Migration of Spanish nurses 2009-2014. Underemployment and surplus production of Spanish nurses and mobility among Spanish registered nurses: A case study.
BACKGROUND
After the financial crisis of 2008, increasing numbers of nurses from Spain are going abroad to work.


OBJECTIVE
To examine the health and workforce policy trends in Spain between 2009 and 2014 and to analyze their correlation with the migration of nurses.


METHODS
Single embedded case study.


METHODS
We examined data published by: Health Statistics, Organization for Economic Cooperation and Development (1996 to 2013); Ministry of Education, Culture and Sports (2006 to 2013); Ministry of Employment and Social Security (2009 to 2014); Ministry of Health, Social Services and Equality (1997 to 2014); and National Institute of Statistics (1976 to 2014). In addition to reviewing the scholarly literature on the topic in Spanish and English, we also examined Spanish mobility laws and European directives.


METHODS
We used the Organization for Economic Cooperation and Development definition of "professionally active nurses" which defines practising nurses and other nurses as those for whom their education is a prerequisite for employment as a nurse. Moreover, we used the term "nursing graduate" as defined by Spanish Ministry of Education to describe those who have obtained a recognized qualification in nursing in a given year, the term "registered nurses" is defined by Spanish law as nurses registered in the Nurses Associations and "unemployed nurses" are those without work and registered as seeking employment.


RESULTS
A transformation of the Spanish health system has reduced the number of employed nurses per capita since 2010. Moreover, reductions in public spending, labour market reforms and widespread unemployment have affected nurses in two ways: first by increasing the number of applicants per vacancy between 2009 and 2013, and second, by an increase in casual positions. However, despite the poor job market and decreasing job security, the number of registered nurses and nursing graduates in Spain per year has continued to grow, increasing the pressure on the labour market.


CONCLUSIONS
Spain is transforming from a stable nursing labour market, to one that is increasingly producing nurses for foreign markets, principally in Europe. With its low birth rate, increased life expectancy and increasing rates of chronic disease, it is critical for Spain to have sufficient nurses now and into the future. It is important that there be continued study of this phenomenon by Spanish policy makers, health service providers and educators in order for Spain to develop health human resources policies that address the health care needs of the Spanish population.
Postdoctoral Fellow, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada M5T 1P8; Department of Nursing, Faculty of Medicine, Univ Autonoma de Barcelona, Bellaterra 08193, Barcelona, Spain. Electronic address: paolagalbany.estragues@utoronto.ca.
Paola
P
Galbany-Estragués
University of Toronto, 27 King's College Circle, Toronto, ON, Canada M5S 1A1. Electronic address: Sioban.nelson@utoronto.ca.
Sioban
S
Nelson
D004506:Education, Nursing / Q000639:trends; D004641:Emigration and Immigration / Q000639:trends; D006291:Health Policy / Q000639:trends; D009726:Nurses / Q000706:statistics & numerical data; D009729:Nursing / Q000639:trends; D011320:Primary Health Care / Q000639:trends; D013030:Spain; D013041:Specialties, Nursing / Q000639:trends; D006801:Humans
Emigration and immigration; Health human resources; Manpower; Mobility; Motivation; Nurses; Spain; Work conditions