LEAD 6173 Module 1 Global Citizenship Analysis Example

Recruiting 150 Nurses a Year From Abroad: What Global Citizenship Asks of a Hospital Workforce Leader in Houston

Student Name

American College of Education

LEAD6173: Global Perspectives

Module 1 Assignment

Instructor Name

October 12, 2026

Introduction

I direct nursing workforce planning for a composite health system of five hospitals in Houston. Each year we hire about 150 internationally educated nurses, most of them from the Philippines, through a recruitment agency that sponsors their visas and arranges licensure in Texas. Until this course I thought of that work as staffing. This paper asks what it means to be a global citizen in a leadership role that moves nurses from one health system to another, drawing on scholarship that distinguishes kinds of global citizenship and on the international code that governs health worker recruitment.

Conceptions of Global Citizenship

Global citizenship is not one idea. Oxley and Morris (2013) proposed a typology that separates cosmopolitan conceptions, which include political, moral, economic and cultural versions, from advocacy conceptions, which include social, critical, environmental and spiritual versions. A moral global citizen recognizes obligations to people regardless of nationality; an economic global citizen focuses on participating effectively in international markets; a critical global citizen questions the inequalities and power relations that shape global exchanges. The typology is useful because the same activity, such as hiring nurses from abroad, looks very different under each conception.

The Economic Reading

Under the economic conception, international recruitment is a sensible response to a labor market. Our system has persistent vacancies in medical-surgical and critical care units, Filipino nurses are well educated in English and in a curriculum modeled on American nursing, and recruited nurses typically earn several times what they could at home. Both sides gain, and the system's leaders, including me, are rewarded for filling positions efficiently. This reading is how the work is described in our budget documents.

The Moral Reading

The moral conception asks about obligations to everyone affected, not only to our patients and the nurses we hire. It points to the patients in the Philippines who lose experienced nurses, especially in provincial hospitals that train nurses who then leave for Manila and then abroad. Aiken et al. (2004), examining trends in international nurse migration, argued that recruitment by wealthy countries threatens to deplete nurse supply in poorer ones and called for a twofold response: rich countries building more sustainable domestic nurse workforces and investing in nursing education capacity in the countries that supply them. Under the moral reading, my obligations extend to people I will never meet.

The Critical Reading

The critical conception asks why the exchange exists at all and who sets its terms. Nurses migrate partly because of wage gaps that reflect global inequalities, and the recruitment industry profits from those gaps. Some agencies have used contracts with large penalties for leaving early, which bind nurses to employers in ways domestic nurses would not accept. A critical global citizen in my role would ask not only whether recruitment is legal but whether its terms would be acceptable if the nurse were my neighbor.

What Recruited Nurses Say

To ground the analysis in the experience of the people involved, I met with eight nurses recruited in the last three years, in two small groups, with a colleague from the Filipino nurses' association in Houston present. Their accounts were more varied than any single conception predicts. Most were glad they had come and proud of their work, and several were sending a large share of their pay home to support parents or siblings' education. But they also described things our system had never seen: learning about the repayment clause only after arriving, being placed on the hardest night shifts because they lacked seniority, and waiting months for help bringing their families. Two said they felt valued by patients and less so by some colleagues, who treated them as temporary. One nurse put it plainly: "You recruited a nurse, but you got a whole person." These conversations do not settle the ethical questions, but they make clear that equal pay alone does not amount to equal treatment.

What the International Code Requires

In 2010 the member states of the World Health Organization agreed a code meant to govern how countries and employers hire health workers from abroad (World Health Organization, 2010). It is voluntary, yet its principles apply directly to my work: recruitment should be ethical and transparent; member states should discourage active recruitment from countries facing critical shortages of health workers; migrant health workers should have the same rights and conditions as domestically educated workers; and destination countries should develop their own health workforces so that they rely less on recruitment. The code turns the moral and critical readings into specific expectations that an employer can meet or fail.

Where Our Practice Stands

Measured against the code, our system's practice is mixed. On equal treatment we perform well: recruited nurses are paid on the same scale as domestic nurses and receive the same benefits. On transparency we are weaker: the agency's contract includes a repayment clause of up to $20,000 if a nurse leaves within three years, and I have never reviewed it closely. On sustainability we have done little: the system's spending on international recruitment is several times its investment in local nursing school partnerships. And we have never asked whether the provinces our nurses come from are themselves short of nurses. Nor do we track how long recruited nurses stay after their contracts end, which is the simplest measure of whether the arrangement serves them as well as us.

The View From Source Communities

My system rarely considers what our recruitment means where the nurses come from. The nurses described provincial hospitals that train new graduates who leave within two or three years for city hospitals and then for jobs abroad. In their accounts, those hospitals rely increasingly on newly graduated nurses and volunteers to cover shifts. I cannot measure our system's share of that effect, since many employers recruit from the same regions, but the moral and critical conceptions both suggest that not being able to measure a harm does not excuse ignoring it.

What Global Citizenship Asks of Me

Combining the conceptions with the code suggests four responsibilities for my role. First, ensure that recruitment contracts are fair, which means reviewing the agency's repayment terms and limiting penalties to the agency's actual costs. Second, support the integration of recruited nurses as colleagues rather than as temporary labor, from housing to mentoring. Third, invest in domestic supply, expanding partnerships with Houston nursing programs so that international recruitment complements rather than replaces local development. Fourth, give something back to source countries, for example through a partnership with a Philippine nursing school. Later modules will examine these in detail.

Conclusion

International nurse recruitment can be read as efficient staffing, as a moral transaction with people far away or as a product of global inequality. A leader in my position is, whether she chooses it or not, acting as a global citizen, and the question is which kind. The international code offers a practical answer: recruit transparently, treat migrant nurses as equals, avoid harming fragile health systems and build enough local capacity that recruitment becomes a choice rather than a dependence.

References

Aiken, L. H., Buchan, J., Sochalski, J., Nichols, B., & Powell, M. (2004). Trends in international nurse migration. Health Affairs, 23(3), 69-77. https://doi.org/10.1377/hlthaff.23.3.69

Oxley, L., & Morris, P. (2013). Global citizenship: A typology for distinguishing its multiple conceptions. British Journal of Educational Studies, 61(3), 301-325. https://doi.org/10.1080/00071005.2013.798393

World Health Organization. (2010). WHO global code of practice on the international recruitment of health personnel. https://iris.who.int/handle/10665/3090