Overview and Summary: International Nurse Migration: Facilitating the Transition

Abstract

The United States (US) historically has been short on international understanding. We are a people of immigrants, but earlier immigrants came here to participate in a dream of freedom and economic security. Those new to this land often lived in ethnic enclaves, but quickly became assimilated into the larger society by necessity and choice. For many, coming to the US represented a complete break with their roots, or the beginning of the effort to reunite with part of their family already in a new country. Air travel and the advances of modern communication have changed that perspective. For today's immigrants, the bonds of kinship and the memories of their native land persist and co-exist with the qualities of this new country, hopefully bringing out the best of both. As the world has grown smaller, there has been a shifting of our attention towards nursing in the rest of the world. The development of nursing and nursing education in the US has proceeded, more or less, as directed by the U. S. nursing profession over the past 150 years. Though slow and often arduous, there has been growth and success which far out-paced development in many other lands. In turn, many international leaders were educated here, and took home the U.S. ways. Sometimes these close attachments have left us blind to the uniqueness of nursing from country-to-country. Of necessity, nursing must take-on the qualities that are unique to each culture, including our own, and those qualities are not easily learned through an orientation program. This message comes through in several of the articles in this issue of OJIN. The expediency which foreign-educated nurses have represented to offset the U. S. nursing shortage is an ill-conceived gain, a gain without an appreciation that those who serve in other lands may bring a different philosophy of care. There is much we in the US can learn from them, but we must remain sovereign over our own context of care. You will find five informative and enlightening articles in this issue of OJIN. Collectively, they portray in a realistic manner the political and cultural landscape of international nursing. You have to read between the lines and listen with that fine-tuned third ear so common to nurses, but the obstacles and opportunities to international recruitment, exchange, and partnership are laid out before us. Let me correct one misconception, not deriving from these articles, but commonly held. The US, until very recently, was out-paced by the United Kingdom in the numbers of internationally educated nurses that it recruited. That situation corrected itself when the United Kingdom's National Health Service placed a moratorium on hiring as a partial solution to escalating costs. The United Kingdom had been liberal and welcoming to internationally educated nurses, accepting documents at face value and requiring that immigrant nurses participate, by law, in an adaptation program, which is much a counterpart to preceptor programs as we know them. The accusations of brain drain are discussed in the Kingma article, and observations made that migration is becoming more and more of a temporary arrangement with eventual return to the sending country. In that case, the nurse returns more accomplished than when (s)he left, bringing knowledge of new techniques and strategies for care. And conversely, the international nurse adds richness to nursing practice that is noteworthy for patients in our multicultural society. They should be with us to enrich the caring experience, and not to correct shortages resulting from poor working conditions, the major offender in the nursing shortage in the US. Many of our health systems invest wisely in programs to help the international nurse assimilate into the U.S. culture, yet other health systems just assume that being far from home, and eager to make a salary perhaps fifteen times what they could earn in their sending country, they will tolerate sub-standard conditions. …