Are Chinese Nurses a Viable Source to Relieve the US Nursing Shortage?

Yu Xu, PhD, RN, CTN


Nurs Econ. 2003;21(6) 

In This Article

Analytical Frameworks for Examining International Nurse Migration

Many theories or frameworks have been proposed to explain the phenomenon of international migration of professionals, or better known as brain drain. For the practical purpose of this article, brain drain is defined as the migration of professionals and technical personnel to other countries, resulting in a perceived loss of real or potential human capital to their homelands. Brain drain was once a highly emotionally charged phenomenon that became the subject of scholarly and policy inquiry for hundreds of books, reports, and articles during 1960s-1980s. Since then, the debate on the pros and cons of brain drain has become less intense as more professionals return to their homelands after political and socioeconomic conditions improved, as in the cases of Korea and Taiwan. Meanwhile, the global village concept, which highlights the need and reality of interdependence among nations, has gained increasing popularity and acceptance.

The nationalist (Patinkin, 1968) and internationalist (Johnson, 1968) perspectives represent two contrasting lenses through which to examine the migration of nurses globally. The nationalistic perspective posits that the migration of highly trained professionals retards national development by draining the national reserves of talent. Such brain drain represents a significant monetary loss to the home country since the education of those lost professionals are either fully provided or partially subsidized by the home government, less to say their potential contributions to the homeland. Implicit in the nationalist perspective is the rejection of the assumption that the "world" should be considered as a single aggregate (Patinkin, 1968).

On the other hand, the internationalist perspective maintains that the migration of scholars and scientists has been a phenomenon as old as science and human existence (Dedijer, 1968; Mejia, Pizurke, & Royston, 1979). It is only in the post-World War II era that this phenomenon has intensified. The internationalist perspective is essentially rooted in the interdependence paradigm. From this perspective, the mobility of people among nations creates synergy and added values that are unable to achieve otherwise. Consequently, mobility contributes to the optimal utilization of human resources and the maximum realization of human potentials, particularly when there is a surplus of professionals who are unemployed or underemployed. The internationalist perspective is becoming more relevant in the age of globalization when nation states are becoming increasingly interdependent on the free movement of people in the same way as that of goods and services.

By far, the proposed framework that has the most explanatory power is the pull-push model. In essence, this framework states that it is the combination of the push factors in the home country and pull factors in the recipient country that have resulted in the international migration of professional and technical personnel. The push pull factors derive from the unequal and different development levels of the involved countries. The push factors refer to those conditions in the home country that exert negative or pushing forces while the pull factors in the recipient country refer to those that serve as attracting or pulling forces. In general, the push factors include undesirable socioeconomic status, political instability, poor working conditions, oversupply of professionals in a particular field, and underdevelopment of the home country. The pull factors are generally the opposite that exist in the recipient country. The push and pull factors exert their influences at the individual, institutional, national, and international levels simultaneously (Dedijer, 1968; Mejia et al., 1979).

In reality, the migration of professionals across international borders is a double-edged sword. There is no pure looser or winner within the international context, particularly from a long-term perspective. While the home country "lost" the valuable human capital for now, it is rarely a total or permanent loss. In the Korean and Taiwan cases, the professionals working and living abroad turned into a form of human capital conservation and even enhancement. This is especially true when there is a surplus of professionals in a given field that the domestic market is unable to absorb.

At the same time, the remittance from overseas professionals can be a significant source of the much-needed foreign exchange for the home country, as in the case of Filipino nurses. For decades under the free-market economy, private Western-style nursing schools have boomed and trained nurses for export to international markets, including the United States. Many young women go through vigorous training, which may start from being trained as a nanny to screen for qualities to become a nurse. In recent years, Filipino males and even physicians have joined the rank of nurses since it is much easier to go abroad and work as a nurse. The government's laissez-faire, or more precisely, semi-intentional, policy has resulted in the relative oversupply of nurses. For decades, remittance from overseas nurses has constituted a significant portion of Filipino foreign exchange.


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