Addressing the Global Nurse Migration Crisis: Strategies for a Resilient and Equitable Healthcare Workforce
Submitted by Maurice Joy G. Cudal, MSN, RN
Tags: ethical values migration nurse retention nursing shortage
Background
In recent years, factors such as differences in healthcare systems, economic opportunities, and political instability have intensified the global movement of nurses. This unrestricted movement deepens the existing shortages of healthcare personnel internationally and disrupts healthcare delivery. These issues were prominently brought to light during the COVID-19 Pandemic, which underscored the vulnerabilities of health systems and exacerbated the already fragile health and social care workforce (McPake et al., 2024). This phenomenon does not occur in isolation; instead, the migration of nurse’s forms part of a larger global migration system that is shaped by topographic and interconnected sub-systems (Topilin, 2021). While the movement of nurses helps to alleviate workforce shortages in economically prosperous countries, it weakens the underlying constancy of health systems in low- and middle-income countries, putting patient safety and health equity at risk. The World Health Organization (WHO) predicts a shortfall of 11 million health workers by 2030, identifying countries with limited resources as having the most critical deficits. These realities are compounded by a chronic lack of investment in education, training and deployment of the workforce, and a strategy misalignment between educational frameworks and population demand. To mitigate these crises, there is a need to comprehensively devise an understanding of the migration systems as well as strategically invest to retain and support healthcare personnel in region with the greatest deficits.
As the COVID-19 pandemic raged on, it became clear that there was a global lack of fundamental preparedness for managing public health crises of this magnitude. According to Timmis et al. (2020), gaps in a health system’s functionality are more efficiently addressed through international benchmarking and preparedness strategies which are appropriately funded. Such measures are critical for developing health systems that are resilient enough to retain their personnel and manage future crises proficiently. Moreover, the migration crisis poses acute humanitarian problems, especially for nurses affected by conflict and instability. Asylum seekers and refugees, along with many other migrants, face immense mental health challenges and unmet needs, particularly when they’re healthcare workers migrating through these conditions, as pointed out by Griswold et al. (2021). This emphasizes the need to mitigate the migration crisis not just from a healthcare standpoint, but also from a humanitarian one where displaced nurses are able to access support systems enabling them to integrate and continue providing essential services.
Maintaining a well-trained healthcare workforce attends to health system needs and addresses shortages while also leading to inclusive economic development and increased resilient communities. The High-Level Commission on Health Employment and Economic Growth recognized six areas in which investments in the health and social care workforce can contribute to economic growth and creation of adequate job opportunities, especially for women and youth, who constitute 67% of the global health workforce. Improving human resources for health (HRH) information systems and overcoming financial constraints in the public sector are vital primary steps toward universal access to healthcare workers. If countries scheduled education and employment planning driven by health system demands, with an emphasis on workforce attrition retention strategies, the negative impacts of nurse migration could be alleviated, enabling the development of adaptable, enduring health systems capable of responding to global health needs. Solving this intricate problem requires innovative approaches and collaboration toward fairness for all people to access essential healthcare services.
Population:
Registered nurses and nursing professionals worldwide, especially those migrating from low- and middle-income countries to high-income nations, and displaced healthcare workers affected by conflict and instability.
Sustainable Development Goals (SDGs)
The nurse migration crisis is interrelated with the focus area of the United Nations Sustainable Development Goals (SDGs), need and target 16 (Peace, Justice and Strong Institutions). The effectiveness and accountability of any institution is vital for health system stabilization as well as addressing the underlying issues of conflict, nurse migration, political instability, and weak governance. Promoting peace and justice can directly curb the region suffering from nurse migration as there will be increased security for healthcare professionals. The nurse migration crisis can also be alleviated with strong institutions that are able to enforce regulatory policies of equitable distribution of work, fair working treatment, better professional continuity, and effective career advancement. There are several issues correlated with increased retention including corruption and lack of trust among healthcare workers, these issues need to be addressed immediately to gain trust amongst healthcare. Conversely, reduced conflict and increased stability of politically volatile regions can lessen the displacement of nurses so that the health systems can at least function in difficult situations. Hence, achieving SDG 16 creates an impetus towards addressing the nurse migration crisis because it provides the conditions necessary for the health workforce to be responsive and sustainable.
The crisis also pertains to SDG 10 (Reduced Inequalities) and SDG 17 (Partnerships for the Goals) which addresses inequality in the distribution of health workforces and international cooperation. According to the SDGs, countries need to reduce inequalities within and among themselves, and this is especially important given the lack of access to healthcare and a competent workforce in low-income areas. Nurses migrating from resource-poor to richer countries aggravate the inequities by denying adequate healthcare to already vulnerable populations. With disparities in under-resourced regions, these problems can be mitigated with strategic investments in education, training, retention, and policy frameworks that ensure the equitable allocation of healthcare personnel. Furthermore, SDG 17 speaks to the need for global partnerships for the effective management of migration and planning of health workforces. International collaboration can improve the situation by sponsoring the development of ethical recruitment policies and bilateral agreements that are advantageous to both the sending and receiving countries. For instance, some receiving countries could assist in building capacity endorsed by these partnerships sustaining them within source regions, while also making sure that migrating nurses are actively and adequately sustained within their new surroundings.
Through collaborating toward these SDGs, the world can achieve a more equitable and sustainable approach to resolving the nurse migration crisis by improving healthcare access across diverse populations.
Strategic Framework
The approach which deals with the crisis of migration among nurses focuses on the policies of Protection, Equity, Accountability, Collaboration, and Empowerment to form a goal-oriented strategy. At its core is the Protection of Rights (P) which requires strong legislation dealing with the nurse’s rights such as reasonable pay, safe and secure environment, and adequate opportunities for professional advancement. Providing these protections improves job satisfaction and decreases the reasons for migrating simply because of poor working conditions and exploitation. Also, Equity (E) is important as it aims off for treatment and equitable policy to stop migration from the country. To a certain extent, addressing discriminatory and systematic inequalities in the healthcare system like the unequal distribution of the available resources and opportunities, which resulted in the workforce in the low and middle-income countries not being able to escape from the workforce shortage that is disproportionate to the demand placed upon it. Such countries would be able to achieve equity and thus enable the nurses to offered the disabled to influenced to ge m to emigration but rather stay.
Both Accountability (A) and Collaboration (C) are equally important to the framework. While Collaboration draws focus to the need of international collaboration to mitigate nurse migration, Accountability focuses more on the responsibilities of governments, institutions, and other relevant stakeholders to manage healthcare migration. This includes honest recruitment, retention centered policies, and reporting that meets ethical standards. Additionally, source and destination partnerships enable knowledge dissemination, capacity enhancement, and the establishment of reciprocating treaties that serve both parties. Lastly, E drives the focus to the Empowerment of nurses by elevating working conditions, career development pathways, and supportive policies. Together with the continuous active engagement in migration flow tracking to capture the trends, causes, and intervenable factors, data can become the instrument for policymakers to develop resilient strategies aimed at mitigating migration drivers and fortifying the healthcare workforce in sustainability and equity. This integration addresses the nurse migration issues within the holistic context of building future sustainable health systems.
Conclusion
The global crisis of international nurse recruitment and migration requires a specific approach under the context of the SDGs (Sustainable Development Goals) pertaining to the issues of peace, justice and reduction of inequalities, and global partnerships. This approach emphasizes that caregivers’ protection is fundamental, which needs to be guaranteed through sufficient legal systems, adequate remuneration, and a secure occupational environment to ensure that nurses do not migrate for inhumane and exploitative support. It is also important to advance equity to address the systemic inequities prevailing in the healthcare systems which foster treatment and policies that prevent unfair or involuntary migration. There is a need for the government, institution, and other stakeholders to bear responsibility of committing to ethical healthcare workforce contracting in planning, while fostering the recruitment and migration partnerships with the source nations to bluntly aid in the meeting of needs and relief of burdens for the receiving nations, the destination nations. Nurses can be empowered through enhanced occupational conditions, career progression opportunities, and favorable policies, advanced along with the control of migration trends that impose responsive policies, to the building of resilient health system. All these elements address the gaps and provide an effective and robust solution to the crisis of nurse migration while promoting sustainability as well as equality in the healthcare personnel demography.
Together, we can foster a strong and fair future global healthcare system, where people have access to quality care, and nurses are recognized, valued, and supported in equal measures.
References
Bernardi, M. (2021). The COVID-19 pandemic and the inescapable challenge of the anthropocene for museums. Museum International, 73(3–4), 146–155. https://doi.org/10.1080/13500775.2021.2016285
Griswold, K. S., Vest, B. M., Lynch-Jiles, A., Sawch, D., Kolesnikova, K., Byimana, L., & Kefi, P. (2021). “I just need to be with my family”: resettlement experiences of asylum seeker and refugee survivors of torture. Globalization and Health, 17(1). https://doi.org/10.1186/s12992-021-00681-9
ICN calls for urgent G20 action on the global nurse migration crisis. (2024). ICN - International Council of Nurses. https://www.icn.ch/news/icn-calls-urgent-g20-action-global-nurse-migration-crisis
Injac, R. (2022). Global pandemic vaccine development, production and distribution challenges for the world population. International Journal of Risk & Safety in Medicine, 33(3), 235–248. https://doi.org/10.3233/jrs-227019
Mangrio, E., Zdravkovic, S., & Carlson, E. (2019). Refugee women’s experience of the resettlement process: a qualitative study. BMC Women S Health, 19(1). https://doi.org/10.1186/s12905-019-0843-x
Mastromartino, B., Ross, W. J., Wear, H., & Naraine, M. L. (2020). Thinking outside the ‘box’: a discussion of sports fans, teams, and the environment in the context of COVID-19. Sport in Society, 23(11), 1707–1723. https://doi.org/10.1080/17430437.2020.1804108
McPake, B., Dayal, P., Zimmermann, J., & Williams, G. A. (2024). How can countries respond to the health and care workforce crisis? Insights from international evidence. The International Journal of Health Planning and Management, 39(3), 879–887. https://doi.org/10.1002/hpm.3766
Mora, O., Mouël, C. L., De Lattre-Gasquet, M., Donnars, C., Dumas, P., Réchauchère, O., Brunelle, T., Manceron, S., Marajo-Petitzon, E., Moreau, C., Barzman, M., Forslund, A., & Marty, P. (2020). Exploring the future of land use and food security: A new set of global scenarios. PLoS ONE, 15(7), e0235597. https://doi.org/10.1371/journal.pone.0235597
Timmis, K., & Brüssow, H. (2020). The COVID‐19 pandemic: some lessons learned about crisis preparedness and management, and the need for international benchmarking to reduce deficits. Environmental Microbiology, 22(6), 1986–1996. https://doi.org/10.1111/1462-2920.15029
Topilin, A. V. (2021). On a systematic approach to the study of international migration processes. DEMIS Demographic Research, 1(1), 17–30. https://doi.org/10.19181/demis.2021.1.1.2
Umnova, A., Matveevskaya, A., & Pogodin, S. (2021). Muslim community in France: Problems of adaptation. In Springer geography (pp. 283–297). https://doi.org/10.1007/978-3-030-78690-8_25