According to an article, “Nursing and Midwifery – WHO Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020.” World Health Organization, nurses and midwives account for nearly 50% of the health workforce. Of the 43.5 million health workers in the world, it is estimated that 20.7 million are nurses and midwives, yet 50% of WHO Member States report to have less than 3 nursing and midwifery personnel per 1000 population (about 25% report to have less than 1 per 1000), according to the 2017 Global Health Observatory. The U.S. Department of Labor has estimated that 450,000 more registered nurses will be needed through the year 2008. By 2020, the supply of registered nurses is projected to fall 20 percent below demand. Research indicates that there is a relationship between nurse staffing and medical complications. Due to the decreased staffing of nurses, because of high turnover of nurses and retirement, it is becoming more difficult for current active nurses to affectively provide quality patient care to their patients. (Cimiotti, Aiken, Sloane, & Wu, 2012) Hence, debate revolves around the use of nurse staffing mandates, which require hospitals to maintain particular nursing levels. “Recruiting foreign workers really can help fill these staffing gaps,” says Natasha Bryant, senior research associate at the LeadingAge LTSS Center at UMass Boston. (Sherwin, Jane, 2018). So, the trend of recruiting foreign nurses by the hospitals became famous. According to Brush, during the past fifty years the United States has regularly imported nurses to ease its nurse shortages. There are nurses from Philippines, India, Canada, Africa and many more countries of the world are working in USA and helping the hospitals to maintain a nursing level. Among several strategies implemented to increase the nurses in US hospitals foreign nurses recruitment has played a major role in health workforce of USA to reduce the shortage of nurses but it also gives rise to two group- the supporter who focus on the benefits of hiring foreign nurses and the critics who raise question about shortage of nurses and health effect in the importing countries.
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As the shortage of nurses in the country is affecting the health of the people. Mowat explains, the state as well as the government both have shown efforts to solve the problem of shortage of nurses in the country. Both Republicans and Democrats in Congress have sponsored bills to address the nursing shortage. Mowat summaries, several acts are formed by different states which will establish a nurse corps, offering student-loan repayment and scholarships; multimedia campaigns to promote nursing careers; grants for recruitment, retention and training; and loans and scholarships to fast-track the development of nursing faculty. She also adds, states also have introduced legislation that would increase their policy planning capacity regarding the nursing work force. Other attempts too have been made from different level to increase the graduation rate of nurses, which is currently kept low by understaffed training programs. Though these strategies are enacted the shortage of nurses is still is a big issue in the health department of the nation. Glazer in his article on “Legislative: The Nursing Shortage: A Public Health Issue for All” explain that despite several tricks and initiatives from different level, years of government funding of nursing schools we continue to suffer shortages within the profession. By our defining the current shortage of nurses in the US as solely a nursing or nursing faculty problem is to ignore its magnitude. It is indeed a much broader problem. The depth of the current nursing shortage and its impending expansion must be recognized as a public health emergency with implications for all Americans. So, the hospitals started recruiting foreign nurses and the history of bringing foreign nurses lies back from 1990.
Supporters say, hiring foreign nurses not only helps the US hospitals but also supports the foreign nurses since the wages given by the US hospitals to the nurses from developing countries serve as an incentive because they are paid less in compare to the wage paid by the hospitals in USA. Brush in his article “Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities” summarizes, foreign nurses who come to the United States are often very qualified and hardworking and serve for longer duration which reduces the turnover rate in the hospitals. Supporters also argue they can sometimes be useful in caring for people from particular foreign-born communities. They also say that the countries from which foreign nurses come actually benefit, both from the money that the nurses send home and the skills they bring back if they decide to return, as many nurses return to their country back after certain time of their work in US hospitals.
Critics of recruiting foreign nurses argue that the practice drains valuable medical personnel from poor foreign countries that have major health care problems of their own, including nursing shortages. Brush explained the loss of qualified nurses places considerable economic pressure on exporting countries. In the Philippines, for instance, the shortage of nurses resulting from the export of nurses to the United States has led to a shortage of health care for many sick people. Nurses, and even doctors, in such countries are receptive to U.S. recruiting efforts because they can make much more money in the United States than at home, critics argue. At the same time, their presence in the United States makes the situation worse for U.S. nurses, they add, because foreign nurses are less likely to demand better wages or working conditions. Critics argue recruiting foreign nurses is not beneficial to both the foreign as well as domestic nurses. There are several issues for foreign nurses involving recruitment. Chandra in his article explains the issues of wages and salary levels for the foreign educated nurses (FEN) have been one of considerable controversy. He adds, there have been reported instances where FENs with identical qualifications and performances as domestic nurses have been exploited as cheap labor and received wages below that of the domestic nurses. Chandra also summarizes how racism and discrimination for the FEN often occur with their employer, their colleagues, and even their patients. He also explains the recruitment of a FEN has allowed for some of the international recruiting firms to take unfair advantage of the recruits. The FEN recruiting industry is competitive, and a few of these firms have been known to lack ethics as they perform their roles for the recruit. Critics argue that recruiting foreign nurse will not be a solution instead paying nurses higher wages is another approach; other strategies involve offering nurses signing bonuses or repaying their student loans. Such tactics are sometimes used to try to attract nurses to particularly understaffed hospitals. Another approach is improving hospital working conditions. Improvements can include, for example, installing automated lifting devices that prevent back strain while nurses move patients, or forbidding hospitals from requiring nurses to work overtime, which keeps them from their families for long periods.
The nursing shortage prevails in USA is proved by several reports and though the different policy of the government and hospitals has been implemented the nursing shortage is continuously increasing which has a negative effect on the health department of the nation. Consequently, if nurse vacancies continue in health care facilities, and domestic production falls short of the demand, then foreign nurses are likely to remain a viable and increasingly only strategy for filling holes in the U.S. nurse workforce which has its own pros and con both in the importing as well as exporting countries.
- Brush, Barbara L., et al. “Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities.” Health Affairs, vol. 23, no. 3, May 2004, pp. 78–87. EBSCOhost, doi:10.1377/hlthaff.23.3.78.
- Chandra A, and Willis WK. “In Context: Healthcare and Public Policy. Importing Nurses: Combating the Nursing Shortage in America.” Hospital Topics, vol. 83, no. 2, Spring 005, pp. 33–37. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=106535520&site=eds-live.
- Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nursing Staffing, Burnout, and Health Care-Associated Infection. American Journal of Infection Control, 40(6), 486- 90
- Glazer, Greer, and Charles Alexandre. “Legislative: The Nursing Shortage: A Public Health Issue for All.” Online Journal of Issues in Nursing, vol. 14, no. 1, Jan. 2009, p. 4. EBSCOhost,search.ebscohost.com/login.aspx?direct=true&db=aph&AN=36979312&site=ehost- live&scope=site
- “Nursing and Midwifery – WHO Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020.” World Health Organization, World Health Organization, 1 Mar. 2018, www.who.int/hrh/nursing_midwifery/nursing-midwifery/en/.
- “Nurse Staffing: Should U.S. hospitals recruit foreign nurses to compensate for the nurse shortage?” Issues & Controversies, Infobase, 25 July 2008,https://icof.infobaselearning.com/recordurl.aspx?ID=2355. Accessed 29 June 2019.
- Mowat, Rebecca. “Sacrifices, Benefits and Surprises of Internationally Qualified Nurses Migrating to New Zealand from India and the Philippines.” Nursing Praxis in New Zealand, vol. 34, no. 3, Nov. 2018, pp. 18–31. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=133296629&site=eds-live.
- Sherwin, Jane. “Recruiting Foreign Nurses to Remedy Chronic Shortages.” Recruiting Foreign Nurses to Remedy Chronic Shortages, LEADINGAGE MAGAZINE, 2018, www.leadingage.org/magazine/november-december-2018/Recruiting-Foreign-Nurses-to- Remedy-Chronic-Shortages-V8N6.
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