Cooperation Between Italy and Albania to Face Nurses’ Shortage: Insights from Italian Recruitment Process

In Italy, the number of nurses per 1000 population (6.2) is lower when compared to the average ratio of other European Countries (8.8) (OECD, Health at a glance 2020: OECD indicators, OECD Publishing, 2020). The shortage of nurses has been recognized as a key problem of the industrialized countries (Kingma in Health Serv Res 42:(3p2):1281–1298, 2007; OECD, Health at a glance 2008: OECD indicators, OECD Publishing, 2008) and continues to impact the national healthcare system’ service delivery. Two trends have been discussed as impacting the number of nurses in Italy: the first concerns the ordinary turnover related to the high number of nurses who will retire in the next five years (− 29,000); the second refers to the increase in the demand for nursing to enhance the primary care services, following the reforms steaming from the Recovery Plan (+ 21,000) (Ministero dell’Economia e delle Finanze, Conto annuale 2020). Given the nursing staff shortage, over time, countries have introduced the cooperation agreements with other countries to reduce the impact of the phenomenon (Cabanda in Asian Politics & Policy 12:404–431, 2020; Plotnikova in Recruiting foreign nurses for the UK: the role of bilateral labour agreements, University of Edinburgh, 2012). This practice is well rooted among many countries, both the USA and Central and Northern Europe (Brush et al. in Health Affair 23:78–87, 2004; Buchan in International recruitment of nurses: United Kingdom case study, Queen Margaret University College, 2002; Khadria in Health Serv Res 42(3p2):1429–1436, 2007; Reiff et al. in Handling the shortage of nurses in Germany: Opportunities and challenges of recruiting nursing staff from abroad, 2020). Nevertheless, administrative burdens linked to the recruiting have been deemed to hamper the recruitment (Reiff et al. Handling the shortage of nurses in Germany: Opportunities and challenges of recruiting nursing staff from abroad, 2020). In addition, hiring internationally educated nurses may entail issues related to healthcare services’ provision (Li et al. in Int J Nurs Sci 1:314–317, 2014). For instance, the level of qualification and the host country’s language proficiency of foreign-educated nurses can influence the quality of patient care (Habermann and Stagge in Journal of Public Health 18:43–51, 2010; Schilgen et al. in Applied Nursing Research 46:57–66, 2019). Cultural factors can also affect the satisfaction of patients’ needs, if the expat nurses are not trained to deal with the professional values and principles of the context in which they will work (Morin and Talbot in Cultural Intelligence of Expatriate Health Workers in an Inuit Context: an Exploration of Managerial Competency Profiles, 2021). Further, internationally non-homogeneous nurses’ qualification profiles and professional expertise can bring conflicts in multicultural teams when carrying out operational practices (Reiff et al. in Handling the shortage of nurses in Germany: Opportunities and challenges of recruiting nursing staff from abroad, 2020). While studies on problems experienced by expat nurses saw a consolidated expansion over time, scant research aimed at deepening potential actions to face such issues (and the related outcomes) has been produced (Ghazal et al. in Western J Nurs Res 42:373–392, 2020). Thus, this paper aims at identifying the weaknesses and potential actions to improve the anticipatory and in-country adjustment (Black et al. in Academy of Management Review 16:291–317, 1991; Bhaskar-Shriniva et al. in Academy of Management Journal 48(2):257–281, 2005) and retention (Almansour et al. in International Nursing Review 69:125–131, 2022) processes of expatriate nurses in the Italian context. To this regard, the multiple case study research was conducted (Yin in Case Study Research: Design and Methods, Sage, 2003) to investigate the adjustment and retention strategies adopted by three Italian healthcare cooperative organizations and by a company experienced in recruitment considering their aim to recruit Albanian nurses. Potential actions implemented to solve the limitations detected by the recruiters were also examined. Data were collected through focus groups and semi-structured interviews, then analysed using the qualitative content analysis method. The paper allows us to identify the implications related to the international nurses’ recruitment in a Mediterranean country such as Italy as well as at exploring the actions that the recruiters have taken or are urged to take to implement effective adjustment and retention processes. The results will be discussed considering the stream of literature available on international nurses’ recruitment and will inform a larger study of the nurses recruiting process in the Italian context.