Unethical international nurse recruitment ‘is escalating’

World leaders must immediately halt the active recruitment of nurses from red list nations and overhaul the way international nurse recruitment is carried out, a global nursing representative has demanded.

Dr Pamela Cipriano, president of the International Council of Nursing (ICN), penned a letter to the leaders of G20 nation leaders last week demanding action on international nurse recruitment and migration.

“The nurse migration crisis continues to escalate”

Pamela Cipriano

She warned of the “depletion” of nursing workforces in some countries because of  “aggressive” recruitment practices by more-developed nations.

In particular, Dr Cipriano condemned the recruitment of nurses from countries on the World Health Organisation (WHO)’s Health Workforce Support and Safeguards List, also known as the ‘red list’.

Red list countries include Nigeria, Bangladesh and Uganda and are placed on this list because they are suffering their own health worker shortages, or for other reasons related to strains on their health system.

Dr Cipriano’s letter came ahead of the G20’s next leaders’ summit in November and off the back of other calls from the ICN to curb unsustainable recruitment practices, particularly by wealthy Global North countries such as the UK.

The UK has, in recent years, received significant numbers of nurses from various countries on the list.

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“This practice threatens access to essential healthcare services in under-resourced regions, deepening global inequalities and leaving populations without sufficient nursing care,” said Dr Cipriano in her letter to the G20.

She added: “The nurse migration crisis continues to escalate.

“At the recent World Health Assembly in Geneva, we heard alarming accounts of how the active recruitment of vulnerable nations’ nurses continues to drain resources from fragile health systems and push remaining staff to breaking point, with dire impacts on population health, disease response and management, and preparedness for health emergencies.”

Dr Cipriano called on G20 leaders to put in a series of measures to mitigate the crisis in the short term, and fix the underlying issues in the longer term.

She called for a “temporary moratorium” to be put in place across G20 countries that would commit them to halting active recruitment from red list countries and “acute crisis zones”.

In the longer term, Dr Cipriano said, the G20 should work to improve adherence to the WHO’s recommendations around ethical international recruitment and compensate “vulnerable” nations that export nurses.

She suggested an “offsetting” programme in which countries which recruit nurses from abroad must directly fund healthcare systems and nursing education.

Further, she called for G20 countries to prioritise investing in more “self-sufficient” nursing workforces and focus more on domestic recruitment, training and retention. Dr Cipriano said they must “transition away” from unsustainable models currently in use.

The ICN president praised the G20’s Health Working Group (HWG) for making ‘resilient health systems’ a central part of its current agenda, as well as the HWG’s focus on cross-border working for pandemic preparedness – but said that nurse migration must be considered as part of this.

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Dr Cipriano also praised the G20 HWG for its commitment to tackling the social determinants of health, such as employment. However, she once again urged that the ethical recruitment of clinicians was “key” to achieving their aims.

“Global nurse migration is both a workforce and staffing challenge and a public health, global equity, and human rights issue that has a direct impact on the G20’s ability to make progress on its overall vision for a just world,” she said.

“While the HWG discussions are a promising start, what matters now is committing to a clear and decisive course of action.”

Ahead of the publication of Dr Cipriano’s letter, ICN chief executive Howard Catton made similar calls in an editorial for Heath Policy Watch.

There, Mr Catton reiterated calls he for international nurse recruitment to be curbed in order to avoid exploitation and weakening of less developed countries’ healthcare systems.

Mr Catton pointed to a “worsening” crisis and said African healthcare leaders consider the current state of aggressive nurse recruitment as a “new form of colonialism”.

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