BY AKHIL UPNEJA

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Nurses at Falmouth Hospital in Jamaica. Source: Kevin Young, Flickr.

On January 10th, 2017, NPR published a piece highlighting the dire shortage of specialized nurses in Jamaica. Jamaica’s nursing population numbers 4500, with 1000 of these nurses specialized to work in urgent-care facilities such as intensive care units (ICUs) and emergency rooms.1 However, over the past few years, there has been a massive movement of nurses away from Jamaica to the US, Canada, and the United Kingdom. In fact, in 2016 alone, 200 of Jamaica’s 1000 specialized nurses left the country for jobs elsewhere.

To understand this phenomenon, NPR interviewed James Moss-Solomon, the chairman of the University Hospital of the West Indies in Kingston; Kevin Allen, the CEO of the same hospital; and Janet Coore-Farr, the head of the Nurses Association of Jamaica. All three explained that the main reason why Jamaican nurses happily take jobs in North America and Europe is the dramatically higher financial compensation of working in these countries.1 Jamaican nurses are by and large trained in Jamaican schools, which are substantially less expensive than comparable programs in the US. This leads to a proportionally lower salary for trained nurses in the country. According to the article, while in Jamaica nurses can expect to be paid $8000 per year at an entry-level, the US and UK are able to pay 2 to 3 times this amount and still pay less than the entry-level salary that would be given to a nurse educated in the US.1 Even when Jamaica attempted a program that heavily subsidized nursing education in exchange for mandatory service for three to four years, North American recruiters simply paid off the $5000 fine.1

It is not the case that any nurse from a foreign country can practice within the United States. Each nurse must pass the National Council Licensure Examination (NCLEX), a computerized test that assesses knowledge and nursing capability. The exam has two versions, one for registered nurses called the NCLEX-RN, and one for practical nurses called the NCLEX-PN. This exam does indeed seem to be serving its purpose in limiting the foreign influx of nurses to an appreciable extent. Squires et al. (2016) examined data between 2003 and 2013 to understand trends within the population of nurses from 177 countries taking the exam. They found that over this 11-year period, the vast majority of exam-takers were from the Philippines (58%) and India (11%), and pass rates had declined from 58% to 32%.2 This decrease has in large part been due to changes to the exam assessing greater critical thinking skills and knowledge depth. The exam changes additionally served to differentiate English language capabilities between candidates, as the authors showed that candidates from countries where English is not an official language pass the NCLEX at statistically lower rates (12-13% pass rate difference, p-value = 0.001) than candidates from countries where English is an official language.2

While the NCLEX seems to be fulfilling its purpose of limiting the influx of foreign nursing candidates to the US, the test does not seem to be a deterrent for Jamaican nurses. According to statistics collected by the National Council of State Boards of Nursing, the number of candidates sitting for the NCLEX-RN exam who received their education in Jamaica increased almost threefold from 103 in 2014 to 295 in 2015, and through three quarters of 2016 the number of Jamaican nurses taking the exam is already at 384.3,4,5 Because English is the official language for the island country, the pass rate in 2015 for nurses receiving their education in Jamaica was 53.9%, much higher than the 32% international average.4

The rapid migration of nurses from Jamaica has detrimentally impacted hospital care in Jamaica. Since hospitals are now short-staffed, the nurses that chose to stay in the country are being forced to take on additional work shifts. Even with this, due to the sheer number of specialized nurses leaving, hospitals are experiencing increasingly widespread delays, cancellations, and postponements of complex surgeries.1

In sum, as the number of nurses taking the exam continues to balloon, the ‘poaching’ problem will continue in Jamaica and quality of care will decline. Reasonable restrictions must be placed on North American and European recruiters before this crisis worsens.

Akhil Upneja is a senior in Morse College majoring in Molecular, Cellular & Developmental Biology. He can be contacted at akhil.upneja@yale.edu.

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References:

    1. Beaubien, J. (2017, January 10). Jamaica Says U.S. And Others Are ‘Poaching’ Its Nurses. NPR: All Things Considered.
    2. Squires, A., Ojemeni, M. T., & Jones, S. (2016). Exploring longitudinal shifts in international nurse migration to the United States between 2003 and 2013 through a random effects panel data analysis. Human Resources for Health, 14(S1). doi:10.1186/s12960-016-0118-7
    3. 2014 NCLEX Examination Statistics (Vol. 64, Issue brief). (2015). National Council of State Boards of Nursing.
    4. 2015 NCLEX Examination Statistics (Vol. 68, Issue brief). (2016). National Council of State Boards of Nursing.
    5. 2016 QUARTERLY EXAMINATION STATISTICS: Volume, Pass Rates & First-Time Internationally Educated Candidates’ Countries(Issue brief). (2016). National Council of State Boards of Nursing.
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