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J International Models of Nursing
Pages 565-642

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From page 565...
... This paper describes general trends and broad themes in globalization and international nurse migration, profiles nursing education, regulation and utilization in various countries, and relates them to the future of nursing, both in the United States and globally. It describes foreign-educated nurses in the United States workforce within the context of global variances in nursing education programs, credentialing mechanisms, and employment practices.
From page 566...
... . Globalization of the nursing workforce must be viewed within the context of the worldwide development of the knowledge economy.
From page 567...
... In that regard, nursing shortages in the United States mirror the growing interdependency of labor markets throughout the world and the need for national and international nursing workforce policies. The challenge for workforce planning related to the global migration of nurses, however, is to focus not only on the number of nurses entering the country, but also on the number of nurses leaving the country, the number of new nurse graduates and the effect of internal migration, such as the movement of nurses from state to state and from rural to urban areas.
From page 568...
... Moreover, there is a clear linkage between quality nursing education and health outcomes. Since substantial numbers of foreign-educated nurses hold baccalaureate degrees, targeted opportunities for education should be directed at encouraging them to complete masters and doctoral nursing programs as preparation for clinical and faculty leadership roles.
From page 569...
... 7 U.S. immigration law requires that foreign-educated nurses seeking U.S.
From page 570...
... Recommendation 4: Add Global Health as Subject Matter to Undergraduate and Graduate Nursing Curricula To better prepare nurses to work within a globalized health system, U.S. nursing programs should include courses on global health.
From page 571...
... Thus, the globalization of the nursing workforce must be viewed not only within the context of the health status of nations, government investment in health budgets, nurse/health care migration, economic realities, and working conditions but also within the context of the diverse preparation and practice of its practitioners. Achieving global standards for the education of nurses is a vision of many nursing professionals, and has been promoted by the ICN for over a century.
From page 572...
... In short, universal nursing education standards have not been achieved. Entry-level professional nursing programs are designated as diploma, associate degree or baccalaureate.
From page 573...
... Key Issues and Challenges in Nursing Regulation Regulatory Structure In addition to differences in education, the nursing profession varies by country in how it is regulated. Many countries have had statutory nursing regulation for years, regulation that ensures a safe and competent nursing workforce.
From page 574...
... Table J-1 depicts the 2007 NCLEX pass rates of U.S. and internationally educated nurses as well as nurses educated in the countries that are historical and emerging suppliers of registered nurses to the U.S.
From page 575...
... Graduates of nursing programs in such countries as Peru, Columbia, the Dominican Republic, the Ukraine, Armenia, Russia, and other Eastern European countries are not required to hold licenses. The graduate nurse's diploma serves as the permit to practice the profession of nursing.
From page 576...
... The nurse's role and responsibilities also may differ by country, although the titles may be the same. Commonly, there are four categories of titles: first-level or registered nurse, second-level or practical nurse, specialty-midwife, and nonprofessional level.
From page 577...
... Completion of a country's initial nursing education identifies one as a registered nurse (RN, licensed nurse, professional, or qualified nurse)
From page 578...
... This has been a frequent occurrence for nurses educated in Mexico, Eastern Europe, and Taiwan. Professional Nursing Programs Professional nursing education programs are conducted at the post-secondary level.
From page 579...
... Professional nursing programs may differ in the theoretical and clinical courses that are taught. In certain provinces in India male nursing students are not permitted to provide maternal/infant care (obstetrics)
From page 580...
... Graduates are midwives but are not limited to just providing care to pregnant women. Physician to Registered Nurse Programs The worldwide nursing shortage, demand for first-level nurses, and recruitment of foreign-educated nurses have spawned a recent phenomenon -- physician to registered nurse programs.
From page 581...
... The courses are taught in English. In the Philippines a large number of nursing schools now offer nursing programs for physicians with the physician being given transfer credit for previous education.
From page 582...
... , foreign-educated nurses in the United States most frequently cited poor wages and few jobs (due to the nursing shortage, underutilization of nurses and maldistribution of nurses) as the primary reasons for leaving their home countries (push factors)
From page 583...
... Workforce Registered nurses entering the United States for purposes of employment tend to be female, younger than their U.S. counterparts, and educated in either diploma or baccalaureate programs in their home countries.
From page 584...
... Seventy percent of the employed registered nurses worked in hospital settings, and 15 percent worked in nursing homes or extended care facilities. Less than 5 percent worked in community health despite the emphasis on that area in many nursing programs internationally.
From page 585...
... . A greater percentage of foreign nurse graduates worked full time as registered nurses as compared to the National Sample Survey of Registered Nurses (NSSRN)
From page 586...
... Transition to U.S. Practice In an effort to augment descriptive data about foreign-educated nurses in the United States, CGFNS International investigated challenges the nurses confront in their transition to U.S.
From page 587...
... Information on how the system is accessed by patients and the nurse's role in management of care also should be included. Although nurses educated outside the country will not come to understand the system thoroughly until they work within it, preliminary knowledge helps to make the transition to U.S.
From page 588...
... Familiarity with the process of acculturation helps foreign-educated nurses know what to expect within their first year of practice in a new culture and new work environment. It also helps employers to plan an orientation that addresses the foreign nurse graduate's needs when entering practice in a host country.
From page 589...
... The findings, however, are best understood within the context of the diverse education and licensure systems of foreign-educated nurses, since this diversity has significant impact on the skill mix of the U.S. nursing workforce.
From page 590...
... HISTORIC SUPPLIERS OF REGISTERED NURSES TO THE U.S. WORKFORCE Nurses entering the United States for purposes of employment must undergo a federal screening program as part of the visa process to ensure that their credentials are valid, that their education and licensure is comparable to that of a nurse educated in the United States, and that they are proficient in written and spoken English.
From page 591...
... Graduates function under the supervision of a registered nurse. Job skills are com parable to nurse aides in the United States.
From page 592...
... the proliferation of poor quality nursing programs whose graduates are not able to pass the Philippine licensure examination; (2) the high unemployment rate of nurses in the Philippines -- it is estimated that over 400,000 Philippine nurses are not able to find jobs; and (3)
From page 593...
... . Licensure Renewal Prior to 2000, registered nurses were required to renew their licenses every three years.
From page 594...
... The nurse also is required to maintain competence through continued professional education to be provided by the accredited professional organization or any recognized professional nursing organization. Supply and Demand in the Philippines Supply exceeds demand for nurses in the Philippines, with over 400,000 registered nurses unable to find employment in their home country as there were only 60,000 nursing jobs available (Nowhere to train, 2008)
From page 595...
... The major nursing organizations and the Board of Nursing are opposed to the practical nurse programs as well as to ladderization. They have opposed all attempts to change the law regulating nursing to include practical nurses, mainly because of the high unemployment rate of registered nurses in that country (Personal communication be tween Hon.
From page 596...
... . CGFNS VisaScreen data, 2005-2009, indicate that nurses educated in India and seeking an occupational visa to practice in the United States most frequently identified their intended states of practice as Vermont, Florida, California, New York, and Texas (CGFNS, 2010b)
From page 597...
... The goal of the program, which leads to the Bachelor of Science in Nursing, is the preparation of a generalist nurse. Candidates for the program must be registered nurses who have 2 years of experience and a working knowledge of English (Indian Nursing Council, 2009a)
From page 598...
... However, the Hawkes and colleagues (2009) study indicated that the collective labor time spent outside of the country suggests temporary migration may have a profound and underestimated impact on the Indian nursing workforce.
From page 599...
... Nursing education programs in Canada require completion of 12 years of primary and secondary education for entry. There are three types of programs for registered nurses: 3-year diploma programs, which are being phased out, 4-year generic baccalaureate programs and post-basic baccalaureate programs for nurses holding a diploma in nursing that are 2–3 years in length.
From page 600...
... . Accreditation The Canadian Association of Schools of Nursing is officially recognized as the national agency responsible for the accreditation of nursing programs throughout Canada.
From page 601...
... . For example, when nurses apply to the College and Association of Registered Nurses of Alberta (CARNA)
From page 602...
... . Nova Scotia's definition of practice, contained within the Registered Nurses Association Act of 1985, also addresses health promotion, illness prevention and the provision of care.
From page 603...
... CGFNS VisaScreen data, 2005−2009, indicate that nurses educated in the United Kingdom and seeking an occupational visa to practice in the United States most frequently identified their intended states of practice as California, Arizona, Florida, New Mexico, and New York (CGFNS, 2010b)
From page 604...
... . To become a registered nurse, an applicant must complete a 3-year program at a school or college of nursing approved by the NMC and linked to a university.
From page 605...
... These characteristics include working with both individuals and a population, which may mean making decisions on behalf of a community or population without having direct contact with every individual in that community. Specialist community public health nursing aims to reduce health inequalities by working with individuals, families, and communities promoting health, preventing ill health and in the protection of health.
From page 606...
... . Supply and Demand In 2008 the United Kingdom determined that it no longer had a nursing shortage and suspended the immigration of overseas nurses.
From page 607...
... Workforce: China Overview China is viewed as an emerging source country for the migration of nurses. However, because nurses educated in secondary school nursing programs make up the majority of nurses in the workforce in China, they do not easily meet licensure requirements in many host countries.
From page 608...
... Moved from Bachelor of hospitals to Science in universities Nursing Educational 10 years primary 10 years for 12−13 years 11 years primary/ Requirements and secondary diploma based on secondary for Entry education programs province education into Nursing 12 years for 11 years for Programs Bachelor diploma degree programs in programs Quebec Licensure Examination Board Examination Registration Examination for diploma programs University Exams for BS programs Licensure No, license valid No, most states Yes Yes, to maintain Renewal for life do not require registration renewal Title Registered Nurse Registered Nurse Registered Nurse Registered Nurse and Midwife (Sister) Types of Nursing BS in Nursing Diploma Diploma University-based Education in Practical Nursing BS Baccalaureate diploma and Country MD to BSN Masters Practical Nursing baccalaureate program Doctor of MS in Nursing programs Master of Arts in Philosophy Doctorate in Advanced practice Nursing Nursing programs Master of Science in Nursing Doctor of Philosophy Number of Graduate 300,000 230,300 (6% 500,000 (8% Nurses in approximately foreign- foreign-educated)
From page 609...
... 0 APPENDIX J Philippines India Canada United Kingdom Number of 61 13 101 128 Nurses and Midwives per 10,000 population: 2000-2007 Nursing Shortage In rural areas Possibly Yes No developing Source/Host Source Source Host/Source Source. Host status Country for is suspended Migration In-Country Unemployment Quality of Aging workforce Immigration of Nursing Issues of nurses/ schools Under staffing in overseas nurses inability to Shortage of rural areas Aging workforce secure work nurses to meet Educational Vulnerability to experience in-country reform out-migration needed to needs, Health policy Health sector migrate especially in reform reform Variable rural areas Immigration reform accreditation and standardization of schools Proliferation of nursing schools Chronic low pass rates on PRC nurse licensure exam Official Official: Tagalog Official: Hindi Official: English Official: English, Language and English Subsidiary and French Welsh, Scottish Arabic and Official Status: form of Gaelic, Spanish are English for and Irish auxiliary business Challenges and Prepares nurses Circular Nursing shortage Aging of the Issues for export, migration Aging of the nursing which fuels creates nursing workforce proliferation temporary loss workforce EU directives and of low-quality of experienced migration of nursing RNs nurses schools Prepares nurses for export
From page 610...
... , associate degree, and baccalaureate levels and are approved by the Ministry of Education in that country. Mid-associate degree programs are 2−3 years in length and administered by secondary nursing schools that accept candidates who have completed 6 years of primary education and 3 years of junior middle education, usually at 15−16 years of age.
From page 611...
... Scope of Practice China's 1994 Nurses Act described nursing practice as including care that focuses on clinical observation; assisting physicians to complete treatment and administer drugs; implementing care plans through use of the nursing process; patient rehabilitation and education; and quality assurance. Nurses working in public health areas have responsibility for health management along with general practitioners in the community and public health education.
From page 612...
... Initial nursing programs educated auxiliary or enrolled nurses, a classification that is comparable to practical nurses in the United States. Entrance requirements generally included 9 years of primary and middle school education.
From page 613...
... Scope of Practice The scope of nursing practice varies by country. In Nigeria, for example, a nurse is a person who has received authorized education, acquired specialized knowledge, skills and attitudes, and is registered and licensed with the Nursing and Midwifery Council to "provide promotive, preventive, supportive and restorative care to individuals, families and communities, independently, and in collaboration with other members of the health team.
From page 614...
... Some have resurrected long disbanded diploma programs that subscribed to a traditional diploma curriculum. Using Jamaica as a prototype, CGFNS VisaScreen data, 2005−2009, indicate that nurses educated in that country and seeking an occupational visa to practice in the United States most frequently identified their intended states of practice as Arizona, New York, Florida, and Georgia (CGFNS, 2010b)
From page 615...
... Regulation The Nursing Council of the individual country is responsible for conducting site visits at schools of nursing for quality checks and to verify the curriculum, including clinical hours, as well as for the licensure and registration of registered nurses and midwives. It serves as the gate keeper to the Caribbean Regional Licensure Examination.
From page 616...
... . Issues and Challenges • Nursing Shortage: The worldwide AIDS epidemic has taken its toll in the Caribbean, increasing the need for health professionals, especially nurses.
From page 617...
... The Caribbean Overseas Nurses Association works closely with national nurses associations to explore possibilities for joint programs in developing nursing education and practice. − Health and Tourism Model: In this model, nurses would be re cruited from developed countries, such as Canada and the United States, and invited to work in the Caribbean for 6−12 months -- with the advertised goal of achieving greater work–life balance.
From page 618...
... Consequently, a number of initiatives were put in place by schools and recruiters that assist the nurses in language development and in the knowledge of nursing as it is practiced in the United States. CGFNS VisaScreen data, 2005−2009, indicate that nurses educated in Mexico and seeking to practice in the United States most frequently identified their intended states of practice as Texas, California, and New Mexico (CGFNS, 2010b)
From page 619...
... Today there are still two types of nursing programs in Mexico: 3-year diploma programs and 4-year degree programs. However, both are now post-secondary in nature and require 12 years of primary and secondary education for entry.
From page 620...
... . Supply and Demand Approximately 65.1 percent of the nursing workforce in Mexico consists of registered nurses (graduates of diploma and baccalaureate programs)
From page 621...
... Psychiatric Baccalaureate Nursing (3 years) Educational 12 years primary 11 years primary 11 years primary 12 years primary Requirements and secondary and secondary and secondary and secondary for Entry school school school school into Nursing Programs Licensure Yes: Examination Yes: Yes: Regional Yes: School exit Examination examination examination depending on if members of or thesis and country CARICOM hospital clinical If not, individual examination country licensure Licensure Yes, every 2 Country specific; Yes No Renewal years if required, 1−2 years Title Professional Registered Nurse Registered Nurse Technico Nurse General Nurse in Enfermeria Jamaica (2-year degree)
From page 622...
... Languages English Colonial French languages of English, French, Portuguese and Spanish Challenges and Lack of fluency Brain drain Low pass rates Lack of fluency in Issues in English on licensure English exam Shortage of tutors High migration rates SOURCE: Kaiser Family Foundation, 2009.
From page 623...
... The rapid emergence of trade and mutual recognition agreements must be taken into account, as they directly affect nurse migration patterns, possibilities, and challenges. TRADE AND MUTUAL RECOGNITION AGREEMENTS The migration of nurses in many parts of the world has been influenced by the development of regional and international trade and mutual recognition agreements.
From page 624...
... It requires a visa, consular processing, a labor certification filed by the employer, and an I-129 petition for nonimmigrant workers. Mexican nurses also must present a CGFNS VisaScreen Certificate as part of the visa process.
From page 625...
... In each of the three countries there were various pathways to entry into nursing practice and different competencies associated with each pathway. Regulatory systems and nursing specialty certification were more comparable in the United States and Canada (CGFNS, 1996)
From page 626...
... Mexican nursing organizations have used the preliminary work of the Trilateral to upgrade nursing and to increase participation in standard setting for the profession in Mexico (CGFNS, 1996)
From page 627...
... . There are several mutual recognition agreements in nursing: • The European Union (EU)
From page 628...
... , which has enabled the movement of registered nurses among signatory countries of the region. • Internal Mutual Recognition Agreements: In-country agreements be tween states, provinces and territories that provide for the mobility of the nursing workforce in that country.
From page 629...
... Educational Agreements In addition to trade and mutual recognition agreements, agreements also have been negotiated between foreign and U.S. nursing schools to provide clinical experience, internships and language proficiency programs.
From page 630...
... IMPLICATIONS FOR THE U.S. NURSE WORKFORCE The Global Nursing Shortage "The issues surrounding nursing shortages and global nurse migration are inextricably linked.
From page 631...
... As a result of these projections, it is likely that the demand for registered nurses educated in other countries will increase. In other words, foreign-educated nurses will be a permanent feature of the U.S.
From page 632...
... Planning efforts should require that the United States establish a national system that monitors the inflow of foreign nurses, their countries of origin, the states and settings in which they work, and their impact on the nursing shortage. In order to ensure that the nursing care needs of the public are met, a broader workforce policy is needed that balances foreign nurse recruitment and domestic needs.
From page 633...
... To address and/or prevent the disruptiveness of these factors while delivering care, cultural competence and cultural sensitivity must be added to the knowledge and skills needed for nursing practice in the future. Continuing health policy should be developed that proactively manages a well-prepared, multicultural, multilingual, multiethnic, and multireligious workforce and fosters the development of intercultural workplaces.
From page 634...
... The International Council of Nurses, Sigma Theta Tau International, and the Commonwealth Secretariat have issued codes that provide guidelines and methods to improve the ethical recruitment and treatment of health care workers. The United States, in 2009, issued The Ethical Code for Recruitment of Foreign-Educated Nurses, a voluntary code for ethical recruitment practices developed by an Advisory Council of stakeholders that was convened by AcademyHealth, a private-sector health policy organization.
From page 635...
... 2004. The registered nurse population: Findings from the 2004 national sample survey of registered nurses.
From page 636...
... 2009c. Tested solutions for eliminating Canada's registered nurses shortage.
From page 637...
... 2009c. Guidelines to start nursing programs.
From page 638...
... 2008. The global nursing shortage and nurse migration.
From page 639...
... : Ob jectives, coverage and disciplines. http://www.wto.org/english/tratop_e/serv_e/gatsqa_e.htm (accessed January 15, 2010)
From page 640...
... To conduct and publish studies relevant to internationally educated health care professionals The major CGFNS programs used by internationally educated health care professionals are the VisaScreen Program®, which is the leading health care worker certification program for immigration and for obtaining occupational visas in the United States; the Credentials Evaluation Service, which provides a course-by-course comparison of international education to U.S. standards for licensure, education and employment; and the Credentials Verification Service for New York State, which is required of internationally educated registered and practical nurses, occupational therapists and assistants, and physical therapists and assistants seeking licensure in New York State.
From page 641...
... Nichols, D.H.L., M.S., R.N., FAAN, is the Chief Executive Officer of CGFNS International (Commission on Graduates of Foreign Nursing Schools) , which is an internationally recognized authority on credentials evaluation and verification pertaining to the education, registration, and licensure of nurses and health care professionals worldwide.
From page 642...
... She chairs the Compliance Committee of the Alliance for Ethical International Recruitment Practices. A registered nurse and attorney she is an experienced lecturer and author on health policy, political action, legal issues in nursing and health administration, foreigneducated nurses, clinical trials, and minority and women's health issues.


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