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Sat Ananda Hayden, MSN, RN Doctoral Student, Public Policy Lutchmie Narine, Ph D Director, Masters of Health Administration Associate Professor, College of Health and Human Services Rose Marie Tong, Ph D Distinguished Professor in Health Care Ethics

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Picking Out the Pieces

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Picking out the pieces l.jpg

Sat Ananda Hayden, MSN, RN

Doctoral Student, Public Policy

Lutchmie Narine, Ph D

Director, Masters of Health Administration

Associate Professor, College of Health and Human Services

Rose Marie Tong, Ph D

Distinguished Professor in Health Care Ethics

Director, Center for Professional and Applied Ethics

Department of Philosophy

University of North Carolina, Charlotte

Picking Out the Pieces

Ethical Issues in International Nurse Migration


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Why Nursing Density Matters

There are an estimated 136 million births/year worldwide

Source: WHO (Make Every Mother and Child Count)

http://www.who.int/emc-hiv/global_report/slides/slide15.html latest available data

Ethical Issues of International Nurse Migration


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Nursing Density Worldwide

Minimum: 5.4

Maximum : 2171.2839 Mean : 338.03

Standard Deviation : 356.51

http://www.who.int/GlobalAtlas/InteractiveMap/MainFrame2.asp (latest available data)

Ethical Issues of International Nurse Migration


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Density of Source and Destination Countries

Sources: WHO (latest available); India, UK, Nigeria, Australia, Canada, NZ, UK, Australia from Aiken et al, 2005

Ethical Issues of International Nurse Migration


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Study Questions

  • What are the ethical themes in current International Nurse Migration literature?

  • Are those themes different for Source and Destination countries?

  • What are the ethical and moral implications of Brain Drain?

  • Should Health Professionals be treated differently than other professional migrants?

  • What is the best way to frame the ethical discourse about nurse migration?

Ethical Issues of International Nurse Migration


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Study Design & Sample

  • Content Analysis of published and unpublished documents between 2000 and 2005

  • Sample: 212 documents

  • Inclusion Criteria

    • All documents pertaining to nurse migration, global nursing shortage, nurse migrants, foreign nurse recruitment

    • All documents pertaining to Brain Drain of HRH

    • All documents pertaining to ethical recruitment of foreign nurse graduates

Ethical Issues of International Nurse Migration


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Methodology

  • Content Analysis

    • Theories

    • Policy Approaches

    • Ethical Implications of International Nurse Migration (INM)

    • Codes of Ethics for International Recruitment of Nurses (IRN)

  • N = 150

Ethical Issues of International Nurse Migration


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Findings

  • Theoretical frameworks are not typically explicated

  • Policy frameworks are implicit rather than explicit

  • Ethical discussions are at a high level of abstraction and limited to such areas as

    • Social Justice

    • Distributive Justice

    • Tensions between source and destination countries

  • The number of published documents on the topic increased fourfold between 2000 and 2004

Ethical Issues of International Nurse Migration


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Increased International Interest

Ethical Issues of International Nurse Migration


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Source Countries

Push factors

Stick factors

Professional preparation

Wage differentials

Structure of health sector

Exploitation

Remittances and other Diaspora Effects

Destination Countries

Pull factors

Stick Factors

Immigration Policy

Structure of health sector

Supply and demand

Ethical treatment of migrants

SharedThemes

Ethical Issues of International Nurse Migration


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Different Views of “Ethical”

Source Countries

  • Ethical Recruitment refers to

    • Poaching, looting, siphoning, stealing, neo-colonial subsidization of health care in destination countries

  • Destination Countries

    • Ethical Recruitment refers to responsibility without accountability

      • Codes of Ethical Recruitment

      • Codes for Ethical Treatment of Nurse Migrants

      • No coordination or oversight of recruitment

  • Ethical Issues of International Nurse Migration


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    Major Ethical Themes

    • Individual Welfare vs. Professional Values

    • Human Rights vs. Utilitarian Principals

    • Source Country Rights vs. Destination Country Rights

    • Health Professionals vs. Other Skilled Migrants

    • Global vs. Local Professional Competencies

    Ethical Issues of International Nurse Migration


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    Dominant Discourse

    • Codes of Ethical Recruitment

    • Medical Exceptionalism (Alkire & Chen, 2004)

    • Local rather than Global Competencies

    • Brain Drain

    • Exploitation

    Ethical Issues of International Nurse Migration


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    Rights-based Approach

    • First Generation: Source countries

      • Political Freedom

      • Civil Rights

    • Second Generation: Destination Countries

      • Distributive Justice

      • Allocation of Resources

    Ethical Issues of International Nurse Migration


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    How Ethical Discourse Informs Policy

    • Foreign Policy

      • Structure aid policies to support stick and stay factors

      • Structure aid & development policies to support source country self-determination

      • Elevate Global HRH capacity planning at G8 level

      • Global funding and tracking of health professional migration

      • Credits for INM working in-country

    Ethical Issues of International Nurse Migration


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    How Ethical Discourse Informs Policy

    • Domestic Policy

      • Assess HRH impact of proposed policies

      • Engage in coordinated HRH capacity planning and resource tracking

      • Restructure Health Sector

      • Education:

        • Increase educational capacity and funding subsidies based on capacity planning

    Ethical Issues of International Nurse Migration


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    How Ethical Discourse Informs Policy

    • Economic Policy

      • Structure policies to support stick and stay factors

        • Wage adjustments for nursing salaries

        • Incentives for returning nurses

      • Disincentives for HCOs that use INM

      • Eliminate designations of HRH shortage areas as basis for incentives

    Ethical Issues of International Nurse Migration


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    How Ethical Discourse Informs Policy

    • Trade Policy

      • Calculate impact of trade agreements on HRH

      • Include reciprocal reinvestment in HRH for trading partners

      • Determine impact of Trade Policies on domestic health sector

    Ethical Issues of International Nurse Migration


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    Conclusion

    • Source countries view INM from a neo-colonial perspective

    • Destination countries view INM from economic and individual rights perspective

    • Brain Drain, Brain Waste, and Brain Effect can be incorporated into managed migration plans

    • Medical exceptionalism is a palatable solution for some

    • Ethical discourse can be successfully incorporated into policy

    Ethical Issues of International Nurse Migration


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    Final Thought

    If we are headed for a “flat world” model, what does that mean for professional status and standards of care?

    Ethical Issues of International Nurse Migration


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    Corresponding Author

    Sat Ananda Hayden

    Political Science Department

    University of North Carolina, Charlotte

    9201 University City Blvd

    Charlotte, NC 28223

    [email protected]

    Ethical Issues of International Nurse Migration


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