NURS 721 Week 8 Discussion Board Forum 4 on a Global Health Policy Concern Example

Discussion Board Forum 4: Global Health Policy and Ethics

NURS 721 Leadership, Policy and Ethics, Discussion Board Forum 4

Thread by [Student Name]

The hospital, the recruitment proposal and the classmates replied to are composites written for a model discussion.

Last month our chief human resources officer brought a proposal to the nursing leadership team: contract with an international recruitment agency to bring thirty registered nurses from the Philippines to fill vacancies on our medical-surgical and telemetry units. The agency would handle licensing exams, visas and travel in exchange for a fee and a three-year contract with each nurse. Our vacancy rate is 14%, our travel nurse spending last year exceeded our entire education budget, and the proposal would solve both problems. I was asked for my recommendation by the end of the quarter. This forum gave me a reason to examine the ethics before answering.

The policy issue is global. High-income countries, including the United States, have long recruited nurses from lower- and middle-income countries, and many source countries face shortages of their own. The global code the World Health Organization adopted in 2010 to govern how health workers are recruited across borders asks member states and employers to recruit ethically, to discourage active recruitment from countries facing critical health workforce shortages, to treat migrant health workers equally with domestic workers, and to invest in developing their own workforce (World Health Organization, 2010). The code is voluntary, which means its force depends on employers like us choosing to follow it. Recent analysis of the Eastern Mediterranean region shows how migration can leave middle-income source countries with significant outward losses while high-income destination countries rely heavily on internationally educated nurses (Nashwan et al., 2026).

Several principles apply. Justice asks whether one country's solution creates another country's problem. The nursing code of ethics calls nurses to work with others for human rights, health diplomacy and narrower health gaps between populations (American Nurses Association, 2015), which extends our ethical concern beyond our own hospital's walls. Respect for persons, however, requires remembering that the nurses who migrate are moral agents seeking better pay, training and lives for their families; refusing to hire them in the name of their home country's needs would limit their freedom. An ethical recruitment policy has to hold two truths together: the nurse who migrates has a right to a better life, and the country she leaves has a right not to be stripped of its nurses.

Research on how recruitment actually works raises further concerns. In a survey of 76 internationally educated nurses recruited through agencies to the United States, 36% reported no pre-arrival onboarding, and key gaps included legal orientation, communication training and mentorship (Tolarba et al., 2026). A mixed-methods study of 114 Filipino nurses in a large United States health system found supportive workplace relationships but challenges with community integration, orientation and adapting to new clinical practices and communication styles, and recommended extended orientation, refresher sessions, structured mentorship and cultural adaptation programs (Wen et al., 2026).

My recommendation will be to proceed only under four conditions. The agency must certify that it does not actively recruit from countries on the World Health Organization's list of countries facing critical shortages and must not charge fees to the nurses themselves. Contracts must be transparent, with no penalties that trap nurses in unsafe situations. Our hospital must provide extended orientation, a named mentor and support with housing and community integration. And we must pair recruitment with investment in our own pipeline, expanding clinical placements with our local nursing school, so that international recruitment supplements rather than replaces domestic development. The law of Moses commanded Israel to treat the stranger as a native and to love him as oneself, because Israel had been a stranger in Egypt (English Standard Version Bible, 2001/2016, Leviticus 19:33-34). If we bring nurses from abroad, we owe them the welcome that command describes.

Reply to Hannah

Hannah, you argued that the United Kingdom offers a model of ethical recruitment because its government publishes a code and a list of countries not to recruit from. The United Kingdom's experience also shows a tension worth noting. A 2026 analysis of eight United Kingdom policy documents and 17 qualitative studies found that national workforce planning treats international recruitment as a short-term necessity while aiming for future self-sufficiency, leaving internationally educated nurses uncertain about their long-term place in the workforce (Nwambo et al., 2026). The authors found that these nurses must revalidate their expertise before it is recognized and that their sense of belonging remains conditional. A code governs who is recruited, but it does not guarantee how recruited nurses are treated once they arrive. Do you think a hospital-level policy on the integration and advancement of internationally educated nurses, including recognition of prior specialty experience, would address what national codes miss?

Reply to Samuel

Samuel, your post described nurses in your home country leaving for the Gulf states and Europe, and the empty posts they leave behind in rural clinics. Your experience fits a broader regional pattern. Nashwan et al. (2026) describe the Eastern Mediterranean as both a source and a destination of migrating nurses, with several middle-income countries experiencing significant outward migration driven by pay, career advancement and working conditions, while high-income countries in the region rely heavily on internationally educated nurses. They note that initiatives promoting ethical recruitment and workforce monitoring are growing but face fragmented governance. The World Health Organization (2010) code anticipates this by encouraging destination countries to support source countries' workforces, for example through training partnerships. Do you think partnerships of that kind, such as hospitals funding nursing faculty in source countries, would change the incentives that drive nurses to leave?

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Nashwan, A. J., Bani Hani, S., Abd El Hakeem Ali Ahmed, L., Saleh, M. S. M., Hendy, A., Kunjavara, J., & El-Banna, M. M. (2026). Nurse migration and workforce dynamics in the Eastern Mediterranean Region. SAGE Open Nursing, 12. https://doi.org/10.1177/23779608261479007

Nwambo, J. C., Bifarin, O., & Higginbotham, K. (2026). The paradox of workforce self-sufficiency: Policy narratives, professional identity and internationally educated nurses in the United Kingdom. Nursing Inquiry, 33(4), Article e70164. https://doi.org/10.1111/nin.70164

Tolarba, J. E., Orbeso, J., & Rivera, R. R. (2026). Recruitment agency-mediated onboarding, acculturation, and contract completion among internationally educated nurses in the United States: A questionnaire survey. International Journal of Nursing Studies Advances, 11, Article 100622. https://doi.org/10.1016/j.ijnsa.2026.100622

Wen, Y. F., Yang, Q., Allen, D. H., Haithcock, S., Nieve, B., & Reynolds, S. S. (2026). A mixed-methods study of international nurse integration in the United States: Challenges, support, and recommendations. Journal of Transcultural Nursing. Advance online publication. https://doi.org/10.1177/10436596261465671

World Health Organization. (2010). WHO global code of practice on the international recruitment of health personnel. World Health Organization.