Diversifying the health workforce: a mixed methods analysis of an employment integration strategy.

BACKGROUND: Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions. METHODS: A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted. RESULTS: In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer. CONCLUSIONS: The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

'Everything was just getting worse and worse': deteriorating job quality as a driver of doctor emigration from Ireland.

BACKGROUND: Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job-high pay, high job control, challenging demands, with those of a low-quality job-long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return. METHODS: Semi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July-August 2018. RESULTS: Respondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman's work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland. DISCUSSION: The deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.

Migrant Workers and Their Occupational Health and Safety.

In 2015, approximately 244 million people were transnational migrants, approximately half of whom were workers, often engaged in jobs that are hazardous to their health. They work for less pay, for longer hours, and in worse conditions than do nonmigrants and are often subject to human rights violations, abuse, human trafficking, and violence. Worldwide, immigrant workers have higher rates of adverse occupational exposures and working conditions, which lead to poor health outcomes, workplace injuries, and occupational fatalities. Health disparities of immigrant workers are related to environmental and occupational exposures and are a result of language/cultural barriers, access to health care, documentation status, and the political climate of the host country. Recommendations on global and local scales are offered as potential solutions to improving the health of immigrant workers.

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada.

BACKGROUND: Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services. METHOD: In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis. RESULTS: A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants' narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women. CONCLUSION: A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.

A comparison of the education and work experiences of immigrant and the United States of America-trained nurses.

AIM: This study examined the education and work experience of immigrant and American-trained registered nurses from 1988 to 2008. BACKGROUND: The USA increasingly relies on immigrant nurses to fill a significant nursing shortage. These nurses receive their training overseas, but can obtain licenses to practice in different countries. INTRODUCTION: Although immigrant nurses have been in the USA workforce for several decades, little is known about how their education and work experience compares with USA-trained nurses. Yet much is presumed by policy makers and administrators who perpetuate the stereotype that immigrant nurses are not as qualified. METHODS: We analysed the National Sample Survey of Registered Nurses datasets from 1988 to 2008 using the Cochran-Armitage trend tests. RESULTS: Our findings showed similar work experience and upward trends in education among both groups of nurses. However, American-trained nurses were more likely to further advance their education, whereas immigrant nurses were more likely to have more work experience and practice in a wider range of healthcare settings. DISCUSSION: Although we discovered differences between nurses trained in the USA and abroad, we theorize that these differences even out, as education and work experience each have their own distinct caregiving advantages. CONCLUSION: Immigrant nurses are not less qualified than their American-trained counterparts. However, healthcare providers should encourage them to further pursue their education and certifications. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Even though immigrant nurses' education and work experience are comparable with their American counterparts, workforce development policies may be particularly beneficial for this group.

Indian Perspective on Migration of Health Professionals from India.

As part of a Canadian Institutes of Health Research (CIHR) project the author conducted 15 interviews with key informants in New Delhi and reported on the same at a CIHR-sponsored conference held in September 2013 in Ottawa, Canada. On the basis of these interviews as well as other work concurrently conducted by the author, some tentative conclusions are arrived at to facilitate forming a suitable policy framework for the out-migration of health professionals from India.

[The approach to the physician shortage in Israel].

The practice of medicine has changed in the last decade. Physicians no longer work largely solo but are part of interdisciplinary medical teams, and patient cases are more complex, as they suffer from multiple diseases. Today, the physician must also deal with economic, legal and public opinion issues. All of these factors pose new challenges to physicians. Apart from the changing world, there is also a shortage of physicians in Israel, as the number of new immigrant physicians has decreased over the last decade. Other medical professions and infrastructures are also lacking, including nurses, acute care hospital beds, intensive care beds and more. This increases the burden on physicians who must face a rapid turnover of patients per bed, more than in any other OECD country. In our work, we have suggested some new approaches to the physician shortage, apart from increasing the number of positions in medical schools, including changing the residency program and canceling the internship. The residency program will be divided into two stages: Two years in general medicine surgery or pediatrics and the second part in subspecialties such as pediatric surgery, neurology, gastroenterology, cardiology and others. An option to continue residency in general medicine, pediatrics, or surgery will also be possible and must be encouraged. We believe that the Scientific Council of the Israeli Medical Association is the professional organization that must evaluate this proposition.

Foreign domestic workers and home-based care for elders in Singapore.

As with other developed nations where rapid population aging has led to increasing health care and social care burdens, Singapore has searched for ways of paying for and providing long-term care for its increasing numbers of elders. The Singapore state, faced with the prospect of one-fifth of the population aged 65 or older by 2030, has reinforced its basic principle of rendering the family the "primary caregiving unit" and home-based care as the highly preferred option for eldercare. Our paper demonstrates why, despite the range of alternative care arrangements available or emerging on Singapore's eldercare landscape, the employment of live-in foreign domestic workers as care workers for the elderly has become one of the more common de facto modes of providing care for the elderly. In this context, we discuss the politics of eldercare in the privatized sphere of homespace and conclude with policy implications relating to the employment of foreign domestic workers as caregivers for the elderly.

Research on immigrant earnings.

As the first in a trio of pieces devoted to incorporating immigration into policy models, this review of research on immigrant earnings trajectories brings to light several findings. Controlling for demographic and human capital characteristics, immigrants often start their U.S. lives at substantially lower earnings, but experience faster earnings growth than natives with comparable years of education and experience. The extent to which the earnings trajectories of immigrants and natives differ varies by country of origin, with the source-country's level of economic development being a key determinant of the size of the U.S.-born/ foreign-born difference. The earnings profiles of immigrants from economically developed countries such as Japan, Canada, or Western Europe resemble those of U.S. natives who are of the same age and education level. In contrast, the earnings of immigrants from developing nations tend to start well below those of U.S. natives with comparable education levels and experience, but rise more rapidly than their U.S. counterparts. Comparing the earnings profiles of immigrants of similar age, sex, and years of schooling, over time and across groups, a strong inverse relationship emerges between their initial earnings and their subsequent U.S. earnings growth. In other words, the lower (higher) the initial earnings are, the higher (lower) the earnings growth. These and other research results have important implications for the projection of immigrant earnings and emigration in microsimulation models, as discussed in the two articles following this one: (1) "Adding Immigrants to Microsimulation Models" and (2) "Incorporating Immigrant Flows into Microsimulation Models".

[Patterns of utilization of healthcare services among immigrants to Israel from the former Soviet Union].

BACKGROUND: Contradictory evidence exists as to the rate of use of healthcare services by Israeli immigrants from the former Soviet Union (fSU). OBJECTIVES: The aim of this study was to compare the rates of utilization of healthcare services in veteran Israeli Jews and immigrants a decade and a half after immigration. METHODS: The data was obtained from the Israel National Health Interview Survey (INHIS) during 2003-2004, which is based on 6,756 interviews with veteran Israeli Jews and 953 interviews with immigrants from the fSU, of them 835 arrived in Israel during the years 1990-1998, and 118 arrived after 1998. Questions included use of healthcare services, health status and socioeconomic factors. RESULTS: The immigrants from the fSU reported similar rates of visiting a family physician and specialist and lower hospitalization rates after adjustment for socioeconomic variables compared to veteran Jews. However, the rate of use of preventive tests such as serum cholesterol tests, mammography and Pap smear tests was lower in immigrants. There was no significant difference in use of healthcare services between recent immigrants and those living in Israel more than 5 years, except for mammography performance. CONCLUSIONS: The use of community healthcare services among immigrants is similar to the use among veteran Jews. However, the immigrant population in Israel utilizes preventive services less often than the veteran Jewish population.

Florida forecast: partly cloudy.

The continuing influx of new residents has been a boon for hospitals in the Sunshine State, where new state-of-the-art facilities seem to be sprouting next to every palm tree. But questions about Medicare payments, a large uninsured population, and shortages of doctors and other staff pose serious challenges.

Foreign nurse importation and the supply of native nurses.

The importation of foreign registered nurses has been used as a strategy to ease nursing shortages in the United States. The effectiveness of this policy depends critically on the long-run response of native nurses. We examine the effects of immigration of foreign-born registered nurses on the long-run employment and occupational choice of native nurses. Using a variety of empirical strategies that exploit the geographical distribution of immigrant nurses across US cities, we find evidence of large displacement effects - over a ten-year period, for every foreign nurse that migrates to a city, between 1 and 2 fewer native nurses are employed in the city. We find similar results using data on nursing board exam-takers at the state level - an increase in the flow of foreign nurses significantly reduces the number of natives sitting for licensure exams in more dependent states relative to less dependent states. Using data on self-reported workplace satisfaction among a sample of California nurses, we find suggestive evidence that part of the displacement effects could be driven by a decline in the perceived quality of the workplace environment.