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The U.S. is hiring nurses from abroad, depleting some countries' health care systems


Wealthy nations like the U.S., Canada and the U.K. are recruiting nurses from developing countries to replenish health care workforces ravaged by COVID. In the U.S., about 20% of health care workers have quit since the pandemic began, and about 1,000 nurses from African countries, the Caribbean and the Philippines are arriving every month to fill in. That's according to reporting by Stephanie Nolen with The New York Times.

STEPHANIE NOLEN: So I spoke to nurses on three continents who said my social media, my email inbox, my LinkedIn is just a barrage of, we will help you get a visa. We will fast-track you. You could have a green card really quickly.

FLORIDO: Nolen reports that the departure of nurses is stretching health care systems in their home countries. When we spoke earlier, I asked why these jobs abroad are so appealing.

NOLEN: You know, I think what makes it appealing is sort of two things. One is, obviously, you can get paid dramatically more. You can end up with citizenship or permanent residency in another country. But also, we obviously have seen a lot about the exhausting working conditions in the pandemic for nurses, doctors in global north countries. But of course, those conditions, and often worse, exist in global south countries. So if you're going to work too much and be afraid about getting COVID, then maybe doing that and coming out of it with earning 60 or 70 grand a year and permanent residency makes - looks a lot more appealing.

FLORIDO: Describe the dilemma that some of these nurses are facing as they decide whether to stay home and serve their communities or leave home for a new country.

NOLEN: So everyone that I spoke to was torn. I think everyone was quite wistful about the idea that this was kind of the best option that they had. A lot of people said, you know, I really - I'd like to be here. I'd like to be contributing my education and my skills to my country. I don't love that the thing that is clearly the best thing for me or for my family is to have to go halfway around the world.

FLORIDO: Did any one particular nurse's story really illustrate for you this tug and pull?

NOLEN: You know, I think the most heartbreaking conversation that I had was with a nurse in the Philippines who I spoke to. And he said, I look around at everyone who's working tonight, and half of the nurses on this floor have an active immigration process happening. So we are wildly understaffed, and I am exhausted. And what's going to happen when these seven people's - when their papers get approved and they're gone? What's it going to be like around here?

And he said, you know, I think about that moment, and I think, I have to go, too. I already feel like I'm not giving people the quality of care that I would like to give them. And then I think if I'm one more person who goes, then what am I leaving behind me?

FLORIDO: Rich nations have always recruited health care workers from other parts of the world. It sounds like something that's accelerated because of the pandemic. What types of ethical considerations are they making about that push to bring more nurses to richer nations?

NOLEN: So the World Health Organization has a code of practice on this that says how governments can most ethically do this, which is to negotiate bilaterally with health ministries in sending countries about what will be a sort of equitable trade, as it were, and that health care workers would go for a period of time, enhance their skills and come home again. That's the model. That's the ideal. The sort of ethical thing you have to balance - right? - is the right of individuals to migrate and to make decisions that are best for them and their families versus what the impact their personal decision has on a health system.

FLORIDO: In the Philippines, in some of these African countries that you're talking about, what does the drain look like at the hospital level, and how are the governments there responding and reacting?

NOLEN: Well, I think, like, what it often looks like is a slow and maybe not immediately visible decline in the quality of care. Because a nurse who I wrote about in the story I did for The Times about this who is thinking about going to Canada, he's a critical care and operating room nurse with experience in cardiac surgeries. And to say that there aren't a lot of people with his skills kicking around in Zambia is to overstate, right? I mean, he's got a very, very rare and very valued skill set. So if he goes - if Alex goes, there isn't anybody else with his skill set. So it will take a long time before there's somebody who can do what he does.

Everywhere that I talked to people, that's the sort of phenomenon that they described. It's the highly skilled people who leave, and they leave a huge gap. The nursing directors that I spoke to described losing a whole lot of them all at once. Ever since borders opened up a little bit again and visa processing resumed, they said they felt like these people were just disappearing quite quickly.

FLORIDO: That's Stephanie Nolen with The New York Times. Stephanie, thanks for joining us.

NOLEN: It's a pleasure. Thanks for having me. Transcript provided by NPR, Copyright NPR.

Adrian Florido
Adrian Florido is a national correspondent for NPR covering race and identity in America.
Ashish Valentine joined NPR as its second-ever Reflect America fellow and is now a production assistant at All Things Considered. As well as producing the daily show and sometimes reporting stories himself, his job is to help the network's coverage better represent the perspectives of marginalized communities.
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