LEAD 6173 Module 4 Global Issue Analysis Example

Remittances Home, Empty Wards Behind: Analyzing International Nurse Migration From the Philippines as a Global Issue With Costs on Both Ends

Student Name

American College of Education

LEAD6173: Global Perspectives

Module 4 Assignment

Instructor Name

November 2, 2026

Introduction

Three earlier papers in this course looked at the duties, the systems and the cultural encounters involved when my Houston health system hires nurses from abroad. This module steps back to the issue beneath all of that work: the international migration of nurses itself. It analyzes migration from the Philippines as a global issue, its drivers, who gains and who loses, the policy responses on each side and the narrow but real part one employer plays.

A Global Flow

Kingma (2007), reviewing nurse migration globally, described a highly organized international search for talent in which critical shortages in industrialized countries fuel recruitment campaigns, while workforce imbalances in poorer countries often coexist with unemployed health professionals. Nurses' reasons for migrating are multiple and not only financial, and flows change direction and size over time with economic conditions at both ends. Kingma also argued that migration is a symptom of larger systemic problems that make nurses leave their jobs, and that sending migrant nurses into dysfunctional health systems does not solve those systems' problems. The Philippines is among the largest sources of this flow.

Drivers in the Source Country

Lorenzo et al. (2007), in a Philippine country case study, described a job-scarce environment in which even employed health workers face poor working conditions that motivate them to seek work overseas, and a country that has become dependent on labor migration to ease its domestic labor market. National opinion, they found, has focused on the better lives of migrants and their families and on the national benefits of remittances. The recruited nurses I spoke with in earlier modules gave matching accounts: low pay at home, heavy patient loads and a family expectation, sometimes spoken and sometimes not, that a nurse would work abroad and send money home. Several described a common path: two or three years at a provincial hospital to gain the experience foreign employers require, a move to a private hospital in Manila and then an application abroad, so that provincial hospitals effectively train nurses for export.

Benefits and Costs at Each End

For migrant nurses and their families, the benefits are substantial: higher income, remittances that pay for siblings' education and parents' care and professional opportunities. The costs include separation from family, contracts that can bind them to employers and, for some, work below their experience. For the Philippines, remittances support households and the national economy, but Lorenzo et al. (2007) reported a shortage of highly skilled nurses and severe problems for the Filipino health system, including hospital closures, along with the retraining of physicians as nurses to work abroad. For destination countries like the United States, migration fills vacancies quickly but, as earlier research cited in this course suggested, can substitute for investment in domestic nurse supply. The flow benefits individuals at both ends while weakening the health system at one end and postponing reform at the other.

Policy Responses

Responses are debated on both sides. In the Philippines, Lorenzo et al. (2007) found interest in policies that return benefits to the schools and hospitals that train migrating nurses, and they argued that bilateral agreements with recruiting countries are essential so that both sending and receiving countries benefit. Internationally, the code of practice on recruiting health personnel adopted in 2010 asks destination countries to recruit ethically, to treat migrant health workers equally and to strengthen their own workforces, and it encourages mutual benefit between source and destination countries (World Health Organization, 2010). In the United States, the main policy levers are immigration rules for nurses and federal and state funding for nursing education, neither of which an individual employer controls.

Tensions for an Employer

Analyzing the issue exposes tensions that no policy fully resolves. The first is between the nurse's right to move and the source country's need to keep nurses. Discouraging recruitment from the Philippines would protect its health system but would also deny individual nurses opportunities they have chosen, and many nurses I spoke with would regard such a policy as paternalistic. The second tension is between the employer's duty to its own patients, who need nurses now, and its responsibility to patients elsewhere whom it will never see. The third is between short-term and long-term interests: recruiting abroad is faster and, per hire, cheaper than expanding local nursing education, but it keeps the system dependent on a supply it does not control. The point Kingma (2007) made, that migration is a symptom of deeper problems, applies here too, because our own vacancies reflect working conditions and turnover that recruitment does not fix.

Recent Developments

Demand for internationally educated nurses in the United States rose again after the pandemic, as hospitals faced high turnover and expensive temporary staffing, and the recruitment industry expanded accordingly. Rising demand from several wealthy countries at once increases pressure on source countries and gives recruited nurses more choices among destinations. Both trends make the questions in this paper more pressing, not less, and they strengthen the case for benefit-sharing arrangements that make an employer a partner rather than a competitor in the source country.

What One Employer Can Do

A single health system cannot change Philippine wages or American immigration policy, but it can decide how it participates. Four actions are within my system's reach. It can choose recruitment agencies that follow ethical practices, such as not charging nurses fees and limiting repayment clauses to real costs. It can invest in source-country capacity, for example by funding scholarships and faculty development at a partner nursing school in a province that loses many nurses, a small version of the benefit-sharing Lorenzo and colleagues described. It can support circular movement by offering recruited nurses paid leave to teach for a period at the partner school. And it can reduce its own dependence by expanding domestic pipelines, so that recruitment complements local supply rather than replacing it.

Limits of the Analysis

The sources describe conditions up to the late 2000s and the international reports of 2020; Philippine policy and labor markets continue to change, and the effects of the pandemic on migration are still unfolding. My own data on recruited nurses come from conversations with a few dozen people, not a survey. The analysis therefore identifies the shape of the issue and the levers within reach, not precise magnitudes.

Conclusion

International nurse migration from the Philippines is a global issue in the full sense: it is driven by conditions in both countries, it produces gains and losses that fall unevenly, and no single actor controls it. An employer that recruits from abroad is part of that system and can choose to participate in ways that share benefits with the source country and reduce its own dependence. Module 5 will design such a partnership. Doing so will not stop migration, which nurses will continue to choose for good reasons, but it can change what migration leaves behind in the provinces where our nurses trained.

References

Kingma, M. (2007). Nurses on the move: A global overview. Health Services Research, 42(3p2), 1281-1298. https://doi.org/10.1111/j.1475-6773.2007.00711.x

Lorenzo, F. M. E., Galvez-Tan, J., Icamina, K., & Javier, L. (2007). Nurse migration from a source country perspective: Philippine country case study. Health Services Research, 42(3p2), 1406-1418. https://doi.org/10.1111/j.1475-6773.2007.00716.x

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