The Shortage of Nurses in Australia and the World - Implications and Remedy - Case Study Example

Topic: THE SHORTAGE OF NURSES IN AUSTRALIA AND THE WORLD: IMPLICATIONS AND REMEDY (Name) (Institution) (Course/Grade) (Tutor's Name) 10th May 2008 Executive summary Nurses provide essential services in hospitals in support mainly of the services provided by doctors. With the number of qualified medical doctors in the world remaining relatively low given the amount and the cost of training them the services of ''technical level'' doctors in the name of nurses supplement the deficit. These technical doctors are increasingly becoming scarce more so in the developed world and in this case Australia but are seemingly excess in other countries thus necessitating movement from high supply countries to lower supply countries. This paper breaks down the issue of the migration and look at its implications in the human resource field. In the introduction and background we look at the prevailing situation in regards to nurses and identify it as an issue worth more investigation. Further on we analyze the migration shedding light on theoretical explanations that may be responsible for the movement. In the later pages of the paper we look at trend in a positive and negative view in the host and donor countries and relating them to SHRM requirements and teachings. Introduction Reports have been rife about a global shortage of nurses though Australia seems more affected by the problem than other nations. To counter this problem measures have been put in place by private and government agencies going into great lengths of recruiting foreign nurses from countries that have a seemingly excess supply of them. In the due course of doing so, complications seem to arise. Analysts and authors alike have come out strongly against this trend which in one way or another according to them has very many disadvantages. As expected there are those who are for the program supporting it by quoting the advantages being realized that can be linked to the recruitment of the nurses from overseas. Among them is the fact that some countries exporting nurses are also experiencing a shortage themselves thus accelerating the problem further. In line with the subject course, the paper will launch a conceptual framework on the antecedents, implications and effects of this foreign recruitment nurses for better understanding of the various organizational factors that facilitate the establishment of a working strategic human resource management exercise on a wider national scale. SHRM have to consider nurses as resources in accordance with the intentions of the importers and exporters of such on the future direction that they want to take and where their actions will lead. This paper is therefore concerned with long-term people issues and macro-concerns about structure, quality, culture, values, commitment and matching resources to future need in the medical field. Background information The Australian federal government sought to improve the health care system for her citizens by introducing a minimum nurse patient ratio intended at 1:4. However, this ratio does not seem to hold given that there are other patients who require more personalized care. For instance, the ICU patients require about nurse patient ratio of 1:1 thus bringing down the overall ratio to around one nurse for every ten to eleven patients. In an attempt to maintain the earlier ratio, a total of around 40 000 more nurses were required which Australia did not have at its disposal. With the backing of the Federal, State and Territory government, seeking alternative sources in the name of foreign nurses from countries such as Philippines was the next best option. This exercise was delegated to private and national agencies to recruit and organize for the transfer of the nurses from their home countries. In the market in such of nurses was not Australia alone. With an estimated global shortage of 72 000 nurses as of this year, we can see that Australia is experiencing some mild competition. The competition thrives in greater intensity since Australia is “shopping” for nurses in the affected countries also such as the US and the UK. Apart from nurses being bought by the involved governments there are others who are moving out of their own accord. Why? Migratory intentions Push and pull Theory of migration This theory was developed to explain the forces behind migration. It explains migration process through which individuals, and in this as the oversupply and shortage of the same that necessitates the migration in a bid to strike a balance between the two sides. In the push part of it, countries with excess supply of nurses have exhausted their employment opportunities for the same hence have to seek alternative market to sink their investments in the form of nurses. The nurses on their part are more than willing to search for employment in greener pastures after rigorous training in colleges. According to surveys carried out to ascertain the reasons behind the preference by foreign nurses to work in Australia a majority of them stated that their main reason for doing so was that it offered them a life that they did not have in their native countries. Many were encouraged by their families to become nurses, even if it was not their preferred career choice as joining nursing afforded them the opportunity to work abroad. The authorities expressed concern at hiring of nurses lacking the desire to work as a nurse. HR managers are concerned that this trend will saturate Australia with trained nurses who are not dedicated to their work hence the inefficiency in the industry. This was a result of the unfounded belief that nursing as a career should be a calling thereby likening it to priesthood. The surveys have also indicated that foreign nurses usually join the profession as a way of obtaining a ''visa to the world''. The government seems not concerned with the impact the process will eventually have as it will lead to our hospitals being filled with nurses who are not in the least sense dedicated to their work something that could lead to serious medical fatalities facilitated by negligence in the execution of their duties. This could overshadow the progress that the health system has made so far. The migratory intentions of many overseas nurses are influenced by family factors and the ease at which their spouse can find work. Without suitable employment, unexpected living costs and house prices are too high and therefore the nurses consider seeking alternative employment. Some nurses have shown, quite ardently, that they do not intend to return to their home countries even after lacking employment as nurses in Australia and nothing would change their mind. Irrespective of the influencing factors, none of the overseas nurses expressed an intension of returning to clinical nursing in their home country. The main reason was the difficulty of returning to the poorer working conditions in the hospitals. It therefore happens that both the source and recipient country are losing their hold on the professionals as they are losing them into other employment areas for which they are not trained for. Labor importation and HRM Labor in this context is constrained to nurses only. However the issue of HRM spreads from the HR managers themselves to the entire health care industry that encompasses a wide spectrum of the economy and our day to day lives. In simple terms we can say that human resources management entails all activities that an organization or management engages in to attract and retain employees and also ensure that they perform at their highest levels towards the realization of the organization's goals and objectives both in the long run and in the short run. In the case of Nurses in Australia however the situation becomes more complicated by the fact it is the government in the center stage rather than an organization which greatly affects the competitiveness and efficiency of the process. According to the HRM activities we can list the disadvantages of the process as some politicians and analysts have in the recent past been doing. First we list the activities of HRM Recruiting and selecting of employees Training and development of the recruited employees Offering performance appraisals Involved in making payments and awarding of benefits. Facilitating labor relations. In aligning the above activities with the functioning of the organization's goals and objectives we arrive at what we call Strategic HRM. The process of SHRM has to correspond and compliment the workings of other departments in the organization. This is designed at achieving the overall efficiency of the organization. Benefits if importation At the moment, empirical evidence in the country may point at the benefits of the nurse importation programs as the service level in our country has improved in that the current nurse patient ratio has improved a lot giving the taxpayers more reason to submit their taxes faithfully to the government. Recruitment and development- The recruiting of foreign nurses was born out of the idea of improving the health services situation in the country. This move that was highly supported by HR managers in view of the fact that employees would increase productivity as a result of better medical services. Employees were also happy in that they would receive better and quicker services at government hospitals. In the early stages of this process of nurse importation the benefits were open for all to see. Patients received better health care services which in the long run was projected to increase the life expectancy in Australia and hence the overall performance of the country. Labor is an important input in the medical field as a service industry. Defined by the qualities of a service, it is paramount that the management invests heavily in the employees as their contribution in the delivering of the service is more consumer interactive than in the products/goods market. Nurses happen to be the sales persons in the medical field and thus their effectiveness and method of delivering the service is used to measure the effectiveness and quality of the medical service in its entirety. To effectively deliver the service the government realized that there has to be enough employees in the field whose responsibility was to offer the service to the community. As the increased nurse to patient ratio went on, the local nurse market was stretched to the limit calling for another market to be sought. The next best alternative was to import nurses as training them would have taken time. This is thus beneficial in labor perspective in that the government is acting in a HR manager capacity by filling out vacant positions with the respective experts in that field. The migration is also facilitating cultural and social values exchange. With Australia seemingly alienated from the rest of the world geographically the prospects of having a neighbor from another country is enticing to many though some are taking it in bad taste. From a HR point of view the exchanges are doing good to the labor organizations in Australia though comparing and contrasting of the practices prevalent in the source and recipient countries. For HR managers in Australia and other donor countries, they could utilize the overseas nurses as sources of information on the reasons behind their defecting and transferring of their service in another country. This information helps in identifying the mistakes or conditions that can make employees to consider selling their services elsewhere. In doing so the HR managers have the room to avoid creating such a problem that could trigger the movement of employees by being proactive instead of reactive. Negative effects of migration Wayness (2007) states that the negative effects of international migration on nurses from “supplier” and donor countries cannot be experienced immediately with the commencement of the practice but the effects can only be felt some times afterward as the implications begin to take root in the society. For the last three years the effects have been recognized and felt, but that they have not been effectively addressed as the practice is still going on. Certainly, there must be some sort of a balance between the right of individual nurses to choose to migrate (autonomy), particularly when push factors are overwhelming, and the more utilitarian concern for a donor nations’ economic and labor relations health as a result of losing scarce nursing resources (Huston, 2006). The Commonwealth Code of Practice for the International Recruitment of Health Workers (2003) argues that such a balance is possible only when there is “mutuality of benefit” the extent to which the donor country is compromised is minimized as a result of the importer country providing assistance in the form of money, technology, training upon return to the home country or facilitation of the return of recruits to their home country. Pay level and befits imbalance. The relative position of a country's employee incentives in comparison with those of other countries in the same industry employing similar kinds of professional has greatly come to vary as a result of the nurses’ migration. The Australian government is at the moment engrossed in attracting foreign nurses in their country and it may leave the local nurses disadvantaged in that since there are already in the 'fold' they require lesser attention. Acting in a HR manager's capacity, the government can decide to offer low, average or high relative wages. High wages attract and retain high performers but raise costs with the idea that low wages can cause turnover and lack of motivation but provide lower costs. The problem with the immigrants is often highlighted by the local nurses is that the overseas nurses are often entitled to working away from home and relocation benefits. The recruitment is undermining the efforts and steps made the International Council of Nurses and the Commonwealth Code of Practice for the International Recruitment of Health Worker. Both have concurred on remunerating their nurses on an agreed level that corresponds with the economic and GDP levels of that country. Huston (2006) suggests that HR mangers must at least consider whether recruiting nurses from other countries to solve acute staffing shortages is simply a poorly thought out, quick fix to a much greater problem and in doing so, not only are donor nations harmed, the issues that led to the shortage in the first place are never addressed. Clearly, such large scale recruitment of nurses from overseas would not be existent if both donor and source nations made a more concerted effort to improve the working conditions, salaries, empowerment, and recognition of the native nurses they already employ. The recruitment according to Maryberth (2008) is a cover up for a more underlying problem whose continuous denial by the authorities is a recipe for a more gigantic problem that could trigger the downfall of the labor industry in Australia. Though the training, educating and retaining of nurses maybe financially taxing the, the same should be reciprocated in the employment of the investments in the training and educating in the offering of quality health care services. Trust and security felt in receiving of services is not present something that is not guaranteed by the employing of overseas nurses whose qualification in the profession cannot be 100% comparable to the ones of the recipient country. This will lead to lack of trust in the Health profession that could lead to genuine qualified nurses losing credition in the heart of Australians the very people they are supposed to serve. From a SHRM point of view the practice does not reflect the workings of it. As per the definition of SHRM, the activities involved in the foreign nurses recruitment and employment process is not being aligned other areas of the economy and checking whether the benefits of the recruitment really outweigh the problems associated with it. The cultural lives of the source countries for nurses are not in the list of considerations for recruitment as the recruiters are obsessed with professional qualification and experience only. What we do not see is whether the nurses against abortion for example or against it. Their views on such a subject could have a negative impact in the profession. Viable Alternatives HR mangers have been at the fore front of those who are questioning the commitment of the government in fighting this problem and addressing the situation the country desperately need new nurses moving into the system. Offering of incentives in the training of nurses is the most relevant solution to handle the problem in the long run. But has this been the case? Empirical evidence shows that this is not the case. In fact Australian universities turned away 2,716 of qualified applicants for nursing courses in 2005. By this year the nurses would have already graduated and practicing and thus contributed significantly in reducing the deficit. If only the trend of offering incentives for nursing courses was to be adopted, the shortage of nurses would be something of the past. One of my suggested incentives is lowering college fees in nursing schools. On a more convenient and user friendly option is for the involved countries to enact agreements on the modalities involved in movement of workers among them. The agreements should in a way consider the availability of nurses in the source country compared to the destination country. The situation then would call for placing of restrictions or more facilitation of movement. An example of a bilateral mutual agreement is the Trans-Tasman agreement, which enables nurses from Australia and New Zealand to practice in either country. (Buchan, 2004) Conclusion The government seems preoccupied with the fact that sourcing of nurses from overseas is cheaper than training them in the homeland. However the authorities are blind to implications of the trend on labor, culture and social life. In the analysis above the importation of the nurses at the moment is agreeable to many terms and the current situation. However the hidden implications which work against the good of the country are being unearthed slow but sure by analysts and politicians as well. In my view, if the situation is not reverted by encouraging more nursing students in our colleges, then the situation is not on an improvement but trend but leads us to a catastrophic period in the near future. References Buchan J et al (2004). Migrant Nurses: Motivation, Integration and Contribution, (Newcastle, Radcliff Publishing) Lynch, J. & R.J. Simon (2003) Immigration the World Over. (Lanham MD: Rowman &Littlefield) Marino, S. (2002) Current Issues in Nursing (London, McGraw-Hill) Maryberth S. (2008). Push and pull factors in international nurse migration. Journal of Nursing Scholarship, 35 (2), 107-111. Padarath, P. (2003). Nurses on the Move: Migration and the Global Health Care Economy, (London Cornell University Press) Royal College of Nursing (2002). Defining Nursing, (London RCN) Stilwell, M. (2003). Migration of Nurses, (New York, Prentice Hall) World Health Organization, Geneva (2004). Human Resources in Health: report by the Secretariat. Executive Board, EB 114/17. Wayness, Laura et al (2007). Nurses Experiences of Recruiting & Migration from Developing Countries: A phenomenological Approach. http://rphrm.curtin.edu.au/2004/issue2/nursing.html (Retrieved April 22, 2008) www.assa.edu.au/Publications/OP/op12008.pdf (Retrieved April 22, 2008) www.springerlink.com/index/GDLK1QJ303N984RB.pdf(Retrieved April 22, 2008) www.ecom.unimelb.edu.au/research/projects.html (Retrieved April 22, 2008) Read More