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Global nursing leader questions ethics of recruiting nurses from poorer countries

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Aggressive nursing recruitment in poorer nations struggling with their own nurse shortages is “unethical”, according to an international nursing leader who says countries like the UK must try harder to grow their own workforce.

In an exclusive interview with Nursing Times, Annette Kennedy, president of the International Council of Nurses, said it was wrong for NHS trusts to strip much-needed nurses from less well off countries to fill nursing vacancies.

“We have to be more ethical in our relationships with low and middle income countries”

Annette Kennedy

“Our responsibility is to grow our own capacity and retain our nurses, and that’s not happening,” she said about richer nations. “It’s not that nurses shouldn’t travel and work in different countries – nurses have always travelled – but aggressive recruitment is unethical, as far as I’m concerned, and we are taking from low and middle income countries.”

Ms Kennedy, a former director of professional development with the Irish Nurses and Midwives Organisation, said one country that was now struggling was the Philippines, which had a long been a favoured recruiting ground for healthcare organisations in the UK.

“Just recently I heard the Philippines, who always export their nurses, are now very short themselves,” she said. “We have to be more ethical in our relationships with low and middle income countries, because they badly need their nurses and doctors as well.”

She maintained that the UK could develop more ethical overseas recruitment schemes that would support the development of nursing worldwide.

“It would be different if we saw a responsibility in taking nurses from low and middle income countries and providing them with education and resources and then sending them back, and were supporting their governments to invest in nursing,” she said.

Ms Kennedy highlighted that a shortage of nurses, plus problems recruiting and retaining enough nursing staff, were among key issues facing all nations, with the World Health Organization (WHO) predicting health services across the globe will need an extra nine million nurses and midwives by 2030.

Meanwhile, a failure to invest in nursing, and primary care services in particular, had led to high rates of premature deaths from preventable causes like cardiovascular and respiratory disease, said Ms Kennedy, who is a commissioner on the WHO High Level Commission for Non-communicable Diseases.

“We keep saying we are going to put money into primary care but we haven’t done that”

Annette Kennedy

However, she said global organisations like the WHO, United Nations and World Bank were increasingly stressing the need to invest in healthcare to support thriving economies. She said the UK was a prime example of a country that had failed to put enough resources into primary care – an area where nurses and midwives could have a huge impact on health outcomes if given the chance.

“The UK – and Western society as a whole – has not got the model right, because they have invested too much money into hospital care and have neglected primary care,” she said. “We have paid lip service to it. We keep saying we are going to put money into primary care but we haven’t done that.”

When she visited other countries and met healthcare professionals and policymakers, Ms Kennedy said she advised them not to follow in the footsteps of the UK and other high income countries.

“Mostly when I go to the low and middle income countries, I tell them not to follow what we have done because it will not do them well,” she said. “It’s controversial but it’s true. I don’t think the model we have used will work. If they put a lot more effort into – and emphasis on – primary healthcare now, before they get into pouring money into hospital care, they will be in a better situation.”

The ICN continues to gather examples of innovative and successful nursing practice from around the world and Ms Kennedy said the NHS could learn from projects like the Bar Talk scheme in Brazil, where nurses have been going into pubs to encourage men to talk about their health and arrange health appointments. “After four years, they have found 80% of people they’ve asked to come to the primary care centre have come and they have opened it out to a lot more bars,” she said.

Sri Lanka was another country she identified as having a focus on health promotion and disease prevention in the community. “They are going from hospitals out to communities and outreach services and doing all sorts of things like physical assessment, blood pressure and blood sugar. Over three years, more than 200,000 people have been seen in the clinic – that makes a huge difference and doesn’t cost a lot,” she said.

International Council of Nurses

Annette Kennedy

Annette Kennedy

A key goal of the ICN has also been to raise the profile of nursing worldwide and it has worked closely with the WHO on the Nursing Now campaign. By 2020, Ms Kennedy said she was hopeful that the value of nurses and their vital contribution to healthcare would be much more widely recognised in all countries, including the UK.

“Nurses have been indispensable, but they have been kind of invisible. If you ask people what nurses do, they think about it and say ‘they care’ or ‘they work with patients’ but they rarely say that they save lives,” she said. “If you ask what a doctor does people automatically say ‘they save lives’. But nurses save lives every day, because if you are in hospital and somebody doesn’t recognise you have a haemorrhage, complications of infection or raised intracranial pressure, then you are in trouble.”

She said awareness of the role of nurses in the UK was improving, but stated: “I still don’t think people realise the actual work that nurses do and what would happen if you didn’t have nurses and midwives working in the healthcare system. At the end of the day, they are 50% of the workforce and deliver 90% of the hands on care and, of course, there is also advanced practice.”

She said she had benefitted from advanced nursing practice herself earlier this year when she fractured her leg. “I saw an advanced practice nurse,” she said. “She told me what she thought was wrong, X-rayed me, diagnosed me, gave me a boot to wear, told me how long I’d be in it and had me practice walking. It was perfect.”

As well as championing the role of nursing as a whole, the ICN has promoted nursing leadership and involvement in shaping healthcare policy through its Leadership for Change programme, which has now been going for more than 20 years. Ms Kennedy revealed the body was now planning to establish an alumni association for graduates of the training scheme to bring together senior nurses from all around the globe to influence nursing leadership policy.

Specific challenges facing nursing leaders in the UK include the potential impact of Brexit, she noted, though said the impact on movement of nurses between the UK and European Union remained to be seen. However, she noted there were concerns it could affect collaboration between universities in the UK and across Europe.

“I’m not sure how it is going to work in relation to co-operation across universities in Europe and how that will work in relation to funding. I think that might be an issue,” she said. But she was adamant that Brexit would not stop nurses communicating with each other across national borders. “Nurses will always communicate irrespective of politics or anything else, so it will make no difference, because they will talk to each other in whatever country and whatever is happening,” she said.

She also stressed that the ICN would “always talk to nurses in the UK”, despite the Royal College of Nursing’s 2013 decision to leave the body following a dispute over the annual membership fee. She told Nursing Times that she very much hoped the RCN would decide to return.

“Of course, we would like the RCN to come back. It has always been very supportive of other countries and very good at gathering evidence, sharing information and best practice,” she said. “They have been key in leading the way in advancing nursing practice and many countries look at what they’re doing and we miss that – that’s for sure. Besides, the ICN was started 120 years ago next year in a little house in London, so we would really like to see the UK in ICN, seeing as they were one of the main founders.”

She added that she hoped RCN members would reconsider being in the ICN in time for worldwide celebrations of the 200th anniversary of the birth of Florence Nightingale in 2020. “It’s up to them to make the decision to come back and I am confident that they will make the right decision in good time,” said Ms Kennedy who became ICN president in June 2017.

Meanwhile, the WHO is undertaking research into the state of the world’s nursing, which will also be published in 2020 and Ms Kennedy urged chief nurses and nursing organisations in the UK to get involved. She stressed the importance of working together and that the more she saw of nurses around the world, the more determined she was to champion the profession.

“I’m a nurse and a midwife and I believe in nursing,” she said. “I see nurses going out into areas that are unsafe, places where there are no resources, no protective clothing and putting their lives at risk. I see them doing four jobs, looking after their families, being educated, working full-time and trying to support a nursing organisation.

“Inevitably they are always smiling – I have never heard them complain. So if I can do the smallest thing to improve their lives I will,” she said.

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Readers' comments (1)

  • The first thing to do is look to one's own first. If all nations do that everyone will have their corner covered. If poorer nations are losing nurses to richer, they need to do better. Over the last two thousand years, Britain dragged itself up from a lonely outpost on the far edge of Europe to become one of the world's wealthy. Life is unfair and always will be; anyone notice how nurses work hardest in healthcare and get paid least? Maybe Ms Kennedy should shout about that instead of implying that we allow our own patients to be deprived of the best care.

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