International Nurse Migration - Essay Example

? International Nurse Migration International Nurse Migration Nurse migration has concerned a great deal of media as well as political attention currently. The position statement is whether the shortage of nurses can be addressed through international migration. The nursing shortage that is growing, and changes to trade agreements in the United States has led to increased efforts by U.S employers in health care to hire, recruit and utilize registered nurses that are educated in foreign countries so as to curb the shortage of nurses in U.S. Throughout history, migration of nurses has been based on either individual contacts and motivation or opportunity (Buchan, 2001). Planned recruitment of nurses internationally has been taking place, in the past decade period, developed nations recruiting nurses from developing nations and other developed nations. Additionally, developing nations are recruiting nurses from each other, especially within similar regions geographically. As a result of this statistics recruited health professionals from countries represent over a quarter of the nursing workforces of The U.S, Canada, Australia and the U.K (Aiken, 2004). The reasons for migration of nurses is as a result of pull or push factors. Pull factors are factors that attract the nurse in the direction of another country. This includes; quality of life perceived to be better, career development, personal security, learning opportunities and better pay (Buchan, 2001). Push factors are circumstances that drive a nurse to leave their country to search for greener pastures elsewhere. They include inadequate remunerations, lack of standard work equipment or facilities, career development options lacking and political instability in their country (Awases, 2003). The consequences of the pull or push factors leading to migration of nurses to other countries has dealt a huge blow in their countries of origin. More common is the brain drain which is experienced by donor countries that is the loss of personnel that is skilled and also loss of development in education due to human resources that are limited migrating elsewhere (Awases, 2003). Also, migration of nurses threatens health globally since recruitment and hiring of nurses in developing countries leads to a vacuum in developing nations thus health services in such countries are compromised. Moreover, International migration by nurses undermines the capacity of countries to deal with regional, national and global commitments and also their individual development. The Commonwealth Code of Practice for the Recruitment of Health Workers Internationally has discouraged greatly health workers recruitment from nations that experience shortages, and also due to the above negative consequences of health workers recruitment. Aiken, et. al (2004) agree, basing their argument on the fact that developing nations require to come up with their own workforce of nurses that are able to cater for their countries needs and ensure that those nurses are well compensated, and that they experience good working environment. Despite all the above negative consequences, there is a positive impact on the recruitment of nurses internationally. This includes economic benefits in relation to income remittance generation. These remittances are estimated to contribute over $70 billion globally to world economies. According to Buchan (2001), the negative consequences of international migration of nurses on donor countries are starting to get acknowledged, but they have not yet been fully dealt with. A balance should be maintained between the push factors driving nurses to migrate, and the utilitarian concern on health of donor countries due to loss of scarce nurses. The Commonwealth Code of Practice for the Recruitment of Health Workers Internationally (2003) believes that for such a balance to be possible there must be a mutual benefit. That is minimization of compromise of the donor country by the importer country making an effort to provide help in the form of technology, training upon arrival in the home country, and money or the return of recruits to original country being facilitated. Migration of nurses to countries also poses several dangers for the migrating individual nurse. There is a lack of agencies to oversee regulation and global migration of nurses contracting practices. Also, nurses recruited from foreign countries face the risks of being employed under false pretences and also can be lied about work conditions, remunerations offered and benefits (Aiken, 2004). As a result, they are put at a risk whereby they practice medicine unethically, if not being employed illegally. Buchan (2001) also suggests that nurses from supplier countries may face prejudice and discrimination from their work colleagues, who consider them to be outsiders, thus not receiving respect owed to them. It is imperative for health institutions to provide a conducive working environment by offering education and training that incorporates the acceptance of nurses from foreign countries. According to Aiken (2004), countries recruiting foreign nurses should be careful when making such a decision since in doing so the circumstances that led to nurses shortage in these countries is not dealt with, and also donor nations become disadvantaged. It is very clear, that international recruitment of nurses would be required less if donor nations and countries recruiting concentrated on improving health care related issues in their countries. This includes acknowledgment of their own nurses through better pay, improving working conditions, and empowerment of those nurses. In order for nurses to carry out their profession on a global scale, they are required to meet both criteria of migration and professional standards. The right to practice; for example requires them to have a registration license, and the professional criteria that is the right to work requires them to have a permit of work. But often, they require a set of procedures that are different with a separate set of experienced authorities (Awases, 2003). Qualifications of nurses must be screened systematically to make sure that nurses meet the basic standards of professional nurses required in the recruiting country. This is done due to consideration of the safety of the public. This may be carried out through paper screening; for example, qualifications got from a certain country are automatically recognized. Also, tests like the NCLEX exam on licensing, clinical practice that is supervised, and completion of a program or course successfully (Awases, 2003). Language is a very important mode of communication necessary for both the care giver and patient, and also among health team members. In most recruiting countries, a nurse’s chance is limited if the educated nurse from the foreign country’s language does not support practices of safe care. Therefore, such nurses are required to pass specific tests in specific languages depending on the country that they wish to work. In other countries, the employer is responsible for ensuring competence in language of his employees. Historically, it is evidenced that nurses looking for better prospects migrate to countries that they share a language that is common with (Buchan, 2001). For example, nurses from Morocco will tend to migrate to France while those from Ghana will migrate to the United Kingdom. As the number of nurses that wish to migrate changes, and as competency in language becomes a requirement in career advancement, language barriers in language may become less of a limitation, and we may experience Nurses from Korea migrating to U.S and Nurses from China migrating to Ireland. Nurses that wish to migrate also need to meet the recruiting country’s immigration criteria and national security so that they can enter and stay in the country either on a temporal or permanent basis. This is so, with or without employment access. National Security issues affect mobility of nurses by making their borders in terms of security air tight or open; for example, terrorism attacks lead to border restrictions being tighter while new economic arrangements lead to opening of borders (Awases, 2003). The Position Statement of ICN on Nurse Recruitment Ethics protects the freedom of movement for nurses. It also insists on the need for bargaining in good faith between the employee and employer and health workers’ rights to protection from exploitation and decent work. It also emphasizes on efficient mechanisms of regulation for screening qualifications of nurses as well as for recruitment agencies regulation. Despite all these ethical considerations, there are still issues to be addressed. These includes recruiting nurses from countries that are experiencing a shortage of nurses, refusing to employ nurses that want to improve their living standards and those of their family and also refusing to employ nurses that cannot find work in their native countries. All these concerns raise a lot of ethical questions that lead to implications based on choices made (Aiken et.al, 2004). Different attempts have been carried out to try and reduce the level of migration through international agreements, national guidelines or legislation. However, it has been recognized that nurses’ migration is a feature of the modern world of globalization, and that such measures of control may have the negative effect of interfering with freedom of individuals to move and expose the process of recruitment to even greater double standards and corruption. A careful balance must, therefore, be ensured between labor and human rights of the nurse, and a utilitarian concern for the nation’s population health (Awases, 2003). At the international and national level, different codes of practice that deal with international recruitment or matters pertaining to ethics have been introduced. However, their efficiency is yet to be verified; and their systems of support, sanctions or incentives, and monitoring implementation means continue to be non- existent or weak (Aiken, 2004). According to Aiken (2004) codes are defective due to information systems necessary for analysis of decisions making and policy being inadequate. For example, codes assume that nurses’ migration is an enduring loss to the donor country but there is no evidence to support this belief. A number of studies have shown that 60% of African nurses that migrate to the United States ultimately return to their countries of origin. This kind of mobility that is circular may lead to a net gain of skills and knowledge for the African continent (Aiken, 2004). Brain drain, which is a loss to the donor country in terms of professional knowledge, very important skills, and management capability, is only applicable as a concept if connected with migration that is permanent. Statistics suggest that there is a mix of permanent and temporary migration, with temporary migration being common (Aiken, 2004). Therefore, if migrant nurses return to their native countries they will continue being a resource to their nation, more so if their acquired knowledge and skills are utilized. Until we have better information backed with research, it is not possible to recognize if brain circulation and not brain drain is the reality we face currently. However, brain circulation has the possibility to be the best situation for the future. In conclusion, migration is seen increasingly as a way of global wealth distribution and development means. Although some developing countries suffer due to loss of their nurses, others are benefiting from programs of exchange by making use of remittances from those nurses to develop public sectors in their source countries. Also, they consider migration as an answer to high levels of unemployment in their countries. The developed nations that are faced with a shortage of nurses continue to view nurse recruitment in foreign countries as part of the answer to their health systems which are failing. References Aiken, L., Buchan, J., Sochalski, J., Nichols, B. & Powell, M. (2004). Trends in international nurse migration. Health Affairs, 23, 3, 69-77. Awases, M., Gary, A. & Chatora, R. (2003). Migration of health professionals in six countries: A synthesis report. World Health Regional Office for Africa. Buchan J. (2001). Nurse migration and international recruitment. Nursing Inquiry, 8 (4), 203-204. Read More