With a growing nursing shortage and 500,000 seasoned nurses set to retire by years’ end, U.S. hospitals are looking for new staff outside the U.S.
This is not a new trend. The number of nurses moving to the U.S. from abroad has more than tripled since 1994, with over 15,000 nurses immigrating to the U.S. annually. It is estimated that 8% of U.S. nurses were educated abroad, totaling over 219,000 nurses.
The U.S. is not the only country who recruits foreign nurses. The United Kingdom has a long history and sees about 13,000 nurses a year immigrate.
As developed nations continue to face a nursing shortage, international nurses are helping to fill the gap. It’s a win-win, as it meets a need in the nation’s hospital system, while providing a wonderful opportunity for the nurse.
The U.S. and other affluent countries afford educational opportunities and exposure to new procedures and techniques. The exchange in knowledge across cultures is beneficial for the nurse and the host hospital.
There are economic incentives for a nurse to come and work in a more affluent country. For example, nurses from the Philippians can make 10-15 times as much money in the U.S. or Europe. This is one reason the Philippines sees 15,000 nurses a year immigrate to over 80 countries.
Other developed countries are looking to follow the U.S. and U.K.’s pattern of filling their staff shortages with immigrants. But is this a good idea? Are there other considerations?
The World Health Organization estimates that there will be a worldwide nursing shortage of 9-10 million by 2030. This is not just an American or European shortage. It is worldwide, and wealthier countries are not the areas of greatest need.
The bulk of the shortage is in low- and middle-income countries who can least afford to lose seasoned nurses. In 2018, developed countries had 14.6 nurses per 1,000 residents. By comparison, the U.S. had 17.4, Canada 11.7 and Sweden pushed 20 nurses per 1,000 people.
This is a far cry from the Philippines, which averages 5.4 nurses per 1,000 people or Mexico’s 2.85 nurses per 1,000 people. The biggest shortfall is among African countries, which struggle with less than one nurse per 1,000 people on average across the continent.
A 2020 World Health Organization nursing report further illustrated the global inequities. “There are almost 10 times more nurses in the Americas than in the African Region,” the report said. “Around 81% of the world’s nurses work in three regions (Americas, Europe and Western Pacific), which collectively account for 51% of the world’s population.”
Less than 1.3% of the world’s health care professionals work within populations that experience 25% of the global disease burden, most of which are in sub-Saharan Africa.
The disparity in the distribution of nurses worldwide illustrates a potential moral problem with recruiting from less affluent countries.
“In the past, rich countries have seen importing nurses from poor countries as a key part of the solution to address their own shortages,” says Howard Catton the CEO of the International Council of Nurses. “That has never been acceptable when it robs countries with weaker healthcare systems of much needed nursing resources.”
One justification for recruiting nurses from countries struggling to staff patient beds is that the nurses will return to their home country with new skills and upgraded credentials. However, 90% of foreign nurses choose to stay in the host community after completing their initial contracts.
The point here is not to proclaim that the recruitment of foreign nurses is immoral. It is a reminder that countries like the U.S., which control most of the health care resources internationally, have a moral obligation to help all nations provide adequate health care to their citizens.
With more nurses and health care workers than everyone else, what is the U.S. doing both to reduce our nursing shortage and help the world with theirs? We are willing to actively recruit nurses from other countries, but are we actively sending nurses or promoting nursing education in nations with the greatest needs?
Throughout the COVID-19 pandemic, we have witnessed affluent countries hoard vaccines to the point that they had more than their country could use, while less than 10% of people in low-income countries have been fully vaccinated.
African nations have received less than a third of the 66 million doses pledged through COVAX, the UN initiative seeking to distribute COVID-19 vaccines equitably.
The failure to provide more vaccines for lower-income countries opens the door for new variants of the virus. In like manner, the unfair distribution of nurses and other health care workers and resources, opens the door for the spread and proliferation of all kinds of disease.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
