in another country.
It is pending for future investigations to analyze the presence and functioning of
international recruitment agencies in Mexico as instances that promote the migratory
process. It would also be advisable, within the framework of the international demand for
nursing personnel, to encourage research interested in studying the impact that health
institutions in Mexico would have if the migration of this personnel becomes widespread,

and to analyze their working conditions as a mechanism that could help regulate the
market.
Thanks
This study was carried out with resources from the Sector Fund CONACYT-SALUD through
the project "Employment, training and regulation of human resources for health, Bases for
its strategic planning". We also thank the team working on human resources in health of the
INSP that contributed in various aspects in the conduct of the study.
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▲ Application for overdrafts:
Dr. Gustavo Nigenda
Health Systems Research Center
National Institute of Public Health
Av. Universidad 655
Col. Santa María Ahuacatitlán. 62100
Cuernavaca, Morelos, Mexico
Email: gnigenda@insp.mx
Date received: July 17, 2009
Date accepted: February 4, 2010
* StataCorp Stata Statistical Software: Release 8. College Station TX, USA, StataCorp LP,
2005.
National Institute of Public HealthCuernavaca - Morelos - Mexico
E-mail: spm@insp3.insp.mx
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