Health Affairs, 23, no. 3 (2004): 68 doi: 10.1377/hlthaff.23.3.68 © 2004 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Nurse Migration

PROLOGUE

Can Migration Cure Nurse Shortages? Should It?

In the first paper Linda Aiken of the University of Pennsylvania nursing school and her colleagues demonstrate the extent to which foreign-born workers are filling the gaps in several English-speaking countries and how, despite the immigration of foreign-born nurses, nurse shortages are expected to grow. Foreign-born nurses are increasing as a percentage of the nurse workforce in the United States. The United Kingdom saw greater numbers of foreign-educated than domestically educated nurses join its workforce. And Ireland, once an exporter of nurses, has seen the flow reverse as a result of an economic boom and an expansion in the number of nurse positions. Meanwhile, source countries are feeling the effects of nurse emigration. Although the Philippines has had a deliberate policy of training nurses for export to help bring in hard currency as emigrants send money home to their families, the country now is suffering a nurse shortage of its own. Aiken and colleagues write that responsibility for the migration patterns lies at the feet of developed nations: "Sustained underinvestment in nursing education is a theme across the countries that are now turning to aggressive international recruitment," they write. "The world’s nurse supply appears insufficient to meet global needs now and in the future. Countries that use the most nurses should make the biggest investments in nursing education in both their own and the developing countries from which they recruit nurses."

In the second paper Barbara Brush of Boston College’s Connell School of Nursing and colleagues ask some broader questions about quality and ethics in a U.S. context. Little is known about the quality effects of an increasing reliance on foreign-born nurses. Testing and certification prove technical competence, but differences in clinical care between native and foreign-born nurses has not been assessed. Meanwhile, the effects of the nurse "brain drain" on source countries’ health care systems and economies must be considered by any country that is a net nurse importer, along with its own long-term strategies for training and retaining nurses.

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