The Journal of Nursing Research

The Lived Experience of Indonesian Nurses who Worked as Careworkers in Taiwan

--Manuscript Draft--

Manuscript Number: JNR-D-18-00298

Full Title: The Lived Experience of Indonesian Nurses who Worked as Careworkers in Taiwan

Article Type: Original Articles

Corresponding Author: Nursalam Nursalam

Surabaya, Jatim INDONESIA

Corresponding Author Secondary

Information:

Corresponding Author's Institution:

Corresponding Author's Secondary

Institution:

First Author: Nursalam Nursalam

First Author Secondary Information:

Order of Authors: Nursalam Nursalam

Ching-Min Chen

Ferry Efendi

Eka Misbahatul Mar’ah Has

Laily Hidayati

Setho Hadisuyatmana

Order of Authors Secondary Information:

Abstract: Background: Despite the large number of migrating Indonesian nurses to Taiwan to
work as careworkers, no literature has been found to explain the underlying situation of
this phenomenon.
Purpose: This study aimed to elicit and describe the lived experience of Indonesian
nurses being care-workers in Taiwan.
Methods: Phenomenological research was used to explore the experiences of
Indonesian nurses working in long-term care facilities. The participants were recruited
from care facilities in Taiwan. This study utilised semi-structured interviews conducted
with sixteen Indonesian nurses in a suitable setting. All of the interviews were
transcribed, and the work of Van Manen was used to analyse the data.
Results: Four main themes were identified from the migrant nurses: expecting a better
life, the feeling of being trapped, a difficult journey and the feeling of being supported.
These themes reflected the lived experience of Indonesian nurses while working in
Taiwan’s long-term care industry.
Conclusions: The nurses who migrated to Taiwan were driven to move by their poor
financial background and the chance of a better life when applying for work. However,
they were stressed, challenged, and disappointed when faced with the unmet
expectations of being employed as careworkers without a clear career path. Facing an
unfamiliar language was also raised as one of the big barriers to carrying out their role.
Better policies should be put in place in order to have mutually improved outcomes for
both countries.

Suggested Reviewers: Angeline Bushy, PhD

Professor & Bert Fish Endowed Chair Community Health Nursing, University of Florida
Angeline.Bushy@ucf.edu
Expert in this field.

Eileen Savage
Professor, University College Cork College of Medicine and Health
e.savage@ucc.ie

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Title Page

The Lived Experience of Indonesian Nurses who Worked as Careworkers in

Taiwan

Short Title: Experience of Indonesian Careworkers in Taiwan

Nursalam Nursalam1*, Ching-Min Chen2, Ferry Efendi3, Eka Misbhahatul Mar’ah

Has4, Laily Hidayati5, Setho Hadisuyatmana6

Authors

1. M.Nurs (Hons), RN, Professor, Faculty of Nursing, Universitas Airlangga,

Surabaya, Indonesia

2. DNS, RN, Professor, Research Center for Humanities and Social Sciences,
Department of Nursing, College of Medicine, National Cheng Kung
University of Taiwan, Tainan ROC Taiwan.

3. PhD, RN, Department of Community and Mental Health, Faculty of Nursing,

Universitas Airlangga, Surabaya, Indonesia

4. M.Kep, RN, Department of Community and Mental Health, Faculty of Nursing,

Universitas Airlangga, Surabaya, Indonesia

5. M.Kep, RN, Department of Basic, Medical-Surgical and Critical Care, Faculty

of Nursing, Universitas Airlangga, Surabaya, Indonesia

6. M.NS (CommHlth&PC), RN, Department of Community and Mental Health,

Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
Address correspondence to:

Prof. Dr. Nursalam Nursalam, M.Nurs (Hons)

Professor, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

Jl. Mulyorejo Kampus C Unair Surabaya Indonesia 60285

+62315913257 (Office)
Email: nursalam@fkp.unair.ac.id

Author Contribution

Study conception and design: NN, CMC, FE, EM, LH, SH

Data collection: FE, SH

Data analysis and interpretation: FE, EM, LH, SH

Drafting of the article: NN, CMC, FE, EM, LH, SH

Critical revision of the article: NN, CMC, FE, EM, LH, SH

Manuscript (including structured abstract and keywords) Click here to view linked References

The Lived Experience of Indonesian Nurses who Worked as Careworkers in

Taiwan

Short Title: Experience of Indonesian Careworkers in Taiwan

5 ABSTRACT

Background: Despite the large number of migrating Indonesian nurses to Taiwan to

work as careworkers, no literature has been found to explain the underlying situation

of this phenomenon.

Purpose: This study aimed to elicit and describe the lived experience of Indonesian

10 nurses being care-workers in Taiwan.

Methods: Phenomenological research was used to explore the experiences

of Indonesian nurses working in long-term care facilities. The participants were

recruited from care facilities in Taiwan. This study utilised semi-structured interviews

conducted with sixteen Indonesian nurses in a suitable setting. All of the interviews

15 were transcribed, and the work of Van Manen was used to analyse the data.

Results: Four main themes were identified from the migrant nurses: expecting a

better life, the feeling of being trapped, a difficult journey and the feeling of being

supported. These themes reflected the lived experience of Indonesian nurses while

working in Taiwan’s long-term care industry.

20 Conclusions: The nurses who migrated to Taiwan were driven to move by their poor

financial background and the chance of a better life when applying for work.

However, they were stressed, challenged, and disappointed when faced with the

unmet expectations of being employed as careworkers without a clear career path.

Facing an unfamiliar language was also raised as one of the big barriers to carrying
25 out their role. Better policies should be put in place in order to have mutually

improved outcomes for both countries.

Keywords: lived experience, Indonesian nurses, foreign careworker, Taiwan.

30 Introduction

A critical shortage of nurses in high-income countries contributed to the active

recruitment of nurses coming from developing countries, including Indonesia (Efendi,

Chen, Nursalam, Indarwati, & Ulfiana, 2016; Efendi, Mackey, Huang, & Chen,

2017). Globally, migration of nurses driven by high demand in receiving countries is

35 recognised as a quick remedy for the large demand in aged care services and to

improve adequate staffing levels (Buchan, 2006). Indonesia has become one of the

international players involved in the sending of careworkers to meet the global

demand (BNP2TKI, 2014; Efendi, Nursalam, Kurniati, & Gunawan, 2018). In the last

decade, Indonesia has encouraged nurse migration as an economic benefit to the

40 global market, underlining the scope for overseas occupation as a professional nurse

(Efendi et al., 2009).

Responding to the international recruitment of health professionals, the World

Health Organisation regulated this movement by issuing the WHO Global Code of

Practice (World Health Organisation, 2010). The code emphasises and promotes the

45 ethical recruitment of health personnel in order to minimise brain drain and brain

waste, specifically from developing countries. The code acts as a guide for receiving

countries to promote and respect fair labour practices for all health personnel (World

Health Organisation, 2010).

The latest data showed that Taiwan was the most common destination for

50 nurses migrating from Indonesia with a total placement of 597 nurses by 2013

(BNP2TKI, 2014). It is surprising to know that Taiwan became the top destination for

Indonesian nurses; 75% (178,205 labourers) working in Taiwan were taken on by the

informal employment sectors (KDEI, 2015). However, little is known on their level of

education, placement channels, type of employment, and background as the reasons

55 behind their migration to Taiwan. This situation worsens with incomplete and

inconsistent data on migration in the existing literature (Clemens & Pettersson, 2008).

Taiwan, as a developed and wealthy country, has attracted foreign labour

workers including those from Indonesia. The Council of Labour Affairs (CLA) firstly

allowed Taiwan to accept foreign workers in 1989. Three years later, the nation

60 started to recruit foreign careworkers in 1992 and onwards to meet the rising care

needs of the elders (Kung, 2002). Recently, the number of foreign labour has

exceeded 440,000, mostly from Philippines, Thailand, Indonesia, Malaysia, Mongolia

and Vietnam (Ministry of Interior, 2013). Earlier in 2016, there were 245,180 of

Indonesian registers working as careworkers in Taiwan (KDEI, 2015). Although the

65 number was slightly reduced in 2017 (190,587), Indonesia remains ranked first as a

careworker-exporting country to Taiwan (ROC Taiwan Ministry of Labour, 2017)

In spite of Indonesian nurses movement to Taiwan, there are a limited number

of studies capturing what their have faced and what has pushed them to work as a

careworker in Taiwan. Foreign careworkers have become an important part of care

70 provision in Taiwan’s Long Term Care (LTC) industry despite little information

about their lived experience. This study has explored their lived experience, from

when they are working and living in Taiwan. This study gathered insights from their

perspective to improve future placements and maximize the potential mutual benefits

of both countries.

75 Methods

Research Design

This study was conducted using phenomenological approach was to illuminate

the lived experience of being a careworker in Taiwanese Long-Term Care Institutions.

 An interpretive phenomenology was employed to better understand the nature of the

80 essence through the participants’ perspectives (Van Manen, 1997). In attempt to

conduct precise analysis and interpretation, participant-friendly settings were pre-

arranged to allow for the provision of rich and deep information.

Participants

Indonesian nurses who have worked as careworkers in Taiwan’s long-term care

85 institutions were purposively involved as participants in the study. The inclusion

criteria were that they were Indonesian nurses who (1) have lived and worked as a

care-worker in Taiwan for a minimum of six months and (2) hold an entitled role as

an enrolled nurse in Indonesia. The size of the research participant population was

pre-determined, but only until data saturation was reached. Twenty-four careworkers

90 from different regions of Taiwan (Taipei, Tainan, and Kaohsiung) were contacted as

potential participants for this study. The recruitment of the participants was through

the snowballing technique due to the scattered location of the nurses throughout

Taiwan.

Data Collection

95 The data collection was conducted between August and September 2017. The

participants were contacted and informed prior to their voluntary participation. The

data were collected using a pre-designed semi-structured interview for 45-90 minutes

each. The questionnaire was designed to unveil (a) the reason for their migration; (b)

their lived experience while working as careworker; (c) barriers prior to cultural

100 differences; (d) unwanted events; (e) experiences that they have lived and (f)

recommendations for nurses who wanted to come to work in Taiwan. SH and FE were

employed to obtain the data through interviews and to engage with the in-depth

information from the perceptions and experiences of the participants. The interviews
 were audio-recorded and transcribed verbatim. No new themes emerged after 16

105 interviews.

Ethical Consideration

The Universitas OOO Health Research Ethics Committee (HREC) in Surabaya,

Indonesia (OOO) approved the ethical clearance of this study. Written consent was

obtained prior to the interviews being conducted. The participants were assured that

110 their data would remain confidential and be used only for this research purposes.

Access to this study’s data has been maintained only for the members of the research

study.

Data Analysis

The data was carefully analysed after transcription following the work of Van

115 Mannen’s (1997) phenomenological approach, including: (1) emphasizing on the

phenomenon by developing the research question around the essence of being

careworkers in Taiwan; (2) selecting the participants and undertaking interviews to

explore the everyday lived experience; (3) recognising and identifying on the

important themes; (4) describing the lived experience by writing the phenomenon; (5)

120 preserving a solid and oriented relation and (6) considering the balance of research

context by taking into account the parts and the whole. QSR NVivo 11 software was

used to assist in the analysis, exploring the content themes. Four themes emerged

through this process, which were then used to describe the participants lived

experiences accompanied by one verbatim excerpt each.

125 Rigor & Trustworthiness

The rigor and trustworthiness of this study was examined following the work

by Lincoln and Guba (1985), maintaining the concept of dependability, credibility,

confirmability, and transferability. A professional transcriber was hired to translate

 the verbatim data for each interview session. The transcribed data was then reviewed

130 by the team of this research study and an external expert to address the dependability

issue. Three ways were used to improve the data’s credibility. First, the researchers

have been formally qualified in qualitative data collection method. Second, the

researcher asking the feedbacks on the quality of the data and subsequent

interpretations from an expert in hermeneutic phenomenology. Third, the Indonesian

135 careworkers were invited to give suggestion and comment on the data.

The confirmability aspect of this study was maintained by sending back the

results to the participants. The transferability was evaluated by providing a thick

description of the study which fits with other contexts.

Results

140 Participants’ Description

Sixteen Indonesian nurses who have worked as careworkers participated in this

study by way of an individual interview. Most of the participants were women (n =

11), with their age ranging from 22 to 41 years old, single (n = 11), holding a

Diploma in Nursing as their highest level of Education (n = 12) or higher (BSN n =

145 4). The nurses mostly originated from the province of Jawa Tengah (n = 9), and are

currently working and living in the municipal area of Taipei (n = 8). All of the

participants were identified to have been living in Taiwan for more than two years (n

= 11), with a net-salary ranging from 15,000-30,000 TWD per month (See Table 1).

Table 1 is here

150 Findings

Following the work of Van Mannen’s phenomenology, this study revealed four

themes and eight sub-themes, including (1) Motives for working abroad: financial
 motives, and in search of different life-experiences; (2) Feeling of being trapped:

victim of fraud, losing their professional identity, losing their professional skills; (3)

155 Difficult journey: communication inadequacy, limited career pathway and (4) Feeling

of being supported: support from their employer, and support from the recruiting

agent.

Theme 1: motives of working abroad

Being of a poor financial background has driven the nurses to migrate to

160 Taiwan, expecting to have a better future. Nevertheless, there are some nurses who

rejected this reason and upheld the experience of working abroad as their reason. All

of these responses refer to the first theme identified in this study, and they reflected

their personal goals of moving to Taiwan to live and work. They initially believed

Taiwan to be a place where they could earn money and gain more experience.

165 Financial motives:

Most of the nurses’ reasons behind their migration to Taiwan were driven by

their families’ poor -economic situation. The nurses expected that working in Taiwan

would improve their financial situation and, thus, support their family needs. As

participant 5 described,

170 “...my family need my support to live in a decent life.”

The following participants were encouraged by the higher salary offered by the

recruiting agents in their home country. As participant 3 and 5 replied,

“…Second, was the economy (motive)… I know that the salary was low. It was

175 far under my expectations. Here, good-Lord, it is far better than in Indonesia”
 “I am here because the offered salary is much higher than in Indonesia. By doing

a similar job, I can earn five times higher...”

In search of a different life experience

180 For some of the nurses, money was not the only reason to migrate to and work

in Taiwan. Moreover, acquiring experience of working away from the country of their

birth was more interesting for them. Participant 11 and 1 respectively recalled:

“I really want to go abroad to acquire new experience; working in foreign

countries has challenged me. Frankly speaking, I was hoping to go to Japan, but

185 I failed and this brought me here.”

“I was just, like… I wanted to know better the differences in the medical and

nursing instruments used in caring for patients here, and what nurses do in

Indonesia... yeah, especially about the instruments they (refer to Taiwanese

190 nurses) use...”

However, other participants put the life-experience of working abroad as their

first priority. Participant 4 underscored that:

“...My very first reason (of working abroad) was just wanting to go abroad,

195 looking for life experience”

Theme 2: Feeling of being trapped

Nurses who have worked as a careworker in Taiwan revealed that they were

faced with unexpected experiences while working and living in Taiwan. Eventually,
200 they felt trapped in the different nursing qualification system as they were hoping to

work as professional nurses.

Victim of a fraud

Some participants who came, in their first experience of working as care-

workers, did not know that they had to do the work of others lower than their

205 previously-held qualifications. They were persuaded by a higher salary and the easy

work. Participant 10 recalled that:

“I was lulled by their (recruiting agency) sweet offer… a high salary and the

load (workload) wouldn’t be heavy. Only five days of work per week, eight hours

per day. But it didn’t work out. I have to work 12 hours a day, and the five

210 working days was a heavenly promise only...”

Losing their professional identity

Almost all of the participants started to realise that it was not possible for them

to transfer their qualifications and work in Taiwan. as the country’s system does not

215 recognise foreign nurses working as professional nurses. Participant 8 stressed that:

“... we felt very sad, our status is not clear here. We have a high degree in

nursing from our country but here, we are nothing. Maybe there is another way

to solve this problem.”

220 Participant 10 stated that working as their professional background dictated

was only a promise without truth in it.

 “...To be honest, it was not like what I expected. When I first arrived, I didn’t see

it (as part of my job)…I was given the dirty parts to clean, tidying up the

mess…or just (helping) old-people in what they wanted to do”

225

Losing their professional skills

The participants also discussed how they felt losing their skills, first by

working in a nursing home but also working in LTC facilities and not being able to

perform procedures that they were competent at doing. They reasoned that they were

230 made to put off their learned and trained skills, and saw that there was no further

future for their career. As participant 15 stated:

“…I am not allowed to practice some of the skills that I know I can do. Like

suction, as long as you are qualified, we were allowed to do that back home. I

think that only Taiwanese nurses are allowed to perform this procedure.”

235

For some of the nurses, they started to compare what they might be allowed to

do under their respective qualifications. As participant 10 recalled:

“...Unlike other nurses in Indonesia, we don't have any right to give an injection

240 or other things that they may do in their job...”

Theme 3: Difficult journey

There was no consensus on the challenges experienced by Indonesian nurses in

Taiwan. However, communicating with aged care residents and other local
245 counterparts appeared to be another big hurdle at work. Other participants identified

that this caused them to be stuck in relation to their career development.

Communication inadequacy

Failure to understand what others have been saying in the local language had

hindered the participants in fully understanding the message conveyed. The

250 participants agreed that this hindrance contributed to their hardship. Furthermore, in

the workplace, it caused a large amount of stress. As one participant identified:

“Taiwanese speak in a different intonation and so quickly. As you can guess, it

causes a lot of stress when I could not understand anything about my patients.”

255 For the younger participants, the language barrier made them to bear others’

problems as their own and taking on all of the consequences, as they were unable to

give themselves a voice. Participant 9 recalled:

“...as a first-timer, I didn't fully understand the language. If other careworkers

made a mistake, all of them were older than me and put the guilt on me. I

260 couldn’t speak for my self... so silence was my only option.”

Limited career pathway

The limited career offered to nurses in Taiwan has become another inevitable

dead-end for Indonesian nurses. They reported that this had a big impact on their

future plans. Participant 11 stated that:

265 “Here is impossible to advance my career. It is just about settling myself, and

just a matter of moving to another country.”

Likewise, participant 4 agreed:

 “There is no such thing as a career. We’re not Taiwanese. Otherwise we have to

270 take another test and have another school to through…”

Finding the situation hard, they even suggested that the younger generation of

nurses should think twice before deciding to work as careworkers in Taiwan.

Participant 1 stressed:

275 “If they were able to put Taiwan as the last option, they should. If they can, they

should think of Japan or the Middle-East. Indonesian nurses would have a

brighter future there...”

Theme 4: Feeling of being supported

Nevertheless, the participants felt that their management were supportive at

280 work. Although, for others, their agents in Taiwan always offered help whenever the

nurses needed help to cope with their current situation.

Support from the employer

The participants agreed that support from the employer or nursing home/LTC

institution was critical to create a supportive workplace environment, as participant 7

285 suggested:

“My nursing home is doing its best to help me adjust and adapt in the new

environment. They are motivating us to learn and study in Mandarin in every

situation. So far, we seldom have a problem with our employer.”

290 Participant 6 added:

“They said to me to keep smiling while working...”

 Support from the recruiting agent

The participants voiced that the role of the placement agencies played a more

nurturing role, particularly when dealing with problems in the workplace. Participant

295 9 said that:

“I was prepared because the agency that helped us gave us a few suggestions for

when we are dealing with any problems in our life. They will come when I

complain about almost anything.”

300 Participant 3 highlighted the supports received from her recruiting agent, as she

recalled:

“..In almost any trouble, my agent came to handle it. If I have any problems with

my employer, they would sent someone. They were very helpful”

305 Discussions

This study elucidates the lived experience of Indonesian nurses who were

working as migrant careworkers in Taiwan. This study revealed the nurses’

underlying reasons for working abroad and their personal experiences while working

as careworkers. This included the situations they had to face, and explored what could

310 be learnt from their experiences. The current trends informs us of the popularity of

working abroad (BNP2TKI, 2014), and narrows the gap by unveiling the learnt

experience from the participants’ first-hand perspective.

The latest data from BNP2TKI (2017) showed that Taiwan was ranked as the

second biggest country receiving Indonesians as migrant labour after Malaysia. The

315 nurses participating in the research stated that the poor financial background of their
 families was a strong drive for them to seek a better future by applying for work in

Taiwan. This finding shared a perspective with previous studies that identified an

economic motive as being one of the pulling factors of the destination country (Aiken,

L. H., Buchan, J., Sochalski, J., Nichols, B., & Powell, M, 2004; ICNM & Buchan,

320 2015). All of the participants agreed that Taiwan was one of the most popular

destination countries for Indonesian nurses to live and work in. Anecdotally the

nurses were attracted by the ease of access when applying to work as a careworker in

Taiwan. However, eventually, they felt neglected by their current position due to their

high expectations of doing what they were allowed to in their home country.

325 However, the opportunity to have a better life was underscored by the nurses since the

currency conversion between the two countries offered them a higher income when

compared to being a nurse in Indonesia. Despite this, other nurses asserted that

gaining experience of working abroad became one of the pushing factors to migrate to

Taiwan (Aiken et al., 2004; ICNM & Buchan, 2015; Kingma, 2007).

330 The expectation of being employed in an advanced technological and

sophisticated health system was emphasised by the participants. However, some

revealed dissatisfaction with their identity and their skills going unused abroad.

Previously, the nurses perceived that being a careworker would result in them holding

a similar role to the nurses’ previous professional work and identity. This

335 misunderstanding was one of the reasons for dissatisfaction among them regarding

their professional identity as a nurse. The term careworker is not well recognised by

Indonesians, which creates a different perception among Indonesian nurses.

Indonesian nurses associate this term with geriatric nurses. Therefore, they expected

that they could work as professional nurses. This situation was also similar to that of
340 the Indonesian nurses who worked as careworkers in Japan under the bilateral scheme

(Kurniati, Chen, Efendi, & Ogawa, 2017).

A clear career-path for foreign care workers should be addressed as an

important component in sustaining the migration cycle within the nursing sector

(ICNM & Buchan, 2015). Nevertheless, the different approach between the two

345 countries has failed to direct this issue. The Government of Indonesia (stated in the

national law number 36, year 2014) recognises nursing as a profession with a set of

roles to be carried out by the certificate holder (Government of Indonesia, 2014). On

the other hand, the health system in Taiwan does not recognise foreign nurses to work

using their certificated qualification to the same level. This finding urges the need for

350 a clear, informed and well-explained contract for Indonesian nurses prior to signing

the contract document related to posting them as careworkers in Taiwan. The term

‘careworker’ or ‘care worker’ should clarified as it confuses nurses who sign-up to

work in Taiwan’s LTC facilities.

Thorsteinsson (2002) reasoned that the need for effective communication is

355 more to assure nurses that they should involve feeling, trust, and empathy in care

delivery. The findings of this study also highlight the importance of effective

communication at work. The participants argued that it signified the accuracy of the

transfer of information among the nurses, careworkers, residents and their manager.

They indicated that the insufficient language became a great challenge in them

360 delivering care and coordinating work. All of which underscores communication as a

critical element in nursing care. The different use of language was perceived by the

participants as a more complex process of communication that requires sets of skills,

techniques, and processes. Therefore, the different languages used in their work
 became an inevitable barrier against the migrant nurses conducting their role as

365 careworker.

The uniqueness of the migration scheme is related to the support of the care

facilities and the agency of Taiwan, which adds to the available evidence around the

studied issue. The participants outlined the support from the Taiwan Long Term Care

(LTC) institutions as being critical for their initial adjustment when working and

370 living in Taiwan. They also stressed that the private recruitment agencies both in

Taiwan and Indonesia should cater assistances for both the employers and migrant

careworkers. The details of foreign careworkers should be provided to prospective

employers by capitalizing the cooperation with the recruiting agencies in target

countries. The agency in the sending country shall assist the selected foreign

375 careworker in completing the formal processes prior to starting the work in Taiwan

(Chen, 2013). As most of Indonesian nurses did not speak Mandarin fluently, the

service from the agency may be of higher perceived importance in relation to their

future needs.

Limitations

380 Given the nature of qualitative research, the findings in this study can only be

transferred to gain understandings of a phenomenon within a similar context and

setting. Secondly, the absence of the Indonesian Nurses’ Association in Taiwan has

limited variety in the participants as a potential resource of information for this study.

Conclusion

385 The nurses who participated in this study were prompted to move by their poor

financial background and better life expectations when applying for work in Taiwan.

In relation to the further findings, they expressed feelings of being stressed,

 challenged and disappointed. The unmet expectation of them being employed as

nurses raised as their unavoidable dead-end feeling during their migration experience

390 as seen in the brain waste context. Thus, it highlights the need for a clear definition

for those who sign-up to work in Taiwan’s LTC facilities. An unfamiliar language

was raised as one of the barriers unavoidable in the area of international nurse

migration from Indonesia to Taiwan. Fortunately, they felt somewhat supported by

the LTC management and recruiting agencies. It is hoped that structured policies

395 related to strengthening the supportive LTCs toward Indonesian careworkers are

standardised over Taiwan.

Implications for Practice

Some findings of this study reveal the challenges encountered by Indonesian nurses

while working in Taiwan’s Long Term Care industry. The results of this study

400 highlight better pre-departure preparation and recruitment processes. Nurses who

intend to work abroad need to know the formal translation of what they are applying

for. The expected implication of this study is to inform future appropriate formula in

migration policies based on the contexts specific to Taiwan. This study recommends

that the policy should change in order to facilitate professional career development in

405 nursing, particularly for those who have migrated to Taiwan. Putting the experiences

of Indonesian careworker nurses into the global market context reveals a cycle of

brain gain, brain drain and brain waste within which hinders the career path of

Indonesian nurses. Taiwan, as a receiving country, may take part to promote and

encourage good practices among recruitment agencies that comply with the WHO

410 global code.

 Acknowledgements

A special thanks to Universitas OOO, Surabaya, Indonesia for funding support to this

study.

415 Conflict of interest statement

Nothing to declare

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Table

Table 1.

Demographic Distribution of the Indonesian Nurses Who Worked as Careworkers in Taiwan,

2017 (N=16)

Characteristic Migrants caregivers

n (%)

Age (Years; Mean (min - max) 27 (22 - 41)

Gender

Female 11 (68)

Marital status

Single 11 (68)

Children in household

One or more 5 (31)

Current Province

East Java 5 (32)

West Java 2 (12)

Central Java 9 (56)

Current region

Taipei 8 (50)

Tainan 3 (19)

Kaohsiung 5 (31)

Highest education
 Diploma 3 in nursing 12 (75)

Having worked experience before emigrating

Yes 16 (100)

Years of residence in Taiwan

≥2 years 11 (69)

Salary while abroad (NTD)

(min - max) 15,000-30,000