Research centre REACH

A deskilling and challenging journey: the lived experience of Indonesian nurse returnees

Kurniati, A., Chen, C. M., Efendi, F., & Ogawa, R. (2017). A deskilling and challenging journey: the lived experience of Indonesian nurse returnees. International Nursing Review, n/a-n/a. https://doi.org/10.1111/inr.12352

Aim: To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees.
Background: The creation of bilateral agreements between Indonesia and Japan has facilitated the
movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life.
Method: A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia’s provinces between August and October 2015. Data were analyzed thematically, supported by QSR NVIVO 10 software.
Findings: Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin.
Conclusion: Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation. Implication for nursing and health policy: The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees’ expertise with the needs of the national labor market. The public-private partnership should be strengthened to utilize returnees in healthcare services

Discussion:

For returnees in this study, their homecoming was driven by contract termination as a result of failing the examination, family consideration and the feeling of being under pressure in Japan. This ?nding is in line with other return migration studies. Expired contracts have been among reasons compelling the return of Filipino nurses to their home country (Lorenzo et al. 2007). Cassarino (2008) reported that 12.6% of North African migrants were forced to return home due to losing their job. Family was among the strong motives for returning home considered by Ghanaian health professionals (Adzei & Sakyi 2014) and Indonesian nurses (Hirano et al. 2012). In our study, returnees who were both certi?ed and  non-certi?ed caregivers claimed their stressful work experience in Japan contributed to their decision to return. Feeling distressed has also been reported by internationally educated nurses working in Iceland (Magnusdottir 2005) and the USA (Jose 2011). Language and communication barriers, discrimination and different working environment are among common stressors experienced by foreign educated nurses (Moyce et al. 2015). Brain waste occurs when overseas educated health professionals are unable to apply their professional skills in the destination countries (Alam et al. 2015), and this is referred to by Kingma (2006) as a gradual deskilling process. Deskilling has been experienced by migrant nurses who worked as professional nurses (Alexis & Shillingford 2015; Pung & Goh 2016) or as lower-skilled health workers (Salami et al. 2014). For the returnees examined in this study, inability to perform nursing interventions had decreased their skills. Deskilling was unforeseen, because Indonesian nurses were unfamiliar with the caregiver job description (Nugraha & Hirano 2016) and they expected to improve their nursing career and learn advanced technology in Japan (Hirano et al. 2012). The migration policy of Indonesian nurses emphasizes on the expansion of work opportunities and acquisition of new knowledge, skills and work experience (MoH 2012). The dispatch of Indonesian nurses to Japan as caregivers, therefore, is mainly a way to overcome the saturated domestic labour market, but has not yet fully addressed the issue of deskilling and reintegration of returned professionals. Retaining nurses within the nursing profession has remained a global concern in maintaining a robust health system (International Council of Nurses 2013). The dif?culties faced by returnees are particularly related to their return to nursing or their career path. In this study, only three of the 15 returnees (20%) were employed in nursing areas, which is in contrast to a previous study on the return migration of Jamaican nurses by Brown (1996), which found that 76% of these returned to nursing practice. Sadly, Efendi et al. (2013) also found that Indonesian returnees who previously worked as nurses in Japan under the EPA also had a problem in ?nding jobs. Although there are no clear data on nursing unemployment, Indonesia’s labour market is reported to have low capacity to absorb new nursing graduates (Suwandono et al. 2005). The overall unemployment rate in Indonesia is quite high, at 6.18% in 2015, or approximately 7.56 million people of productive age unemployed (BPS 2015). As noted by the returnees in this study, supports from the Indonesian government and the Indonesian National Nursing Association are strongly required in facilitating their return. Having refresher training is crucial to enable them to go back
to the nursing profession. Constructing a returnees’ database and the placement in public hospitals in underserved areas would be a signi?cant contribution in strengthening the health workforce. Haour-Knipe & Davies (2008) emphasized the important role of government in developing such a mechanism. In general, returned Indonesian migrants lack support and urge the government to intervene (International Labour Organization 2015). Both the Japanese and Indonesian governments regularly run job fairs once a year to link between prospective employers and returnees (Efendi et al. 2013). This collaborative effort should be strengthened further by aligning returnees’ competency into the national ageing policy. The caregiving background of nurse returnees would be bene?cial for leveraging the quality of care in the elderly long-term care industry in Indonesia. Returnees who were unable or unwilling to join the nursing workforce utilized the ?nancial and human capital gained in Japan to support their living in their home country. This is parallel with the global pattern of nurse migration in which returnees bring back ?nancial, human and social capitals (Haour-Knipe & Davies 2008). This ?nancial capital is often used to improve the economic status of the family or to start businesses. A migration study of doctors and nurses carried out by Brown & Connel (2004) found that returnees chose self-employment or establishing their own businesses using capital collected from savings and remittances which might compensate their skill drain. The human capital, as expressed by the study participants, is manifested in the acquisition of Japanese language pro?ciency and positive work attitude. Pro?ciency in the Japanese language helped some of the participants to be employed at Japanese companies or health facilities. Returnees’ positive in?uences from their work experience were also con?rmed in a previous study by Efendi et al. (2016), which found that Indonesian migrant nurses in Japan adopted discipline as a work ethic and way of life.
Limitations This study is not without limitations. First, although coming from the same cultural background, the interviewers were not known by most returnees. The participants might be cautious or hesitant about speaking more openly. Second, only participants from Java Island were recruited, thus ignoring disparities among regions in Indonesia.

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