POST-BASIC NURSING STUDENTS’ PERCEPTIONS OF THE EMIGRATION OF NURSES FROM THE REPUBLIC OF SOUTH AFRICA

The emigration of nurses from South Africa to work in overseas countries continues to increase despite efforts to curb this phenomenon. This exploratory descriptive survey attempted to identify nurses’ perceptions of their colleagues who have emigrated as well as their own intentions to emigrate should the opportunity arise. Selfcompletion questionnaires were posted to all students registered for underand postgraduate studies at a distance education institution. The analysis of the data obtained from 453 completed questionnaires indicated that almost all respondents knew nurses who had emigrated, and that approximately 60% of the respondents would emigrate if the opportunity should arise. The major deterrent to their emigration was family ties which kept them in South Africa. The major reasons why they would emigrate related to better remuneration and to the ability to save money quickly for specific reasons. Besides improved remuneration and fringe benefits, employers could help nurses to remain in the Republic of South Africa (RSA) by showing appreciation for their work, by improving facilities and resources and by appointing competent health managers. The South African government could help nurses to remain within the RSA by appointing people in the frozen posts, eliminating corruption within the government and by improving safety and security in the country. Almost all respondents indicated that the government had no right to prevent South African nurses from emigrating to other countries.

Migration can be defined as movement from one place to another (Oxford Handy Dictionary, 1991:552). In the context of this article 'migration' refers to the movement of nurses from one country to another. The global shortage of nurses is aggravated by the fact that large numbers of nurses globally fall within the age range of the "baby boomers" born between 1946 and 1952; implying that these nurses will reach retirement ages between 2005 and 2020. The United Kingdom's (UK's) shortage of nurses has been predicted to reach 57 000 by 2004(Ka Mzolo, 2001. In the United States of America (USA) the shortage of nurses is predicted to be 291 000 in 2020, but the USA shortage will be hard hit by the expected retirement of 50% of the USA's nurse lecturers by 2001:179). South African nurses, whose training as well as their ability to communicate in English are valued by many countries, could help to address the dire shortage of nurses in the English speaking countries, while enhancing their own standard of living (Christmas, 2002:20

RESEARCH DESIGN
In this section the methodology, population and research instrument will be discussed. Issues pertaining to reliability, validity and ethical aspects will also be addressed.

Methodology
A quantitative, exploratory and descriptive design was used to ascertain the reasons why nurses left South Africa to work abroad. Postal questionnaires were used to collect data for this survey.

Population
The population comprised 4 280 students registered at a tertiary, distance education institution for underor postgraduate nursing studies during 2000. A census was done as each student was requested to participate in the survey.

Research instrument
A structured questionnaire was used to collect data from nurses pertaining to reasons as to why their colleagues and/or themselves, emigrated or considered emigrating, or would (in future) consider emigrating from South Africa to work in other countries.
Open-and closed-ended questions were accommodated in the questionnaire which contained 264 items. Open-ended questions allowed the subjects to respond in their own words whereas closed-ended (or fixed alternative) questions offered respondents a number of possible replies from which they had to choose the most appropriate alternatives according to their views.
The questionnaire consisted of the following sections: • biographic information of the respondents,

Validity and reliability
Content validity of an instrument is the extent to which the instrument represents the factors under study.
Each content area must be defined and representative behaviours then identified (Dempsey & Dempsey, 1992:75). Face validity is a subtype of content validity and is determined by inspecting the items in the questionnaire to ascertain whether the instrument contains important items that measure the variables in the content area (Burns & Grove, 1993:343-4).
The content of the questionnaire was developed by the research team, making use of information gained from the literature, radio news, newspaper articles and television programmes. Content and face validity were ensured by submitting the questionnaire to a number of experienced research academics and professional nurses. These experts agreed that the instrument complied with face and content validity.
Reliability of an instrument can be equated with the stability, consistency or dependability of a measuring tool (Nieswiadomy, 1993:201). The degree of reliability is usually determined by the use of correlation procedures. A correlation coefficient is determined between two sets of scores or between the ratings of two judges and is expressed as a number. Correlation coefficients range between -1,00 and +1.00. If the scores are perfectly correlated, the correlation coefficient is 1,00 (Polit & Hungler, 1993:244-245).
Although no specific correlation coefficients were statistically calculated for determining the reliability of this research instrument, the statisticians were satisfied that expected correlations between related findings were found.

Data collection and analysis
Questionnaires were posted to 4 280 registered students studying at a distance education tertiary institution requesting them to participate in this project.
An accompanying letter indicated that all information would be treated confidentially and that they would

Ethical considerations
Participants received the questionnaires with a cover letter stating that their anonymity was ensured.
Students who did not complete questionnaires could not be discriminated against nor intimidated in any way, because there was no way to determine which students returned completed questionnaires and which students failed to do so. Participation was voluntary. As anonymity had to be maintained, it was accepted that those students who returned completed questionnaires, consented to doing so. This research was approved by the Departmental Research and Ethics Committee of the particular educational institution.

RESEARCH RESULTS
The discussion of the research results refers to the data obtained from the 453 (N=453) completed ques-tionnaires. However, as these were self-completion questionnaires, a number of questions were left unanswered, accounting for the reason that the total number of responses do not add up to 453 in each case. In accordance with the data produced by the SPSS programme, the number of non-responses are indicated in the tables. Furthermore, in terms of the statistics produced by the SPSS programme, the cumulative frequencies add up to approximately 100% in some cases -depending on the calculations of the percentage for each category -but these statistics are portrayed as produced by the SPSS programme by two statisticians from Unisa's Department of Computer Services. This implies that the statistics were not changed to produce a cumulative percentage of exactly 100%, but are reported as produced by the SPSS programme.

Introduction
The research results will be presented and discussed according to the different sections of the questionnaire.

Biographic information of the respondents
The biographic data of the respondents provide important information about who these respondents were in order to contextualise their knowledge and  Based on the data reflected in Table 2, it can be deduced that the major reasons why nurses left the RSA corresponded with the major reasons why they were considering leaving the RSA.
The two most important reasons were to find better remuneration (84.0% and 77.5%) and to save money quickly for a specific purpose (79.7% and 72.7%).
Both these reasons indicated that nurses perceived their salaries to be poorer in the RSA than those offered in other countries. It is interesting to note that the reasons for actually working in foreign countries were reportedly somewhat different from those perceived by nurses still living and

Respondents' intentions to work in countries other than the RSA
Respondents were asked three questions related to their intentions to work in countries other than the RSA. These responses are summarised in Table 3.
The results portrayed in Table 3

Reasons why respondents considered leaving the RSA
Respondents were asked why they considered leaving the RSA at some earlier stages of their lives, why they did so at the time of completing the questionnaire (indicated in Table 4 as "current") or why they would leave the RSA in future should the opportunity arise. Only reasons marked by more than 40% of the respondents are reflected in Table 4.   (less experienced) and older (physically less capable) nurses who might be left to provide the bulk of the nursing services in the RSA. Losing many of these experienced nurses might also impact negatively on the teaching of student nurses, aggravating potential future shortages of nurses in the RSA. Table 5 indicates that the most significant reason for not leaving the RSA was "family ties" (77.7%). As more South Africans, including nurses, do continue to emigrate from the RSA, the family ties can be expected to get weaker and weaker within the RSA. Consequently health care planners should consider the possibility that more nurses will continue to emigrate in future as their family ties get weaker within the RSA. If the percentage (46.9%) of those currently not leaving the RSA because they are still busy with studies be considered together with those relating to family ties (77.7%), fearing the unknown (30.9%) and lacking the courage to emigrate (23.2%), to be reasons which could change within the foreseeable future, then health care planners in the RSA should consider the impact on the health care services should more than 50% of its employed nurses leave the country. Only 2.3% of the respondents indicated that they did not leave the RSA when they previously considered doing so, because their job applications were unsuccessful. Thus the respondents did not seem to experience major difficulties in obtaining overseas jobs.

Respondents' previous and current reasons for not leaving the RSA
This finding coupled with the fact that 59.8% (see Table   3) of the respondents indicated that they would leave the RSA, given the opportunity, should indicate the seriousness of the situation for the RSA's health care services should approximately 60% of the current actively employed nurses in the country emigrate. It might also be significant that not one respondent (n=162) indicated that an unsuccessful job application was the current reason for not emigrating from the RSA. This apparently high success rate of overseas job applications might be peculiar to this research population comprising only registered nurses furthering their qualifica-  Factors which would make nurses stay in the RSA  2000:20). A survey conducted among professional and managerial workers found the two most important rea-sons for emigration to be crime and violence (Mittner, 1999:31).

What employers can do to keep nurses in the RSA
The results are summarised in Table 7,  Ensure that health facilities and infrastructure are improved to its former state 58.5 Government must stop using "apartheid" as an excuse and accept responsibility 58.0 Get back the well qualified nurses lost through severance packages 41.5 Nothing, government is doing fine 2.7

General comments concerning the emigration of nurses from South Africa
Respondents were requested to provide any comments about the emigration of nurses from the RSA in an open-ended question. A large number of respondents indicated that the RSA might achieve greater success by managing the emigration process rather than by trying to prohibit the emigration of nurses. Some of these comments included that:

LIMITATIONS, CONCLUSIONS AND RECOMMENDATIONS
The final section of this report addresses the limitations and present the conclusions and recommendations of this research project.

CONCLUDING REMARKS
The RSA needs to address the factors influencing nurses to emigrate from this country. Merely placing bans on the emigration of nurses from the RSA is unlikely to impact on this phenomenon while dire shortages of nurses exist in foreign countries, offering remuneration packages exceeding those available within the RSA up to ten times. "The prospect of medical and technological efficiency without skilled nurses to provide human care, even on a basic level, has provided a challenge of pandemic proportions.
The world's attention is focusing on what can be done to alleviate the shortage of nurses and provide for the future" (Purnell et al. 2001:179).