Push and Pull Factors in International Nurse Migration - University of ...

International Nurse Migrationretention and recruitment of nurses have not been addressed.The potential for exploitation of foreign nurses is of greatconcern. In 1998, six people in the US were charged withfraudulently obtaining H-1A visas and using them to employFilipino nurses as nurse aides rather than as registered nurses(Puente, 1998). In 1996, the Catholic Archdiocese of Chicagopaid $50,000 in fines and $384,700 in back pay to 99 Filipinonurses working in a Catholic nursing home. The nurses wereemployed as nurse aides (Allen, 1996). Filipino nurses inMissouri were awarded $2.1 million for failure to receivecomparable wages as U.S.-born nurses in the same facility(Grimsley, 2000). Brubaker (2001) reported that someWashington, D.C. area hospitals offered overseas nursessalaries that were less than those offered to comparable U.S.nurses, by crediting overseas nurses with only half of theiryears of experience. Reports also have indicated that foreignnurses working in the US are restricted to less-desirable jobs,have to work in entry-level positions because they are notnaturalized citizens, and are excluded from jobs in leadingfacilities (Glaessel-Brown, 1998).In the UK, foreign nurses have tended to fill entry-levelpositions (Hardill & MacDonald, 2000) and they earn muchless than do domestic nurses. In Ireland, a period of supervisedpractice and assessment can be required of foreign nurses,although qualified nurses from the EU, Australia, Canada,New Zealand, and the US are exempt from the requirement.Foreign nurses not exempt are paid a wage equal to one-thirdof a 3rd-year student salary for the required period ofsupervised clinical nursing practice, after which they are paida salary commensurate with their verified nursing experience(Department of Health and Children, 2002). The period ofsupervised practice was not specified.Finally, Mugera (2002) reported that the UK is consideringintroducing compulsory HIV tests for all foreign health staffworking in the country. The action is being considered afterhealth authorities found 10 nurses recruited from South Africawere HIV positive and they fear that more South Africannurses might carry the virus. In a newsletter, the Nurse andMidwifery Council’s (“HIV test for new NHS staff,” 2002)published view was that employees should be honest with theemployer and having the virus should not affect a nurse’sability to practice. The potential for discrimination based ontest results could affect thousands of African nurses who havebeen recruited to work in the UK.StrategiesPush and pull factors exist between donor and receivingcountries, and nurses continue to migrate in search of higherstandards of living and improved professional opportunities.International strategies vary in response to some of theproblems created by nurse shortages and the resulting “braindrain” of nurses. The Australian Nursing Federation calledfor a national workforce plan that would include timely andconsistent nursing workforce data (which has been severelylacking) and the creation of a chief nurse role at the federallevel to advise on nursing issues (“Senate submission callsfor a national workforce plan,” 2002). The South AfricanGovernment proposed to the Commonwealth that recruitmentof health professionals from developing countries take placeonly within formal bilateral agreements between richer andpoorer nations. In the US, the ANA has resisted the passageof the Rural and Urban Health Care Act of 2001 that wouldexpand the existing H-1C visas to ease the immigration offoreign nurses (Trossman, 2002) out of concern thatimmigration “doesn’t address the underlying problem thatdrives shortages—nurses’ deteriorating working conditions”(Trossman, 2002, p. 86). Buchan (2001) discussed severalstrategies being undertaken in the UK to address the migrationissue. The Department of Health in the UK established practiceguidelines in international recruitment for NHS employers.This attempt has had minimal success, because it did notinclude the private sector recruiters or employers. A bilateralagreement was established between Great Britain and Spainfor Spanish nurses to work in the NHS for a defined period oftime. The English-language Caribbean countries havedesigned a common approach to managed migration,including compensation from receiving countries.Migration can be considered a freedom of choice and italso is an expected result of globalization. However, the extentto which the recruitment of foreign nurses is used to solve theshortage problem raises many questions about nursing andhealth care. The UK, Australia, and Canada are importingnurses to fill vacancies left by their own nurses migratingelsewhere, as well as to meet the increased demands for nursesin their changing health care systems. In the US, changes inthe health care system in the 1980s and 1990s have increasedthe demand for nurses; at the same time, decreased studentenrollments in nursing and the undersupply of nursing facultyfurther compound problems in producing an adequate supplyof nurses.Addressing the nurse recruitment and retention issuescontributing to nurse shortages in developed countries seemsthe best strategy, but it is a long-term one. Aiken and colleagues(Aiken et al., 2001) reported on nurse surveys completed by43,000 nurses in five countries, three of which are majorreceiving countries, with different types of health care systems.These nurses reported similar inadequacies in their workenvironments and the quality of care provided. The authorsdescribed deficiencies on an international scale in hospitalorganization, work design, and nursing care that have resultedfrom the restructuring of health care systems and hospitals that“emulate industrial models of productivity improvement” (p.51) but stopped short of developing policies and benefits fornurses such as “opportunities for career advancement, life-longlearning, flexible work schedules, and policies that promoteinstitutional loyalty and retention” (pg. 51). Buchan (2000)advocated use of “an evidence-based approach to identify whichflexible employment practices and pay and nonpay incentivesare effective in specific labor market conditions” (p.204) inpromoting improved job satisfaction and nurse retention.110 Second Quarter 2003 Journal of Nursing Scholarship