Migratory flows of nurses

As mentioned earlier, a comprehensive monitoring of the movement of nurses across borders has many deficiencies, but it is extremely important for the management of the workforce. It can reveal interesting migratory trends which need to be acted upon.

The global share of foreign-born nurses grew from 11% to 14.5% between the years 2002 and 2012 years, which imitates the increased trend in migration of skilled workers. Switzerland, New Zealand, Australia and the UK have a nursing workforce consisting of more than 10% of foreign trained nurses. The percentage of foreign-born nurses in the Czech Republic seems to be low, at 1.6%, while the number of foreign trained nurses in the CR was not included in the study (OECD, 2015b). After 2008, the migration from countries endangered by the intense out-flow of nurses was slowed down by the economic crisis. Migration from EU10 to EU15 decreased by 50% from 2008 to 2009, due to the economic recession. Even though the authors do not provide any further details and the real numbers might be smaller, the Czech Republic supposedly had the biggest relative reduction in flows during this time (Schultz and Rijks, 2014). Fundamental changes in the patterns of nurse migration to some traditional destination countries during the economic crisis are described in other articles as well (Buchan and Campbell, 2013).

When comparing the migration of nurses from the developing world with the mobility of nurses within the EU countries, previous studies have suggested that intra-EU migration is at a low level, again copying the general mobility of citizens within the EU (Aiken et al., 2004), (Bach, 2007). At the same time, a more recent EU assessment suggests that EU health care professionals are nevertheless the most mobile professional group in the EU, and that nurses have the second highest rate of mobility when compared with the other professions included in the health care professionals group. The European Commission reported that between the years 2007-2011, about 15,200 EU nurses were granted an automatic recognition of their education (European Commission, 2011).

The stock of doctors and dentists from the new EU-12 member states in the old EU-15 member states has more than doubled since the 2004 and 2007 enlargements. The same data for nurses are extremely limited, but show only a slight increase. Around 1-2% of all EU nurses worked in an EU member state which was not their own. However, large numbers of

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irregularly employed nurses working in the home-based, long-term care sector are not included in this number, and the UK, a major destination country, was not included in this study at all (Ognyanova et al., 2012). A quantitative study from the Netherlands found that the migration of EU nurses to the Netherlands was rather low (0.5% of the total workforce); but these data were collected before the EU-12 countries officially accessed the EU (de Veer et al., 2004).

The low absolute numbers of nursing migrants from Eastern Europe were somewhat surprising - the experts predicted a strong flow of citizens to the old EU states after the EU enlargement in 2004 because of the wage disparities in the health care sector between the old EU countries and the EU-12 countries (Vavreckova et al., 2006), (Aiken et al., 2004). This did not occur to the predicted extent. The annual migration from EU12 countries was estimated to be around 3% of the domestic workforce, which was probably influenced by the market restrictions in some destination countries and by implemented improvements in source countries (Ognyanova et al., 2012).

The European country with the biggest inflows of nurses, the UK, experienced fundamental changes in its recruitment approach when it implemented policy to restrict active recruitment from overseas14 _{destinations and open its market fully to nurses from Europe. However,} British health care managers were uncertain as to what to expect from Central and Eastern European nurses after they had had experience with overseas nurses. They had doubts about the Eastern European nurses’ skills, commitment and language abilities (Bach, 2010). Similarly, Irish health care managers also preferred overseas nurses for identical reasons (Schultz and Rijks, 2014).

In reality, between the years 1989-2008, the entrance of overseas nurses into the UK register fluctuated from 2,000 new nurses in 1989 to 14,000 nurses in 2004, and then back down to 2,300 nurses in 2008. In line with the reported smaller flows from Eastern Europe, the number of EU nurses on the UK register increased from less than 1,000 nurses to only 2,000 nurses during the same period (Young, 2011). Bach believes that if this trend prevails, it might

14 _{The term “overseas“ refers to the typical source countries and typical migrants from geographically distant}

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probably necessitate another wave of migration from overseas (Bach, 2010). Between the years 2008-2010, the annual flow of internationally educated nurses to the UK did not exceed 2000 people; the majority of them were from the EU. After the year 2010, the number increased up to 4000 incoming internationally educated nurses in 2012, again with the majority being from EU countries (Romania, Portugal, Spain and Ireland). There was an interesting gradual decline in the numbers of incoming Polish nurses in these years (Buchan and Seccombe, 2012).

The flow of nurses that migrate, but work abroad in jobs and professions other than as nurses responsible for general care is very difficult to estimate, because these numbers are not expressed in any official statistics (Buchan and Aiken, 2008a), (Haour-Knipe and Davies, 2008). If these nurses stay out of the nursing profession permanently, it is considered to be brain wasting, a situation where the skills of the person are not used efficiently (Kingma, 2006).