The Implication of Foreign-Born Nurses on the US Nursing Collegiality - Thesis Example

Implication of foreign born nurses on us nursing collegiality Lecturer: Introduction The United s has perpetually experienced a dearth of qualified nurses, a situation which is projected to deteriorate further in view of the continued job apathy within the profession from native born workers. The US Department of Health and Human Services has projected a deficit of over 275,000 permanent registered nurses (RNs) by 2010 and 800,000 by 2020. Emerson (2007) alludes to this grim scenario which is further aggravated by the onset of an increasingly aging population and rising number of Americans with chronic and acute diseases requiring expert nursing care. The hiring of foreign professional nurses has therefore been identified as an obvious solution to curb the shortfall. Although a practical alternative, the implication of the emigration on the native born nurses has not been wholly welcome. The moral or ethical consequences of the nurses’ immigration on both the exporting and importing countries can be counteracted by the consequentialism or utilitarianism paradigm which upholds that ‘the consequence of actions affects their moral value’(Idanan, 2008). Historical Overview In a Health Affairs survey of nurses in the United States, Canada, England, Scotland, and Germany, it was revealed that 41percent of practicing nurses in various hospitals were unhappy with their occupation, with 22 percent actively preparing to abscond from employment within an year (those younger than 30, were more with 33 percent). The main factors mentioned for the respondents dissatisfaction included long hours, employee cutbacks, more assignments, more non-patient cores, inequalities, oral abuse, and general poor management (Aiken, 2008). This unpleasant state of affairs has contributed greatly to the low esteem upheld by the nursing profession with high turnovers and low recruitment to fill the gaps among native born Americans. The lack of a nursing collegiality among the staff reveals a distressing trend whereby many practicing nurses become alienated by their colleagues who engage in negative irrelevant power plays. The medical institutes have therefore been forced to seek foreign workers to cover the deficit while diluting the vicious infighting amongst medical personnel. Foreign Personnel Foreign born professionals have always been used to augment shortfalls among many western countries. Immigration of health-care workforce within the United States has often been used to offset the deficiencies. Most of the foreign born health workers are from Asia (39.9 percent) with significant number emigrating from Philippines; Latin America (34.4 percent); Europe, Canada, and Oceania (16.8 percent); and Africa (8.9 percent). Over 70 percent of those in the nursing profession are women. The bulk of the foreign nurses (75%) emigrate from the Philippines, Canada, India, and Britain (Xu & Kwak, 2005). Many of these foreign nurses are mainly economically motivated to emigrate in search of better wages due to the poor nature of the domestic economies. Xu & Kwak (2005) argue that nurses engage in both internal and external migration not only to improve their livelihood but also to enhance their technological skills and education. The ratification of the Immigration Act of 1965 heralded radical changes in U.S. immigration policies. This Act was meant to encourage the immigration of skilled workers into the United States to augment areas suffering from labor deficiency like nursing. This has promoted many nurses from many developing countries to migrate to the U.S. mainly due to better pay and work conditions. Dugger (2006) cites the wide-ranging disparity between the remuneration in the Philippines as contrasted to those enjoyed within the United States, with a nurse in former making as little as $2,000 annually while a compatriot in the U.S. makes $48,090 annually. Kingma (2001) however cites the issue of security as a major motivation to those desiring a safer and stable environment to practice their profession. Maslow’s hierarchy of needs paradigm (physiological; safety; love and belonging; self-esteem; and self-actualization) can however explain the moral and economic motivation underlying the foreign nurses emigration to the more developed countries. Disadvantages of Emigration Brush, Sochalski and Berger (2004) argue that the emigration of nurses however has adverse effects on the domestic countries which are depleted of the meager pool of qualified personnel lured by better foreign prospects in the more developed countries. Although the expatriates provide a much needed source of income to their domestic relatives, the resultant drain on their country’s heath facilities far outweighs the gains on the economic front. The recruiting agencies largely target the English-speaking health workers from the former British colonies (Commonwealth countries) of sub-Saharan Africa, Southeast Asia, and the Caribbean. These countries however have poorly developed health systems and are unable to assimilate the graduating nurses within the established health facilities. The onslaught of the AIDS epidemic, political and economic upheaval has however made the need for more health and nurses necessary. A USAID (2003) report The Health Sector Human Resource Crisis in Africa revealed that there was an average of 100 nurses per 100,000 population in sixteen countries in Africa; ten countries had approximately 50 nurse for each 100,000 population; while nine had twenty per 100,000; and three had less than ten nurse for each 100,000 of their population (USAID, 2003). This contrasted sharply with the averages enjoyed within the U.S. and U.K. which had ratios of 782 and 847 nurses per 100,000 of their population respectively. In Ghana, the government is crying foul over the ‘brain drain’ exemplified in the over half of the country’s nursing graduates immigrating to the developed countries after training (Reilly, 2003). The economic loss to the countries where the nurses immigrate from is enormous, with the United Nations Conference on Trade and Development (UNCTAD, 1998) estimating the average annual loss to the South African economy as $184,000 (UNCTACD, 1998). The recruiting or receiving countries also benefit from the immigrant professional education and training invested by the exporting country. In South Africa, the South Africa Nursing Council has called for a levy on the emigrating nurses to recover the costs of training and discourage the loss (Jordan, 2001). Yearwood (2007) cites the great risk posed by nurse migration from the poor developed countries on children and adolescents especially those afflicted by psychiatric problems. A United Nations Secretary-Generals World Report on Violence Against Children (2006) cited emigration of nursing and other medical personnel as one of the major threats faced by children growing in the poor countries. Yearwood (2007) therefore alludes to the disruptive nature of nurses’ emigration as latent obstacle to improving the health of the most disadvantaged populations in the world (Yearwood, August 2007). U.S. Concerns Within the United States, the major concern for the imported nurses has been the level of competence. This has emanated from the concern of the perception that foreign countries particularly the developing nations lack the capacity to properly train nurses within the context of modern nursing techniques and practice. Stevens (1995) further argues that competence of the imported personnel should also be evaluated regarding the ability to effectively communicate with the patients rather than on mere technical competency (Stevens, 1995). The Commission on Graduates of Foreign Nursing Schools (CGFNS), which was established to verify the foreign nurses’ technical and cultural competencies prior to employment, verifies the nurse’s credentials including their educational certificates. Additionally, it administers the U.S. nurse licensure exam (NCLEX-RN) before they are allowed to immigrate to the U.S. This tests their nursing competency as well as their proficiency in the English language. Berger (2003) argues that an assessment of the cultural aptitude imported nurses add to patient care need to ascertained. The lack of proper nurse-patient communication has been cited due to the conflicting nature of the cultural orientation issues and upbringing including religion, hygiene, norms, language, among others (Berber, 2003). Tensions Among Health Workers Bally (2007) alludes to the infamous incidence of ‘nurses eating their young’ due to horizontal violence practiced by health workers even as many opt out of the profession citing stress factors, unease, tyranny, and disempowerment (Bally, 2007). There have however been tangible steps to promote more recruitment from the domestic native pool of personnel. The American Hospital Association (AHA) convened a Workforce Commission for Hospitals and Health Systems aimed at enhancing the recruitment and operational conditions that would ensure improvement in the nurses’ terms of employment among other raft of measures. This would ensure fewer turnovers while attracting more recruits towards the nursing profession. According to the Maslow hierarchy of needs paradigm (physiological; safety; love and belonging; self esteem; and self actualization), employee motivation can be cultivated through evoking a sense of loyalty hence ease the periodic turnovers within the nursing profession. Asian Influence A census-based study by the Independent Centre for Immigration Studies revealed that there are more foreign born Asians than native born Americans especially the minorities. The report suggested a more balanced hierarchy of recruitment as there was a tendency in over-reliance on foreign professionals. The Asian immigrant also earned more than native born Americans, with Korean and Indian nationals were earning a median income of $101,000 and $82,205 respectively. The siphoning of the best foreign professionals should be discouraged as it undermines the efforts of the developing countries to emerge from decadent economies. The international deliberation on the moral principles of dislodging professionals from poor countries has raged for a long time with contributors suggesting that the developing nations should be duly compensated for the exports. Other issues debated are the recruiting guidelines and codes of practices to financial compensation for the deprived nations. Alternatives to Use of Foreign Labor Gamble and Thompson (2003) and Martineau, Decker & Bundred (2002) allege that continued reliance on foreign labor while neglecting domestic development of native American professionals is not a best option as it would be more viable to train native workers especially the minorities to improve the level of their income. Thus the United States government should evolve measures aimed at encouraging native born Americans into enrolling in the professionals which continue to lack enough manpower. U.S. president Barrack Obama has echoed these sentiments by proposing reforms in the health sector that would improve nurses working conditions while similarly encouraging technical education to enhance recruitment of qualified personnel among native born citizens. The United States has 2,750,000 registered nurses plus a further 500,000 licensed practical nurses. Among these 11% (300,000) are born outside the country with 80% of these expatriate nurses emanating from poor developing countries. Between 2001 and 2003, the recruitment growth in the nursing profession was largely driven by foreign nurses, accounting for a third of all new nurses (Aiken, 2008). The United States lacks a formal national policy regarding the nursing personnel. Even with the current prevailing shortfall of nurses, Aiken (2008) alleges that the projected nursing deficiency is unlikely to be solved through foreign conscription. She affirms that the detrimental implications occasioned by recruiting nurses from the least deserving nations in the third world can be effectively handled by turning to the abundant domestic labor pool rather than relying on the commercialized foreign recruitment (Aiken, 2008). The inefficient deployment of nursing personnel in the decentralized U.S. system which has resulted in a majority of nurses hiring out in large cities while the less affluent regions lack. To encourage interest in nursing, the educational faculty including infrastructure, clinical learning, as well as removing financial obstacle that discourage students must be enacted. The working conditions for nurse should be improved to retain those workers who regard the profession as transit while craving for better rewarded professions. More men should be encouraged to take the profession largely viewed as a ladies preserve. This would assist in dispelling the unfortunate perception associated with the profession as mediocre. The public should also be fully educated on the positive aspects of the profession in addition to informing them of the deficiencies of personnel. US nursing profession have often been underscored by the strained relationship between the physician and their nursing colleagues. The lack of a significant collegiality among fellow nurses and physicians is cited as one of the leading causes of nurses’ turnover. Kant’s moral philosophy or Kantianism espouses the need to understand the limit of human knowledge within reason or from experience. The U.S. nursing collegiality requires application of a Kantanian rational concept that will encourage the health worker fraternity to embrace their counterparts both in the nursing profession and physicians as well as the foreign recruits to further their profession. Lorenz’s instinctive hypothesis alludes to these comparable aspects in human nature that ensures a natural progression from a need to self actualization. Lorenz’s assumptions that human beings strife for basic needs is inherent without much reasoning explains the concept of nurses lacking the perceived ethical inclination to persevere within their poor regions rather than emigrate to the highly developed zones. Reasons for Lack of Collegiality A Nurse-Physician Relationship Survey conducted by the VHA West Coast, (a regional division of VHA, Inc., composed of community-owned hospitals and health care systems) revealed that many nurses harbor latent resentment towards the fellow medical physicians, and management which contributes greatly to the high turnover in the profession (Rosenstein, 2002). This disruptive environment not only affects the medical personnel but also the patients and services leading to cancellations of operations or units closed in some facilities. Rosenstein cites “an aging workforce, fewer nursing school programs and applicants, hospital restructuring, poor public perceptions of nursing as a career, and rising burnout and job dissatisfaction among nurses” to be some of the adverse effects slowing down retention and recruitment in the nursing profession (Rosenstein, 2002, p. 34). The research results suggest that there is an urgent need to improve the nurse-physician relationship to enhance nurse retention and employment. The American Surgical Association has acknowledged the strained relationship between the two corresponding players with some suggesting that over two-thirds of nurses suffer abuse at the hands of physicians and administrators (Surg, 1999). Jervis (2002) argues that the protracted historical class conflict in addition to supremacy battles among medical personnel have never been amicable resolved hence leading to inadequate duration of careers. Incentives There have however been noted improvements in employee incentives and benefits especially on the part of the hospital nurses who are on high demand. Some of the enhanced benefits include tuition reimbursement, home-care for their offspring and aged parents, a more flexible work program, and salary hikes. All these enhanced benefits plus the likelihood of job security particularly in these unstable economic times have led to fewer turnovers and more workers entering the nursing profession. A Kuhnian paradigm shift is required within the U.S. nursing industry to radically alter the cold war existing between the health workers that would usher in a more collegial amity hence halting the perpetual animosity. This envisioned paradigm shift is possible with the assimilation of the less antagonistic foreign nursing emigrants who can diffuse the simmering underlying tensions among health workers. A Marxist philosophical approach of materialism or the perpetual class struggle among the capitalist society explains the large-scale economic exploitation of one of his tenets, human labor. The United States continued hegemony over the global economy has forced the loss fortunate developed countries to sell their meager trained labor while depleting and continually perpetuation their dependency on international aid assistance while enslaving their populace. This is possible due to the utilitarianism concept employed by the U.S. nursing community while ignoring all moral and ethical implications of their actions vis-à-vis the poorer exporting regimes. The emigration of the foreign nurses however helps in easing the simmering discontent among the nursing profession as the feuding antagonists are dissuaded from further aggression due to the foreign workers lack of apathy to the previously contentious issues. The Kegan’s theory of development or social maturity explains the need to embrace opponents views while creating a win-win situation rather than engaging in confrontational stunts that lessen the likelihood of creating a collegiate situation. Conclusion The U.S. nursing collegiality has been boosted by the recruitment of foreign workers mainly from the developed countries. The prevailing state of animosity between the virtually exploited nursing personnel and the tyrannically oriented but equally overworked physician colleagues underrate the good work done by the disharmonious dual and may have detrimental effect on their patients. Kegan’s theorem of social impact must be applied by the administrators to create a nursing collegiate. The impact of the foreign born workers on the health-care system cannot be underrated due to the acute shortage faced by many hospitals. The overriding Marxist tendency of recruiting from the poor developed nations however casts an ethical shadow on the U.S. recruitment methods. The country’s slow growth of local recruitment especially among the minorities while seeking the easier option of international staffing is not economically viable in the long term as the exporting countries seek compensation and levy the departing professionals. Foreign recruitment has however helped create better synergy and collegiality. References Aiken, L. H. (2004). Does International Nurse Recruitment Influence Practice Values in U.S. Hospitals? Journal of Nursing Scholarship , Volume 34 Issue 1, Pages 67 - 73. Aiken, L. (2005). International Nurse Migration: Bellagio Conference July 5-10. Maine: Center for Health Outcomes and Policy Research; University of Pennsylvania. AMA. (2009, June 22). International Medical Graduates: Practicing Medicine in the US. 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