Nurse migration and hierarchies of care in the Norwegian health care sector By Susan Savides. Paper at the National Metropolis Conference in Vancouver 2006

Single nurses We were very explicit in whom we were going to select, that we want those who are alone…. Unmarried! Adventurous! To bring a whole family is, you know…. And then the kids are not content, the wife is not content (…) we have to view this from the employers perspective. So if we can choose between someone who is married and someone who is unmarried, and if they are equally qualified, than we have chosen the ones who are free and single. It is much easier, you know, they can live in a rented room. For the others, we have to try and find an apartment and it is not easy for them. And than you have the need for kindergarten and maybe the husband doesnt get a job and that may cause some conflicts. So, here you need to be a little selective." Employer)

Employers success stories We have chosen many handsome young men [Germans]. There is one male who has become a head nurse, and then we have the guy in surgery. Like, we have many. They are very, very proficient, and they have really contributed. So this summer, when I was going to place one, then she said: Oh God, do you have another man? We really want to keep the male that we already have, and we would like to have another one! So, it has been successful. (Employer)

Being similar means being inside Germans slide into Norwegian society. The Norwegian and German cultures are very similar. Germany and Norway are like little brother – big brother and vice versa (Recruitment agent) The Germans are very committed to language (employer)

Medical terminologies vs. private conversations It was much more pleasant to participate in work related discussions than private conversations. I still have troubles with that today. I become insecure, I mean when the clock strikes at three and I am finished at work and I am going to talk to them in private, then I become fairly insecure and I dont have so much to talk about, and I am not used to none-hospital terminologies. I mean, those hospital terminologies resemble… they resemble a lot the German terminologies, right. So you use a little Latin and English and then you may have the same expressions (…) Everything is very similar, also the procedures are very similar, right. (…) I opened the closet, and what I found were German bandages, everything was in German, even the procedures were the exact same as I had thought or as those we had in Germany (Male German nurse)

Being different means being outside It was a nightmare, I must say (…) We demanded that they [the polish nurses] had to pass the Norwegian language courses, otherwise we wouldnt allow them to come.They passed, but even though they passed we werent satisfied. They knew a lot less Norwegian than the Germans did. (…) We had to initiate extra courses. (…) I talked to a couple of them [polish nurses] and they said that they dont need any extra even if there had been complaints about them. So I tried to tell them that there were a couple of vacant places [at the language course] and that it would have been fun for them to try it. So thats also a big difference because we were used to them [Germans] being eager to learn and wanting to learn more. As for the Poles they had received this piece of paper and they knew enough (…) It was a very big difference (employer).

Troublesome Polish nurses The nurses are kind, but the requirements are so strict and there are so many circumstances (…) Their language is so completely different than the Germans and otherwise that they struggle so hard to learn it [Norwegian]. And when things are so unsettled with the Ministry regarding authorization, so we have… We have spent recourses. The wards have spent an incredible amount of recourses because they constantly need training. The patients have probably noticed… (…) We have told them that we have obligations of professional secrecy, but we have become too much like a social service office (employer)

Coming from the east means coming for money Employer2: If you go and talk to them [the polish nurses], then you will find out… (…) The motivation for coming to Norway was probably not about coming to Norway or this city… Employer1: [interrupts] Money! Its about putting aside some money. Plain and simple. And some are trying to bring their families here. (…) They sent all the money home to Poland, right. And then they came here and said that they needed money for food. Emloyer2: More money! Had to explain to them that you have to keep some money so that you will be fine. You must not send off the entire amount.

Upwards professional and social mobility You have very traditional hierarchical systems [in Germany] (…) You dont work as autonomous; youre an assistant, a doctors assistant. Not a slave, right, but it is the doctor who is in charge. Here [in Norway] it is a completely different reality, here you have an independent profession with a lot of competence (…) Here you have more democracy, the way I have experienced it. I know that not everybody… especially nursing homes are different, but the way I have experienced it; you sit down together in the morning, you chose a group leader, you distribute tasks evenly as best as you can, you evaluate, you have time for feedback. Its a dream job. You have better salaries, shorter work hours, you work every third weekend which is a dream. (…) (German male nurse) And then the whole world looks at Germans like; oh they are so competent, and things like that, so therefore people listen to you right away when you say something. (…), so you are representing a society you really dont know that much about. Like, I didnt know that Germany was so ahead with everything. (…) (German male nurse)

Loss of status and self confidence I had so much self confidence and believed that I knew a lot, that I often said: I do understand a lot, really I do understand a lot. Maybe I cannot express myself as well, but I understand a lot. But now, when I think about it, I realize that I didnt understand very much (…) I mean communication is a different thing. It is very important at work, in my profession, because we work with people. We dont work with apparatuses or machines, but we work with people. (…)What bothered me is that I felt really stupid. I wasnt used to that because in Poland I had achieved a high status as a nurse. I was head nurse and... so I had high status and I was the one guiding and teaching the others. Now I was reduced to the most stupid one at the hospital ward. Maybe..... well my colleagues didnt say this or give me the impression that they thought I was stupid. I thought so myself. I felt very stupid, and then I had the impression that patients... that they thought and maybe they said to themselves Oh my God, who is that person taking care of me, who is that, she doesnt know anything and that wasnt right because I have..... I had very good qualifications and.... but I couldnt explain anything... (Female polish nurse)

Important things in life and emotional surplus value Yes that was wonderful [working in the nursing home]. I never thought that it would be that good. In my professional life I always worked in emergency rooms. It was surgery. Operations... I was used to action, adrenalin and things happened all the time, and so I thought; Oh, how will it be working with elderly people when doing the same things all the time and talking about the same things - no challenges at all?...things like that. But it was really good. I have experienced a lot. I have learned a lot and I knew other values in life before, but those are not the most important in the world. The most important is for example to sit beside someone and holding someones hand and let him talk, for example, and things like that. So it was very, very good. (Female Polish nurse)

Language and patient communities in a nursing home No, most of our patients are senile. They do not remember us from the one moment to the next. They are totally dependent on around-the-clock care from us. They cannot eat, drink, go to the toilet or do anything without help (Female Latvian nurse) Old people and nursing home patients talk a language typically for their generation and a language that is only relevant for situation as patients. When I come out in society, young people like me use different words that are more modern…. (Female Latvian nurse)