Why nursing graduates migrate despite health worker shortage

Spending up to four years in training, only to serve the sick in other countries, appears to have become a defining feature of nursing as a tertiary field of study in Kenya.

A 2023 ministerial report on Kenya’s health workforce said at the time that 40,000 trained nurses were seeking employment.

According to Stephen Ruteere, a veteran nurse at the Kenyatta National Hospital and the industrial relations officer, Kenya National Union of Nurses, at least 10,000 students graduate as nurses each year and, out of those, fewer than 3,000 manage to get employed by the government and private facilities.

“Nurses have always been respected professionals in society, and the recent COVID-19 pandemic when nurses were at the forefront in the fight and even crowned as global heroes are among some of the reasons that have continued to encourage students to join the profession,” Ruteere told University World News.

“For a long time, the Kenya Medical Training College (KMTC) used to be the main nursing training institution in Kenya but, today, several universities and colleges have joined in the race and KMTC also went on to expand its intake numbers, hence a surge in nursing graduates each year,” he said.

While the increase in nurse training was noble, with the intention being to solve staffing shortages in health facilities, it led to a huge number of jobless graduates and, now, the even bigger concern of Kenya potentially losing its future nursing talent to other countries.

Brain drain

Over the past decade, the migration of nurses, including new graduates, to other countries has become rampant.

According to the 2023 ministerial report, a total of 5,000 trained nurses left Kenya to work overseas in countries such as Canada, the US, the UK and the Middle East.

In July 2021, the United Kingdom and Kenya signed a bilateral labour agreement that was expected to see 20,000 newly trained nurses move to and work in the UK. By April 2024, 280 nurses had moved to the UK through the programme, with 200 more awaiting placements.

TruMerit, an organisation verifying credentials, in a nurse migration report, said Kenya accounted for about 7% of all Africans applying for work visas to the US, making it third in visa applications for nurses globally, behind the Philippines and Canada, while it ranked first in Africa.

While nursing graduates leave the country, public hospitals in Kenya struggle with a shortage of these essential health service professionals.

Preparing to leave

Jackline Kwamboka and Evelyne Achieng are nursing graduates from KMTC. Kwamboka finished her studies in 2019, while Achieng finished in 2020, but both are yet to be employed in their profession.

They are also members of a WhatsApp group made up of registered nurses in Kenya who are unemployed and seeking ways to fly out of the country to get jobs.

“Being part of this group helps us maintain our sanity,” the nurses said.

Kwamboka said she was in the process of applying for her visa to the UK, while Achieng already has everything ready and expects to travel to Qatar in October this year to work as a nurse.

“I applied for a caregiver position in the UK and I am only awaiting a letter from my employer to help speed up my visa processing,” said Kwamboka.

Why nursing graduates battle to find work

Today, the migration has become a norm, such that some nursing graduates do not even bother to seek employment in Kenya and, instead, start applying for passports and work visas as soon as they are issued with their licences. Students are now taking up nursing with the mindset of working overseas as their primary goal.

“I flew out to Dubai one year after I had received my nursing licence,” said Grace Muthoni. A friend, who was already working at a hospital there, advised her to do so, she said.

Muthoni graduated from the KMTC in 2023. She is also the mutual friend who helped Kwamboka and Achieng to join the WhatsApp group for unemployed nurses in Kenya.

“I started working as a nurse one month after landing in Dubai, where I earn Ksh123,000 (or DIR3,500) (about US$952). That is the best career decision I ever made,” Muthoni told University World News.

In Kenya, some registered nurses with degrees are known to earn as little as Ksh25,000 (US$193.5). This is almost five times less than what Muthoni makes.

“As a nurse in Dubai, my food, transport and accommodation are all catered for, which means that I am able to save almost all of my salary. This is something that nurses in Kenya, unfortunately, do not get to enjoy,” she said.

Samson Kamande, whose case made the local news in June this year, brought to light the struggles that nursing graduates go through after completing their training. Kamande has been unable to secure an internship, despite finishing his studies in 2024 – a health professional forced to hawk for a living.

According to Ruteere, the KMTC is known to produce some of the best trained nurses in the world, a fact that makes them attractive to employers in other parts of the world.

“There was a time the head of the health department in the United States was a Kenyan, and the same case also happened in Namibia. This shows you the quality of professionals that we are losing to other countries yearly while our own health sector continues to struggle,” he said.

Local working conditions

However, Ruteere adds that, despite the global recognition that Kenyan nurses have, they are overworked and underpaid in their own country. This, according to him, is the main reason why more and more nursing graduates are opting to leave the country.

“As nurses, we are forced to work in very unfavourable conditions that entail the lack of adequate work equipment, overworking due to a shortage of nurses, contracts without job guarantees and, most importantly, underpayment,” Ruteere told University World News.

“Currently, as nurses in Kenya, we are paid a risk allowance of Ksh3,850, which is hardly enough to get proper medication for ourselves in case we get sick while on duty. Our uniform allowance is also only Ksh10,000, yet our uniforms cost up to Ksh50,000,” Ruteere said.

“We are also overworked – such that, while the rules stipulate that one nurse is expected to oversee four patients, we end up having one nurse catering for up to 30 patients. How is someone expected to provide quality services in such conditions?”

A document seen by University World News confirmed that the ratio of nurse to patient in Kenya was expected to be 1:4.

A lecturer at the KMTC who wished to remain anonymous told University World News that the poor earnings and unfavourable working conditions as a nurse in Kenya forced her to further her studies and become a lecturer or nursing trainer where her workload is reduced and pay is better.

“I had worked as a nurse for a long time with no meaningful salary increase, and the working conditions remained bad – so I decided to go and become a trainer instead. Back in my day, travelling to work outside the country was not as easy as it is today, but if I had had the option then, I would have also migrated to practise nursing in another country,” she said.

“It is sad that we have come to a point where we are losing a lot of talent to the outside world when there is urgent need of the same here. I have worked as a nurse for more than 20 years, and most of my colleagues and I are now old. So, who will take over from us in future when everyone is fighting to leave the country?” she told University World News.

“Today all the government does is talk about having no money to allocate for nurse employment, while also delaying salary payments of nurses who are already working,” she concluded.

According to Ruteere, it is time the government adhered to the agreement made during the Abuja declaration in 2001, where 15% the national budget was supposed to go to the improvement of the health sector.

“We need more budget allocation in the health sector as it is the only way to ensure that our hospitals get to have the required number of nurses and that they are all well compensated. This will also help minimise the brain drain that is taking place,” Ruteere said.

“Nurses provide important services to our health facilities and it is sad that students now no longer trust their government enough to even bother practising their craft in their own country.”