Nurse migration: let's tackle the real issues.

Abstract

Migration of health care workers is on everyone's mind these days. This is especially so after the 2004 World Health Assembly resolution citing the severity of the problem, particularly for developing countries, and setting out a series of actions for the World Health Organization (WHO) and countries to take in addressing the problem. These actions include better information and information management, effective retention strategies, and stronger planning processes. The Assembly agreed that the theme for World Health Day in 2006 would be Human Resources for Health Development and that WHO would consult within the United Nations on the possibility of declaring a year or a decade of Human Resources for Health Development. The resolution, which follows work that ICN, WHO and a number of other agencies have been doing – and continue to do – is expected to generate an enhanced WHO program of work on migration. It offers new platforms for all of us to draw attention to the migration issues important to nurses and nursing. As ICN pointed out in its intervention during the Assembly, migration is a major factor contributing to the global nurse shortage. It is a symptom of dysfunctional health systems and not the primary disease. No matter how desirable the ‘pull’ factors attracting nurses to other countries, there must be strong ‘push’ factors in their home countries. We believe emphasis must be given to retention measures in both developed and developing countries. In too many countries today there is a critical shortage of nurses willing to work under the present pay and working conditions offered. And this shortage is not limited to clinical practice. It also includes the nursing faculty needed to prepare future generations of nurses. There is in fact a paradox in industrial and developing countries alike. Today nursing shortages exist side-by-side with the unemployment of thousands of nurses. As well, there are large pools of locally trained registered nurses who choose not to work in the health sector. Creating viable work practices, supportive infrastructures and targeted incentives in these countries would encourage inactive nurses to return to health care facilities and decrease the demand for professionals from other countries. In some developing countries nurses may have to wait nine months before being paid. In countries offering special allowances for scarce skills or placement in rural areas, nurses not only receive relatively poor salaries when compared with other health sector professionals, but they also receive lower percentages of salary for these allowances. The message that their contribution to the health sector is not equally valued is demoralizing and insulting. It is not surprising that nurses consider migrating, either temporarily or permanently. ICN is clear that any strategy must incorporate the benefits of temporary mobility as well as the potential threats of permanent migration. The very nature and magnitude of migration is unclear because there has been no systematic attempt to collect the relevant data. There is a real need for comprehensive information systems. ICN also believes that innovative retention approaches must be found. This includes providing free HIV/AIDS care to nurses, other health care workers and their families. Mechanisms should be considered to direct donor aid to financing salaried positions within health systems in crisis and for expanding training facilities. Ethical recruitment principles are the same in international and intranational contexts. Decent working conditions, safe work environments and equal pay for work of equal value are nurses’ minimum expectations. Condemning nurses to work in substandard conditions and attempting to ban the emigration of nurses are unacceptable options. Retaining nurses in active practice is key to resolving the present nursing crisis, both in the industrialized world and in developing countries. Equally importantly, the retention of nurses encourages and facilitates the recruitment of future nurse professionals. We need to make the workplace safe, just and attractive to current and future nurse professionals.