Eg Phd, Mphil, Dclinpsychol
Total Page：16
File Type：pdf, Size：1020Kb
This thesis has been submitted in fulfilment of the requirements for a postgraduate degree (e.g. PhD, MPhil, DClinPsychol) at the University of Edinburgh. Please note the following terms and conditions of use: • This work is protected by copyright and other intellectual property rights, which are retained by the thesis author, unless otherwise stated. • A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. • This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author. • The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. • When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. From Aspirations to “Dream-Trap”: Nurse Education in Nepal and Nepali Nurse Migration to the UK Radha Adhikari PhD University of Edinburgh 2010 1 ABSTRACT The migration of nurses is stimulating international debate around globalisation, ethics, and the effects on health systems. This thesis examines this phenomenon through nurses trained in Nepal who migrate to the UK. Since 2000, increasing numbers of Nepali nurses have started crossing national borders to participate in the global healthcare market, particularly in the affluent west. By using qualitative multi- sited research and in-depth interviews with key stakeholders in both Nepal and the UK, this thesis explores why nurses aspire to migrate, how they fulfil these aspirations, and their experience of living and working in the UK. The thesis begins by examining the historical development of nurse training in Nepal, particularly from the mid 1950s. This period saw profound socio-political transformations, including in the position of women in Nepali society and in the perception of nursing in Nepal. Previously, many families were very reluctant to send their daughters into nursing. By the late 1990s, middle-class women and their families were increasingly attracted to nursing, both as a vocation and as a means to migrate. The thesis explores the rise of private training colleges to meet the increased demand for nurse training, and the new businesses that have grown up around the profession to facilitate nurse recruitment and migration. Around one thousand nurses have migrated to the UK since 2000, and the second part of the thesis presents their experiences of the migration process and of working and settling in the UK. Nurses have faced complex bureaucratic and professional hurdles, particularly after UK nurse registration and work-permit policies changed in 2006. The thesis also highlights how highly qualified nurses with many years of work experience in Nepal have become increasingly deskilled in UK. Frequently sent to rural nursing-homes by recruiting agencies, they create and join new diasporic support networks. Further, many have left their loved ones behind, and experience homesickness and the pain of family separation. Often, they plan for their husbands and children to join them after several years, and the research explores this and the issues faced by their families, as they relocate and adapt to life in the UK. Finally, the thesis makes some important policy recommendations. For Nepal, these relate to greater regulation of nurse training and the brokering of nurses abroad. In the UK, they relate to increasing the flexibility of registration and visa regulations to 2 assist in supporting Nepali nurses‟ work choices, and to value and utilise their professional skills in the UK better. Table of Contents Page No. List of maps, plates, graphs and tables 4 Acknowledgements 6 List of Abbreviations 8 Introduction: Origin of research idea and research design 10 Chapter One: International human migration: changing scenario and debates on health professionals‟ migration within the context of globalisation 29 Chapter Two: Nepal, gender politics and female migration 56 Chapter Three: Professional nursing and the healthcare system in Nepal 88 Chapter Four: International migration: planning and preparation 127 Chapter Five: Arriving and surviving in the UK 154 Chapter Six: “There is a vast difference from what I had thought”: working in the UK 181 Chapter Seven: Family and social lives in the UK: expectations and reality 206 Chapter Eight: Concluding discussion: nurse education in Nepal and nurses‟ migration to the UK. 229 References 242 Appendices: i) Letter requesting interviews ii) Invitation to participate in nurse migration research 3 iii) Already published articles from this research in European Bulletin of Himalayan Research, and Studies in Nepali History and Society Maps: Map of nursing colleges I visited during the research 16 Plates: 2.1 View of Kathmandu valley from Syambhunath Temple 55 2.2 Migrant women at the Departure Lounge at Tribhuwan International Airport, Kathmandu 55 3.1 Second year student nurses in 1982 87 3.2 Aspirant nursing students, Intel brochure, 2008 87 4.1 Putali Sadak, Kathmandu 126 4.2 Billboards in Bag Bazar, Kathmandu 126 6.1 Newspaper images of Nepali nurses in Britain in the Nepali press 180 6.2 Newspaper images of Nepali nurses in Britain in the Nepali press 180 7.1 Pasni in Edinburgh, April 2010 205 7.2 Nepali Nurses Association UK, AGM in London, August 2010 205 Graphs: 3.1 Growth of nurse training programme since 1991 (SN, BN and BSc) 99 5.1 Nepali nurses in the NMC-UK register 2002 – 2007 157 4 Tables: 3.1 Overview of total nurse training programmes in Nepal in 2008-09 98 6.1 Nepali nurses‟ professional mobility after migration to the UK 186 7.1 Nepali Nurses‟ husbands‟ social/professional position after migration to the UK 215 5 Acknowledgements First and foremost I would like to thank all the Nepali nurses and their families I met with in the UK, who shared their personal experiences of migration with me. Many nurses have given me their precious time after finishing long hours of nursing shifts; some after completing night duty. As well as sharing their deeply personal experiences with me, both pleasurable as well as painful ones, nurses and their families have been extremely welcoming and accommodating. This has facilitated the whole research process and made it very enjoyable and fulfilling. Without their support, this piece of research would not have been possible. There are too many to name individually, but I thank them all for their full participation throughout the research process. I have been also hugely supported by numerous people in Nepal, while I was desperately trying to understand the complex contemporary politics and new economy around professional nursing in Nepal. Once again there are too many to name all my informants, but I would like to thank senior colleagues, nurse managers, the NNA President and the Board, staff members at CTEVT, the NNC, nursing college administrative staff, academic members and student nurses. Without their information, it would not have been possible to put all the pieces of this jigsaw together to make a picture of the contemporary nursing situation in Nepal. I am truly very grateful to all of them. I am particularly grateful to Mrs Sabitri Joshi, who helped me to research further some of the previously unexplored history of nursing in Nepal. I thank Miss Suzanna Mukhia, Mrs Rebecca Sinha and Mrs Radha Bangdel for all their support during my fieldwork in Nepal. I feel extremely privileged to have been supervised by Professor Kath Melia in the School of Health in Social Science, and Professor Patricia Jeffery in the School of Social and Political Studies at the University of Edinburgh. I feel that I have hugely benefited from their fine supervisory skills, guidance, accessibility and close reading of my work. They have extensive knowledge in the fields of nursing and healthcare, and gender and political economy and this has given me deeper insight into all the aspects of this research. At the most anxious times of my research journey, just 6 speaking through any issues with them has helped me to move on. I would like to thank them both very much for all their support over the last five years. Astrida Girgulis at the UCL and Jeevan R. Sharma have been inspiring colleagues for me. I have been regularly stimulated by their very valuable insight into aspects of research about international migration, and for intellectual engagement in the subject area, and I thank them both for sharing their work and ideas with me. I would like to thank my nursing colleagues, Sheena Muir, Clinical Nurse Manager and Andrea Mclean, Charge Nurse at Astley Ainslie Hospital, Edinburgh, for granting me leave from work and helping me to source some funding for this research. I thank NHS Lothian Nursing Education Fund for their financial support. The NMC‟s Public Relation Officer Ms Polly Kettenacker provided me with professional records and statistics and I wish to thank her for invaluable information. Finally I thank Miss Kate Weir for proofreading this thesis and for all her social and moral support, my husband Ian Harper for his total support all the way through this research and Tara, our daughter, for being patient with me during the whole of Summer 2010. I am also very grateful to my parents, parents-in-law and my siblings for their encouragement and support to complete this work. This research is dedicated to Nepali nurses in particular, but also to all migrant nurses throughout the world. 7 List of Abbreviations ANM Auxiliary Nurse Midwife BN Bachelor