The global migration of nurses: importing skills, exporting shortages

Facing nursing shortages, health systems in developed countries are recruiting nurses from other developed and developing countries. What is the impact of this short term solution on recipient and source countries?  How can health systems plan for the effects of increasing migration of nursing staff?

Research by the World Health Organisationexplores the international migration of nurses and the implications for fivecountries: Australia, Ireland, Norway, the UK and the USA. The flow of nursesto these countries has risen during the 1990s, and, in some cases, recruitmentis from developing countries.  Theresearchers propose a number of policy options to manage nurse migration andmake a number of recommendations for improving workforce data systems.

Significant findings include:

• Between 1990 and 2002, Ireland and the UK saw a steep rise inthe number of internationally trained nurses joining their registers.  In 2001 they accounted for two thirds ofnew entrants to the Irish nursing register and over half of those added tothe UK register.
• In the USA, overseas recruitment fell during the second half ofthe 1990s but has increased rapidly since 1998.
• In 1990, nurses migrating to the UK came from a total of 71countries.  By 2001 this figure hadincreased to 95 countries.
• The majority of foreign trained nurses migrating to Norway andAustralia (Victoria State) are from other high income countries, whereasin the United Kingdom and the USA the majority are from lower-middleincome countries.
• The proportion of nursing recruits from low income countries ishighest in the UK (18 percent) and the US (11 percent).
• Basic data for monitoring the migration of nurses and assessingimpact is often inadequate, incomplete or not available.

The evidence points to a sharp increase inthe international flow of nurses. However, the absence of basic information makes it difficult to assessthe impact of migration.  For countriesto plan for the effects of nurse migration, the ability to monitor trends inthe inward and outward flow of nurses is essential. 

Methods to improve the availability andcomparability of data need to be promoted. The information base must enable policy-makers in both source anddestination countries to address key policy questions related to the internationalmigration of nurses.

Recruiting nurses from overseas can createa shortage in source countries that are less well equipped to deal withit.  Three policy options are proposed todeal with this:

• Improve the status, pay and working conditions of nurses intheir own countries.  This wouldmoderate the factors driving them to seek employment elsewhere.
• Encourage and facilitate managed flows of nurses betweencountries.  This should include theoption for nurses to return home if they wish.
• Institute arrangements for compensation to flow from therecruiting country back to the source country.  Such compensation could be financial –through direct remittances or educational support – or the return flow ofbetter-trained staff.

The international flow of nurses is asymptom both of a global shortage of nurses and of deep-seated problems incountries that have failed to plan for and retain sufficient nursingstaff.  The underlying problems can onlybe solved through country-level improvements in the status of nursing, in theplanning of health services, and in the management of the nursingworkforce.