Nurses on the Move: Migration and the Global Health Care Economy (review)

A couple of years ago in the middle of an organizing drive at a New Jersey hospital, we discovered that management had arranged to change all the telephone exchange numbers in the apartment building in which the hospital housed their "sponsored" Filipino nurses. The result, of course, was to cut off phone access to union organizers. But it also amounted to abuse of Filipino nurses, something that would ring familiar to Mireille Kingma, who has written Nurses on the Move, a detailed study of migrant nurses around the world that bores into the heart of migration and its integral relationship to globalization. Kingma reveals how the exploitation of nurses actually results from a lack of meaningful health-care policy in most countries.

Relying on statistical data, anecdotal stories of RNs in several countries, and keen analysis, Kingma, who is a consultant on nursing and health policy for the International Council of Nurses in Geneva, takes the reader on a fascinating journey by way of the "pull and push" influences that spur nurse migration through countries like South Africa, Ireland, Ghana, Pakistan, Philippines, United Kingdom and the United States. "It is clear," she writes, " that during the 1990's reform in the developing countries significantly downsized the health care workforce in general and nursing in particular. In many countries this set the stage for mass nurse migration. But . . . economic reform could not have pushed so many nurses out of developing countries if accompanying pull factors in the industrialized world did not create a hospitable environment for foreign recruits."

The facets of this study are various and complex, as are the opportunities for governments, hospitals, recruitment agencies and healthcare related businesses to take advantage of nurses who emigrate to better their lives and the lives of their families through their profession. Kingma provides us with a picture of conflicting interests, such as a "source" country's attempts to curtail the emigration of nurses by skirting the right of everyone to leave their home country under the UN Declaration of Human Rights. Nelson Mandela, for instance, in 1997 asked the government of the United Kingdom to ban their recruitment of South African nurses. Mandela, made his case on humanitarian grounds because South Africa could ill afford to lose their nurses who were leaving that country in increasing numbers (Kingma uses the term, brain drain.) But the timing of Mandela's request came shortly after the downsizing of South Africa's health sector, resulting in significant unemployment for nurses.

Nurses on the Move offers several national and international policy solutions that are helpful in thinking about the intricacies of labor migration in the health sector, including strategies of regulation, integration, recruitment, and retention as well as recommending strong attention to labor rights and issues of pay and working conditions.

Kingma's thorough research and analysis does not overwhelm the humanity of her book, which cites examples of nurses from all over the globe and tells their stories with compassion and intelligence. Nurses on the Move is eminently readable and makes a valuable contribution to the literature on globalization and the profession of nursing.