Friday, May 27, 2005

Nurses From Abroad

I was reading something the other day about the influx of nurses trained in other parts of the world, particularly Africa, where in some countries education of doctors and nurses is completely funded by the government. Some African countries are paying to create nurses and doctors, only to have them leave and take their skills to the US or UK.

African hospitals are overflowing with patients, yet they cannot hope to offer medical staff the pay that can be made by coming here. I found another story about the situation in the UK:

"[the] report focused on Ghana, where the flow of nurses to the UK has soared tenfold in the past six years and the number of doctors has doubled. The Korle Bu teaching hospital in Accra is 1,000 short of the 2,000 nurses it needs, and 60 per cent of the babies in its intensive care unit suffered asphyxia at birth because their mothers were not properly monitored during labour, owing to the shortage of staff.

The director of the hospital, Professor Kawabena Frimpong-Boateng, described the staff shortage as "devastating" and appealed to the UK and the US to show restraint, by restricting their recruitment to medical staff who had already served at least five years in Ghana. "We don't think we should be paying for the training of doctors and nurses to work in the UK," he said.

The findings were backed by a study in The Lancet that said half of the 16,000 extra staff hired by the NHS in recent years had come from overseas, with damaging effects on health services in sub-Saharan Africa.

Steve Webb, the Liberal Democrat health spokesman, said:
"It is appalling that, as one of the richest nations in the world, we are draining developing countries of their doctors and nurses. Overseas staff have a valued place in the NHS but must not be exploited to cover up the failure to recruit and retain home-grown doctors and nurses."

Why does it seem easier to import nurses than to support the training of them here? The nursing shortage is fueled by the fact that there are not enough spots for students to get into nursing programs. There are not enough instructors or programs.

Just as you sacrifice quality by getting the frozen pie rather than making it yourself, going the easy route and letting doctors and nurses immigrate (and even actively recruiting them) to the US rather than supporting programs here is going to hurt US healthcare and completely devastate the healthcare systems in developing nations.
Posted by HypnoKitten at 10:57 PM

Blogger Third Degree Nurse, at 2:03 PM  

I couldn't agree with you more. I am very concerned that the NCLEX is now being given in London, Hong Kong and Seoul. Although I would be the last person to not support people wanting to come to America for opportunity, it seems that our policy would benefit us more if we would limit the NCLEX being given abroad and foster more nursing programs.

The 2 year RN program is a good start but in our area we average about 400 applicants for 50 slots. If I were getting into this younger, I'd find a way to work with hospitals to develop their own nurse forces...and make it lucrative. Universities are not going to hire more faculty and pay them more than they can get in the field unless they are going to benefit from it at the bottom line, so perhaps the hospitals' interest would be better served by developing their own schools rather than relying on universities.

Blogger NurseWilliam, at 12:13 AM  

Third degree nurse, I see your point, and I agree. Nearly a century ago, nurses were exclusively trained by hospitals. But the public health revolution of the 1920s, and then the Second World War, caused such an increased demand for nurses that hospitals could not keep up. Nursing schools opened in response to the demand.

In Washington State where I work, there is a growing concern that hospitals are planning to phase ADNs (Associate's Degree Nurses) positions in favor of all BSNs for their hospital staffing. Why? Because BSNs receive intensive training in healthcare systems, unit management and leadership before they hang their tassels. I know many BSNs who became charge nurses only a year after grasuation.

I think that hospitals are content to have their nurses university-trained because it saves money. Running a school within a hospital can be cumbersome and expensive. More staff has to be hired on to teach.

As far as the NCLEX going abroad, I think we are seeing the globalization of the nursing field. Is that a bad thing? Not necessarily- provided the nurses are competent and able to clearly communicate in English, which many are not.

Blogger NurseWilliam, at 12:14 AM  

Oops. Pardon my spelling. New laptop.

Blogger Jodie, at 12:26 AM  

Part of the problem with increasing nursing program slots is the clinical experience -- hospital floors can only take so many students. I completed nursing school not that long ago, and there were students from several schools at each of our clinical sites...sometimes it was hard to get enough patient assignments for students.

Blogger WyzWomn, at 3:16 PM  

I have a novel approach. Well, in my mind it's novel, anyway...Why don't hospitals and other healthcare agencies come up to the plate and take some of the responsibility for producing quality nurses by allowing their STAFF RNs (BSN-prepared and above) to serve as Clinical Faculty for the ADN and BSN programs?
For example, take "Nurse Betty." She has her BSN, has been working on Med-Surg for 3 years, and is slam-bang awesome at what she does. She currently works a 1.0 FTE on the floor, and she'd LOVE to be a Clinical Instructor for Hope Valley Community College, but she a) can't afford to quit her full-time gig at the hospital (we'll get into how poorly faculty is compensated at a later date!) and b) she can't physically do both!
How come the hospital can't REWARD Betty for her selflessness and her commitment to Nursing by turning her weekly schedule into a Wednesday-through-Friday deal at a 0.6 FTE (maintaining her insurance and benefits) which would allow her to teach Monday and Tuesday for the community college?
Can you IMAGINE how many nurses would consider teaching if it looked so attractive? As it stands now, it looks HORRENDOUS to teach in the clinical setting for most experienced nurses. They don't get any particular support from their hospitals, and they still have to rotate through their weekends...
As a nursing instructor myself, I think it's time ALL of us start to pound on our administrators' doors and get something done about this...AND QUICK!

Anonymous Ron Sullivan, at 8:42 PM  

You're right about needing more training slots here, but training new nurses is only half the problem. That other word in the Brit statement , the one about retention, is important. Has anyone ever done a survey to find out how many ex-nurses* are running around Britain and the US?

I had to laugh when, some years ago, I got this funny little letter asking if I wanted to renew my license on some sort of standby/inactive basis for only $75/year. (Not a chance.) And somehow the boilerplate bureaucratic prose managed to sound just a bit wistful.

Conditions for hospital nurses have become worse since I bolted 20 years ago, and in my state, the Governator is trying to make them still worse. Every few years we hear the general whine about nurse shortages -- as if the cause were some big mystery! It was even used as an excuse to postpone the nurse-patient ratio changes that the voters mandated a couple of elections ago. Meanwhile the people who are doing the whining are consistently making things worse for patients and nurses, and doctors too, come to think of it.

Nurses from abroad aren't new. When I was in the game, it was nurses from the Philippines and then from, if you don't mind, Ireland, coming to the US. All that changes is which continent we're raiding this year. Importing nurses is as close as hospital corporations can get to outsourcing -- they're outsourcing training instead of troubling themselves about retention. Don't you wich there were some sort of effective tariff on nurse bodies, e.g. the importers having to pay the exporting nation the equivalent of the cost of educating every nurse they recruit?

They can have all the Nurse Day buffets and corsages and fringe benefit inventions they want, but the only thing that will retain nurses, even in the crappy economy we've had lately, is making floor conditions better. And you know that's the one thing they won't do, because it hits the bottom line harder than the odd ski vacation or plastic banner over the door.

*(I once called myself that to a surgeon's office nurse. She said, "There's no such thing as an ex-nurse.")

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