Trends in International Migration

Worldwide, demand for nurses exceeds supply and chronic shortages are characteristic of the current global nurse workforce. The 2006 World Health Report (WHO, 2006) identified shortages of human resources as a critical obstacle to the achievement of the Millennium Development Goals (MDGs) for improving the health of global populations.2 Moreover, the report identifies the importance of nursing as an integral element of health systems’ infrastructure.

Various studies also have documented the important link between nurse staffing levels, service delivery and health outcomes, suggesting that important issues exist with respect to how the nursing health workforce is managed. One important factor that has received considerable attention is the mobility and migration of nurses and their impact on the global delivery of health services (Kingma, 2006).

Globalization of the nursing workforce must be viewed within the context of the worldwide development of the knowledge economy. This phenomenon identifies intellectual capital as a valuable asset and encourages the export of education and knowledge workers as significant contributors to a country’s economy. For example, national policies in the Philippines and India support the export of nurses (Healy, 2006; Thomas, 2006) with China and Korea beginning to follow a similar path (Fang, 2007).

The importance of the nurse export business is reflected in the exploding growth of nursing schools in the Philippines and India, and in the large sums of money received through remittances.3 Many countries, such as India and China, see the current demand for nurses as a business opportunity. Khadria (2007) describes the process in India as “business process outsourcing” (BPO). It includes comprehensive training, recruitment and placement programs for popular destinations, like the United States and the United Kingdom. It is assumed that these growing markets facilitate care as a global product delivered by migrating nurses.

Worldwide, the education and regulation of nurses is highly diverse and varies considerably in scope and complexity. Despite these international differences, a number of factors allow nurses to migrate throughout the world, creating continuous challenges to the maintenance of nursing education, practice and regulatory standards. For example, the United States is unique in having created


WHO estimates that the world needs to increase the number of health workers by more than four million. WHO defines health workers to be all people engaged in actions whose primary intent is to enhance health, such as doctors, nurses, midwives, and others.


The World Bank defines remittances as the personal earnings international migrants send back to their family and friends. Remittances represent an important source of added income and stability for individuals, families, and communities. Remittances play a significant role in reducing the level and severity of poverty (each social determinants of health) and contribute to the economic development in many low and middle income countries.

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