Nurses across borders: foregrounding international migration in nursing history.

Abstract. Although the international migration of nurses has played a formative role in increasing the racial and ethnic diversity of the health care labor force, nursing historians have paid very little attention to the theme of international migration and the experiences of foreign-trained nurses. A focus on international migration complements two new approaches in nursing history: the agenda to internationalize its frameworks, and the call to move away from "great women, great events" and toward the experiences of "ordinary" nurses. This article undertakes a close reading of the life and work of Filipino American nurse Ines Cayaban to reconceptualize nursing biography in an international framework that is attentive to issues of migration, race, gender, and colonialism. It was a Hannah keynote lecture delivered by the author on June 5, 2008, as part of the CAHN/ACHN (Canadian Association for the History of Nursing/Association Canadienne pour l'Histoire du Nursing) International Nursing History Conference. Without a doubt, health care workers are on the move. In the new millennium, they are moving across national borders in significant numbers, and policy analysts and academics are taking note of the phenomenon. The 2007 conference organized by the health policy journal Health Affairs, "Stories Told and Untold: Health Workers on the Move," featured panels on "demographics and living in the diaspora." Physicians comprised the majority of the conference speakers, but nurses play a major role in this global phenomenon. Nurses on the Move is the title of Mirielle Kingma's 2006 book that highlights the policy and human dimensions of migration and the global health care economy. Kingma observes that "while nursing has been advertised as a 'portable profession' and nurses have always moved from town to town, city to city, and country to country, never has nurse migration been the mass phenomenon we see today. Foreigneducated health professionals represent more than a quarter of the medical and nursing workforces of Australia, Canada, the United Kingdom, and the United States." 1 For half a century, the Philippines has dominated this trend as the world's leading exporter of nurses. 2 Since 1994, more than 100,000 nurses have left the Philippines to work abroad. Because well-publicized nursing shortages in the United States and the United Kingdom have fueled recruitment of foreign nurse graduates, Filipino physicians have started to enroll in accelerated nursing courses in the Philippines designed for physicians who wish to become nurses to work abroad. According to a 2003 San Francisco Chronicle article, as many as 3,000 Filipino medical doctors have left the Philippines as nurses. 3 Furthermore, the international migration of foreign medical graduates to work as physicians in mid- and lower-level posts in U.K. hospitals and in rural areas and inner cities of Canada and the United States also continues in recent times. A 2005 article by Fitzhugh Mullan on the "metrics of physician brain drain" concludes that international medical graduates "constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia . . . . India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines." 4 The loss of professional health providers from poorer countries to richer ones, popularly referred to as "brain drain," is not new. In the late 1970s, reports by Alfonso Mejia, Helena Pizorki, and Erica Royston culminated in a landmark 1979 study of the global dimensions of physician and nurse migrant flows that illustrated the imbalances regarding their geographical distribution. In the 1970s, approximately 15,000 nurses migrating each year went to eight countries, primarily the United States, United Kingdom, and Canada. …