The nursing shortage: real, getting worse, and global

My thanks to Joe Paduda for alerting me to Health Affair’s articles on the nursing shortage. the shortage is real, will get worse, and is global. So any major new recruitment from abroad takes nurses from other countries. That is the message from a Linda Aiken, a professor of sociology, and director of the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania in Philadelphia.
Aiken wrote in the Health Affairs blog this month, “Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000……The nurse shortage isn’t confined to the U.S. — it’s global. Extracting nurses from other countries would simply bankrupt the international supply of nurses, affecting global health.”
In her 2004 article in Health Affairs, she wrote:
The world’s nurse supply appears insufficient to meet global needs now and in the future. Countries that use the most nurses should make the biggest investments in nursing education in both their own and the developing countries from which they recruit nurses. It is not common for developed countries to invest their international aid in nursing education, and this should change to help build sustainable nursing education infrastructures in developing countries.
Ethical recruitment guidelines provide a strategy for responsibly managing international nurse recruitment, although to date the first test case—the U.K. Department of Health guidelines—has been disappointing. Since 1999, when those guidelines were established, the outflow of nurses from sub-Saharan Africa to the United Kingdom has greatly increased, and emigration from South Africa has quadrupled. The challenge is in enforcement of the guidelines, especially considering the private, entrepreneurial character of international recruitment.
The most promising strategy for achieving international balance in health workforce resources is for each country to have an adequate and sustainable source of health professionals. A two-prong strategy is required for this to happen. First, developed countries must be more diligent in exploring actions to stabilize and increase their domestic supply of nurses and moderate demand through strategic investments. Second, even without the exodus of so many qualified health professionals to work in developed countries, most less developed countries do not have the health care workforce capacity to respond to the health problems of their citizens that also can threaten global health. Making health, especially nursing, a legitimate focus of international aid and democracy building is needed.
She addressed the limited supply of nurses trained overseas:

The Philippines. The Philippines is the leading primary source country for nurses internationally by design and with the support of the government. The 2001–2004 Medium Term Philippines Development plan views overseas employment as a key source of economic growth.16 Filipino nurses are in great demand because they are primarily educated in college-degree programs and communicate well in English, and because governments have deemed the Philippines to be an ethical source of nurses. A motivator for the Philippines to produce nurses for export is remittance income sent home by nurses working in other countries. In 1993 Bruce Lindquist reported that Filipinos working abroad sent home more than $800 million in remittance income.17 No other country produces many more nurses than are needed in their own health care systems at a level of education that meets the requirements of developed countries.
However, the Philippines may be reaching a natural limit in its ability to provide enough nurses for escalating worldwide demand. An estimated 85 percent of employed Filipino nurses (more than 150,000) are working internationally. About one-fourth of the total number of nurses employed in Philippine hospitals (some 13,500) reportedly left for work elsewhere in 2001.18 There has been recent debate that the growing global demand for Filipino nurses is so great that emigration of nurses could be threatening the country’s health care quality.19 It is estimated there are more than 30,000 unfilled nursing positions in the Philippines.20 In 2001 the United Kingdom, Saudi Arabia, Ireland, Singapore, and United States were the most common destinations for Filipino nurses.21
A number of less developed countries, such as India, China, and some of the Newly Independent States of the former Soviet Union (NIS), aspire to train nurses for export following the Philippine example. That model is based mainly on the provision of private-sector education. Countries considering the development of nurses for export face challenges because of limited access to capital to build an appropriate nursing education infrastructure that meets Western standards and by the emigration of nurse faculty and leaders to developed countries.

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