Nurses are central to the delivery of care in all countries. Developed countries have come to rely on many more nurses than they produce, and increasingly depend upon nurses recruited from less developed countries. "Approximately 80 percent of nurses immigrating to the United States are from developing countries, however close to 60,000 nurses residing in the U.S. come from Canada, the United Kingdom, Ireland and other developed countries also facing nursing shortages. This contributes to the need for these countries to recruit from developing countries," says Linda H. Aiken, professor and director of the Center for Health Outcomes and Policy at the University of Pennsylvania. "This exodus of nurses from developing countries impacts the ability of these countries to develop sustainable health care systems, provide appropriate care, and manage disease."
The expert group's work was based on guiding principles that advocate countries' self-sufficiency in their nursing workforce; equitable nursing migration; use of trade and foreign policy to enhance nursing capacity; and the use of partnerships among nursing peers worldwide to advance nursing services.
The group's recommendations for resolving the global nursing shortage build upon previous successes in developing policies and practices to recruit, build capacity, motivate, and retain nurses. On an international scale, the expert group recommends developing:
- A Global Health and Nursing Equity Index including elements such as work conditions, nurse production, inflow/outflow of nurses, nurse/population ratio, and burden of disease. This index can then be used to guide performance assessments, develop practice guidelines, and inform distribution of foreign aid to enhance nurse capacity;
- Strategic partnerships and networking to share best practices, promote leadership development, and support cross-national evaluative research;
- Appropriate international credentialing to recognize and elevate prestige of nursing work.
On a national scale, the expert group recommends:
- Promoting targeted investment in nursing education and work conditions;
- Harmonizing curricula and certifications within regions to promote regional self-sufficiency;
- Including nurse/bed ratios in hospital accreditation instruments;
- Reforming local regulations that discriminate against nurses returning home and recognizing international experience abroad in pay and seniority;
- Evaluating strategies for motivating and retaining nurses;
- Evaluating the impact of trade agreements on nurse capacity;
- Stabilizing visa/work permit quotas offered by destination countries to support effective supply planning in source countries;
- Creating a high-level governmental body to coordinate and recommend national and international nursing workforce policies;
- Developing oversight of recruitment agencies to align activities with national plans;
- Promoting and monitoring immigrant nurses' rights.
The meeting, organized by AcademyHealth and The University of Pennsylvania, brought together representatives of universities in Canada, the U.K., the U.S., four Sub-Saharan African countries, India, the Philippines, China, and the Caribbean, as well as The World Health Organization, The International Council of Nurses, The Commonwealth Secretariat, and the U.S. Commission on Graduates of Foreign Nursing.
Sponsorship support for this meeting was provided by the Rockefeller Foundation, the International Development Research Centre, Johnson & Johnson, The Robert Wood Johnson Foundation, the Nuffield Trust, the Agency for Healthcare Research and Quality, the Canadian Health Services Research Foundation, the Canadian Nurses Association, and the Joint Committee on Economic and Policy Analysis.
The dialogue on global nursing shortages will continue at the AcademyHealth Health in Foreign Policy Forum, February 8th, 2006 at the Renaissance Washington D. C. Hotel. The 2006 event will bring together domestic and foreign policy experts to explore ways to build health workforce capacity in this country and abroad, and to tailor policies to specific regional situations. For more information on the Forum, visit http://www.