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Abstract
Like many other global north countries, the US is facing a nursing shortage. In the last few years, such nursing shortages have been identified as part of a broader ‘global crisis’ in nursing. Resorting to importing internationally educated nurses is a popular strategy to address the shortfall. Importing nurses into the US is not new. However, the current shortage is different because of greatly intensified efforts to recruit nurses from overseas, and because of the unprecedented scale of global nurse migration. This article uses an analysis of Census data to track the trends and geographies associated with internationally educated registered nurses (IERNs) in the US since 1980. I show that there are important subnational differences in the distribution of IERNs; most are concentrated in a few states. By paying particular attention to subnational geographies within the US, I draw attention to the variations in and implications of the distribution of IERNs and how this impacts public policy discourses associated with the transnational migration of IERNs into and within the US.
Enfermerxs a través de las fronteras: la migración global de enfermerxs certificadxs hacia los EE.UU.
Como muchos otros países del Norte Global, los Estados Unidos está enfrentando una escasez de enfermerxs. En los últimos años, esta escasez ha sido identificada como parte de una “crisis global” de la enfermería. El recurso de importar enfermerxs capacitadxs en el extranjero es una estrategia común para enfrentar este problema. La importación de enfermerxs a los EE.UU. no es nueva. Sin embargo, la escasez actual es diferente debido a los esfuerzos mucho más intensos por reclutar enfermerxs en el exterior, y por la migración global de enfermerxs de escala sin precedentes. Este artículo utiliza un análisis de datos censales para seguir las tendencias y las geografías asociadas con lxs Enfermerxs Certificadas educadxs en el exterior (ECEE) en los EE.UU. desde 1980. Muestro que hay diferencias subnacionales importantes en la distribución de lxs EC educadxs en el exterior, la mayoría están concentradxs en unos pocos estados. Prestando particular atención a las geografías subnacionales dentro de los EE.UU., llamo la atención a las variaciones en la distribución de lxs ECEE y sus implicancias, y cómo esto impacta sobre los discursos de políticas públicas asociados con la migración transnacional de lxs ECEE hacia los EE.UU. y dentro de este país.
跨境的护士：注册护士移民美国的全球迁徙
如同许多其他的全球北方国家一般，美国正在经历护士荒。过去数年来，此般护士荒被认识到做为更广泛的“全球照护危机”的一部分。仰赖进口外国训练的护士，是因应此一短缺的盛行策略。美国进口护士已非新鲜事，但目前的短缺情形却与之前不尽相同，因为大幅增加的海外护士招募劲道，以及史无前例的全球护士移民规模。本文运用人口普查资料，追溯美国自1980年代以来与国际教育注册护士（IERNs）有关的趋势及地理。我将展现国际教育的注册护士分布中，存在着显着的次国家差异，并多半集中在一部分的州。我透过特别关注美国次国家层级的地理，关照IERNs分佈的变异与意涵，及其如何影响与IERNs跨国移民至美国与在美国境内移动的相关公共政策论述。
Acknowledgements
The reviewers and Mark Ellis gave supportive and thoughtful suggestions on an earlier version of this article. I want to thank them for the care they showed during the publication process. Faculty and postgraduate students in Geography at Queen Mary, University of London offered generous and impressive feedback for which I am also grateful.
Notes
1. ‘Nursing shortage’ is a relative and chaotic concept. It is measured in a variety of ways (e.g., nurse-to-population ratios, nurse-to-patient ratios, and job vacancies) and is dependent on a particular context's historical patterns of nurse density. To confuse matters further, the definition of ‘nurse’ also varies, especially in a comparative global context.
2. Nursing is a highly gendered occupation, both in terms of who does the work and the feminized attributes associated with nursing. These data show that in 1980, less than 5% of RNs were men; by 2007/2009, 11% were. Certainly, the increase in men going into nursing is significant, but I exclude them because this growth is a more recent phenomenon.
3. It is possible that some IERNs completed their training and entered the US before the age of 25 though this is likely to be a small number. It is also possible that some foreign-born nurses trained in the US after the age of 25. Again, this number is likely to be small.
4. County-level data are not available in the Public Use Microdata Sample, but even so their boundaries can change too. In addition, some of the other publically accessible data that are pitched at the state and county level, including the US Health and Human Service's National Sample Survey of Registered Nurses (respondents are drawn from state licensure records), only use ‘internationally educated nurses’ as a monolithic category and do not include place of birth.
5. The Index of Dissimilarity is calculated as follows:
where ATRNi is state i's percentage share of American-trained Registered Nurses in state i, and IERNi is state i's share of IERNs.
An index score of 100 means that the distributions of the two groups are perfectly dissimilar (i.e., 100% of one group would have to change location to match the distribution of the other). Conversely, an index score of 0 means the two groups have exactly the same spatial distribution.
6. I also compared the distribution of IERNs with all immigrants and their geographies were also dissimilar. As high-skilled professionals, RN's weak ties (e.g., nonfamily contacts, employers) play a more significant role in the migration process. This does not mean that some RNs do not arrive via chain migration through contacts with family and friends, but that their migration pattern is more likely to be linked to employment rather than family (Bagchi Citation2001).
Additional information
Notes on contributors
Kim England
Kim England is Professor of Geography at the University of Washington. Her research interests include care work, labor markets, critical social policy, immigration, and critical theory.