U N I T E D S T A T E S
Nursing Exodus Weakens Developing World
by Akhilesh Upadhyay
NEW YORK — A glance at the nursing situation in the United States helps explain why the United Nations is warning that health care in developing countries will decline as those nations continue to lose workers to industrialised nations.
Surveys of registered nurses here have found that complaints of physical and emotional "burnout" due to demanding work schedules are common.
A study conducted at four metropolitan U.S. hospitals discovered they lost an average 900,000 dollars every year because of the turnover of nurses.
That high turnover has led to the "signing bonus", war as hospitals try to recruit nurses away from their competitors. Some hospitals even award bonuses to employees who refer a nurse for employment.
Other institutions have become so desperate that they now hire "travelling" nurses to supplement their in-house staff.
Experts warn of imminent staffing crises as more nurses approach retirement and the number of ageing patients continues to grow.
That situation helps explain why in October 2002, the World Health Organisation (WHO) warned that globalisation and the lure of lucrative job markets in countries like the United States could seriously damage health care in developing nations.
"If the world's public health community does not correct this trend, the ability of many health systems to function will be seriously jeopardised," said WHO Director-General Gro Harlem Brundtland.
Yet evidence suggests the trend is here to stay, and that despite its slowing economy and restrictions on immigration after the Sep. 11 terrorist attacks of 2001, the Unites States will be a major beneficiary as it absorbs thousands of new health professionals from the developing world to take care of its ageing baby boomers.
It is not alone. Despite pledges to not meet its shortfall in health workers at the cost of poor countries, in 2001 Britain poached 2,114 nurses from South Africa, 994 from India, 473 from Zimbabwe, 207 from Pakistan and 195 from Ghana, says the 'Guardian' newspaper.
But it is in the U.S. economy, which already accounts for more than 50 percent of the global brain drain, that the trend becomes obvious.
According to the 'Health Forum Journal', 20 percent of doctors and 10 percent of nurses in the United States are foreign born.
In its 1999 report, the American Association of Colleges of Nursing (AACN) pointed out that nursing enrolment in Bachelor of Science programmes had dropped 6.6 percent in 1997 and 5.5 percent in 1998, capping a four-year trend of declining enrolments.
"The shortfall in the nursing staff is expected to peak in 2010," said Ganga Mahat, professor of nursing at Rutgers University in New Jersey.
Even the new trend of professionals from other disciplines turning to nursing will not fill the demand, said Mahat.
"This switchover is because the nursing sector continues to offer jobs unlike most other sectors. But such a trend will neither meet the qualitative nor the quantitative needs created by the shortfall. It is approaching a crisis situation."
The hiring of more foreign nurses is inevitable, she said, "whatever be the costs" to developing countries. The costs are significant, warns the 'British Medical Journal'.
Migration of medical professionals from developing countries worsens the already depleted health care resources in poor countries, widening the gap in health inequities worldwide, the 'Journal' argued in its Mar. 2 edition.
One-third to one-half of South African medical graduates emigrate; 150,000 nurses from the Philippines and 18,000 from Zimbabwe work abroad. With each migrating professional, Africa loses 184,000 dollars.
Joytsna Neopane, an anaesthesiologist from Nepal based in New York City, has just completed her medical residency and expects to make anywhere from 225,000 to 250,000 dollars a year once she is hired.
"Compare that with less than 100 dollars a month I used to make at a government hospital in Kathmandu, and you have the answer why thousands of doctors from the Indian subcontinent end up here," she says.
Many experts agree that professionals should not be stopped from moving in search of better lives for themselves and their families, but some have suggested changing the system so that poor countries also gain when their valued professionals emigrate.
Some countries, like Thailand, have succeeded in attracting back medical professionals through reverse brain drain programmes offering generous research funding and monetary incentives.
The 'Journal' says 'exporting' countries should receive compensation. "Just as intellectual property rights need to be discussed by developed and developing countries together, so also should the preservation of the intellectual property of a nation," it says.
U.S. health care facilities have long relied on foreign-born professionals, especially since a staffing crisis in the 1980s, when Congress enacted liberal immigration laws to facilitate the movement.
Foreign nurses typically enter the country as permanent residents. "A specifically designed legislation makes this the easiest option for nurses," says the 'Health Forum Journal', "and many nurses do not satisfy the more complex eligibility requirements of the non-immigrant statuses."
