The Nursing Village around the World: How the US is Influencing Nurse Migration

Every nurse would agree that sharing skills, knowledge, experience, and technology to improve lives of patients worldwide is indisputably necessary. What is the role of US nursing in this unfolding phenomenon?

With the effects of increased globalization the world is becoming a global village. How is the migration of nurses to the US affecting worldwide health care?

A starting point for this discussion would be to evaluate the experiences of internationally educated nurses in the US. What has been their journey?

Internationally educated nurses comprise a growing percentage of newly licensed RNs in the US, a trend that will continue. 68% of these nurses have at least a bachelor’s degree in nursing compared to 50% of US educated nurses.(1) The most common ways nurses find work are through either the placement model where nurses work for the medical center. Integration and wages are more likely to be equal to US educated nurses in the placement model. In the staffing model nurses work for the agency which charges the health care organization and pays nurses a percentage of the hourly charge. Nurses are bound by an 18-36 month contract to work for the same employer. In the staffing model there is a  penalty to break the contract in the form of an expensive fee. Curiously Canadian nurses are not under contract in this manner. Wage differentials not based on training, threats of withholding of documents or immigration status, forced overtime, and lack of training were reported by internationally educated nurses working in nursing homes. In this study internationally educated nurses were reluctant to participate in focus groups, a reticence in part based of fear of possible reprisal from recruiting agencies.

A study conducted by M.M. Jose was based on interviews of internationally educated nurses. It is one of the few studies on the experiences of these nurses conducted in the US. From the interviews 6 themes were evident: Internationally educated nurses came to the US with dreams of a better life, then encountered the beginning of a difficult journey, a shocking reality of adjusting to life in a new country.  They rose above the challenges of work: One nurse explained that she overcame her inexperience which her peers sometimes interpreted as incompetence. These nurses next stage in their new life was feeling and doing better, and finally through their experiences became ready to help others on their own journeys. It is the last that is the key for the US role in advancing nursing globally. Internationally educated nurses’ migration to the US can have vast influence and benefit in the rest of the world. How is that happening?

How does migration affect the countries where nurses migrate from? Nurses working in the US do send money back to their home country, which are called remittances. Remittances can comprise a significant benefit to the receiving countries. Remittances also positively affect the social factors such as poverty and access to education that can provide opportunity for better health care. Yet if internationally educated nurses are actively recruited from countries with severe nurse shortages this has and will have an adverse affect on health care delivery in general. If the medical workers who remain in a home country suffer more difficult working conditions due to understaffing, patients are affected and staff turnover increases a negative feedback situation that is hard to correct.

But migration can also elevate the status of nursing in the countries that provide nurses. This is the case in India where migrating nurses have influenced more students to enter nursing.

Easier and less expensive travel, and the ease of communication via the internet has resulted in globalization. Thus migration may no longer be one way and permanent.  Migrating nurses create and maintain multiple ties between countries is more the reality for many. A study on nurse migration in 2002 found that up to 50% of nurses return to their country of origin usually within 5 years of departure.

So what are some ways that US nursing is sharing its vast resources to improve health care delivery in developing countries? Many of the initiatives are a result of collaboration and partnerships between organizations, be they private companies, educational institutions, medical centers, or non government organizations.

The International Centre for Nurse Migration is a partnership between the International Council of Nurses and the CGFNS. Its vision is to establish effective migration policy and practice that ‘facilitates safe patient care and positive practice environments for migrant nurses.’ It is a resource for research and policy discussion, and has been in existence since 2005.

Some recruiting companies are creating programs either in countries where nurse migration occurs, or in the US. For example, nurses who plan to migrate may be required to work in their home country for a period of a few years acquiring experience, before working in the US. The recruiting companies then assist the source hospitals in planning for the resulting vacancies. US educators also have initiated exchange programs with source countries’ educational institutions to train both faculty and staff.  Hospitals have also participated in sister programs where relationships are established to share technology and information. Some companies create training programs in source countries for their recruits that are also open to all staff. The internet has made diaspora networks a means to share vital knowledge with nations who want to improve their health care delivery. Even if migrating nurses never return to their original country they now have the means to stay connected and contribute to innovation through technological channels even if they are not physically present.

Patients’ right to effective health care must be balanced with nurses’ right to migrate. An examination and discussion of international migration begins with more research and data collection. Because of globalization, migration will continue. Its nature is dynamic, and it is now easier for nurses who wish to migrate to be able to access the information necessary to make it a successful journey.

International migration that is a positive experience for all parties will establish the global significance of nursing. The internationally educated nurses who work in the US contribute to health care delivery in both the US, for example by enhancing culturally sensitive care, and in their home country, by the sharing of knowledge. Continued collaboration, and coordination through the many modes of communication will ensure that patients in the US and abroad have access to excellent health care, and advance nursing everywhere in the world.

(2) (Return Migration of Nurses Fact Sheet)

US based Recruitment of Foreign Educated Nurses American Journal of Nursing June 2010 Vol. 110 No 6 pp 38-48

Lived Experiences of Internationally Educated Nurses in Hospitals in the United States of America International Nursing Review 2011 Vol. 58 pp 123-129

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