Factors Related to Asian Foreign-Educated Nurses' (FENs) Turnover by Hyo Geun Geun A ...

191 Pages·2012·6.27 MB·English

by  Geun, Hyo Geun

Factors Related to Asian Foreign-Educated Nurses’ (FENs) Turnover

by

Hyo Geun Geun

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Nursing)
in The University of Michigan
2012

Doctoral Committee:

Professor Richard W. Redman, Co-Chair
Assistant Professor Marjorie C. McCullagh, Co-Chair
Associate Professor Milisa Manojlovich
Assistant Professor Valerie L. Myers
© Hyo Geun Geun 2012
All Rights Reserved
Acknowledgements
My dissertation would not have been possible without the support of many people.
First of all, I am heartily thankful to my advisor and committee co-chair, Dr.
Richard W. Redman, who was abundantly helpful and offered invaluable assistance,
supervision, and guidance from the preliminary to the concluding moment. His
assistance enabled me to develop an understanding of my initial paper proposal and finish
the associated tasks. Whenever I grew confused about the study, Dr. Redman led me to
the right direction to complete my journey. Our weekly meetings have been extremely
helpful. Dr. Redman consistently found any point I missed so that I can revise and
proceed to the next step. In addition, he was very supportive and encouraged me to apply
for funding from both Rackham and the School of Nursing at the University of Michigan.
With his great advice and comments on proposal review, I was able to receive the
Rackham Graduate Student Research Grant and a New Investigator Award as well.
My deepest gratitude also goes to the members of the dissertation committee. Dr.
Marjorie C. McCullagh (co-chair), Dr. Milisa Manojlovich, and Dr. Valery Meyer.
Especially, in the phase of proposal preparation, I met with them every week or every
other week to discuss the issues I faced. They have reviewed the instruments I used and
even commented on each single item in detail. I always felt that they were glad to help
me figure out the problems and find solutions. Without their knowledge, time and
invaluable assistance, this study would not have been successful.
ii
In addition, it is a pleasure to thank those who assisted during the completion of
my paper; Ray McDaniel from Sweetland Writing Center initially reviewed my paper,
Gissel Kolmic, a consultant from the Center for Statistical Consultation and Research,
reviewed and assisted my data analyses, and Nancy Nelson, a professional editor, edited
every single paper. Without their help, I could not have gotten such a paper and relevant
data.
Last but not the least, I owe my greatest gratitude to my family, especially my
mom, younger brother, and aunt. They have been main sources of motivationing my
journey, and gave me the strength to keep my study despite the fact that I sometime
wanted to give up and turn away from the journey.
I will not forget the contributions of all I have mentioned above.

iii
Table of Contents
Acknowledgements ........................................................................................................... ii
List of Figures ................................................................................................................. viii
List of Tables .................................................................................................................... ix
List of Appendices ............................................................................................................ xi
Abstract ............................................................................................................................ xii
Chapter I Introduction .....................................................................................................1
The Problem Statement and Background .........................................................................1
Significance ......................................................................................................................3
Purpose of the Study ........................................................................................................5
Chapter II Literature Review ..........................................................................................7
International Migration ....................................................................................................7
Nurses’ Migration ..................................................................................................... 8
The U.S. Context ............................................................................................................10
Nurse Shortage in the U.S. ...................................................................................... 10
Asian Nurses’ Migration ......................................................................................... 12
Related Issues .......................................................................................................... 15
Summary ................................................................................................................. 19
Foreign-Educated Nurses (FENs) ..................................................................................20
iv
Definition ................................................................................................................ 20
Demographics ......................................................................................................... 22
FENs’ Pre-Migratory Expectations ......................................................................... 23
FENs’ Post-Migratory Experiences ........................................................................ 25
Summary ................................................................................................................. 34
FENs’ Turnover..............................................................................................................35
Definitions ............................................................................................................... 35
Correlates and Determinants ................................................................................... 36
Related Theories and Concepts ............................................................................... 39
Foreign-Educated Nurses vs. Domestic Nurses ...................................................... 40
Summary ................................................................................................................. 47
Conceptual Framework ..................................................................................................48
Migration Studies and Theories .............................................................................. 48
Proposed Conceptual Model ................................................................................... 49
Chapter III Methods .......................................................................................................52
Design.............................................................................................................................52
Sample ............................................................................................................................52
Recruitment ............................................................................................................. 53
Procedures for Data Collection ............................................................................... 54
Measures.........................................................................................................................56
Instruments .............................................................................................................. 56
Data Analysis .................................................................................................................70
v
Data Preparation ...................................................................................................... 72
Human Subjects ...................................................................................................... 74
Chapter IV Results ..........................................................................................................75
Sample ............................................................................................................................75
Eligibility Testing ................................................................................................... 76
Sample Characteristics ............................................................................................ 76
Relationships of Measures ...................................................................................... 84
Results by Research questions .......................................................................................87
Research Question 1.1; ........................................................................................... 87
Research Question 1.2; ........................................................................................... 87
Research Question 1.3; ........................................................................................... 90
Research Question 1.4; ........................................................................................... 95
Research Question 2.1; ........................................................................................... 97
Research Question 2.2; ......................................................................................... 105
Research Question 3.1; ......................................................................................... 106
Research Question 3.2; ......................................................................................... 108
Chapter V Discussion ...................................................................................................116
Interpretation of the Study Results and Implications for Nursing Practice..................116
FENs’ Demographic and Career Characteristics .................................................. 116
Relationships between the Three Gap Subscales and Other Factors .................... 117
Push/Pull Factors for Turnover ............................................................................. 119
Predictors of Turnover .......................................................................................... 121
The Moderator (Gap Subscales) ........................................................................... 125
vi
Implications for Practice ..............................................................................................126
Limitations ...................................................................................................................127
Recommendations for Future Research .......................................................................129
Appendix .........................................................................................................................134
References .......................................................................................................................166

vii
List of Figures

Figure 2.1. Hypothesized Relationships among Relevant Factors ................................... 51
Figure 2.2. The Final Conceptual Model .......................................................................... 51
Figure 4.1. Differences in Expectations and Experiences by Age at Employment .......... 93
Figure 4.2. Differences in Gap Subscales by Age at Employment and Current Age ....... 94
Figure 4.3. The Final Conceptual Model for Turnover (Organization-Level) ............... 114
Figure 4.4. The Final Conceptual Model (Simplified Version: Organziation-Level) .... 115
Figure 4.5. The Final Conceptual Model (Simplified Version: Unit-Level) .................. 115

viii
List of Tables

Table 3.1. Summary of Methods Used in Data Analyses ................................................. 72
Table 4.1. Characteristics of the Sample .......................................................................... 78
Table 4.2. Distribution of Outcome Categories by Turnover ........................................... 81
Table 4.3. Relationship between Turnover and Selected Demographic and Career
Characteristics ................................................................................................................... 83
Table 4.4. Total/Subscale Scores and Reliabilities of Measured Variables ..................... 84
Table 4.5. Correlations among the Measures .................................................................... 86
Table 4.6. Descriptive Statistics for Gap Subscales ......................................................... 87
Table 4.7. Comparison of Expectation and Experiences Measures (EEM) ...................... 88
Table 4.8. Correlations among EEM Subscales and Corresponding Gap Subscales........ 89
Table 4.9. Independent Sample t-test for Gap Subscales by Gender ................................ 90
Table 4.10. ANOVA for Gap Subscales by Country of Origin ........................................ 91
Table 4.11. Two-way ANOVA for Gender and Country of origin .................................. 92
Table 4.12. Distribution of Expectations and Experiences by Age at Employment ......... 93
Table 4.13. Logistic Regression for Gap Subscales and Turnover (Unit-Level) .............. 95
Table 4.14. Logistic Regression for Gap Subscales and Turnover (Organization-Level) 96
Table 4.15. Comparison of Level of Language Fluency by Country of Origin................ 98
Table 4.16. Distribution of Self-Rated Health .................................................................. 99
ix