Why do male nurses choose to work in foreign countries? A
qualitative study on Chinese male nurses working in Japan
Derong Zeng1, Momoyo Shimosaka1, Xiaoyu Wu2, Despoina Anagnostou1, Ayae Kinoshita1*
1. Graduate School of Medicine, Kyoto University, Kyoto, Japan
2. Faculty of Health Science, Department of Nursing, Kyoto Koka Women's University, Kyoto, Japan.

Background
With the global ageing population, the shortage of nurses is a serious global public health problem. Recruitment of foreign
nurses has been proposed as a solution to the nursing shortage in many developed countries including Japan. However,there are no studies looking at the foreign nurses’ work motivation and experience with the context of Japan.

AimThis study aimed to explore foreign-educated male nurses’ motivation to migrate to a different country and explore thecontextual factors that shaped their career trajectories in Japan.

Methods
A qualitative research design was adopted, using video (zoom), semi-structured interviews. Participants were selected withthe criterion of having a Chinese nationality, holding both Chinese and Japanese nursing licence, and with minimum
clinical experience of 6 months in Japan. Interviews were recorded via zoom and subsequently transcribed. The data wasimported and managed using NVivo software. Two researchers analysed the data independently, using thematicframework analysis. Participants were reached to validate the findings.

Results

Table 2. Factors affecting foreigner male nurses’ work motivation.
In total, 16 male nurses from Eastern and Western Japan
Individual‘I came to Japan for two reasons: I should go out and see
participated in the study (Table1). Their tenure in Japanpriorities
things when I am young. I could not stay in a small placeforever. Another reason was that I heard that Japanese
ranged from six months to eight years. The findings
nurses were well paid, so I came here’. (Pt 16)
confirmed the factors identified in earlier reports as thosethat influenced nurses’ motivation and work (Table 2).
‘My first impression was that the medical system here is
Two new factors were suggested: influence by others andPersonal
very well developed, so for that reason I came here. I
characteris
thought that it would be better to work here first and thensocial reasons (Fig1). The relationship between thetics
return to my country. It's more competitive to have work
various factors was complex and sometimes contradictory.
experience abroad, that's how I feel. (Pt 17)
Table 1. Participants’ characteristics (n = 16).
N (%)
30±2.8

Variables
Mean age (SD+) in years
Years worked in China

Years working in Japan

Educational background

00.5
1
2
0.5-1

1
612

2
3
45678
Vocational training
BSc program
No Answer

221313278
1

Subthemes

Remaining in the 1. To work in other areas of nursing care.
nursing profession 2. To introduce the experience of older adult carein Japan to China.
3. To improve their abilities.
Changing career

Others‘The older family members still cannot accept it (malenurses) and think men have no future in this profession’.
(Pt 10)Workplacecharacteristics‘At the time, there were many countries to choose from,but Japan was closer and the people there were all yellowskinned, like Chinese and Japanese. If you went to Europe
or America, you might feel like you were different, but inJapan, you would feel more like you belong because you
are the same as the Japanese people. Living in Japanmight be easier. ’(Pt 2)

Workingconditions

In the future, I would like to open a visiting nursing
station. Then, if it is a success, I would like to introduce
this model to China’. (Pt 1)

Influenceof others‘Opening a company is currently one of our plans. It will
be more focused on the market and trade aspect, rather
than the nursing aspect. After stabilization, there may beother plans, such as finding a way to expand the company
or establish international connections.'(Pt 9)

8

Table 3. Career Plans.
ThemesInternal,psychologi
calSocialreasons‘The Japanese government set up the social system under
the Japanese colonial system. We are all working class—whether you earn 10 million or less, if your income is high,your taxes will be very high, whether it is income tax oreven paying health insurance or social security—you do not
get to enjoy it much.’ (Pt 7)

Figure 1. Framework of the factors.

1. Engage in international trade.
2. Retake exams to enter medical school as adoctor.
3. Become self-employed.
4. Have a suitable job and want to change career.
1. Staying in Japan and starting a family.
2. Upgrade education.

Conclusions
This was the first study that focused on foreign male nurses’ motivation to seek work abroad with a specific focus on
Chinese nurses working in Japan. The study’s results confirmed perspectives on foreign nurses’ motivation to migrate forwork conducted in other countries. Importantly, it identified two additional influential factors, and thus expanding the current
theoretical factors. The study results may provide a framework for the further development of policy with regards to recruitand retain foreign-educated male nurses, particularly in Japan.

Ethical considerations and conflicts of interest
This study was approved by the Ethics Committee of Kyoto University Hospital (R3261).