The complex ethics of nurse migration.
Article Type: Editorial
Subject: Nurses (Employment)
Nurses (Emigration and immigration)
Nurses (Supply and demand)
Labor supply (Forecasts and trends)
Labor supply (International aspects)
Author: Walker, Leonie
Pub Date: 08/01/2009
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2009 Source Volume: 15 Source Issue: 7
Topic: Event Code: 530 Labor force information; 600 Market information - general; 010 Forecasts, trends, outlooks Canadian Subject Form: Labour force; Labour force Computer Subject: Market trend/market analysis
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 206850893
Full Text: There is a growing shortage of nurses in developed countries, fuelled by rising life expectancy, increasing chronic health needs and an ageing nursing workforce. While there can be no debate about the need for all involved in nurse migration (recruiters, agents and employers) to behave ethically, perhaps it is time to re-examine the issues and perspectives of stakeholders in this complex, multifaceted social phenomenon. New Zealand is a significant exporter of nurses. It is also a destination country for nurses from poorer, less developed countries and is well placed, therefore, to understand the wider ethical implications for nurse migration.

Much has been written about the impact of losing significant numbers of skilled, trained workers on the health care capacities of source countries. For many developing countries, nurses play vital roles in combating significant ill health, especially in rural settings, often undertaking tasks reserved for doctors in other countries. Where training of nurses is partly subsidised by tax payers, there have been demands that these professionals reciprocate the investment by serving the needy in their own countries. (1)

Female phenomenon

Nurse migration is largely a female phenomenon, and the independence and accomplishment associated with it can be both emancipatory and in conflict with roles as wives, daughters and mothers. (Interestingly, though the costs of training, and the impact of losing medics are arguably much higher than for nurses, there has been far less moral panic related to international doctor migration.)

Many countries have experimented with voluntary codes and bans on aggressive recruitment and with manipulating nursing registration requirements, as mechanisms to limit over-recruitment from vulnerable countries. (2) However, these tactics have not only been ineffective in protecting source countries, they have also actively disadvantaged international nurses; condemning them to employment in the most poorly paid and least regulated health sectors. It is in no-one's interests that highly trained theatre nurses are working as porters or caregivers on minimum wages. Additionally, some source countries such as the Philippines (3) and China (4) increasingly deliberately produce trained nurses as an export commodity--to generate hard currency as part of national development strategies. Undoubtedly, patients in both the Philippines and China would have better access to health care if there were more nurses but it is not the absolute lack of trained staff, but the lack of funds to employ the staff that underlies the lack of capacity.

For individual nurses who have invested personally in their training and registration, the aspirations to work abroad for decent wages are completely understandable. For New Zealand nurses, the benefits of having vacancies filled by international colleagues are often balanced by difficulties caused by the different cultural, linguistic and professional backgrounds, which can be confusing and time consuming. Even for a migrant from an English-speaking country, accent, slang, idiom and culture are surprisingly unfamiliar, and clinical protocols, scopes of practice, and workplace policies and procedures new and challenging. It can be distressing to move from one environment where your skills and experience are prized and respected, to one where they appear to count for little. Unless tensions and misunderstandings on both sides are managed well, the potential for personal and professional damage is large.

In the past, national nursing organisations have perceived the interests of their members (job security, wages and competition) to be in conflict with those of migrant nurses. (5) The ICN, while recognising the potential adverse effects on source countries, argued as long ago as 2001 that: "Career mobility allows nursing to respond to scientific, technological, social, political and economic changes by modifying or expanding the roles, composition and supply of nursing personnel to meet identified health needs." (6) New Zealand's nurses have a more sophisticated understanding of the economics and politics of international migration generally, and many have personally benefited from increased experience and financial gain while working abroad.

As a country, we have much to gain from access to nurses with different ideas, new skills, and a passion to work here. Most migrants are resourceful and resilient and, with the right support, can contribute to increasing New Zealand's social and economic capital.

The human right of nurses (and all workers) to migrate to further their careers and assist their families frequently collides with other political and social imperatives. Identifying and addressing the causative factors behind nurse migration requires concerted action by governments in both developed and developing countries. As nurse migration researcher James Buchan has said: "Careful workforce planning, end effective recruitment and retention of domestic nurses are among the most important messages to prevent brain drain from developing countries. " (7)

In 2007, New Zealand signed the Islamabad Declaration on Strengthening Nursing and Midwifery, one goal of which was that "each country must establish policy and practices to ensure self-sufficiency in workforce production within the limits of its own resources" (8) Production and retention are equally important.

While New Zealand cannot greatly affect the "pull" factors for nurses from countries that can ill afford to lose them, it can, with appropriate political will, remedy the "push" factors that drive our nurses overseas in search of fair pay, flexible careers, safe staffing and stimulating and empowering work environments.


(1) Singh, 3, Nkala B, Amuah, E., Mehta, N. & Ahmad A. (2003) The ethics of nurse poaching from the developing world. Nursing Ethics; 10: 6.

(2) Kingma, M. (2006) Nurses on the Move: Migration and the Global Health Care Economy. Ithaca and London: ILR Press.

(3) Aiken, L. et al. (2004) Trends in international nurse migration. Health Affairs; 23: 3.

(4) Yu Xu and Jianhui Zhang. (2005) One size doesn't fit all Nursing Ethics; 12: 6.

(5) Peterson, C.A. (2001) In short supply: around the world, the need for nurses grows. American Journal of Nursing; 101: g.

(6) International Council of Nurses. (2001) Position statement: Ethical Nurse Recruitment. Retrieved 14/07/09.

(7) Buchan, J. and Calman, L. (2004) The Global Shortage of Registered Nurses: An Oven/few of Issues and Actions. Geneva: International Council of Nurses.

(8) Islamabad Declaration. (2007) Islamabad Declaration on Strengthening Nursing and Midwifery. Geneva: International Council of Nurses.

By NZNO researcher Leonie Walker
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.