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International nurse migration experts convened on July 9, 2005 at
the Rockefeller Foundation Conference Center in Bellagio, Italy to
examine the causes and consequences of the global nurse shortage and
to consider strategies to mitigate its negative impact on the health
of people around the world. The recommendations and presentations
from the expert meeting can be found at
http://www.academyhealth.org/international/nurses.htm
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 eighty percent of
nurses immigrating to the U.S. are from developing countries,
however close to 60,000 nurses residing in the U.S. come from
Canada, the U.K., 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 Center for Health
Outcomes and Policy Research of 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.academyhealth.org/nhpc/foreignpolicy/
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