May 14, 2008 -- Today the Australian Broadcasting Corporation site reported that the Fiji Nurses Association has said "developed countries that poach Fiji's nurses should have to pay for their training in the first place." The item explains the Pacific island nation's loss of nurses to nations like Australia and New Zealand. The short piece does not explore how this paying for training might happen. For instance, should governments or hospitals in the nations to which the nurses emigrate pay? How? The piece also does not explore key aspects of the shortage in Fiji. But the article does suggest that the exodus of developing world nurses to wealthy nations is more than a simple job move.
The Fiji Nurses Association reportedly said Fiji has lost about 240 "highly skilled nurses" in the last three years. The piece might have noted that this is in a nation with a population of less than 1 million, so this might be comparable to taking 240 nurses from a city of that size.
Association general secretary Kuini Lutua explained that the nurses leave because of low wages, poor working conditions, and lack of educational opportunities in Fiji. She said the small island nation will "face a severe nursing shortage if the exodus continues." She made the restitution argument in an interview with Radio Australia's Pacific Beat program:
The receiving countries are taking nurses or skilled workers away from the developing countries, (when) they have really not contributed to the training of those health professionals. There has got to be some partnership, some give and take.
She does not explain exactly what kind of help she's looking for, but it is a subject worth exploring. Should developed nations contribute certain amounts of aid to poor nations' nurse training programs for each nurse they recruit, e.g., the amount it took to train the nurse in question? Should they donate directly to alleviate the problems in working conditions that have driven the nurses away in the first place?
As migration expert Mireille Kingma has shown, nurse migration is driven largely by "push factors" in the nations of origin. How much do the nurses remit to their families in Fiji? Should those funds be taken into account, even though they are presumably not applied directly to the health sector? The piece might also have noted what the effects of the shortage are in Fiji, for instance in patient outcomes and possible burnout of the nurses who remain.
There's a lot more to explore with this topic, but we thank the Australian Broadcasting Corporation for highlighting the basic issue.
Those who recruit nurses from developing nations should consider the International Code of Ethics for Nurses, which states:
Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. ... Nursing care is...unrestricted by considerations of...nationality, politics, race or social status.
It may be that some kind of restitution structure (beyond the private remittances that now occur) would at least alleviate some of the suffering caused to developing world health systems when large numbers of skilled nurses depart.
See the article Poachers of Fiji nurses 'should pay for training' on the Australian Broadcasting Corporation website from May 14, 2008.