Promoting the value of nursing in the context of the global shortage

Καταχώρηση 2012/04/19

Dr Beverly Malone, General Secretary, Royal College of Nursing, United Kingdom


When I came from the USA to my current leadership role at the Royal College of Nursing in the UK,
I was aware that I would encounter differences between the two cultures and their respective nursing
and health care systems. What unites these two countries however, and indeed all countries, is the
central role that nurses play in the health of the communities they serve. Nurses deliver the majority of
direct care and it is vital that we play our part in shaping as well as delivering health care.

Effective patient care requires a plentiful, educated, valued and rewarded nursing workforce. Yet
governments and employers across the world, in both developed and developing countries, are 

struggling to recruit and retain nurses. It has been anticipated that the USA will require one million
more nurses by 2010 (Buchan 2002).

Many countries have failed to make effective  plans to recruit people into nursing – and to retain
them through fair pay and career packages.

Women often earn less than male counterparts for doing the same job. Nurses often have been seen
as subservient to doctors, instead of as partners on the multidisciplinary team. This is reflected in
nurses’ lower earnings, and in the power of nurses to influence health care policy and delivery, all the way
from the bedside to the boardroom.

In recent years the UK government and the National Health Service (NHS) have worked to
address the nursing shortage. Nursing has been so successfully promoted that it is now the second
most popular degree course in the country. ‘Return to Practice’ courses offer those who have left nursing
a way back into the profession. Flexible working patterns have been introduced in many workplaces,
helping staff get a better work/life balance.

The good news is that these measures have had some degree of success. But the harsh truth is that
without the aggressive international recruitment of recent years the total number of nurses registered to
practice in the UK would not have increased. International recruits helped build the NHS and the contribution
of overseas nurses is just as important to the UK today.

Nursing is a global profession and the international mobility of nurses is not new. However,
improving patient care in one country must not be at the expense of patients elsewhere. 

The report, launched at the ICN conference last June, is essential reading for anyone who wants to
understand significant trends in the international recruitment and migration of nurses. It follows a
case study of the international recruitment of nurses to the UK published last year (ibid).

According to the case study, there has been a fivefold increase in the number of overseas nurses registering
in the UK since the early 1990s. Between 2001 and 2002 almost half of all new nurses registering to
practice in the UK were from overseas and approximately 90% of these came from outside the European
Union (EU).

Of the 30 000 plus overseas nurses who registered in the UK in the previous three years, the majority
have come from the Philippines, South Africa and Australia. There have also been increases from countries
such as Nigeria, Ghana, India and Zimbabwe.

The EU diminished in significance as a source of nurses entering the UK from between 25 and 33% of
overseas entrants in the mid 1990s to 13% by 2000–2001. The percentage is forecast to fall further. Language
differences appear to be a key factor.

A growing global nurse shortage, increasing competition for nurses from the United States and
an ageing workforce will keep the pressure on recruiters. Research shows that the UK in particular
is going to rely on international recruitment for a long time to come. We need to ensure that recruitment
is done responsibly and that nurses who come to the UK have a good experience of working and
living here.

The RCN has produced good practice guidance for employers and our representatives (Royal College
of Nursing 2002). It outlines best practice in job offers and employment contracts to ensure the fair
treatment of internationally recruited nurses. International nurse recruitment has increasingly become
more than a short-term solution to ensuring patient care. Safeguarding patient care in the long term is
about boosting pay and improving working conditions for all nurses. Pay and career development is

the key to recruiting new nurses and retaining experienced nurses. The NHS has suffered from persistent
recruitment and retention problems.

In the UK, four years of comprehensive and, at times, tough negotiations between unions and the
government recently resulted in a new pay and career package for NHS staff. Representing nurses,
the RCN has been at the centre of these key negotiations. The majority of nurses could benefit by October
2004, the proposed date to roll out the package across the whole NHS. RCN representatives will be
working closely with employers to see how the new arrangements are working out.

In conclusion, promoting the value of nursing has to come from nurses themselves. We need to use
the growing body of evidence which shows the positive impact nursing has on patient care. We
need to give strong and sustained messages about the importance to patient care of recruiting and
retaining nurses through fair pay. In a world of limited resources, we need to affirm that investing in
nursing is investing in patient care.

During her nursing career Beverly Malone has worked in policy, education, administration and
clinical practice. She served two terms as President of the American Nurses Association.

In 2000 she became Deputy Assistant Secretary for Health within the US Department of Health and
Human Services, the highest position so far held by any nurse in the US government. Dr Malone
became General Secretary of the Royal College of Nursing, the UK’s largest professional union of
nurses, in June 2001.


Buchan, J. (2002) International Recruitment of Nurses: United Kingdom Case Study. Royal College of Nursing,

Buchan, J., et al. (2003) International Nurse Mobility: Trends and Policy Implications. Royal College of Nursing, London. 

Royal College of Nursing (2002) Internationally recruited nurses: good practice. In Guidance for Health Care

Employers and RCN Negotiators. Royal College of Nursing, London.

© 2003 International Council of Nurses,International Nursing Review, 50, 129–130










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