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Managed migration strategy needed to mitigate effects of nursing brain drain

Monday, February 11, 2019

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At the 45th annual general meeting of the Regional Nursing Body (RNB) held in August 2018 in Georgetown, Guyana, Nester Edwards, the chairman, called for urgent attention to be given to the migration of nurses and midwives from the Caribbean region. She further argued that “experienced nurses are leaving in large numbers”.

This is not a new phenomenon to us in Jamaica. We not only lose our experienced nurses, but also our specialist nurses. And, the fact is that the large number of specialist nurses leaving the country has the potential to cripple operations in several institutions, especially in highly specialised units such as intensive care units.

I am compelled, however, to wonder, if the call by the RNB chairman is all talk as, from all indications, mass migration of nurses from the region will be with us for some time.

The Regional Nursing Body

To provide some context, the RNB has been around since the 1970s and is an autonomous, non-statutory, collaborative, and advisory body. It comprises chief nursing officers from member states and its responsibilities include:

(a) raising the standard of nursing education in the region;

(b) providing advice to Conference of Health Ministers on matters relating to nursing and its contribution to health care delivery in the region; and

(c) manage manpower planning in nursing to ensure balance between demand and supply inter alia.

The real situation

The World Bank estimates that there are 7,800 nurses employed in the English-speaking Caribbean, or 1.25 nurses per 1,000 people. This equates to one-tenth of the concentration of nurses in some Organisation for Economic Co-operation and Development (OECD) countries. Demand for nurses often exceeds the supply right across the region. The picture in 2006 was that 3,300, or 30 per cent of all nursing positions in the sector were vacant.

Furthermore, it is felt that the unmet demand for nurses will triple during the next 15 years, moving from 3,300 nurses in 2006 to 10,700 nurses in 2025.

In a Jamaica Observer article of January 15, 2017 titled 'No quick fix for the nursing brain drain', I stated to the fact that “migration of nurses to the private sector and overseas will be with us for some time”. Additionally, I called on “policymakers to be creative and engage recruiters of Jamaican nurses in a more strategic and sound manner”. I went on to propose that “recruiters be made to contribute to the training of Jamaican nurses by providing both financial support to training institutions and practice settings, while boosting a resource-constrained public health system”, and concluded that “defined strategies to train and retain Jamaican nurses to effectively manage the needs of the industry must be established”. This was with the intent to encourage Jamaica, and the region by extension, to manage the migration of our nurses.

Managed migration

The term “managed migration” is not a new concept to Jamaica. Jean Yan, chief scientist for nursing and midwifery at the World Health Organization, wrote extensively on managed migration strategies and the benefits to be had in the area of retention of the region's nurses. A managed migration programme, she said, is developed with two guiding principles:

(1) observing the rights of individual nurses to choose where they want to work and live; and

(2) balancing individual rights with a country's obligation to provide quality health services to its citizens.

Further, she articulated that managed migration requires multi-country, multi-agency, multi-interventional strategies to increase intake, production, and retention of nurses (Yan, 2016).

The World Bank 2010 report asserts that the costs and benefits associated with training a nurse in the English-speaking Caribbean are unfairly distributed among nurses, countries of origin, and countries where some nurses choose to live and practise their profession.

In view of the existing migration trends, the report estimates that for every nurse trained in some countries, example Jamaica, receiving countries, such as the United States of America (USA), and Canada reap benefits between US$3,800 and US$26,000.

I endorse the call for action to stem the mass migration of the region's nurses. My position on the matter is influenced by the fact that increased loss of professional and specialist nurses from the region to more affluent and developed countries has significant negative social and economic impact on member states. At the same time, however, it is my opinion that the region needs to adopt policies which leverage the recruiters, as well as establish a code of practice for those who poach the region's nurses.

Concerted effort is required to tackle the issues associated with the nurse labour market in the region. This will ensure that adequate resources are available for training as well as strategies for retention.

A regional approach is needed to manage the migration of nursing professionals. The approach should include engaging financial and technical support from international recruiters, such as those from USA, United Kingdom and Canada. The result may well be a case in which we can train nurses for export, but we will better manage the domino effects of mass migration of the region's nurses.

Adella Campbell, PhD, JP, is an associate professor and head of the Caribbean School of Nursing at the University of Technology, Jamaica. She is the author of the recently published The Jamaican Public Health System from the 17th-21st Centuries. Send comments to the Observer or adcampbell@utech.edu.jm .


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