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It's not only nurses from lower income countries that move for money - pay is the key driver for all nationalities when it comes to nurse migration, says Fadi El-Jardali, assistant professor at the department of a health policy and management at the American University in Beruit Lebanon.

A study of Lebanese nurses headed by Jardali, published in March 2007 in the International Journal of Nursing Studies, found that 19% of nurse graduates from the country's four leading nursing schools were working abroad.

The main reason for leaving Lebanon was financial, with 57% of nurses citing this as the key driver, closely followed by the desire to develop professionally at 42%.

"Many of the people that graduate in Lebanon migrate for different reasons; social, economic, political and workplace; to go to rich countries that can offer better opportunities for professional development and salaries and benefits," El-Jardali explains.

Jordan is another nurse exporter. The government marks nurse training and supply as an important part of its economic policy, says Osama Diadat.

Diadat left his native Jordon for Dubai 12 years ago and now works as a practice development nurse in mental health at the city's Rashid Hospital.

"Unemployment is a common problem, and in Jordon there is nurse exporting. They have made nurses a resource because Jordon is acknowledged throughout the world as having a good healthcare service," he explains. "All the good nurses depart abroad and they are playing an important role in our economic status."

The situation, however, is now starting to have an impact on the quality of nursing care on offer in Lebanon. "It is at a very critical point," warns El-Jardali. "Talking to those people working at the front line they say the quality [of care] and patient outcomes have been suffering as a result."

El-Jardali believes that if workforce planning is not addressed at national levels in the Middle East, both exporting and importing countries could find themselves desperately short of nurses, and totally reliant on staff from less developed countries - while countries such as Lebanon will start having to import nurses themselves.

"Nurse migration is one of the critical challenges many countries in the region are facing," he tells MT.

"The problem here is there is no human resource planning in these countries; there is only a minimal database covering existing staff.

"There needs to be a plan because everyone is competing for the same existing nurses."

Image conscious

Senior nurses agree that encouraging more locals into nursing and midwifery in countries such as Saudi, the UAE and Qatar is urgently needed. But a deep-rooted belief among many national populations that nursing is a lowly, undesirable job is proving a large barrier, discloses Murshid.

"One month ago I was very down so I sent a text to all the Saudi nurses I know asking if anyone one knew the future of nursing in this country," she says. "They replied, and some said there was no future, because this is a country that does not see nursing as a profession. Others said it will take a lot of effort, but there is a future."

The stigma of nursing and midwifery as unacceptable occupations for women is even stronger in Qatar, which was forced to shut down its one and only nursing school for nationals because local fathers refused to let their daughters enroll there, Murshid adds.

Minority report

Both the Saudi and the UAE governments have launched schemes to encourage locals into the profession. Government-backed nursing institutes, colleges and universities have sprung up during the last five years, as part of widespread nationalisation programmes.

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