Globalization and nursing


‘Globalization’ is a modern cliché, but not a new phenomenon. It dates back to the era of exploration and, particularly for countries in Africa, to the establishment of colonial powers. The partition of Africa, the slave trade and the movement of traders around the world all exemplify that globalization evolved over time, and many factors have shaped the ‘global village’ we inhabit today.

Globalization encompasses a broad range of activities, now involving not only the production and distribution of material goods but also the non-material services, notably financial and information services (Smith 2000). Modern-day globalization has been accelerated by, and is now dependent on information technology. Microchip, internet, fax, cellular phones, electronic banking and e-learning are recent technologies, but they have transformed the world, creating today's ‘knowledge economy’. Knowledge is no longer the preserve of particular areas or people; it is for everyone, just a click away. Modern technology and globalization have profoundly affected economic, political and social activity in every part of the world. The ever-increasing ease and speed of travel means that people, as well as goods and services, are in constant movement around the globe. The nursing profession cannot ignore these developments. We must embrace globalization and exploit its benefits for nursing and health care across the world.

When I became a nurse in the early 1970s, nurses’ work was mostly limited to clinics or hospitals, and nurses seldom ventured abroad (or afar) in their working life. Now there is a proliferation of settings in which nurses are employed, including the private health sector, the higher education system and the wider corporate world. ‘Migration’ of nurses is now common. At regional level, nurses come to work in Botswana from other African countries. At international level, nurses from as far as China and Cuba are coming to work here too. There is a chain reaction, with Botswana nurses migrating elsewhere to seek employment, for example, in the United Kingdom, Australia and New Zealand. Thus a new trend has emerged with the import of nursing labour and skills to the developed world whereas, in the past, skilled labour came only from the developed world. There is exploitation in the employment packages for some of these nurses but there also have been positive benefits from increased migration and integration. The nursing world has become closer. Many of the nurses who migrate abroad will return in due course to their home countries with additional experience, perspectives and skills.

It is difficult for developing countries to lose nurses, thus depleting their own workforce at a time of huge challenges for health services, not least in Africa on account of the HIV/AIDS epidemic. In turn, the economic status for nurses has improved because globalization has forced measures to increase local recruitment and retention. In Botswana, the reward system for nurses has greatly improved. There is a need to protect the health of the developing world, prevent exploitation of nurses and stop the ‘brain drain’ of our best nurses. Controls have been introduced to discourage nurses from migrating. In South Africa, international agencies are being discouraged from engaging in active recruitment. In Botswana, nurses have been pleaded with not to migrate abroad. More enduring measures are needed to convince these nurses not to migrate, notably the improvement of working conditions, salary and opportunities for professional advancement. In Botswana, the staffing patterns urgently need to be changed from the inflexible formats of traditional rostering to allow part-time and more flexible working arrangements, compatible with modern-day life.

Many other challenges and opportunities for nursing have emerged from globalization. It is encouraging review and reorganization of the way that nursing is regulated and practised and, in particular, in the way that educational programmes are developed and delivered. The education of nurses traditionally has been a local responsibility, albeit within a unifying framework at regional or national level. In a globalized world, our educational programmes must become more universal, catering not only for more diverse student groups, but also to address more directly the increasingly transcultural nature of health care itself. Conventional, context-specific modes of curriculum development and implementation need to change. E-learning in particular enables nursing students to access programmes at a distance – locally, nationally and internationally. The internationalization of education is a growing phenomenon in other disciplines and professions. The nursing profession needs to move with the current pace of globalization, and must avoid getting left in the colonial past.