Nursing Shortage and Outsourcing Boom - Essay Example

Ethical Problems in Outsourcing Expatriate Nurses Introduction Outsourcing has become an increasingly adopted way of work in the global marketplace. Several countries in the United States, UK, Europe, and Middle East have been regularly recruiting foreign-educated nurses in large numbers to meet the domestic gaps in availability of registered nurses. The need for adequate number of such healthcare professionals from any source whatever at hospitals worldwide can hardly be called in questions. At the same time, the growing mode of outsourcing expatriate nurses is also beset with several ethical issues that need to be addressed in order to make this unavoidable practice internationally acceptable. This paper attempts to identify one ethical problem that arises from the practice of recruiting nurses from other countries. Ethical problems have to be resolved by invoking the application of ethical principles. An attempt is therefore being made here to discuss the ethical problem using one such ethical principle. Literature Review The subject matter is examined in the light of available online studies and reports relating to the issue of outsourcing nursing staff. For instance, the Outsourcing Journal has a story by Todd Hintze, entitled "Healthcare providers' perfect storm and how outsourcing can help weather the winds." NewsFactor Magazine Online however points to the "Possibilities and pitfalls of outsourcing." The American Journal of Nursing cited "The global reach of nursing shortage." Ludwick and Silva wrote a well-researched article on "Nursing around the world: Cultural values and ethical conflicts." Details of the literature reviewed are given under 'References' at the end of this paper. Nursing Shortage and Outsourcing Boom The shortage of qualified and competent registered nurses in hospitals has emerged as a major problem being faced by healthcare institutions worldwide, especially after the start of the new millennium. In the United States, for instance, this has taken on the color of a significant staffing crisis. Susan Trossman, reporting for the American Journal of Nursing (2002), cited a 2001 survey by the American Hospital Association (AHA) that disclosed a vacancy roster of over 126,000 registered nurses across 715 hospitals throughout the country. The report also showed that this phenomenal shortage was not limited to the US, but as estimated by the International Council of Nurses (ICN), several other countries, including UK, Canada, Netherlands, and Zambia were in no better position. Canada, for instance, would require about 10,000 new nursing staff every year through to 2011, but can only train about half that number domestically. Healthcare institutions and individuals in the US have been lobbying hard with federal and state governments to ease immigration rules to allow greater influx of foreign-educated nurses to meet the growing shortfall (2002). In the United Kingdom, the nursing sector hires more foreign workers than any other sector. The Information Technology sector comes second, with about 85% of a total of 22,000 expatriate IT staff hired in UK hailing from India alone. Ann Swain, CEO of the Association of Technical Staffing Companies (ATSCo) made an interesting remark: "The irony is that while low-skilled IT jobs continue to be shipped to India, highly skilled Indian professionals are coming to the UK to take up managerial roles." (CIPD, 2005). Rosenthal reports about outsourcing in the customer relationship management (CRM) process at the Cedars-Sinai Medical Center in Los Angeles because "hospitals need nurses on the floor, not answering the phone"(2005). Ethical Issues and Conflicts Ethics is all about cultural and moral values that have come to be traditionally recognized by society. Ludwick and Silva (2000) have defined it in these words: "Ethics has many definitions but, typically, ethics is viewed as a systematic way of examining the moral life to discern right and wrong; it also requires a decision or action based on moral reasoning." Ethics are essentially rooted in cultural values, beliefs, and ideals that an individual or a society accepts and abides by. Such value systems generally apply across various fields of human activity and behavior. Nursing is no exception. The risks associated with outsourcing are many. The impact of depriving hospitals that resort to excessive outsourcing from the tax-exempt status is one. Another is the scope for low employee morale, especially in an environment where unemployment has been increasing. (NewsFactor Magazine, 2005). In the US, for instance, nursing ethics and value systems are essentially based on the principles of individualism and self-reliance that lies at the core of American culture. In contrast, the majority of other world cultures (70%) are committed to the values of collectivism, where group interests take precedence over individual preferences (2000). This can have the effect of generating ethical problems or conflicts among staff and service beneficiaries from different nations and culture. As Ludwick and Silva noted, "ethical conflicts occur when a person, group or society is uncertain about what to do when faced with competing moral choices" (2000). To cite an instance, a nurse from a largely vegetarian-oriented nation serving in a US hospital might experience problems in serving a non-vegetarian diet to patients. The Problem of Exploitation and Equity Most countries have legislation that provides for equal opportunities in employment, irrespective of age, gender, color, race, or nationality. Likewise certain laws also ensure justice in matters of employment for certain 'protected groups' and minorities. In the US, for instance, as Mary Foley, ANA president emphasized, "every qualified nurse has the right to seek employment in the United States, just as we believe US nurses should have the same opportunity to practice in any other country of their choice" (Trossman, 2002). However, what is not acceptable is "the practice of luring highly skilled nurses from South Africa, India, and other countries that depend greatly on these health care practitioners' skills and talents, to work in health care facilities here" (2002). An important ethical concern that arises here is the fact that such a brain drain from an impoverished and ill-equipped developing nation to the developed world amounts to robbing Peter to pay Paul. Rice, chairperson of the Legislative Coalition of Virginia Nurses queries: "When we have a nursing shortage and ease our immigration laws, what we're doing is stealing nurses from other countries. What happens in those countries when the brain drain occurs" (2002). This process of outsourcing foreign-educated nurses also has the indirect impact of possibly denying the same job opportunities to domestic hands by supplanting with expatriates. Even on assuming that a genuine shortage exists that cannot be filled locally due to non-availability of registered nurses, indiscriminate outsourcing of foreign hands can act as a dampener on the potential of training and developing more staff domestically. Yet another ethical dilemma concerns the human dimensions that emerge from uncontrolled exploitation of a global nursing workforce. The US administration and the ANA are concerned to ensure prevention of exploitation of foreign nurses after they sign up with health care institutions. Exploitation in this context mainly refers to sub-standard working conditions and other forms of unfair treatment. Among several examples cited by Foley, one case related to the fraudulent issue of 225 visas obtained by an agency for hiring Filipino nurses as nursing aides at lower salaries against regular nurse posts. In this case, the Immigration and Naturalization Service of Chicago District imposed a fine of $1.29 million against the offender (Trossman). The Solution Ethical problems need ethical solutions based on time-tested ethical principles that are globally accepted. Certain ethical values are universal, and not confined by national boundaries. In the problem under discussion, a solution lies in resorting to the golden principle of justice. This principle, as suggested by Ludwick and Silva, comprises of two dimensions, namely autonomy and fairness (2000). Autonomy, as an ethical principle, "is related to self-determination, that is, the individual's right to make decisions for him or herself" (2000). It implies as a corollary the need for respecting others' autonomy. Fairness is the bedrock of justice, wherein none is denied what is his due. While absolute autonomy may lead to imbalances in ownership or possession, it is the fairness implied in the principle of justice that resolves the ethical problems that arise. Conclusion In the global health care marketplace, outsourcing of nursing staff from overseas has come to stay as an inescapable reality. It certainly has cost benefits and other advantages, but has to guard against potential pitfalls and ethical predicaments. When industries encountered stormy weather, "outsourcing provided a viable means to weathering the storm. When healthcare providers outsource, they focus on the outcomes they want to achieve, then set appropriate parameters. . . An outsourcer understands the relationship between cost and complexity" (Hintze, 2004). Steering through the ethical dilemmas, cost, and complexity constraints is perhaps best done by banking on the principles of justice, fairness, and equity while respecting autonomy to the extent possible. References American Journal of Nursing. (March, 2002). Global reach of the nursing shortage". Vol. 102, Issue 3. Retrieved November 27, 2005, from http://www.nursingworld.org/AJN/2002/mar/Issues.htm CIPD. (2005). Most foreign IT workers in UK are from India. Retrieved November 26, 2005, from http://www.cipd.co.uk/new/_articles Hintze, T. (2004, August 17). Healthcare providers' perfect storm and how outsourcing can help weather the winds. Outsourcing Journal. Retrieved November 27, 2005, from http://www.outsourcing-journal.com/aug2004b-everest.html Ludwick, R. & Silva, M.C. (2004, August 14). Nursing around the world: Cultural values and ethical conflicts. Retrieved November 26, 2005, from http://www.nursingworld.org/ojin/ethicol/ethics_4.htm NewsFactor Magazine Online. (2005, November 23). Possibilities and pitfalls in outsourcing. Retrieved November 27, 2005, from http://www.newsfactor.com/story.xhtmlstory_id=39663 Rosenthal, B.E. (2005). Hospitals need nurses on the floor, not answering the phone. Retrieved November 26, 2005, from http://www.outsourcing-crm.com/cedars.html * * * * Read More