Health Services Delivery: Reframing Policies for Global Nursing Migration in North America—A Caribbean Perspective

Abstract

Countries of the Caribbean face critical challenges in nurse migration and health services delivery. They are experiencing two types of migration-country-to-country migration within the Caribbean and migration from the Caribbean to developed countries, including the United States, Canada, and the United Kingdom. Aggressive international recruitment practices in the Caribbean resulted in a dramatic loss of nurses in the region and had an adverse impact on health-services delivery. A Managed Migration Program is being developed with two guiding principles-observing the rights of individual nurses to choose where they want to work and live while balancing individual rights with a country's obligation to provide quality health services to its citizens. It is a multi-country, multi-agency, multi-interventional strategy to increase intake, production, and retention of nurses. Various efforts designed to balance nursing supply and demand are underway, with the goal of providing universal, effective, and quality health care in the Caribbean.

Turnover Intention Among Hospital‐Based Registered Nurses in the Eastern Caribbean

“…Researchers have identified push and pull factors related to nurses migrating out of their country. Factors include economic conditions, political factors, social reasons, job satisfaction, educational opportunities, working environment, and professional status (Buchan, 2006; World Bank, 2009; Yan, 2006). In response to the migration problem, the Caribbean region adopted a managed migration strategy to address push and pull factors.…”

“…In response to the migration problem, the Caribbean region adopted a managed migration strategy to address push and pull factors. Some of the strategies relate to improving the practice environment in the Caribbean region, such as terms and conditions of work, management practices, and retention (Yan, 2006). Though these broad strategies to reduce the push factor are well intended, there is a paucity of research in the region to guide specific interventions.…”

Making Mental Health a Priority in Belize

“…Within the Caribbean Basin, country-to-country migration has been encouraged, however, to deal with the supply of nurses in the region. Initiatives developed by the collective efforts of regional nursing organizations are replacing "Brain Drain" with "Gain Brain" (Yan, 2006). Attrition of nurses in Belize has declined within the last few years because of some of these efforts, but improvements in the numbers and working conditions are still sorely needed (Salmon, Yan, Hewitt, & Guisinger, 2008).…”

International recruitment

“…African countries with British colonial origins are most likely to produce nurses that migrate and are the countries with the fewest nursing human resources in the world 8,15. In the Americas, the English-speaking Caribbean has historically had many nurses work in the U.S., with Jamaica among the leaders in the region 7. Spanish-speaking Latin America has seen regional migration between countries or to Spain, but large numbers of nurses haven’t left to work in the United States 15.…”

“…Many of these countries provided free or very low cost vocational or university-based training for nurses in their countries. When they don’t stay to work in return for their free or low cost education, the country can experience financial losses in public sector investment between $5 million and $20 million annually 6,7. The shortages in those countries make ours look small in comparison.…”