A study on why nurses migrate has revealed that the intent to find greener pastures abroad among nurses in Botswana is still rife.

The study was done by Gloria Thupayagale-Tshweneagae, of the Department of Nursing Education at the University of Botswana in conjunction with the Nurses Association of Botswana (NAB) and the Botswana Trade and Poverty programme (BTPP) based at the Botswana Institute for Development and Public Administration (BIDPA).

Presenting the finding to the just ended conference of the Commonwealth Nursing Federation (CNF), Tshweneagae said that nurses still migrate because they believe that conditions under which they work are not conducive.

She stated that the study showed some of the conditions that they see as uncomfortable as long working hours, shortage of staff, poor remuneration and not being allowed to do flexi time.

"Little attention has been given to making the life of a nurse comparable to other workers in the country. The nurses mentioned failure to be transported at night, transfers that are made with no consideration to one's family and slow progression for further studies and promotion," she said.

Tshweneagape said in this study, the desire for one to further one's education superseded the need for better pay. She stated that there was also a slight difference regarding pay for nurses who have migrated to Botswana, whose main reason for coming to Botswana was that pay in Botswana was higher than pay in their countries.

The issue of'pay' stood out when nurses reported on their quality of life, which they defined as the ability to purchase or build themselves a decent house, take their children to good schools and enjoy a seemingly debt free life with a comfortable bank account," Tshweneagae said.

She noted that there has been a steady trend on the migration of nurses in Botswana. She said most nurses who migrated are aged between 25 and 48 years of age.

"It also appears that nurses who have trained solely in Botswana prefer the United Kingdom, whereas, those who have had their education in countries such as the United States of America and Australia prefer to go and work in those countries. The verification data also shows that the numbers have been steadily increasing of nurses seeking verification to migrate," she stated.

It was very difficult to ascertain any shortage of nurses in Botswana, she said this was due to many issues such as the fact that shortage was verbalised by nurse leaders but existing vacancies were very few.

Another factor was that most of the nurses who have retired were employed in almost all the health facilities visited for the study. She stated that Botswana has entered into bilateral agreements with several governments such as Cuba and China hence there were nurses from these countries working in Botswana. She said it was not established by this study if such bilateral agreements had anything to do with shortage of nurses in Botswana.

"A number of expatriate nurses from African countries such as South Africa, Zambia, Tanzania and Zimbabwe have been found in the study sites. This also could probably mean that there is shortage of nurses in Botswana," she suggested.

Tshweneagae revealed that while qualifications of nurses working in other countries are recognised, the study findings showed that the Family Nurse Practitioner's certificate is not used when a nurse chooses to work in a nursing home.

Nurses working in hospitals are placed on a probation period of three months in Australia and up to twelve months in the United Kingdom to prove themselves. For other specialisation courses such as midwifery and anaesthesia it could take longer than twelve months for nurses to be allowed to help women to deliver or to prepare a patient for anaesthesia.

There was a general feeling that nurses who migrated and returned are made to wait for a long time before they are deployed in the system in Botswana. Participants reported that some of them had to wait for more than six months before they were deployed at a scale that they were in before they migrated, even if they had acquired a higher qualification like a master's degree and or an extra diploma in one's area of speciality.

They found the practice to be punitive and not encouraging for nurses to return home.

Fear of being infected with HIV/AIDS with no risk allowance has also been mentioned.

The study also found that the United Kingdom is still the most favourite destination country for nurses in Botswana. Its nearness to the country, easy communication, and the strength of its currency were supposedly the pull factors for United Kingdom.

Australia was the second most favourite destination. However, distance militated against Australia for most nurses. Those who preferred Australia are those who have prior knowledge of Australia through school.

This was found to be the same with the United States of America. Apart from distance, places like USA and Saudi Arabia were said to be far and their registration process inhibits most nurses to go there. The cultural differences for Saudi Arabia and the Emirates were also inhibiting reasons against nurses wanting to migrate.

The findings also show that Botswana, unlike other countries, still has a young nursing work force where the majority of nurses are aged between 20 and 30 years. Most of these nurses are registered with the Nursing and Midwifery Council of Botswana.

A nurse must have registered with the council when she migrates. It was also worth noting that the findings showed that 80percent of all nurses in administrative positions as heads of units were between the ages of 40 and 60 and that none are between the ages of 30 and 40 years for both the schools of nursing and the service.

The findings of the study also negate any development of a policy on migration by nurses. They all believe that a policy on migration will inhibit their movement, so they believe that the government should work on improving their working conditions before a policy is determined.

Tshweneagae concluded that the migration of nurses will continue until firm procedures are put in place that will make pull factors more readily noticed in Botswana.

"Poorly designed and operated human resource management systems reinforce low morale, foster out-migration and make it difficult for those wanting to come back. Lack of opportunities for further studies, and the poor perception of nurses by those in power are often mentioned as symptomatic of poorly specified human resources systems," she said.