Crisis of Nurse Migration in Developing Countries, The

Crisis of Nurse Migration in Developing Countries, The

Yearwood, Edilma L

At the 10th Coloquio Panamericano de Investigacion en Enfermería (Panamerican Colloquium of Nursing Research) in Buenos Aires, Argentina, in November 2006, a spirited topic of conversation was the impact of nurse migration on human resources and health care in developing countries. Nurses from Canada, the United States, Central and South America, Mexico, and the Caribbean gathered for 4 days to discuss a variety of issues, including the impact of nurse migration from developing to developed countries on healthcare resources; intercountry partnerships and collaborations; nursing practice in community mental health; and nursing research occurring in both developed and developing countries. The conference was supported in part by the Pan American Health Organization and the World Health Organization.

As a novice participant to such a large-scale gathering of nurses from this hemisphere, I was impressed with the passion surrounding the discussions and presentations and the collegiality among the participants. It was affirming to see nurses from different countries openly discussing shared problems and looking at potential solutions.

One issue that rose to the top and clearly affects resource availability, capacity building, quality of care, access to care, and overall health in developing or resource-poor countries is the internal and external migration of nurses from rural to urban areas and to resource-rich or more advantaged countries. Nurses from Mexico, Central and South America, and the Caribbean reported frustration with training nurses who would then migrate to other countries or move within country to the larger cities. Migration, insufficient numbers of trained health workers, poor salaries, poor working environments, long hours, and sicker patients to care for have created a healthcare crisis in developing countries resulting in inequities in health care and poor health outcomes (McElmurry et al., 2006). While all agreed that the advantages associated with migration were understandable, the consequences to good health care that is available in poorer countries has suffered and continues to suffer significantly, affecting mortality, morbidity, and quality of life.

Nurses engage in internal and external migration to earn more money, access education and advanced technology skills, provide for their families, and improve their overall quality of life (Xu & Zhang, 2005). However, the gap that they create in the healthcare system in their country of origin is adversely affecting those most in need. The ongoing erosion of human resources means that there are fewer healthcare services for in-country individuals and families, there are units and facilities that have had to be closed, there are longer wait times to receive scarce services, and services that are available are providing only basic care rather than primary and tertiary preventive services.

One population that has been placed at greater risk as a result of nurse migration from resource-poor countries are children and adolescents vulnerable to or with mental health needs. The number of inpatient beds for child and adolescent psychiatric patients are too few to meet the needs of the population in most developing countries, and community facilities providing mental health services are scarce despite increased needs. The recent United Nations Secretary General’s World Report on Violence Against Children (2006) paints a bleak picture of the impact of violence worldwide on children and draws a direct relationship between “income inequality, migration and threats to health . . . having an affect on how children are treated” (p. 11). The report also provides disturbing data on Latin American and Caribbean (LAC) youth. LAC children ages 15-17 have the highest rate of homicides (as perpetrators and victims) worldwide; between 11 and 25 million youth in this region have witnessed domestic, school, or community violence; corporal punishment in schools is still an acceptable practice in some countries; and there is no consistent mechanism for reporting, investigating, or prosecuting child abuse and neglect cases in the region. Along with these factors, substance abuse is a major problem in the region and no doubt is a factor in the level of violence that exists. The recommended solutions to the problem of violence against children are many of the things child mental health and pediatrie nurses worldwide have engaged in as part of our practice. The report recommendations include strengthening the capacity of each nation to improve health (for all) and develop infrastructure by increasing human and financial resources; advocating for a cessation of violence (in all forms) against children; working with individuals and families to improve parenting skills, thereby strengthening families; educating all levels of individuals about the societal ramifications of violence; and providing treatment for anxiety and depression associated with violence exposure (2006). The ongoing drain of nurses is indeed removing a potential barrier to providing services for the most vulnerable individuals in society.

Provision 8 of the American Nurses Association Code of Ethics (2001) states that, “The nurse collaborates with other health professionals and the public in promoting community, national and international efforts to meet health needs.” It further states that, “The nurse has a responsibility to be aware of broad health concerns such as … inequitable distribution of nursing and health care resources . . . existing threats to health . . . and that the nurse supports initiatives to address barriers to health” (p. 23). The American Nurses Association Code of Ethics can serve as a basis for the work that nurses from resource-rich and resource-poor countries can use when working together to tackle the problem and sequelae of nurse migration. For nurses in resource-rich countries, increasing awareness of the impact on overall health of entire populations when human resources are removed is vital. For nurses in resource-poor countries, developing a collective voice to demand health service changes from their government to meet the needs of all their citizenry will call attention to the infrastructure that must be in place, including appropriate remunerations, to adequately meet healthcare needs and retain nurses in country.

I am hopeful that this exciting opportunity for exchange will continue to spark ongoing dialogue and development of creative strategies to meet the needs of all countries and populations. How can intercountry nurse partnerships be developed that do not erode human resources? What types of exchanges can occur that respect and value the identified healthcare needs of both types of countries? How can nurses work together across borders to enrich and further develop the nursing profession so that we are able to advocate most effectively for individuals, families, and groups in need of quality health care?

References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Springs MD: Author.

McElmurry, B., Solheim, K., Kishi, R., Coffia, M., Woith, W., & Janepanish, P. (2006). Ethical concerns in nurse migration. Journal of Professional Nursing, 22(4), 226-235.

United Nations Secretary General. (2006). Study on violence against children. Retrieved March 25, 2007, from http://www.unviolencestudy.org

Xu, Y., & Zhang, J. (2005). One size doesn’t fit all: Ethics of international nurse recruitment from the conceptual frameworks of stakeholder interests. Nursing Ethics, 72(6), 571-581.

Edilma L. Yearwood, PhD, APRN-BC

Assistant Professor

Georgetown University School of

Nursing & Health Studies

Washington, DC

Author contact: ely2@georgetown.edu, with a copy to the Editor: poster@uta.edu

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