Waiting and watching: Nurse migration trends before a change to the National Council Licensure Examination as entry to practice for Canada's nurses

Background

A number of factors in the health care environment, including a change in regulatory policy, may affect a country's nursing workforce and nurse migration and mobility.

Purpose

This study compared the characteristics of Canadian-educated nurses who had migrated to the United States to work with their colleagues in the United States and Canada in anticipation of a change in Canada's RN entry to practice requirements in 2015.

Methods

We conducted a retrospective comparative study of nurses in Canada and the U.S. using 2008 data from the US National Sample Survey of Registered Nurses and the Canadian Institute of Health Information.

Discussion

There was little change in the number of Canadian-educated nurses working in the United States in 2008 compared with 2004. We found differences between U.S. nurses and Canadian-educated nurses working in the United States in educational level, work status, work location, and age. No differences were found between Canadian-educated nurses working in the United States and those working in Canada.

Conclusions

This research highlights the value of international comparisons of the nursing workforce, especially in the context of anticipated regulatory changes, which may affect a country's nursing health human resources.     

An international programme in nursing and midwifery: building capacity for the new millennium

AIM: The global economy is changing rapidly and frequently affects the ability of the health sector to respond to a variety of needs. Nurses and midwives are reaching across national boundaries to strengthen their ability to improve the health of populations. This article describes an innovative programme of collaboration among different nations to strengthen the capacity of nurses and midwives. BACKGROUND: Over the course of 4 years, nurses and midwives from several countries in East Central Europe, Central America, and the Caribbean came together in the United States and in Europe to learn about opportunities for growth and collaboration to improve professional development, leadership capacity, educational and curricular development, and knowledge about international health. CONCLUSION: Programme participants reported increased capacity to perform their professional roles as a result of their having participated in this programme. More capacity building activities are needed to further enable nursing professionals to meet the demands for health care around the world.     

American Nursing Scholars Abroad, 1985–1995

Purpose: To explore the international activities of American nursing scholars from 1985 to 1995, as indicated by their international teaching, scholarship, and consultation.
Methods: All faculty (N = 2,254) teaching in nursing doctoral programs in the United States were surveyed using an investigator-designed questionnaire. The professional characteristics of American nursing scholars who worked abroad and the dates, nature, and types of international activities they undertook were ascertained. From a total of 928 usable returns, 247 described international activity.
Findings: Data indicated a three-fold increase in international activity from 1985 to 1995 in the three major areas investigated. Universities in Western Europe and Asia were the most frequent recipients of nursing scholarly activity. The scholars or representatives of the host institutions made approximately half the initial contacts. The international hosts or U.S. universities were the predominant providers of funding. Nurses most likely to participate in international scholarly activity were senior faculty who were full professors in doctoralgranting institutions, published in international journals, presented educational topics, and were recognized by peers through membership in honorary organizations.
Conclusions: A substantial increase in international nursing scholarship occurred during the decade studied, particularly related to teaching.     

Opportunities in preparing global leaders in nursing.

During the past decade, there has been a large increase in the number of international nurses pursuing doctoral education in the United States. The influx of these nurses has ramifications for the institutional systems providing education as well as on international and American nursing students. To begin understanding the issues presented by international doctoral nursing education, a survey of U.S. schools of nursing as well as a focus group of currently enrolled international doctoral students was conducted. The survey revealed that both international students and nursing programs experience challenges with regard to language, communication, financing, and support systems. More specifically, information gathered from the focus group identified issues regarding (1) lack of familiarity with the U.S. health care system, (2) lack of previous experience with the seminar format used in doctoral programs, (3) restricted opportunities to participate in faculty research, and (4) stress from a heavy course load to finish the program within a very short time period. Universally, the surveys and focus group lauded the positive global perspective imbued on all students and faculties via the international connection. Nonetheless, schools of nursing need to identify more effective strategies to aid international students in their development as successful global leaders. Meleis's framework for culturally competent scholarship is offered as a guide for schools of nursing.     

Immigrant youth at risk for disorders of mood: recognizing complex dynamics

The number of youth immigrating to the United States from Latin America and the Caribbean has consistently and dramatically been increasing. However, little research or epidemiological data that capture the mental health status of these youth from their countries of origin or once they enter the United States exist. As a result of migration and the acculturation process, these youth are at risk for exacerbation of preexisting mood disorders or development of mood or other psychiatric symptoms. Pre-migration social and environmental stressors affecting this population include poverty, exposure to violence, sexual or physical victimization, and substance abuse. Post-migration stressors include loss (of friends, family, country, and lifestyle), changes in social support, negative experiences in the United States, language difficulties, and academic challenges. This review of the existing literature will describe the contextual experiences of immigrant Latin American and Caribbean youth from their country of origin and as new immigrants in the United States, discuss their risk for mood disorders, highlight relevant assessment data that should be obtained, and identify treatment implications for advanced practice psychiatric-mental health nurses working with this population.     

Historic and Future Health Promotion Contexts for Nursing

Purpose: Health promotion in the United States has been narrowly defined focusing primarily on individual behaviors, risk factors, and lifestyle. This article traces the historic and conceptual roots of health promotion care in the United States and critically examines the direction nurses have taken in health promotion.
Scope: Health promotion care in Western ideology emphasizes the value of individuals and the importance of personal responsibility for success or failure.
Conclusions: Health promotion nursing interventions, based on the tenets of individual choice and knowledge, restrict the range of interventions. The complex nature of health promotion requires that nurses consider the economic, sociopolitical, and cultural context in which health care takes place. Recommendations are made for an expanded nursing role in health promotion, one that is consistent with nursing's underlying contextual focus and concern with environments.     

Caribbean nurses migrating to the UK: a gender-focused literature review

Background:  International nurse recruitment is an integral part of government health care strategy in many countries. However, the gendered implications of nurse migration have been little explored despite the fact that the nursing workforce is predominantly made up of women.
Aim:  Based on the migration of nurses from the English-speaking Caribbean region to the UK, this paper explores the significance of gender at both the macro and micro levels.
Methods:  Four strands of inquiry were explored: nurse migration, impact on development, work experiences and family life. Key terms were used to search the electronic databases SSCI, EBSCO and JSTOR. An interpretative framework based on the feminist theory of intersectionality was used to systematically review the 15 studies that met the inclusion criteria.
Findings:  Gender issues are significant across all aspects of the migratory process. Migrant nurses contribute to social progress through remittances and knowledge gained abroad although overall, nurse migration negatively impacts development and there are hidden implications for women. For some Caribbean nurses, migration reflects increased economic freedom; however, for others, gender inequality lies at the centre of the decision to relocate. Gender inequality also permeates the lives of many migrant nurses even in countries where economic and work conditions are improved.
Conclusions:  The ramifications of nurse migration cannot be fully understood without attention to gender inequalities and the specific socio-economic contexts in which they exist. There is need for a gender-centred approach to international nursing recruitment policy that takes account not only of the impact on developing countries, but also of the well-being of migrant nurses themselves.     

Pale, poor, and 'pretubercular' children: a history of pediatric antituberculosis efforts in France, Germany, and the United States, 1899-1929

An international consensus emerged in the years between 1900 and 1910 regarding the need to refocus antituberculosis efforts away from treating tuberculosis in adults and toward preventing active disease in children. This paper uses social history as a framework to explore pediatric health experiments in France (foster placement of city children with rural farm families), Germany (open-air schools), and the United States (preventorium) for children considered 'pretubercular'. The scientific, social, and political variables that reshaped prevailing ideas and practice with regard to TB prevention during those years are described. The creation of the first preventorium in the United States is explained and the way in which French and German pediatric prevention strategies were adapted to address a specific population considered at high risk in the United States, indigent immigrants, is detailed. For each of these three nations, nurses were central actors. Their efforts provide a unique vantage point to study the cultural dimensions of risk and prevention embedded in nursing care and the interplay between science, culture, nurses, and the state.     

Future of the Nudrse Labor Market According to Health Execudtives in High Managed-Care Areas of the United States

Purpose :To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States.
Design : Survey in 1995 of a convenience sample of 62 health excutives in 11 states with high enrollment in HMOs. Excutives included officals in state goverments, state and metropolitan hospital associations, professional an nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non-acute care associations, and leading HMOs.
Methods : Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aids for RNs, patients severity, quality of patient care, and expectations for nurse employment during the remainder of the decade.
Findings : Executives perceive a mostly and fast-changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to th need to prepare nurses for rapidly changing employer requirements.
Conclusions : Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in these changes, no evidence of an "employment disaster" exists it the views of health     

Use of Immigration Policy to Manage Nursing Shortages

Purpose: To examine long-term implications of using temporary, nonimmigrant nurse programs to manage fluctuations in the demand for registered nurses.
Organizing Framework: This discussion is located in the full context of migration—reviewing theories and concepts of labor migration—referring to experience with guest-worker programs worldwide, outlining recent nursing shortages in the United States, describing the Immigration Nursing Relief Act (INRA), and raising questions for nurses in the United States and in the global marketplace.
Sources: Review of scholarly literature on international migration, existing studies on nurse migration to the United States, and original research, conducted between 1992 and 1994, for the Immigration Nursing Relief Advisory Committee (INRAC) Report.
Methods: Policy analysis of theories, concepts, and perspectives related to nurse migration.
Findings: In the United States, highly skilled foreign nurses tend to complement rather than displace local labor. Yet recruiting foreign-educated nurses for entry-level jobs perpetuates patterns of dependency in the sending country and delays creative solutions to staff development in the host country. Nonimmigrant status creates a vulnerable workforce. There may be a disparity between the ideal of nurse migration as collaborative exchange and the reality of institutionalized occupational migration networks.
Conclusions: While foreign nurse recruitment might solve short-term needs, repetitive temporary nurse migration programs create long-term consequences that are not in the best interests of the profession. The absence of consistent policy creates an opportunity for nursing to take an active role in developing the rules and direction of future nurse migration.     

Effective promotion of breastfeeding among Latin American women newly immigrated to the United States

Across the United States, advance practice nurses (APNs) are increasingly encountering recently immigrated Latin American populations. This article provides an overview of the situation of Latin Americans in the United States and discusses aspects of Latin American culture such as, respeto (respect), confianza (confidence), the importance of family, and the value of a personal connection. Strategies that will assist practitioners to incorporate culturally holistic principles in the promotion of breastfeeding among Latin American women who are new arrivals in the United States are described. If practitioners are to respond to the increasing numbers of Latin American women who need health care services, and also provide thorough, holistic health care then health care activities must be integrated with cultural competence.     

Nursing shaping and influencing health and social care policy

Aim  This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.
Background  The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.
Methods  This paper critically reviews recent UK and USA literature and policy with relevance to nursing.
Results  Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.
Conclusions  Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.
Implications for Nursing Management  All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.     

Social Justice and Social Determinants of Health: Lesbian, Gay, Bisexual, Transgendered, Intersexed, and Queer Youth in Canada

TOPIC:  While nurses address lesbian, gay, bisexual, transgendered, intersexed, and queer (henceforth LGBTIQ) patients' health needs, the professional nursing practice value of social justice provides a larger role for nurses in identifying and minimizing social barriers faced by LGBTIQ patients.
PURPOSE:  This paper examines the social and health-related experiences of LGBTIQ youth in Canada, a country which has removed many of the social and legal barriers faced by LGBTIQ in countries such as the United States. An awareness of the Canadian LGBTIQ experience is instructive for nurses in different countries, as it reveals both the possibilities and limitations of social legislation that is more inclusive of LGBTIQ youth.
SOURCES:  Review of literature in PubMed, Academic Search Premier, government documents.
CONCLUSION:  The literature reveals that exclusion, isolation, and fear remain realities for Canadian LGBTIQ adolescents. The Canadian experience suggests that negative social attitudes toward LGBTIQ persist despite progressive legislation. The value of social justice positions nurses to constructively intervene in promoting the health and well-being of LGBTIQ youth in the face of social homophobia.     

Regulatory, institutional, and market-based approaches towards achieving comprehensive chemical policy reform

The purpose of this article is to inform nurses and other health care professionals about the nexus between the environment and health and present approaches in which they can be involved so as to support comprehensive reform of chemicals management in the United States. It discusses the health impact of hazardous chemicals and the environmental regulatory failures within the U.S. to protect the public. It also reports on international chemical management initiatives and key elements of chemical policy reform that can guide the U.S. regulatory, market-based, and institutional-based approaches to a comprehensive, chemical policy reform. The role of nursing in advocating for these reforms will be presented.     

Hmong American women crossing borders in nursing education: two case studies

The Hmong population in the United States is rapidly growing. Cultural differences between this population and the American health care system lead to health disparities. These differences are exacerbated by the shortage of Hmong American nurses. The shortage may be related to difficulty in navigating the U.S. education system. The purpose of this study was to examine the perceived impact of Hmong culture on Hmong American women's nursing education. Data analysis identified four themes that were confirmed by participants: support factors, entrepreneurism, positive outcomes, and cultural expectations. On the basis of these themes, schools of nursing can positively influence Hmong American women's education by providing information sessions for their families regarding school expectations, allowing flexibility in meeting course requirements, increasing the number of Hmong and minority faculty members, and providing language assessment and support programs for English language learners.     

Nurses' agricultural education in the southeastern United States

The number of nurses across the United States with expertise in agricultural health nursing is unknown, yet as many as 8,000 are needed. This article describes agricultural health content in nursing programs in the southeastern United States. Agriculture is primarily family based but ranks among the top three most hazardous industries in America. Nurses in the southeastern United States serve more than 541,000 farm families, more than a quarter of the nation's agricultural population. A 15-item survey was mailed to 185 nursing schools located within 13 southeastern states. Information was requested about undergraduate and graduate curricula that included information about agricultural health and safety. Surveys were returned from 113 programs (61.1%). Schools with larger percentages of rural students were more likely to include mention of agricultural health; however, scant attention was given to any rurally focused content. In 27.4% of the schools, no mention of agricultural health issues was made, and 54.0% of nursing faculty who completed the survey were not aware of the need for nurses with agricultural health expertise. Results suggested that, when agricultural health topics were presented in class, student interest in the topic increased. Given the occupational hazards faced in agriculture and the region's economic dependence on agriculture, increased attention should be focused on agricultural health content within nursing programs.     

Nursing and Health Policy

Purpose: To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena.
Design: Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level.
Method: Semi-structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work.
Findings: For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occured after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses.
Conclusion: Once engaged, nurses seldom turned their backs on the world of policy-making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.