There has been unprecedented debate over economic policies with the advent of globalization marked by increased international labor mobility (Stilwell et al, 2004). But while in some economies, trade restrictions and protectionism has continued to hinder labor mobility, other economies are increasingly opening up their borders for international labor flow. This is a field of inquiry that has continued to attract attention of social scientist than many other aspects of globalization and world economy (Fanning and Munck, 2011). There has been substantial theoretical and empirical research on international migration of healthcare professionals in the last decade, a trend that has also invited multilateral financial institutions such as World Bank and international agencies like World Health Organization. The economic implications of healthcare professional mobility have thus; become fundamental public policy concern (Debisette, 2011).
This essay seeks to review the trends in international nurse immigration, economic factors motivating such migration and the consequence of international capital flow on health systems. This discussion is informed by the changing policy responses that seem to be shifting from simply preventing labour mobility towards more economically beneficial agenda of managing such migration for the mutual benefit of the destination and labor source countries (Stilwell et al, 2004). With international nurse immigration being viewed as solution to shortage of nurses, this paper maintains that improved working conditions and wages supported by effective human resource systems primarily influence international nurse migration.
Trends in International Nurse Migration
Nursing shortage in developed economies has heightened international recruitment and human capital flow. International recruitment and nurse migration refers to movement of nursing professionals from one country to another in search of employment opportunities and greener pastures. This today, is viewed as short-term solution to the serious nursing shortages in countries like the United States, United Kingdom and larger Europe. In the past, nurse migration was basically motivated by personal desire to establish international labor contacts or based opportunistic event when nursing services are needed in the destination countries (Stilwell et al., 2004). In the past decade, however, nurse migration and recruitment has largely been planned with recruitment agencies in developed countries increasingly sourcing nurses from either developing or other developed countries (Stilwell et al., 2004). Also, developing countries are no exception as they are also sourcing nurses from each other.
In United Kingdom, the British National Health Service (NHS) has been experiencing unprecedented budget increase to finance panned growth of the nursing workforce. There has also been an increase in nurse training with the nation while also, directing efforts to attract nurses from outside borders characterised by explicit labor policies on international recruitment although with region restrictions (Aiken et al., 2004). This trend has been witnessed since the beginning of millennium. In 2002, for instance, about 16, 155 nurses joined U.K’s labor register from other nations more than in any other economic sector with education registering only 14, 538 (Aiken et al., 2002). Such recruitment efforts have also been reinforced by improved foreign-based nursing curriculum that has promoted eligibility of nursing practice in United Kingdom. In addition, dependency on foreign-trained nurses in many healthcare sectors in United Kingdom has routinely facilitated funding of international healthcare labor to a point that organizations sponsor extended work permits for its personnel. Empirical findings shows that one in four nurses based in London are from foreign countries while some privately-run healthcare organizations employ even up to 60% foreign-trained nurses (Alien et al., 2004). Most of these nurses do not necessarily come from Europe but rather Australia, South Africa, Philippines, India, and some other Africa countries with the labor flow being consistent with a well-established trade patterns.
Controversy surrounding mass nurse migration from considerable number of African countries resounds. The pattern perhaps has been promoted by the revision of Healthcare ethics code in 1999 that waived restriction of labor recruitment from sub-Saharan Africa by the British National Health Service board. That notwithstanding, private organization preference for African-trained nurses has perpetrated this practice and who ultimately on gaining practice eligibility in UK find their way into NHS. This explains why migration of nurses into U.K. from Africa has been on an upward trend. Similarities of commonwealth nursing curriculum also confer graduates from such countries eligibility of practice in U.K due to recognition of their certifications.
There are assumptions with the labor corridors that the United States is the force to reckon with regard to nurse immigration owing to its large heath care system, good wage structure, favorable human resource practices and unsurpassed media attention to its international nurse recruitment activities (Lisa, 2007). Since late 1990s, foreign-trained nurse population has been on the increase at a rate estimated to outweigh that of U.S-educated nurses (Alien et al., 2004). Accordingly, foreign-born nurses United States accounts for about a third of the increased recruitment of nurses nationally, although it has not been established with accuracy how many of such nurses are trained oversees. Contrary to the belief that United States is the leading importer of nurses, the country has highly restrictive licensure and immigration policies which greatly limit entrance of oversees-trained nurses to the country. For example, it is a requirement for all nurses to pass the National Council Licensure Examination in order to practice as registered nurses. This requires adequate demonstration of professionalism that meets the country’s standards with those whom English is not neither their native language nor a primary language in their mother countries sitting for English proficiency tests. Other restrictions include visa screening and trade-tariff restrictions. But this does not overrule the fact that America does import nurses especially from developing countries. Canada for instance, has for many years been the largest source of nurses to United States particularly in neighboring states where Canadian-trained nurses are explicitly endorsed owing to comparability of nursing curriculum and licensure policies.
Ireland is a notable example of developed economies that is a major host of foreign-trained nurses. In the past, Ireland educational system produced more nurses that the country could absorb which facilitated international migration of nurses to other developed countries. But with its current economic boom, which has also led to an enlarged healthcare system, the Ireland-trained nurses could no longer meet the nursing demand making the country a major destination for overseas recruits. According to Alien et al (2004), Ireland is a major host of U.K-trained nurses with the country importing large numbers of nurses than it training domestically.
Economic Reasons and Implications of International Labor Flow
Economically, the nurse migration can be explained by the push/pull labor theory. Push factors are the reasons that drive the nurses to other countries and connote economical factors such as unsatisfactory wages, inadequate work facilities, lack of career development options and government policies or social-political factors (Peter and Groningen, 2004). On the other hand, Pull factors are the forces of attraction in destination countries and include better opportunities for career development, improved standards of living, better wages and learning opportunities.
The push/pull labor model is expounded by the Neo-classical economic theory which maintains that migration results from geographical differences in the supply and demand for labor (Peter and Groningen, 2004). As such, countries with large supply of nursing workforce have relatively lower demand for such labor hence offer lower wages. On the contrary, those with limited number of trained nursing personnel have a higher demand for their services and consequently, offer higher remuneration. It is this imbalance between supply and demand for nurses that induces them to migrate from low-wage areas to countries that offer better wages.
Figure 1: Labor market and interaction between demand, supply and minimum wages.
As shown in the Figure 1, when the equilibrium wage falls below the minimum wage there will be surplus supply of nurses because demand for labor is low hence unemployment sets in. Under such situation, not all qualified nurses even willing to work for a minimum wage will be absorbed by the system. This forces nurses to seek employment opportunities in other countries. Similarly, countries offering higher minimum wage acts as bait for international labor migration. If differences are evident in countries’ minimum wages for nurses, the neoclassical theory of migration takes effect.
The Keynesian economic theory, which is critical of the tenets of neoclassical theory on labor and capital flow, posits that international labor migration eliminates unemployment differences. It contends that labor supply further do depend on the nominal wage and not only the real wages as posited by neoclassical theory. Since Keynesian economics views money both as medium of exchange and saving, the latter function of makes the nurses to be attracted to countries with higher nominal wages (Fanning and Munck, 2011).
Another economic theory that has sought to explain international labor flow is the dual labor market theory which contends that international labor migration is largely driven by unemployment levels of trained workforce and the general labor shortages in developed economies and their need to fill bottom positions in the job hierarchy (Peter and Groningen, 2004). In most cases, shortages in the bottom positions in modern societies resulting from motivational problems and marked social changes. As such, few resident professionals are willing to take up such bottom positions which therefore, create labor shortages. Foreign nurses inspired by better lives and standards in developed societies migrate to take-up such positions.
In conclusion, there has been unprecedented international nurse migration in the last decade. Some of the destination countries include United Kingdom, United States, and Ireland. These nurses are sources from both developed and developing countries and the pattern is influenced by economic and social reasons such as wage difference, better career development prospects, good human resource practices and better lifestyles.
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