Nurses and midwives constitute the largest of the health professional groups in Zambia and other low-income countries. This commentary paper highlights changing patterns of outward migration of Zambian nurses and addresses the factors involved in trends both before and after that change, using a detailed analysis of data from Zambia, 1991-2005.
We used the number of nurses requesting verifications from the General Nursing Council (GNC) in Zambia as an indicator of nurses' intention to leave the country. Any nurse wishing to practise abroad must be registered with the professional regulatory authority of the destination country. Data on Zambian nurses registering with the United Kingdom NMC were also collected and analysed as part of this study.
Let's delve into the specifics of nurses' salaries in Zambia and the trends in their migration.
Nurses' Salaries in Zambia
The average salary for a Registered Nurse (RN) in Zambia is ZMK 59,994. Here's a breakdown by experience level:
- An early career Registered Nurse (RN) with 1-4 years of experience earns an average total compensation (includes tips, bonus, and overtime pay) of ZMK 61,463 based on 6 salaries.
- A mid-career Registered Nurse (RN) with 5-9 years of experience earns an average total compensation of ZMK 60,000 based on 11 salaries.
Our data indicates that the highest pay for a Registered Nurse (RN) is ZMK 310k / year. Our data indicates that the lowest pay for a Registered Nurse (RN) is ZMK 12k / year.
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How to Increase Salary
Increasing your pay as a Registered Nurse (RN) is possible in different ways. Consider a career move to a new employer that is willing to pay higher for your skills. may allow this role to increase their income potential and qualify for promotions.
Migration Trends of Zambian Nurses
There has been a considerable volume of analysis and commentary on migration trends of health workers from Africa to the United Kingdom and other well-resourced countries in the early 2000s, but little detailed mapping and analysis with data from African 'sending' countries. Number of RNs requesting verifications from the GNC for the top eight destination countries (1991--2005).
Prior to 2000, South Africa was the most important single destination for Zambian registered nurses. Since 2000, the substantial increase in migration is attributable to access to new destination countries such as Australia, New Zealand, the United Kingdom and the United States, in addition to established destination countries such as Botswana and South Africa. Countries within the Southern African region are also used as stepping stones to migrate to the United Kingdom and elsewhere.
However, since 2004 there has been a dramatic decline in migration, especially to the United Kingdom, the most popular destination country. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits.
Table 1 compares the number of Zambian nurses applying to the Zambian GNC for United Kingdom verifications with those registering with the NMC in the United Kingdom. This time lag is a plausible gap between applying for verification in Zambia and formal admittance to the United Kingdom's NMC register. During this time, nurses must complete paperwork, move to the United Kingdom and undertake three to six months of supervised practice.
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However, there are some discrepancies between these two datasets, most importantly the 76 nurses who seem not to have registered with the NMC in 2004-2005, despite having applied to the GNC for verification letters in 2003. The shortage of supervised-practice places and greater difficulties in obtaining visas may account for this failure to absorb the supply in 2004-2005 [2], although the will to migrate remained. Some may have registered in 2005-2006, as the registration process is valid for two years.
Factors Influencing Migration
A new South African immigration policy introduced in 1994 may have led fewer nurses to migrate to South Africa between 1994 and 1999. On the other hand, an active recruitment policy in the United Kingdom seemed to play a substantial role in increasing the migration from 2000. This, however, had a different purpose from the policy in South Africa.
The United Kingdom did have an ethical recruitment policy, yet interestingly the ethical guidelines issued by the United Kingdom's Department of Health in November 1999 appear to have had no impact: there was a dramatic increase in migration after their implementation. The guidelines specifically state that NHS employers should avoid direct recruitment from South Africa and the Caribbean. In 2002 the United Kingdom Department of Health released a more detailed Code of Practice; in 2003 it added other countries to a list of less-developed countries to be avoided, including Zambia. The Commonwealth also adopted the Code of Practice for the International Recruitment of Health Workers in 2003. However, there is no direct evidence that these ethical guidelines were effective.
Enrolled Nurses (ENs)
Although the majority of nurses requesting verifications are RNs, enrolled nurses (ENs) are also leaving Zambia. The United Kingdom is the most popular destination country for RNs, but ENs favour New Zealand and, more recently, Swaziland. In contrast to the reductions in RN verifications in 2004 and 2005, EN verifications increased substantially in 2002 and more recently in 2005. While EN migration mirrored RN migration between 2002 and 2004, by falling sharply, the trends for the two cadres diverged in 2005. It is not clear what the causes of the initial decline were, as the United Kingdom had not been the major recipient country and explanations for RN decline do not therefore apply.
Comparison between sending country verifications and registration with the United Kingdom NMC provides new insights into nurse migration. Furthermore, our data suggest that the number of migrants is determined by active recruitment policies or those restricting migration in destination countries. South African immigration policy aimed to limit regional recruitment within the Southern African Development Community (SADC) and an active recruitment policy in the United Kingdom seemed to play a substantial role in influencing migration patterns.
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For the first time, the data in this paper confirm the declining trend in Zambian nurses migrating to South Africa 1994-1999. Although migration to South Africa was reduced, the change of immigration policy by one destination country does not significantly affect the number of migrants from a specific country, as long as substantial push factors and migration opportunities in other destination countries remain.
In 2006, the United Kingdom removed entry-level staff nurses and senior staff nurses from the shortage-occupation list that allows employers to hire overseas staff more easily [6]. After this rule change, about one third of the United Kingdom members of the Philippines Nurses Association said they were applying for jobs elsewhere, e.g. As Figs 1 and 2 suggest, there are many potential destination countries for nurses; agreeing upon a quota of nurses with only the main destination countries will not be sufficient to halt migration trends entirely.
Kingma argues that restrictive immigration policies violate an individual's rights to make international moves, while neglecting the root causes of migration [7]. Policy-makers tend to focus on migration restriction as a retention strategy.
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