Archive for the ‘international nursing’ Category


Workplace Discrimination: A Survey among Newly Arrived Foreign-Educated Nurses

January 27, 2014

By Sylvia Foley, AJN senior editor

Table 2. Outcome Metrics by Recruitment Model

Table 2. Outcome Metrics by Recruitment Model

This country has often relied on foreign-educated nurses (FENs) to ease nursing shortages—and  with more shortages predicted for as early as next year, it’s likely we’ll do so again. A positive workplace environment is a known predictor of staff retention; yet little is known about how FENs experience their jobs. To learn more, Patricia Pittman and colleagues surveyed more than 500 FENs. This month’s original research CE, “Perceptions of Employment-Based Discrimination Among Newly Arrived FENs,” reports on their findings. This abstract offers a brief overview.

Objective: To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007.
Background: With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction.
Methods. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes.
Results: We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. Read the rest of this entry ?


Worsening Global Health Workforce Shortage: What’s Being Done?

December 9, 2013
JM: photo emailed to you. Photo is of Frances Day-Stirk, president of the International Confederation of Midwives, and David Benton, CEO of the International Council of Nurses. Photo courtesy of Marilyn DeLuca, consultant, Global Health - Health Systems  and adjunct associate professor, College of Nursing, New York University.

Frances Day-Stirk, president, International Confederation of Midwives, and David Benton, CEO of International Council of Nurses. Photo courtesy of Marilyn DeLuca.

By Shawn Kennedy, MA, RN, AJN editor-in-chief

While it might seem—based on what we see in our own country—that there is no shortage of health care workers, there is indeed a global shortage and it’s only going to get worse. We reported on the global health workforce last year; new reports are revealing just how much worse things may get. According to the World Health Organization (WHO), by 2035 there will be a shortage of 12.9 million health care workers; currently, there is a shortage of 7.2 million.*

The shortage is being exacerbated by a confluence of occurrences:

  • the aging population is living longer and with more illness
  • noncommunicable chronic illnesses like cancer, cardiovascular disease, and diabetes are increasing worldwide
  • many undeveloped countries lack educational facilities for training new professionals
  • experienced health care workers migrate to developed countries for better working conditions and pay

Discussions focused on how nations individually and together can develop and strengthen the workforce to meet Millenium Development Goals and attain the goal of universal health coverage. The result was the Recife Declaration, a call to action detailing what needed to be done to address the problem, asking nations and organizations to commit to a goal of universal health coverage for all, and committing resources to develop the workforce to provide it.

Read the rest of this entry ?


We Call You ‘Wheat Head’ – An Unexpected Crosscultural Encounter

November 8, 2013

I entered the wall-less, thatch-roofed waiting area of the clinic with my right hand in a ball of bandages, taped to my chest. The airy space was almost empty, without nurses or even a receptionist. The only other person in the little space, sitting very elegantly on one of the narrow wooden benches, was a woman in traditional West African dress who was quite pregnant.

NovemberReflectionsThe November Reflections essay in AJN is called “Surprise!” Its opening paragraph is above. This is one of our occasional Reflections essays by a writer who is not a nurse. In this case, the author Thomas Turman’s easy, self-deprecating tone, and the matter-of-fact manner in which his unexpected patient faces a situation that might induce a certain panic in many people from wealthier countries, feels just right. Read the rest of this entry ?


AJN’s August Issue: Positive Deviance, Vital Sign Alert Systems, Using Focus Groups, Teaching Nursing Abroad, More

July 29, 2013

AJN0813.Cover.OnlineAJN‘s August issue is now available on our Web site. Here’s a selection of what not to miss.

Sometimes rules are meant to be broken in order to serve the greater good. This month’s CE feature “Exploring the Concept and Use of Positive Deviance in Nursingaims to increase our understanding of positive deviance (“an intentional act of breaking the rules in order to serve the greater good”) within the context of nursing practice. You can earn 2.5 CE credits with this article. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

The early warning signs of deterioration that patients often exhibit several hours before cardiopulmonary arrest often go unrecognized by nurses. “Developing a Vital Sign Alert System describes an automated vital sign alert system that was designed to enhance patient monitoring without increasing the nurse’s workload. Earn 2.4 CE credits by reading this article and taking the test that follows it.

“Using Focus Groups to Inform Innovative Approaches to Care,” an article in our Professional Development department, uses case studies to describe how nurses can use patient focus groups for gathering qualitative data that can advance patient advocacy.

And if you are interested in what’s going on in the nursing world in other countries, read this month’s In Our Community article, “Buurtzorg Nederland,” which focuses on a grassroots effort led by nurses in the Netherlands to create an improved model of home care. Called Buurtzorg—Dutch for “neighborhood care”—the model is designed to improve patient outcomes while reducing costs and increasing nurse and patient satisfaction.

Despite many challenges, Bangladesh is a rapidly developing part of the Indian subcontinent that has made significant progress on the United Nations Millennium Development Goals. “Teaching Nurses in Bangladesh,” an article in our Correspondence From Abroad column,  describes the experience of teaching bachelor of science in nursing–prepared nurses in Bangladesh since 2004, and provides some lessons in transcultural education.

There is plenty more in this issue, including an article on how to best measure wounds. Stop by and have a look, and tell us what you think on Facebook or here on our blog.

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At Least Once in Every Nursing Career: Final ICN Congress Recap

June 4, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

from Great Ocean Road in Australia

from Great Ocean Road in Australia

Here’s a final recap of my trip last week to the 25th quadrennial congress of the International Council of Nurses (ICN). (My previous posts on this year’s ICN events are here and here; there’s also a podcast of my interview with outgoing ICN president Rosemary Bryant.)

My final few days were busy with sessions as well as a meeting with some members of AJN’s International Advisory Board. Here are some highlights:

  • Nurses and the Nazis. A session on ethics led by Australian nurse Linda Shields examined nursing in Nazi Germany and discussed how nurses might have rationalized participation in Nazi euthanasia and killing programs. She noted that aside from the usual “just following orders” mantra, obedience was tied to housing and livelihood, as well as to the belief that “the health of the volk (community) was more important than the health of the individual.” (The topic brings to mind our 2009 article, “The Third Reich, Nursing, and AJN [abstract only], which made the case that “in the interest of promoting international cooperation and an image of nursing unity, AJN shirked its duty to hold German nurses accountable” for complicity in the Holocaust.)
  • Nursing visibility. Presentations by Canadian nurse union leaders reminded me of home: they talked about campaigns to make what nurses do more visible, noting that if RNs were invisible and their work not valued, they would be at high risk for job cuts. Debbie Forward, president of the Newfoundland–Labrador Nurses Union, talked about “role clutter” and the loss of an RN identity when one couldn’t distinguish RNs from other health care providers, and she described a union campaign—the Clarity Project—to protect and promote the RN role. Sandi Mowatt from the Manitoba Nurses Association, which represents all levels of nurses, talked about initiatives to protect and support all nurses. Ten years ago, she said, only 26% of their members would recommend nursing as a career because of dissatisfaction with workplace policies and wages; today, 72% of nurses in the union would recommend nursing as a good career. Read the rest of this entry ?

Dispatch #2 from Melbourne: Dues, Election Results, Nursing at the WHO

May 21, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

There’s lots happening at the International Council of Nurses (ICN) meeting and I’ve logged more walking miles here in Melbourne in the last two days than I do in a week at home.

Judith Shamian

Judith Shamian

On Monday, the Council of National Representatives (CNR), the ICN’s governing body, announced election results. Judith Shamian, a well-known Canadian nursing leader, was elected the 27th president of the ICN. (For more information about Judith and other election results, read this press release.)

The CNR also agreed to address issues related to membership models and will move forward with a plan designed to support inclusiveness and membership growth in national associations. The plan also includes a tiered voting model that takes membership and percentage of membership into account. (The final vote will take place at the 2015 Congress).


Rosemary Bryant

New dues scheme: will RCN return? The CNR approved a new scheme for dues that should address the issue that led the Royal College of Nursing (RCN) to withhold dues, resulting in its suspension from the ICN and its recent vote to withdraw from the ICN. According to ICN president Rosemary Bryant, Norway and Japan, who were also unhappy with their dues payments, were pleased with the new model. She is hopeful that the RCN will be as well. (A podcast interview with Bryant can be listened to at our podcast conversations page here.)

I spoke with David Benton, chief executive officer of the ICN, about the RCN’s two-year suspension. According to Benton, the ICN had no choice. “The RCN made a unilateral decision in 2010 with no attempt to negotiate another resolution,” he said. He added that as a long-time member and a fellow of the RCN, he’s personally saddened by its decision to withdraw from the ICN. He noted that only a small portion of RCN’s dues goes to ICN membership and that other countries with far less resources continue to support the ICN’s work. He, too, is hopeful that the changes recently approved by the CNR will prompt the RCN to reconsider its position.

Meanwhile, two new associations were admitted to the ICN: the Chinese Nurses Association and the Palestinian Nursing and Midwifery Association (read more here).

Invisible nurses at the WHO. Another issue, not new but perhaps one that is coming to a head, is the “eradication of nursing expertise at the WHO.” Nursing positions, especially leadership posts, have been disappearing from the WHO headquarters and regional offices and are now at an all-time low of 0.6% (down from 2.6% in 2000).  (See AJN‘s July 2011 editorial and July 2012 report on this.) According to a document issued Monday, the CNR “calls upon the WHO Director General to urgently reinstate the vacant positions of WHO Chief Nursing Scientist  at WHO headquarters and urges regional directors to retain and strengthen senior nursing advisor positions in their regions.”

I also attended several interesting sessions: Read the rest of this entry ?


Dispatch from Melbourne: A Significant Loss for International Council of Nurses?

May 20, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

So this week I’ve traveled halfway across the world to Melbourne, Australia, where the International Council of Nurses (ICN) is holding its 25th quadrennial meeting. Nearly 4,000 nurses from 134 countries are expected to attend. There’s a mind-boggling number of concurrent sessions—there must be about 60 sessions each hour, offering glimpses into various  international  health problems and solutions from nurses.

Chinese Nursing Association at ICN 2013

Chinese Nursing Association at ICN 2013

A river of nurses. Sunday morning was the opening plenary. I left my hotel at 8:30 am to walk to the convention center along the Yarra River, which runs through this very metropolitan city. I began as a fairly solitary walker, but was soon joined by other walkers, mostly women, all carrying the same ICN2013 conference bag, all walking purposefully in the same direction. We were mostly middle-aged and dressed in sensible walking shoes and “business casual” clothes, and must have looked like a well-dressed walking club to those biking and strolling past. I was quickly reminded that, for all our differences in language and customs, we’re all pretty much alike.

Missing this year from the Congress of Nursing Representatives, however, is the Royal College of Nursing (RCN), which represents nurses from the United Kingdom. The RCN was suspended for failing to pay all of its dues and now is expected to withdraw membership from the ICN. In April, over 91% of members attending (539 of 588 present) an “extraordinary general meeting” voted for withdrawal. The precipitating issue for the RCN was the breakdown of negotiations to reduce its annual dues payment, which is currently about 600,000 pounds (about 1.8 pounds per member). Though a number of RCN members forcefully dissented from this decision, this dues payment was, according to the RCN, “unsustainable.” The question that no one is asking is, “Will any other members follow suit?”

More to come . . .

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Appreciating War-Time Nurses the World Over

November 14, 2012

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

Vivian Bullwinkel / Wikipedia

“Chins up, girls. I’m proud of you and I love you all.”

According to a survivor’s account, these words were spoken by an Australian nurse, Irene Drummond, on Radji Beach, February 16, 1942. This crescent-shaped stretch of white sand is in the Banka Strait near Banka Island, Indonesia. Ms. Drummond and 21 fellow Australian nurses (plus one civilian) walked into the warm sea holding hands, creating a human chain. As their feet touched the surf they were riddled with bullets from Japanese machine guns set up on the beach behind them.

The Banka Strait was an escape route from Singapore and the larger region just before and during the Japanese occupation of Singapore during World War II. The Aussie nurses, some of the very last military personnel to be evacuated from Singapore before the occupation, had snuck away under at night aboard the Vyner Brook in February 1942. They were among approximately 200 passengers attempting to escape to safer ground, but Japanese pilots bombed and sunk the ship. Civilians, military personnel, and nurses died during the attack on the Vyner Brooke, and many of the same escaped into lifeboats. Some of the survivors made it to the shore and ultimately ended up on Radji Beach.

As an American nurse living and working in Australia and the greater Asia Pacific region, I recently had the chance to visit the Australian War Memorial. As I wandered through this amazing museum, I read about Radji Beach and the one nurse who survived that particular massacre. Afterward, in the bookshop I picked up On Radji Beach, by Ian W. Shaw. It’s the story of Australian nurses after the fall of Singapore during World War II, and is the primary reference for this blog post.

The lone nurse survivor of the Radji Beach massacre was Vivian Bullwinkel. Her story and that of the other nurses kept me engaged and often on the brink of tears. I couldn’t imagine working as a nurse during World War II, and felt proud to share the same vocation as Vivian.

Ms. Bullwinkel was one of 65 nurses evacuated from Singapore on the Vyner Brooke in 1942. Only 23 returned to Australia, after finally being discovered in a Malaysian POW camp in 1945. She left the Australian Army Nursing Service in 1947 and subsequently had a distinguished career in civilian nursing, passing away in July 2000.

My few hours in the war memorial and the book also brought to mind our U.S. military and the medical teams that work near the front lines every day. I know I’m not cut from the same cloth, as this is not something I would choose to do, but I thank them for doing it. Since Australia celebrated Remembrance Day and the U.S. celebrated Veteran’s Day this past week, my thoughts go to those who have fought and died for both countries, especially all the medical personnel—particularly nurses.

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Nurse Staffing: Are the Brits on the Right Track?

June 26, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

hazard/jasleen kaur, via Flickr

According to an article at Nursing Times, hospitals in England may be required to publish “nurse-to-bed” ratios as part of an overall “dashboard” of indicators to measure  performance. While some say this is a step forward, UNISON, the public service union that represents nurses, argues that the better ratio to measure is nurse-to-patient and that variables in patient acuity should also be considered.

Nurse staffing has become an issue in National Health Service hospitals and in April UNISON released results of a survey of over 1,500 nurses and other health care workers about their shifts during the 24-hour period of March 6. The vast majority of respondents (73%) felt they did not have “enough time to spend with patients to deliver dignified, safe, compassionate care.” The Royal College of Nursing also supports mandatory safe-staffing ratios that take into account the skill mix of RNs to “health care support workers” or nursing assistants. 

Here in the United States, California is the only state to achieve any legislation for mandatory hospital staffing and it is a “minimum” nurse-to-patient ratio. While similar legislation has been introduced in a few other states and nationally, it hasn’t advanced.

The ANA does not support mandatory minimum ratios per se, noting in its Principles for Nurse Staffing (2nd edition), released earlier this month, “The solution is not as simple as increasing the number of nurses beyond what is minimally necessary.” The ANA advocates for a “nurse-directed” approach that includes minimum ratios but also takes into account patient acuity, the setting, and the skill set and mix of staff.

At the recent House of Delegates meeting, the ANA reaffirmed that safe staffing is a “top priority.” (Read the press release.) And in a December 16, 2011, letter to the Centers for Medicare and Medicaid Services, the ANA advocated for public posting of “hospital staffing plans” that take into account patient acuity, mix of staffing, and other factors, with these staffing plans to be modified as needed according to measurable patient outcomes—but did not necessarily call for staffing ratios.

What do you think? Should nurse staffing details be made public?

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A Face in a Village: Remembering a First Encounter with AIDS in Africa

February 8, 2012

We’d already guessed there was a problem at the health post—we hadn’t received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren’t receiving reports.

That’s from “A Face in a Village,” the February Reflections essay in AJN by Susi Wyss, the author of a well-received recent novel, The Civilized World (Henry Holt, 2011). Set in Africa, the novel, like this essay, was inspired by the author’s international health career. In this essay, Wyss recalls a vivid first encounter with the ravages of AIDS and the hopelessness it inspired. (Click through to the PDF version for a cleaner read.)—JM, senior editor


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