Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Importing Foreign Nurses

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Recruitment of Foreign Nurses Common means for alleviating current nursing shortage International recruitment Nurse migration (moving from one country to another in search of employment) Historically, migration individually motivated Currently, active planning of large-scale nurse recruitment –Effect on ability of developing countries (see Table 6.1)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Global Migration of Nurses Push factors: drive or push nurses to leave their countries to go to another: –Low pay –Inadequate opportunities for career advancement or continuing education –Sociopolitical instability –Unsafe workplaces

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Global Migration of Nurses (cont.) Pull factors: draw nurses to different countries: –Higher pay –More developed career structures –Opportunities for further education, professional development –Safety from threat of violence –Opportunity to travel or participate in foreign aid work (see Table 6.2)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Sociopolitical instability is a common pull factor for nurse migration.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Sociopolitical instability would be considered a push factor for nurse migration; that is, one that would drive the nurse to leave one country and go to another.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Global Migration and Developing Countries Possible depletion of single facility or educational institute Some countries encouraging outflow for remittance income such as Philippines, China, India Negative impacts: –Reduction in level, quality of services –Loss of specialist skills –“Brain drain”: loss of skilled personnel, investment in education when human resources migrate elsewhere (developing countries losing individuals they can least afford to lose) –Band-aid on problem of nursing shortage

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Issues Issues involving allocation of limited resources Most relevant ethical principles: –Autonomy –Utility –Justice Increased complexity when issue viewed using philosophical frameworks containing embedded ethos or straight thinking concepts

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Response of Professional Organizations ICN –Position Statement: Nurse Retention and Migration (see Box 6.1) –Principles of Ethical Nurse Recruitment (see Box 6.2) International Centre on Nurse Migration (ICNM) The AcademyHealth Project (Voluntary Code of Ethical Conduct for the Recruitment of Foreign Educated Nurses to the United States) The World Health Organization (The Code of Practice)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? An individual nurse’s right to migrate is a fundamental issue involved with the ethical principle of autonomy.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. There must be a balance between the right of individual nurses to choose to migrate (central to self- determination and autonomy), especially when push factors are overwhelming, and the more utilitarian concern for donor nations’ health as a result of losing scarce nursing resources.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mistreatment of Foreign Nurses Substandard jobs or wages; illegal employer practices False promises Questionable hiring or employment practices (see Box 6.3)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins International Community Response by some governments to international recruitment: –National nursing strategies –Policy statements –Good-practice guidelines Countries initiating policies to reduce outflow –Work-time requirements

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins International Community (cont.) Initiatives such as “managed migration” U.S. Immigration Policy –Employee: valid job offer –Employer: Department of Labor approval for hire Special petition with U.S. Citizenship and Immigration Services Labor certification laws & visas (H-1B Visa for Skilled workers or TN NAFTA Work Visa) E3-to I-140 status (“green card”)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Commission on Graduates of Foreign Nursing Schools (CGFNS) Before 1977: 2 ways to get license: –Endorsement or SBTPE Since 1977: establishment of CGFNS qualifying exam –English-language component; nursing component –Strong predictor of performance on NCLEX-RN exam –Passing of CGFNS exam before allowed to take NCLEX-RN NCLEX-RN now offered in 11 countries and non–member board territories

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A foreign nurse obtains licensure upon passing the CGFNS exam.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Foreign nurses first must pass the CGFNS exam. Then they are permitted to sit for the NCLEX-RN exam and must successfully pass it to obtain licensure.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assimilation Through Socialization Basic needs to be addressed for success 4 broad categories of challenges: –Language and communication –Variance in nursing practice –Marginalization, discrimination, and racism –Cultural displacement and adjustment

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation