Going Global? The Regulation of Nurse Migration in the UK

DOIhttp://doi.org/10.1111/j.1467-8543.2007.00619.x
Date01 June 2007
Published date01 June 2007
AuthorStephen Bach
Going Global? The Regulation of Nurse
Migration in the UK
Stephen Bach
Abstract
This article examines the growth of overseas nurse recruitment to the UK and
reviews a number of explanations used by migration specialists to explain these
developments. It is argued that these approaches provide an incomplete expla-
nation and that an industrial relations perspective enables an integrated under-
standing of nurse mobility. By highlighting the role of the state in source and
destination countries and by placing labour market institutions centre stage, a
more adequate account of nurse migration to the UK is developed. Trends in
mobility indicate that state policy and employer behaviour have resulted in the
internationalization rather than the globalization of the nursing labour market.
This facilitates state action to regulate nurse migration, although the results to
date using forms of soft regulation have been modest.
1. Introduction
In recent years, health sector employers have assigned a high priority to the
recruitment of overseas-trained health professionals, especially nurses, to
address recruitment and retention difficulties. Data from the Nursing and
Midwifery Council (NMC) indicates that since the 1997 election, almost
80,000 overseas nurses have been admitted to the UK register, comprising
approximately 45 per cent of new registrants, compared to 11 per cent in the
early 1990s (NMC 2005a). Women migrants are an increasing component of
migration flows and there is greater awareness that women are no longer
confined to less-skilled sectors of the labour market (see Raghuram and
Kofman 2004; Winkelmann-Gleed and Seeley 2005). Nursing is subject to
professional regulation and is also one of the most prominent examples of
gendered occupational segregation and it is therefore pertinent to assess
trends in the employment of migrant nurses in the UK. This article addresses
three questions.
First, how has labour mobility among nurses been theorized by migration
specialists and can a more integrated account of nurse migration be
Stephen Bach is at the Department of Management, King’s College, University of London.
British Journal of Industrial Relations
45:2 June 2007 0007–1080 pp. 383–403
© Blackwell Publishing Ltd/London School of Economics 2007. Published by Blackwell Publishing Ltd,
9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
developed drawing on industrial relations (IR) scholarship that highlights the
role of state regulation and labour market institutions? Second, what are the
trends in nurse migration to the UK and how can these patterns of mobility
be explained? Third, to what extent have forms of ‘soft regulation’, notably
codes of practice on international recruitment, been effective measures in
regulating the movement of nurses? It is argued that the distinctive patterns
of nurse mobility highlight the limitations of existing equilibrium explana-
tions and the shortcomings of those based on the globalization of labour
markets. The role of the state and related labour market institutions have a
crucial role in understanding patterns of migration among registered nurses
which remain international rather than global.
This article reviews the current state of knowledge about nurse migration
drawing on research commissioned by the ILO and the UN University World
Institute for Development Economics Research (Bach 2003, 2006). It is based
primarily on secondary sources such as registration data from the NMC,
which is used to assess trends in nurse migration.
It is also informed by 18 interviews drawn from 12 key stakeholder organi-
zations involved in nurse migration. Those informants were drawn from UK
organizations, including the Department of Health (DH), National Health
Service (NHS) employers (i.e. acute hospital trusts), trade unions and profes-
sional associations (i.e. Royal College of Nursing (RCN) and UNISON), and
international organizations (ICN, ILO, IOM, PSI and WHO) with some key
informants reinterviewed in 2006. Respondents were key policy makers who
had a direct policy or managerial responsibility for international recruitment.
In some organizations, discussions were held with more than one respondent;
for example, in the DH, civil servants from the workforce and nursing
divisions were interviewed. International respondents were interviewed by
phone, while those based in the UK were interviewed face-to-face. In most
cases, the interviews were recorded and fully transcribed, and typically lasted
between 40 and 90 minutes. The semi-structured interview schedule included:
(1) the role of the interviewees and their organization in international recruit-
ment; (2) assessment of trends in nurse mobility; (3) explanations for these
trends; (4) the effectiveness of codes of practice and bilateral agreements; and
(5) the impact of soft regulation on international recruitment and working
conditions. Those interviewed made available additional documentation,
provided insights into the policy context, suggested practitioner conferences to
attend, and assisted in shaping the analytical framework presented below.
2. Theories of international migration
The analysis of international migration is an eclectic field, fragmented by
disciplinary boundaries and differing levels of analysis, resulting in little
consensus about the causes and consequences of worker mobility (Massey
et al. 1998: 17). Three distinct perspectives have been used to analyse the
mobility of health professionals.
384 British Journal of Industrial Relations
© Blackwell Publishing Ltd/London School of Economics 2007.

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT