A utilitarian ethical approach views to balance the greatest good over harm to everyone involved while considering the benefits and consequences (Velasquez et al., 2021). Migration occurs when a new circumstance or opportunity is better than the existing situation. The looming shortages in the nursing workforce globally make migration inevitable. It is essential to weigh the benefits and consequences of nurses’ migration.
Nurses can migrate and work in other countries if the country’s visa and employer requirements are met. Frances Hughes, RN, BA, MA, DNURS, FAAN says that nurses in lower-income countries migrate to higher-income countries seeking better career and financial opportunities (Hughes, 2022). Stakeholders directly impacted by the migration process include individual nurses and their families, recruitment agencies, and supplying and accepting countries.
Benefits and Consequences
There are several benefits to migration. Nurses who migrate to higher-income countries are happy with the host countries’ social, financial, and health-related advantages (Hendriks, 2018). One of the greatest benefits of migration is the diversity foreign nurses bring to the workforce. Recruiting foreign nurses also improves the workforce shortage in the host country. A diverse workforce elevates the quality of patient care by ensuring the provision of culturally competent care to a diverse patient population (American Association Colleges of Nursing, 2023). The benefits are not only limited to the host or higher-income countries. The remittance from immigrant nurses financially benefits the supplying countries (Shaffer et al., 2022), families, and individual recruitment agencies.
From a utilitarian view, other consequences of migration are the potential depletion of the workforce in supplying countries due to mass migration and the demand for additional resources by host countries to train foreign nurses to meet the needs of a diverse patient population. It is also important to remember that adapting to a new country and environment could be challenging for individual nurses.
Takeaways: Finding Solutions
The migrating nurses bring cultural diversity, unique knowledge, and skills to the nursing workforce in the host countries (Hughes, 2022). It is unethical to prevent migration considering the overall benefits to the individual, host, and supplying countries. However, a utilitarian cannot ignore the other consequences.
Migrating from one country to another comes with challenges, which vary for individuals from different countries. It is essential to identify the unique needs of foreign nurses and distribute resources in a manner that is easily accessible to avoid waste of resources. Most often, it is not the availability of the resources that is challenging but the need for knowledge in accessing them and finding the best resource that works for each individual—having a common website that provides information on the boarding process, eligibility exam centers, financial support, mentoring, and other essential resources during migration.
Regulated and ethical recruitment practices can be implemented to prevent nursing workforce depletion in supplying countries. From a utilitarian view, it is recommended to ensure transparency on the benefits and consequences of each nurse migration experience for all stakeholders. The availability of information on benefits and consequences will allow better planning and implementation of policies, programs, and resources that support migrant nurses and migration.
American Association of Colleges of Nursing. “Enhancing Diversity in the Nursing Workforce.” AACN. April 2023. https://www.aacnnursing.org/news-data/fact-sheets/enhancing-diversity-in-the-nursing-workforce.
Hendriks, Martijn. “Does Migration Increase Happiness? It Depends.” Migration Policy Institute. June 21, 2018. https://www.migrationpolicy.org/article/does-migration-increase-happiness-it-depends.
Hughes, Frances. “Nursing Shortage and Migration: The Benefits and Responsibilities.” CGFNS International. 2022. https://www.cgfns.org/nursing-shortage-and-migration-the-benefits-and-responsibilities/.
Shaffer, Franklin A., Mukul Bakhshi, Kaley Cook, and Thomas D. Álvarez. “International Nurse Recruitment Beyond the COVID-19 Pandemic: Considerations for the Nursing Workforce Leader.” Nurse Leader 20, no. 2 (February 2022): 161–67. https://doi.org/https://doi.org/10.1016/j.mnl.2021.12.001.
Velasquez, Manuel, Dennis Moberg, Michael J. Meyer, Thomas Shanks, Margaret R. McLean, David DeCosse, Claire Andre, Kirk O. Hanson, Irina Raicu, and Jonathan Kwan. “A Framework for Ethical Decision Making.” Santa Clara University. November 8, 2021.
Nursing is more than a profession. It’s a calling. And those who answer the call become the backbone of a high-functioning, compassionate health care system. People who become nurses are capable, compassionate, and strong scientists and clinicians who have worked hard to start their careers. Their expertise, patient care delivery, and commitment to the profession contribute a distinct perspective on how health care should be managed and delivered.
While nurses are strong and resilient, they can’t fix their biggest problem: a dire nursing shortage. A decade in the making, our national nursing shortage threatens our already struggling health care infrastructure. Studies have long predicted that the demand for nurses would intensify as the U.S. population aged. And just like the trends in general higher education, nursing schools have become less accessible, as many face faculty shortages, limits on enrollment, and limited space for clinical training at teaching hospitals.
And, of course, the COVID-19 pandemic only accelerated these trends. Nurses came under incredible pressure from the increase in patient numbers and acuity, and public distrust surrounding politicized vaccines and treatments, with a large number of their peers opting to leave the field due to these pandemic stressors. The nurses who remain find themselves in professional limbo, looking for ways to squeeze in continued education and professional development, manage work demands and challenges, and find a healthy work-life balance.
And that is if they chose to stay. A staggering number of nurses have decided to leave. The total number of registered nurses in the workplace decreased by more than 100,000 in 2021, the most significant drop observed in four decades. The largest group to depart was nurses under 35.
We need to do everything in our power to create sustainable solutions that don’t simply “put nurses on floors” but will provide our nurses with the best possible experience, one that allows them to practice at the top of their license. The circumstances are challenging, and there’s no quick fix, but our patients, our communities, our health systems––health care itself can’t afford to continue in this direction.
At Trinity Health, we started developing solutions well before the pandemic and have seen first-hand how thoughtful solutions, informed and led by nurses, impact job satisfaction most. Programs that give nurses greater flexibility and options based on where they are in their career and what they want to do, innovative care delivery models that support their work and provide opportunities for professional development, continuing education, and alternative career pathways work.
Supporting Education and Career Advancement
Starting a career in nursing is no simple endeavor. So, when entry-level nurses are just beginning, it’s critical to jump on the moment’s excitement and encourage them to dive as deep into their new role as possible. In 2014 we collaborated with Vizient, the country’s largest member-owned health care services company, to create our Nurse Residency Program. This program helps orient entry-level nurses as they transition into practice. The evidence-based curriculum incorporates three key areas: patient outcomes, leadership, and professional development.
For experienced nurses, we provide a robust system-wide learning platform for those interested in advancing their skills in various areas of practice specialization. Obtaining the highest level of education doesn’t just support their careers and livelihoods, but it helps us ensure we provide the best patient care possible.
Opportunity must be equitable, and we are committed to living Trinity Health’s values of equity, diversity, and inclusion in everything we do. Unequal access to education, specifically for underrepresented communities, is a well-documented barrier for students who wish to pursue a nursing degree. To that end, we provide tuition assistance, flexible online programming through our nursing schools and seven academic partner schools, scholarships, on-the-job training, and career advancement programs to help level the playing field for nurses from diverse backgrounds. This is crucial for delivering health care that is representative of the populations we serve.
Multiple Options to Support Work-Life Balance
Nurses especially need work-life balance. Options for flexibility and roles that match their needs and goals are essential to increasing the longevity of a fulfilling and meaningful career.
Nurses at Trinity Health led the development of FirstChoice, our internal staffing agency that offers flexible scheduling and travel opportunities for nurses and clinical staff. Having our pool of travel nurses helps prevent colleague burnout and maintains continuity in patient care. In addition to FirstChoice, we’ve introduced a new care delivery model to improve patient care, experience, and nurse satisfaction. The delivery model has been well-received by nurses who are early in their careers and benefit from the unique mentoring experience and from more tenured nurses who can continue to work in a less physically demanding but gratifying capacity.
Beyond flexibility, we must provide other ways to support nurses’ well-being and resilience. A recent study reports that a quarter to half of the nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) multiple times a week. Mental health benefits are an essential requirement once considered a luxury perk or not considered at all. We began offering Colleague Care Resiliency Rounding, a real-time, one-on-one, human connection for colleagues in high-volume, highly demanding areas within the hospital setting. The program’s goal is to address mental health proactively and sustain their mental well-being in the face of the inevitable stress of the job.
To ensure that there are no barriers to mental health support, we offer six free therapy sessions and six free coaching sessions per calendar year, as well as options for personalized care, access to diverse providers, self-guided wellness exercises, personal medication management training, substance use support, work-life services, and more.
When someone is a nurse, their career can easily become their identity. Nurses love their job, and we love them for that. But we must recognize that every nurse is more than the exceptional care they give to patients. They are whole humans with lives away from the bedside. They need support that is designed with that in mind.
Nurses have long been renowned for confidently taking control of situations many shy away from. While I firmly believe it’s up to administrators and health systems to provide the essential support nurses need to thrive, I also know nurses must have a hand shaping their work lives. From my 40 years of experience as a nurse, with nearly 30 of those as a chief administrator, here is my advice to nurses searching for a career that will meet their personal and professional needs and goals.
Find an organization that shares your values. Look at the organization’s mission, vision, and values. Does it align with your own? Can you see evidence of their commitment to these values? Make sure the operational structure meets your needs. Does flexibility matter? Ask about shift offerings, virtual opportunities, or options to work in multiple locations. Do you care about mental health access? See what benefits they offer from day one.
Make sure the organization will truly see you and hear you. Your input is key to creating improved work environments and patient care. You must feel nothing less than supported in asking questions and contributing your voice to the conversation.
Whatever stage of your career––recently graduated or 20 years in––make sure an employer is willing to support your professional development. Opportunities for a new nurse should look vastly different than those for someone who has spent decades in a specialized unit. Ensure you can access individualized educational opportunities that impact your career trajectory and help you meet your goals.
I can only speak for myself and my team, but until all nurses feel adequately supported, I won’t rest my case that urgent action needs to be taken. Patients’ lives depend on our ability to care for and empower the people who care for them.
I am encouraged by my colleagues who have taken notice and have started to make meaningful changes. Nurses have been through a lot in the past few years, and we never know what awaits around the corner. But a positive shift is coming. The momentum we’ve built so far must continue so that the next generation of nurses feels more supported, better equipped, and more passionate about their calling than they ever dreamed possible.
Nurses face various challenges in their day-to-day activities, and one of the most prominent currently is the ongoing healthcare staff shortage. The shortage creates greater stress for nurses but can also affect patient outcomes, workplace safety, and meaningful career growth.
Administrators and industry leaders must commit to meaningful systemic changes to address the issue. However, nurses’ commitment to helping one another throughout this crisis is also essential. By offering support, guidance, and insights in key areas, nurses can empower one another to thrive throughout these challenges.
Communicate About the Causes
It is likely to be clear to all nurses that there are significant staff shortages in the healthcare industry across a range of roles. There are various reasons, including aging populations living longer, which has increased the demand for services. Many professionals are aging out of the industry. Toxic workplace cultures – resulting from stress, insufficient pay, and patient abuse – can also contribute to a lack of new nurses.
Nurses must understand these causes and what is causing specific staffing shortages in their area. With a clear idea of the root problem, it can be easier to have clarity on how to find solutions.
Perhaps most importantly, nurses should communicate with each other about staffing problems. Nurses representing traditionally marginalized demographics or interacting with minority communities can also highlight specific challenges. The better insights everyone can gain about the shortage causes, the more empowered everyone can be when navigating them.
A recent National Council of State Boards of Nursing survey found that 45.1% of nurses reported feeling burned out, contributing to many professionals leaving the industry. While burnout isn’t a diagnosable illness, it does have physical and psychological symptoms that can have long-term negative impacts. Relentless workplace stress and toxic working environments can lead to sleep loss, weight fluctuations, anxiety, and suicidal behavior. It’s no wonder nurses are leaving the profession rather than risk continued burnout.
Certainly, some of the root causes of burnout are related to systemic issues that administrators must address. However, from the perspective of nurses supporting nurses, one of the key contributions professionals can make is encouraging one another to prioritize self-care.
Prioritizing self-care is challenging, particularly given how busy working life as a nurse can be. This only emphasizes the importance of keeping colleagues accountable for taking care of themselves. Nurses must encourage one another to take breaks, eat healthy meals, and engage in hobbies. Committing to looking out for signs of exhaustion and stress in one another can open up conversations leading to effective resources.
Another key form of self-care as a nurse is advocating against inequalities and toxic environments contributing to burnout. Particularly among nurses from marginalized populations, the cumulative effect of microaggressions can be disruptive. One study found that 80% of nurses have witnessed workplace or nursing school discrimination. It is important to talk to one another about the presence of these elements and present a united front in highlighting the problem to administrators and demanding change in the workplace.
Influence Inclusive Recruitment
There are certainly recruitment issues that contribute to the healthcare shortage. It’s important to recognize that one of the most positive ways nurses can help one another address this is to be meaningfully involved in influencing recruitment. After all, no one has better insights into the challenges, benefits, and needs of the nursing industry than those who are a part of it. Importantly, nurses from minority backgrounds can ensure recruitment approaches are more accessible and welcoming to a wider proportion of the population. This can help bridge the labor gap and bring much-needed diverse cultural perspectives into the industry.
It can be helpful to encourage administrators to engage in meaningful community outreach. This may involve arranging formal opportunities for experienced nurses from various backgrounds to visit schools or community organizations. They can then discuss the options and provide practical advice on pursuing the path.
During outreach, it’s vital to share nurses’ experiences that have made later life career switches to the industry or pursued educational courses despite tough socioeconomic conditions. Nurses can also act as much-needed mentors among still under-represented minority communities. One recent study found that only 19.4% of registered nurses are from minority backgrounds. These outreach efforts give community members a sense that people with similar challenges can thrive in the industry, which may prompt engagement.
It can also be wise for nurses to have frank discussions with human resources (HR) personnel about facilities’ current recruitment processes. It’s common for systemic biases to result in recruiters overlooking ways to reach more diverse candidates. There can also be cultural hurdles that HR staff must be aware of. Providing these insights and suggesting solutions can help more potential nurses enter the sector.
Nurses committing to supporting one another through the healthcare staff shortage is essential. Communicating with one another about the causes of the shortages can aid well-informed approaches to addressing the issues. Promoting mutual self-care – including advocating against toxic workplaces – can help mitigate the potential for burnout. Engaging in more inclusive community recruitment can also positively impact greater nursing numbers and more diverse professionals in the field.
Though nurses’ contributions can be invaluable, it’s also important to take only part of the responsibility for meaningful change on their shoulders. Nurses are already overworked and face significant career stress. Recognizing personal limitations, setting strong boundaries, and seeking solid resources are essential for navigating this difficult time.
Stacy Hull MS, RN, CCNS Clinical Practice Consultant NCAL Kaiser Permanente Regional Office
Stacy Hull MS, RN, CCNS, CCNS Regional Clinical Practice for KP Practice Excellence, Clinical Education and Effectiveness. Hull is a UCSF School of Nursing graduate as a Cardiovascular Clinical Nurse Specialist.
Luis Perez, MNA Consultant V for KP Nurse Scholars Academy
Luis Perez, MNA, Consultant V for KP Nurse Scholars Academy, has over a decade of healthcare experience and earned a master’s degree from the University of San Francisco.
Jim D’Alfonso DNP, RN, PhD (h), FNAP, FAAN Regional Executive Director Professional Excellence and KP Scholars Academy
Jim D’Alfonso DNP, RN, PhD (h), FNAP, FAAN, Regional Executive Director Professional Excellence, and KP Scholars Academy. Graduate and Faculty at USF and Associate Editor of Nursing Administration Quarterly.
Janet Sohal, DNP, RN, NEA-BC Regional Director of KP Nurse Scholars Academy
Janet Sohal, DNP, RN, NEA-BC, Regional Director of KP Nurse Scholars Academy. Caritas Coach and HeartMath Trainer. Graduate of USF with her doctorate in nursing practice.
Many nurses commit to a long career in healthcare, so it’s essential to support aging nurses.
This longevity may be due to their continued passion for serving the community, or it can also result from the family of colleagues they’ve built around them. Nevertheless, having a long career or even joining later in life can see professionals in the field facing challenges related to aging.
This isn’t to say that nurses are no longer vital or relevant as they age—quite the opposite. One study of more than 900,000 patient admissions over four years found that more experienced nurses on wards improve patient outcomes. They also make invaluable mentors and can bolster community engagements with facilities. It is, therefore, imperative that facilities make significant efforts to meet nurses’ changing needs.
We will dive deeper into this idea and explore three considerations for supporting aging nurses.
Nurses, like everyone else, have changing needs as they get older. This may involve mobility challenges, mental or emotional wellness hurdles, or audio-visual issues. These elements don’t mean nurses are unable to perform their duties. However, there are expectations under the Americans with Disabilities Act (ADA) for employers to provide accommodations that may ensure nurses can perform duties more practically and effectively.
Facilities administrators should make accommodations provisions a positive part of workplace discussions. After all, most workplace injuries for registered nurses in most age groups resulting from overexertion and bodily reaction. Accommodations in everyday tasks minimize negative impacts on long-term wellness.
However, accommodations are also vital for challenges related to age. Human resources (HR) personnel should reach out regularly to nurses and invite discussions on the subject. Direct supervisors should also talk about employees’ developing needs during performance reviews.
That said, it’s wise to make older employees aware of their options rather than force these. The adverse treatment of resources may wind up contributing to the experiences of ageism that 82% of older Americans report living with.
Nurses, too, need to be open in talking about the resources they need to thrive in the workplace and care for their wellness. Asking for ADA accommodations at work can be a difficult experience for many people. Nurses should prepare for meetings on the subject with ideas of what resources could be helpful and how they might impact performance. They must also be clear that the requests are disability-related and therefore apply to ADA legislation. Nevertheless, solutions-oriented approaches tend to be more positively impactful.
Robust Wellness Programs
Aging nurses are fully aware of how vital maintaining health is and the imperatives for managing it as they age. Yet, more facilities must be more proactive in providing resources in the workplace and beyond to support nurses here. It is, therefore, vital for administrators to provide and for nursing staff to push for robust workplace wellness programs.
This can include collaborating with local businesses to offer nurses subsidized or employer-funded access to fitness benefits. Memberships for local gyms or sports facilities can benefit mental and physical wellness. Subscription services that provide nurses with fresh and nutritional meals can help them continue to eat positively. This is particularly useful when long shifts can make fixing healthy food less practical or desirable.
Any robust wellness program needs to include specific mental health resources, too. This doesn’t just mean options for dealing with crisis periods or burnout. Nurses must be able to use services regularly to maintain wellness rather than treat symptoms. For example, access to telehealth counseling or therapy services can be good for aging nurses to gain care without having to find time to travel during their breaks or days off.
Flexible Working Practices
One of the key considerations for aging nurses is that their priorities may change with their day-to-day roles. They may be looking for less stressful or intensely physical lifestyle routines. On the other hand, it may be the case that they want to shift toward focusing their time on outside interests as well as their nursing commitments. It is worth arranging for nurses to have the option of more flexible working opportunities.
Working from home as a nurse is an increasingly practical option for many roles. The rise in the adoption of telehealth means that professionals who prefer to work remotely can still interact with patients. If nurses want to shift to different specializations when working from home, there are options for telehealth physiotherapy, psychotherapy, and occupational therapy workers. In addition, travel nursing could align with the reduced schedule some nurses want to keep as they age.
Hybrid work can also offer flexibility for nurses while still being a core part of the facility environment. For example, they can attend to management or administrative elements at home or in a more comfortable coworking space. Then, part of their schedule can be focused on in-person patient interactions or training and mentoring roles.
Aging nurses remain an invaluable part of the healthcare landscape. However, facilities and nurses must collaborate on support solutions addressing changing needs. This should include discussing ADA accommodations where needed, providing robust wellness programs, and raising awareness of access to more flexible roles. These more experienced professionals positively impact patients, facilities, and colleagues, so ensuring they can thrive in the workplace is vital.
As an occupational therapist at VA, your expertise could make a huge difference in a Veteran’s life by helping them regain a sense of normalcy.
Employing more than 1,400 occupational therapists and certified occupational therapy assistants, VA provides state-of-the-art, evidence-based care to those who have served our country with dignity and honor.
Now, these Veterans need your assistance in reclaiming the control over their daily lives that will make them feel whole.
An array of expertise
No other discipline measures the functional, physical and cognitive skills that make up the daily lives of our Veterans more than occupational therapy.
These “occupations” – whether at home, school, the workplace, the community or elsewhere – can take on a number of forms. As an occupational therapist at VA, you’ll be able to explore opportunities across the continuum of clinical care.
Areas of practice include:
Traumatic brain injury
Practice where you want
Occupational therapy evaluation and treatment supports Veterans’ engagement in everyday life, and there is no better way to see that than in the variety of settings where you can practice your trade.
Those settings include VA medical centers, outpatient clinics, long-term community living centers and even inside Veterans’ homes through our Home-Based Primary Care program. Telehealth options allow you to meet with your patients virtually and conduct assessments at a distance.
More than just a job
VA offers a remarkable compensation package, with an assortment of benefits that make the job of serving Veterans all the more appealing.
Competitive starting salaries. We offer our employees strong starting salaries based on education, training and experience. We also offer steady growth, with periodic pay raises that address inflation and local market changes.
Flexible schedules. Our employees receive 13-26 paid vacation/personal days, as well as 13 sick days annually with no limit on accumulation, and we celebrate 11 paid federal holidays each year.
Robust insurance. You can choose from a variety of health maintenance organizations or fee-for-service health plans, and all cover preexisting conditions. Additionally, we pay up to 75% of health premiums, a benefit that can continue into retirement.
Education and leadership. We offer ongoing leadership development through every level of employment, whether it is mandatory programs or competitive opportunities. All leadership programs align the organization around a set of core competencies that facilitate career development through continuous learning, coaching/mentoring and assessment throughout your career.
Work at VA
Become an integral part of our patient care team as an occupational therapist, and apply the latest advances in rehabilitative treatment to create the best treatment plans for Veterans.