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The return of Chinese nurses from overseas (2009–2023): a mixed-method study on influencing factors
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DOI：10.1186/s12992-025-01157-w.png)
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Abstract
En 中文
The shortage of nurses poses a growing threat to global healthcare quality, particularly in low- and middle-income countries. Out-flow of nurses from these regions to developed countries exacerbates the global imbalance in nursing resources. However, some nurses decide to return home after gaining experience abroad. Understanding their motivations, challenges, and opportunities can offer valuable insights for China and other nations facing similar challenges. Data were collected from October to November 2023, with a mixed-methods research design. Trends and the distribution of returning nurses were visualized. Cox proportional hazards regression and subgroup analyses were used to examine the relationship between associated factors and return rate. Qualitative data, gathered through semi-structure interview, were analyzed using inductive thematic analysis. 29.69% participants have returned to China, with the cumulative incidence of return was 47.01% (95% CI 37.96%-57.04%) after 13 years, varying by destination. In the multivariable Cox model, factors like age 30–39 (adjusted HR [aHR] = 0.48, 95%CI 0.31–0.74), advanced language proficiency (aHR = 0.30, 95%CI 0.14–0.64), and average annual income abroad of $50,000: $100,000 (aHR = 0.32, 95%CI 0.20–0.52) and over $100,000 (aHR = 0.52, 95%CI = 0.33–0.83) were independently associated with return rates. Interviews with returning nurses revealed three main themes: (1) challenges faced overseas, mainly language barriers; (2) reasons for return, particularly family considerations; and (3) challenges and opportunities after returning, with better chance in private hospitals as a notable subtheme. This study provides the first comprehensive analysis of Chinese nurses returning from abroad, revealing that nearly 30% returned, mainly due to family considerations. More skilled nurses, with international licenses and higher incomes, tend to stay abroad. Most of these returning nurses secure employment in private hospitals, while reintegration into public hospitals proves challenging. The study indicates the potential to leverage returning nurses’ global expertise to enhance China’s healthcare system.
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