html5-img
1 / 21

Picking Out the Pieces

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

azra
Download Presentation

Picking Out the Pieces

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Increased International Interest Ethical Issues of International Nurse Migration

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. Corresponding Author Sat Ananda Hayden Political Science Department University of North Carolina, Charlotte 9201 University City Blvd Charlotte, NC 28223 sahayden@uncc.edu Ethical Issues of International Nurse Migration

More Related