Rich countries, such as Australia, are resorting to the “quick fix” of international recruitment as a way of overcoming nurse shortages.
The COVID-19 pandemic has worsened the global nurse shortage and rich countries are using foreign recruitment to quickly raise their nurse numbers, says a leading academic who specialises in the international nursing workforce.
Professor James Buchan of the University of Edinburgh says this is still happening despite the risk of relying on high levels of foreign recruits having been exposed when international borders closed during the pandemic.
And foreign recruitment is doing serious damage to the health systems of some of the “exporting” countries, Professor Buchan told the NSWNMA annual conference in August.
Professor Buchan, who is also Adjunct Professor at the University of Technology, Sydney, is co-author of a 2022 study of COVID-19’s impact on the global nursing workforce.
He works as a consultant and policy adviser on health workforce issues for governments and international agencies, including the World Health Organization.
He said established importers of nurses, such as the US, UK, Germany and Australia, were increasing their international recruitment activity.
At the same time, countries such as France that previously took in relatively few foreign nurses, were becoming more active in international recruitment.
He said dozens of studies across the world showed that low staffing, high workloads, and the inability to participate in decision-making, were causing stress, burnout, psychological trauma and higher leaving rates among nurses.
In the US, about 15 per cent of nurses left their jobs in the first year of the pandemic.
“All the indicators are going in the wrong direction for nurses,” he said.
Such indicators included COVID infections, COVID-related deaths, mental health problems and “moral injury”, stress, abuse and physical attacks.
“One of the underlying major concerns is that many systems are putting a lot of emphasis on individual nurse resilience to somehow continue to get through this.
“The reality is the emphasis should not be on the nurse to be resilient, it should be on the system to support the nurse.”
Five million extra nurses needed globally
A 2020 WHO report said one in six of the world’s nurses were expected to retire in the next 10 years, and about five million nurses would need to be educated just to replace them.
Professor Buchan said high retirement rates would greatly impact rich countries, such as Australia, the UK and US, where “a significant proportion of nurses are coming into retirement age.”
He said countries such as India and the Philippines now operate schemes to train nurses specifically for export.
The number of nursing colleges in India training nurses to bachelor level has grown from a handful in 2000 to over 2000 in 2020 in response to international recruitment programs.
The “train for export” model, where students pay for a private sector nursing education on the assumption they will move abroad after qualifying, is likely to be adopted by other countries, he said.
At the same time, poor countries with very low numbers of nurses and no private sector training are also being targeted for recruitment.
“That is having a negative impact on the ability of those countries to deliver safe care,” Professor Buchan said.
“It’s something we need to monitor very closely because there is real damage being done in some countries – and with the potential for more damage.
“High-income countries are essentially solving their nurse shortages by creating shortages in countries that can’t afford it.
“The countries that have been hit most negatively by (international recruitment) are not politically powerful or influential, so they need to work as a collective with the World Health Organization to get some balance and shine a light on what’s happening to ensure it is ethical.”
Australia depends on foreign-trained nurses
Australia has about 53,000 foreign-trained nurses, or 18 per cent of the nursing workforce.
That is the third highest rate in the world, Professor Buchan said.
Only New Zealand with 26.6 per cent and Switzerland with 25.9 per cent, are more reliant on foreign-trained nurses.
The average rate among the 27 wealthy countries of the OECD is 6.1 per cent.
The world had 28 million nurses and a global shortage of about six million nurses – mostly in poor and middle-income countries, according to a 2020 World Health Organization report.
England, for example, is unable to fill 10 per cent of its funded nurse vacancies.