Overview and Purpose of the Paper
The purpose of our paper was to analyze recruitment and integration measures adopted in three Canadian provinces – Quebec, New Brunswick, and Nova Scotia – and to examine whether these measures adequately align with the principles of the WHO’s 2010 Global Code of Practice on the International Recruitment of Nursing Personnel. Based on this analysis, we propose a set of priority strategic actions calling on policymakers to invest in domestic workforce development, strengthen health-workforce planning, and support Canada’s move toward greater self-sufficiency.
This work responds to growing ethical concerns raised in both the media and the scientific literature regarding the active international recruitment of healthcare workers, especially nurses. Canada is one of the countries that increasingly relies on international recruitment through the implementation of international recruitment campaigns to fill vacant nursing positions, which have increased sharply in recent years. But why does this matter?
Over-Reliance on International Recruitment Would Worsen Inequity
Although the WHO has identified many countries as being in a “red zone”, which means they face critical health workforce shortages that threaten access to essential healthcare services, the over-reliance of Canada and other high-income countries on recruiting nursing personnel from low-income countries would negatively impact their health systems. More particularly, it would lead to inequitable distribution and disparity of the nursing workforce between and within countries.
Since the nursing workforce shortage is a global concern in the health sector, this inequity would undermine health systems in source countries by weakening their workforce capacity, exacerbating their workforce shortages, and worsening working conditions. At the same time, it does not solve the long-term sustainability of healthcare systems of host countries. Ultimately, this inequitable global distribution of nurses would compromise the quality and accessibility of healthcare services and make the goal of universal health coverage increasingly unattainable. Without addressing these imbalances, social and economic development will remain constrained. So, how could we address these issues and ensure equity between and within countries?
Fostering Ethical Recruitment Is a Cornerstone Strategy for Promoting Equity and Building Sustainable, Effective, And Efficient Healthcare Systems
To foster ethical recruitment and ensure equity between countries, it is imperative to respect the WHO Code of 2010. This means that Canada and other comparable countries need to become self-sufficient by prioritizing the retention of domestically educated nurses while also supporting internationally educated nurses who are already in the host country but remain unemployed or underemployed.
Policymakers who are responsible for health workforce governance and management must critically re-examine their recruitment approaches and take concrete actions to mitigate the harmful effects of this practice. In our paper, we propose a set of strategic actions for all key stakeholders (e.g., governments and employers) to establish a strong nursing workforce recruitment policy that aligns with the 2010 WHO Global Code of Practice, in order to promote the ethical recruitment of internationally educated nurses within the context of a global health workforce shortage.
Ultimately, respecting this Code and investing in long-term, sustainable, and evidence-informed retention strategies are not only ethical practices; they are essential for building resilient, effective, and efficient healthcare systems and achieving universal health coverage for all.
