Qom University of Medical Sciences Journal

Introduction
Context and purpose: One of the foundations of the health system are nurses. The training, recruitment, and maintenance of this important group of healthcare employees is vital and at the same time an issue all over the world. Migration of nurses results in reducing and losing these valuable assets. Considering the global trends and the evidence indicating the increasing migration of nurses, it is necessary to evaluate the factors affecting this process.
Methods
 In this systematic review study, PubMed, Scopus, Web of Science, SID, Magiran and Google Scholar databases were searched without time limit. Articles were searched based on the Prisma method, and in order to evaluate the quality of the articles, critical evaluation checklists of the Joanna Briggs Institute (JBI) were used.
Results
First, 265 articles were extracted. After screening and removing 233 duplicate, unrelated, without complete text articles, the qualitative evaluation stage was performed, and finally 17 articles were included in the study. There were 2 articles from Iran, one was published in Farsi and the other in English, and the other articles were from other countries. 7 articles were implemented with qualitative-quantitative method and 10 articles with qualitative and content analysis. No intervention was reported in the articles and no study prioritized the identified effective factors. In 5 articles, factors affecting migration were categorized and studied in three areas: individual factors, social factors, and cultural factors. In eight Studies, without creating a specific category, the researchers mentioned several factors including: Income, job position, job security, continuing education facilities and educational technology, team relations in the work environment, and facilities and family status as having an effect on migration. The causes affecting migration were classified into two main categories: Causes related to the country of origin (push factors) and causes related to the destination country (pull factors). The push factors in the countries of origin included economic recession, low salaries, lack of job security, lack of freedom and independence, lack of medical equipment and proper health facilities, the superiority of people without education and knowledge over educated people, the humiliation of nurses and lower socio-economic status. In the destination countries, pull factors included higher wages, job security, continuing education, the existence of career development facilities and suitable relationships in the work environment and team work, social factors including: Acceptance and appropriate position of specialties such as nursing, lack of social customs and traditions, social and religious freedoms and gender equality. These factors in destination countries were identified as the most important factors affecting nurses’ migration. The reasons for migration vary from country to country, but there are also common reasons. The results of the studies indicate that there are factors affecting migration both in the countries of origin and in the countries of destination, and policy makers and government and health officials in both groups of countries intensify or weaken the migration process with their decisions.
Conclusion
 nurses and especially young nurses from third world countries had a high desire to immigrate. Not paying enough attention to the socio-economic status and the position of nurses, their livelihood and welfare issues, the problems of their work environment and questioning and damaging their reputation in the field of health; all these factors create a lack of motivation and a severe drop in the morale of these irreplaceable and valuable assets of the healthcare system, and there would be no other way for them but to leave the country and emigrate. On the other hand, the destination countries pave the way for their migration with tempting financial and welfare offers and better opportunities. The management of this issue has become one of the basic and priority challenges of the health management system, and therefore it has caused many concerns regarding the distribution of specialized manpower such as nurses in the future. Considering the multi-dimensional causes affecting the migration of nurses, in order to manage this phenomenon effectively, special attention and structural reforms in the social, cultural, political and economic dimensions are needed in the countries of origin.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Tehran Medical Branch (Code: IR.IAU.TMU.REC.1401.279).


Funding
This article is taken from the master's thesis of Alireza Khorram, approved by the Ethics Committee of Islamic Azad University, Tehran Medical Branch (Code: IR.IAU.TMU.REC.1401.279).
Authors contributions
All authors equally contribute to preparing all parts of the research.
Conflicts of interest
The authors declared no conflicts of interest.