In case you were interested in the growing menace of nurse poaching, take a look at the article that I just wrote for the Lancet. It is available online, even if you don’t subscribe. Free registration is required, though, to access any of the articles.

Nurse poaching? Strange combination of words, you may think.

Most people would never equate the word “poaching” with nurses. But yet, it is a very real problem. At first glance, it really does appear that the world is suffering from an unprecedented shortage of trained nurses. Some 69 nations, reporting in from every geographic region, state that they are experiencing a diminishing supply of nursing staff. Even more insidious is the fact that 44 nurses’ associations and unions in 33 countries, primarily in Africa, Central America and the Caribbean, all report that the outflow of their nurses to more affluent countries was a serious to extremely serious problem.

But truth be known, the shortage is really that of tolerable places to work. There are enough nurses living on our planet, but growing numbers are refusing to put up with poor working conditions and wages. In the U.S., a recent study found that 50% of employed RNs had considered leaving patient care within the last two years for reasons other than retirement, and 21% of them said they expect to quit within five years. Similar statistics can be found in other industrialized nations. But rather than improve working conditions, raise salaries, and treat nurses as something more than the hired help, industrialized nations are instead, aggressively recruiting replacements from the developing world. Welcome to nurse poaching.

And of course, one cannot blame nurses from impoverished lands for wanting a better life. They’re not treated any better than nurses are in industrialized countries, so why not go where the grass is extremely greener? Why work 14 hour days caring for 30 or more patients at a time, risk exposure to HIV, and be paid a paltry $70 a month, when your skills are needed in a safer and far more lucrative environment? But since neither the wealthy nor the poor care enough about their nurses to introduce real changes and creative strategies, they will continue to flee—out of the country or out of profession completely.

Take the following scenario: The U.S., which lies at the very top of the food chain, recruits nurses from Ireland and Canada. Ireland, once overflowing with excess homegrown nurses, is now recruiting from the Philippines. Canada is recruiting British nurses. Great Britain has turned its sights on South Africa and Jamaica. South Africa, close to the bottom of the barrel, holds out the carrot to nations such as Ghana, while Jamaica is recruiting from Nigeria and Guyana.

But the buck stops here, so to speak. Where does Ghana go for replacements? Or Malawi, one of Africa’s poorest nations, where 15% of the adult population is infected with the AIDS virus? During the past two years, 9% of Malawi’s nurses left the country, with nearly all of them heading to the UK. Nations like Ghana and Malawi see the writing on the wall. They cannot compete with overseas jobs, nor can they ever hope to attract foreign nurses to their respective nations.

Except for countries at either extreme of the spectrum, the majority function as both poacher and poached. Lose your own, entice them from elsewhere. Great Britain has become the most active recruiter of health professionals from developing nations, as its own nurses either quit the profession or go abroad. In 2002 alone, over 8,000 British nurses were lost to overseas employment—the highest number in ten years.

The practice of nurse poaching has raised the ire of the World Health Organization (WHO), countless national nursing organization, ethicists, and even world leaders—Nelson Mandela harshly reprimanded the UK for depleting South Africa of its much needed health care workers. And on a simplistic level, it does appear quite cut and dry. The rich should not be stealing from the poor. There is enough inequity on the planet. Poaching is wrong, it’s bad, it’s evil. But as with most things in this world, the real situation is far more complex and disturbing.

There are about 11 million nurses worldwide, with 2.7 million in the U.S. alone. Gro Harlem Brundtland, former Director General of the WHO, has publicly stated that nurses make up the backbone of health care systems. The salt of the earth, the selfless Florence Nightingale incarnates who care for the sick and dying and provide comfort to the infirm. I’ve been told many times over what a noble profession nursing is, and then I flinch and grind my teeth when I hear the words angel and nurse spoken in the same sentence.

Herein lies the basic problem. Nurses are not fluttering apparitions, but instead, human life forms who cannot survive by compassion alone. All health care systems, whether they be in Mozambique, Honduras, or the U.S., have one thing in common; the pathetic treatment of their nursing staff. Worldwide, nurses are underpaid, treated much like the hired help, and then discarded when they can no longer be of use.

Image: Courtesy of the National Library of Medicine