May 21, 2010
Response by Randy Lynn Rosamond to "International Nurse Migration: Facilitating the Transition" (May 31, 2008):
I am writing in response to the topic addressing Nurse Migration. International nurse migration has added a new economic dimension to global healthcare through the practice of migrated nurses sending remittances to family members in their countries of origin (source country). A remittance, in the context of international nurse migration, refers to the money nurses who have migrated to a new country (destination country), send back home to their families. Without this remittance, the individual families back home may otherwise not have access to basic necessities such a food, shelter, or healthcare.
While international nurse migration has been touted as unethical and the cause of poorer countries’ “brain drain,” this migration has the potential to provide an economic lift to many third world nations. This economic lift could lay fertile ground for more ethical social networks in the nurses’ country of origin.
Newly migrated nurses can earn up to 100 times what their annual income would be back home (International Council of Nurses [ICN], 2007). It is estimated that migrated nurses send home, at a minimum, 26% of their income. This estimate is the reported percentage. It is believed that a much greater percentage would be more accurate; however, the true amount of money sent home remains unknown (ICN). The World Bank, however, has compiled data demonstrating that remittance income can be as much as 45% of the gross domestic product in many of the source countries (Ratha, 2008). This income is sent directly to families in need and has been documented as providing an economic boost to local economies (Kingma, 2008). This has become a positive ethical component which is not always recognized by the general nursing community and others.
The unethical aspect of nurse migration, in my opinion, is not that these nurses leave impoverished nations of origin. The Global Workforce Healthcare Alliance (GWHA) and the International Council of Nurse have stated that it is the right of individual nurses to move freely to better their own life circumstances and or those of their family (Brush, 2004).
Rather, the unethical aspects of nurse migration concern the recipients of the remittance fees. One unethical practice with remittances is that third parties take advantage of the nurses who are sending remittances home to their families. These third parties charge exorbitant fees to transmit this remittance money back to the home country. The cost of sending a remittance can be as much as 25% of its total value, imposing further hardship on the sender (Boldt, 2009). Another unethical concern is that fees collected by the individual or agency recruiting the nurse, fees from the hiring organization, and/or fees from the nurses who have been recruited go to fast-growing, entrepreneurial organizations, giving them a handsome profit (Brush, 2004).
Careful regulation of the above fees, possibly through a feedback system, could result in these fees being better and more ethically spent by boosting national economies, implementing needed healthcare educational systems, and developing infrastructures of the source nations. Some could also be spent developing a better healthcare educational system in the destination countries. I encourage nurses to support initiatives, in both source and recipient nations that will promote the use of part of these fees to develop national economies, healthcare systems, and infrastructures of source nations. These fees could also be used to educate more nurses in the recipient countries, thus filling their void of healthcare workers that partially “pulls” nurses from developing nations to the developed nations.
Randy Lynn Rosamond, RN, MPH, MSN
Louisiana State University Health Sciences Center
New Orleans, LA
Boldt, M. (2009). Filipino nurses find openings in Dakota, USA. Philippines Today Online Edition. November 24, 2009. Retrieved November 24, 2009 from: www.philippinestoday.net/ofwcorner/April03/ofw403_2.htm
Brush, B. L., Sochalski, J., & Berger, A.M, (2004). Imported care: recruiting foreign nurses to U.S. health care facilities. Health Affairs, 23(3), 78-87.
International Council of Nurses. (ICN). (2007). International Nurse Migration and Remittance Fact Sheet 2007- ICN. Retrieved June 2, 2009 from: www.intlnursemigration.org/assets/pdfs/Nurse Migration Remit fact sheet US.pdf updated July 29, 2009 from : www.icn.ch/matters_aging.htm
Kingma, M. (2008). Nurses on the move: Historical perspective and current issues. The Online Journal of Issues in Nursing, 13(2). Retrieved May 26, 2009 from: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No2May08/NursesontheMove.aspx
Ratha, D. (2008). 2002- 2008 & 2007-2008 World Bank remittance data tables for under developed nations in terms of US $ and % GDP. Retrieved May 19, 2009 from: http://go.worldbank.org/QGUCPJTOR0