Case 5
Developed nations Australia, Canada, the United Kingdom (UK), and the United States (US) are currently facing a nursing shortage. Australia's nursing shortage is projected to rise to 31,000 by 2006 (currently 218, 615 nurses are licensed in the country). The UK will need 35,000 more nurses by 2008. In the U.S. the deficit is expected to reach 275,000 by 2010 and 800,000 by 2020 (currently 2.4 million nurses are licensed in the US).
The importance of registered nurses in avoiding negative health outcomes is well documented. The more care a patient receives from a registered nurse (RN), the less likely s/he is to experience urinary tract infections, pneumonia, shock, or cardiac arrest. Increased RN care also shortens length of hospital stay.<
In an attempt to alleviate this shortage, many health care institutions recruit foreign-born nurses. According to the U.S. Census Bureau, of the 2.4 million U.S. registered nurses, 11.5% received their education outside the U.S. In the UK, 8.34% of 645,000 nurses are foreign-born, as are 7% of approximately 33,000 Canadian nurses. In addition to recruitment to meet general demands for RNs, countries with significant immigrant populations often target RNs from those same populations; for example, US states with large Latino populations recruit heavily from Mexico in the hope of attaining RNs who can both communicate with and understand cultural particulars of Latino patients. Great Britain employs a disproportionate number of Indian RNs, especially in urban areas with a large Indian population.
Nurses emigrate for the same reasons as other persons: better educational and working conditions; to join family members; to escape adverse environments in their home countries. Economic advancement is a particularly compelling motive to emigrate from an underdeveloped to an industrialized country. In India, for example, the average salary for a hospital nurse is $2,029—compared to $36,596 in the UK. An RN working in a Mexican hospital makes $4,200/year—compared to $43,476 in the US.
The World Health Organization (WHO) has noted that the flight of nurses (and other health care professionals) from Africa severely comprises that continent’s ability to respond to its HIV/AIDS epidemic, and to deal with endemic infectious diseases (e.g., tuberculosis, malaria,). Moreover, countries that heavily subsidize the education of their nurses lose the return on these intellectual investments when nurses emigrate. Furthermore, as the WHO has documented, nurses provide the vast majority of health care in developing nations:
In many countries nurses, midwives and allied health personnel are the main providers of health care, particularly in rural and remote areas where vulnerable populations reside. In Guyana these providers deliver as much as 80% of health care; in Chile 92% of child health visits are by nurses; in Colombia more than 75% of consultations for expectant mothers are by nurses; in Kiribati nurses are the only health workers in the rural and remote areas; in Samoa 99.5% of all health care is provided by nurses; and in Indonesia the use of community midwives increased antenatal coverage from 74% to 88%.
Residents of developing countries desperately need their nurses. Without nurses, underserved populations are unlikely to receive health care at all; at the least, access and quality will suffer. Sub-Saharan countries will need 620,000 nurses in this decade to meet the profound health crises posed by infectious diseases that disproportionately affect their impoverished populations; yet Zimbabwe (for example) lost roughly 30% of its 2001 graduating nurses to the UK. In 2000 twice as many nurses left Ghana as graduated that year from Ghanian nursing schools. The UN has estimated that each migrant African health professional (not limited to nurses) represents a loss of $184,000.