Nursing in North and Central America – Toward Harmonizing Qualifications

Amid aging populations and the growth of chronic diseases, the demand for skilled health-care professionals is on the rise in the three countries of North America. In the United States alone, an estimated 5.6 million vacancies for health-care professionals at all skill levels will open up between 2010 and 2020, and the numbers in Canada and Mexico tell a similar story. At the same time, the countries of Central America, particularly El Salvador and Guatemala, are facing a critical nurse shortage.

Thus far, regional approaches to increasing the supply of qualified nurses have been rare. One promising yet underexplored avenue is the harmonization of nurse qualifications across the region, a process by which countries that face similar health-care challenges work together to develop an understanding of one another’s training and education systems, identify gaps between these systems, and create strategies to bridge these gaps over time.

This report explores the policy implications, benefits, and challenges of harmonizing nursing qualifications in North America. The payoffs of such cooperation are substantial: it can decrease brain waste and deskilling among nurses, increase the quality of care in all countries involved, and expand opportunities for nurses to practice where their skills are needed and to take advantage of new job opportunities in medical tourism and tele-health. However, as the report discusses, policymakers and private-sector actors must first overcome a range of obstacles to harmonization. Challenges include differences among the countries involved in the educational requirements of entering into nursing programs, dispersal of decision-making power among a patchwork of institutions regulating the nursing profession, and administrative barriers to recognition of qualifications—the flurry of red tape that nurses must pass through to take up nursing again after moving across borders.

Despite the inherent challenges, the report emphasizes that the collection of experiences and best practices available today is rich enough to inform and underpin more concerted regional harmonization action, and notes that political will and commitment are necessary to take the next step of moving to the harmonization of licensing requirements and other standards, in the nursing field and beyond.

Emerging regional attempts to harmonize nurse qualifications face significant roadblocks. The decision- making power of regulatory bodies that determine curricula and the licensing requirements of nurses is highly dispersed, presenting a structural barrier to successful harmonization attempts that require the broad buy-in and collaboration of these actors. Second-language skills and levels of basic education vary substantially among the region’s nursing workforce, adding individual knowledge barriers to the list of obstacles. Finally, the red tape nurses have to overcome domestically and internationally when they enter into practice after moving across a state or national border adds administrative barriers that delay or even impede entry into practice.

Harmonization efforts tackle these hurdles by pursuing two parallel tracks: one aims to align the region’s education systems to create nursing graduates with more comparable skill bundles before they enter the profession; the second seeks to bridge skills and knowledge on a case-by-case basis after nurses have joined the profession. While the region has witnessed a variety of harmonization efforts, successful interventions can broadly be grouped into four types of policies that are worthy of attention:

• Exchange programs and language capacity building. Student exchanges between nursing programs in the region and intensive language capacity building should be expanded. Policies to support these programs are long-term investments into future generations of the region’s workforce. Speeding up language learning helps chip away at the knowledge-related barriers that have slowed down past harmonization efforts.
• Agreements between regulatory bodies. Shared curricula and similar or even unified licensing requirements for nurses are among the tangible results from agreements between regulatory bodies. Collaboration between regulators in charge of approving educational programs and issuing licenses carries the promise of direct impact on millions of nurses throughout the region.
• Bridging programs and support for Internationally Educated Nurses. Programs to
  help nurses who have received their education in another country gain entry into practice are widespread in the region, but their content varies widely, as do the required time and financial investments. Successful bridging programs go beyond providing additional training modules to prepare nurses to gain a new license, and include profession-specific language classes and support during job searches. State-level support of Internationally Educated Nurses (IENs) can also include special temporary or conditional licenses to bridge the time between entering the labor market and gaining all required qualifications to practice without supervision.
• Networks among the region’s stakeholders. Solid networks with fluid communication between the region’s professional associations, educational institutions, and other relevant governmental and nongovernmental stakeholders represent a fundamental precondition for most harmonization policies. Regular exchanges between nurses of the region are vital building blocks to create mutual trust and spark future harmonization efforts.

Chosen excerpts by Job Market Monitor. Read the whole story at  Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing | migrationpolicy.org.