West banks on developing world to plug nursing gap
By Andrew Stern
CHICAGO: The Filipino teachers who trained Fe Sunga to be a nurse fined her $1 each time she was caught speaking her native tongue rather than English.
The Tagalog speaker needed to master English because she and her classmates were destined for better-paying jobs in the United States. They were part of the initial wave in a flood of foreign-educated nurses emigrating to meet an acute nursing shortage in the West that promises to worsen as populations age.
Sunga, a registered nurse who came to the United States from Manila in 1972, took part in a rally marking ‘nurses week’ in Chicago recently. After three decades, she would not consider returning to her native country. “No way. The salaries there are so cheap, maybe $200 a month,” she said.
Nurses have become an essential import in what the World Health Organisation and other critics have called an insidious ‘brain drain’ of health care workers from developing nations to wealthier countries, where nursing jobs go unfilled because of an aging workforce and a shortage of nursing school graduates.
“Around the world the nurse is becoming a commodity to be traded among nations, and firms are lining up to become part of the profit that occurs in this exchange,” said Peter Bruehaus of Vanderbilt University School of Nursing in Nashville, Tennessee.
A global industry of nurse recruiters and nursing schools has emerged in developing countries to fill the job openings in the West, though some have unsavoury reputations, experts said.
A less-publicised undercurrent in the US debate over immigration is whether to expand or lift caps on prospective immigrants with special in-demand skills such as nurses and computer engineers.
In general, foreign-trained nurses who meet skills and language criteria bypass the years-long backlog faced by most hopeful immigrants because of the US-declared nursing shortage.
Bruehaus estimated the current US nurse vacancy rate at nine per cent, among more than two million nursing jobs, and US projections anticipate a shortage of 800,000 nurses by 2050.
In the Philippines, thousands of doctors train to become nurses to qualify for openings in the West; South Korea recently pledged 10,000 nurses over the next five years to bolster New York hospital staffs; and African and Caribbean countries with precarious health care systems have seen their nurses leave for the United States, Europe and Australia.
The Philippines long ago became a government-supported nurses training ground, and expatriate Filipino health workers send nearly $11 billion a year back home.
Meanwhile, many poor outside of Manila die without seeing a health care worker, and health care crises plague the poor in India, China, and African and Caribbean nations that lose nurses to wealthier countries.
Africa has one-quarter of the world’s burden of diseases, but just three per cent of the world’s health care workers, WHO says.
In Ethiopia, for instance, there are 21 nurses per 100,000 people compared to 900 nurses per 100,000 Americans.
Beth Delarama, another nurse trained in the Philippines who immigrated in 1980 and lives in the Chicago area, said salaries are not the only factor. “It’s not the money, it’s the conditions. The quality of care here is much better,” she said.
Newcomers from Thailand, South Korea, India, Nigeria, Jamaica and elsewhere rarely say they plan to return to apply their nursing skills at home, nurses said in interviews.
At Advocate Christ Hospital in Chicago, keeping and recruiting nurses is a priority, executives said.
“We are right now in the process of working with a group of nurses from the Philippines,” said chief nursing executive Darcie Brazel.
“It’s not something I’m particularly crazy about doing because I feel like, boy, it’s not being a good global community citizen. Those countries need their nurses as well. But a lot of (hospitals) are looking at overseas recruiting.”
During past nursing shortages, Bruehaus said a few thousand foreign-trained nurses would fill US job openings in a given year, but 2001 saw a spike to 40,000 nurses from overseas that set a trend that shows few signs of abating.
“The future of the labour market in nursing is more older nurses and more foreign-born nurses. Those are the two groups growing the fastest at an annual rate of about 15 per cent each — with the exception of 2005,” Bruehaus said.
The number of foreign-educated nurses dropped unexpectedly last year, though other experts traced it to a temporary crackdown on work visas.
Over the past two years, the number of working American-trained nurses declined, which may signal the anticipated retirement of an ageing generation of nurses. The 2.2 million working US nurses average 47 years old.
Tens of thousands of older nurses returned to the profession in the 1990s as pay and prestige were restored after a period when their ranks shrank due to hospital layoffs related to managed care, coupled with poor working conditions.—Reuters
