Mary Seacole was in London in 1854 when she heard about a shortage of nurses on the frontlines of the Crimean War. The Jamaican nurse offered her services but was turned away. Some contention remains about whether Seacole was rejected because she was a mixed-race woman or because she did not apply properly, but Seacole regardless navigated her own way to the battlefield. After opening a hotel and caring for soldiers near what is today Kadikoi, Ukraine, Seacole wrote a best-selling autobiography about her experiences travelling the world.
On its face, the story of a Jamaican nurse stepping forward to try and fill a need in the United Kingdom’s healthcare system seems like a relic of the colonial era. But fifty-five years after Jamaica gained its independence, Jamaican nurses are still heading to the United Kingdom. Unlike Mrs. Seacole, they are not being turned away. On the contrary, they are being given job offers that they cannot refuse.
The Caribbean Community and Common Market estimates that between 1996 and 2006, 50,000 nurses left Jamaica to work in other countries. This migration resulted in a loss for Jamaica of $2.2 million dollars in nurse training expenses. According to Janet Coore-Farr, head of the Nurses Association of Jamaica, Jamaica lost around one fifth of its specialized nurses in 2016 alone. The chairman of the University Hospital of the West Indies reports that around half of specialized nurses trained by the hospital are recruited by foreign organizations before they even graduate.
The nursing shortage has had dire consequences for the Jamaican healthcare system. Reports of short-staffed hospitals cancelling surgeries due to a lack of specialized nursing staff appear frequently in Jamaican newspapers. The impacts of the nursing shortage are not limited to any one sector of the healthcare system. According to a UN Development Programme report on Jamaica’s ability to meet the Millennium Development Goals, nursing shortages have adversely impacted Jamaica’s immunization and maternal health clinics. In 2006, the World Health Organization published a report providing evidence of a correlation between density of healthcare workers and population health outcomes.
Decades of nursing migration have caused a sizeable decline in nurses relative to Jamaica’s population. According to the World Bank, Jamaica had 1.65 nurses and midwives per 1,000 people in 2003. By 2008, that number had decreased to 1.08. For comparison, the World Bank listed the average number of nurses and midwives for OECD nations at 7.7 per 1,000 population in 2012. Meanwhile, the demand for nurses in Jamaica is expected to grow as the population ages. The World Bank estimates that the English-speaking Caribbean will need 10,700 more nurses by the year 2025. Nurses are a key component of any healthcare system, and a shortage of this magnitude could leave the nation unprepared to handle disease outbreaks and other public health emergencies. But nurses are also a key component of Jamaican society, often serving on the frontlines of public health provision and education in their communities. Without an adequate number of nurses, these communities will suffer.
Push and Pull Factors in Jamaican Nursing Migration
At its core, Jamaica’s nursing shortage is the product of decades of nursing shortages in the developed world. A rising demand for nurses, due in part to increasingly complex needs of an aging population, has been coupled with a decreasing supply of qualified nurses in many countries. A 2007 study of nurses in the American Midwest region found that 38% of surveyed nurses reported feeling problematic burnout associated with their jobs. Young nurses are even more likely to experience burnout, with almost 44% of nurses under the age of 30 reporting the same level of burnout. The stressful nature of the nursing profession has been compounded by staff shortages, driving more nurses away from nursing. Ironically, the nursing shortage also been exacerbated by a shortage of nurses qualified to teach in nursing schools. Over 75,000 qualified applicants are turned away yearly from US nursing schools because of a shortage of qualified faculty.
As nursing shortages ravaged healthcare systems in places like the United Kingdom, United States, and Canada, these countries began working to attract qualified nurses from other countries. In the case of the United Kingdom, the migration of nurses from other parts of the Commonwealth began with the formation of the National Health Service. A BBC documentary drawing attention to Britain’s black nurses reports that as staff shortages threatened the nascent NHS, thousands of nurses from Britain’s colonized countries stepped in to fill the need. According to a 2017 report by the British parliament, around 1,700 Jamaican medical staff currently work for the NHS.
In the face of these staff shortages, Jamaican nurses are attractive candidates for international recruiters. As part of the English-speaking Caribbean, Jamaican nurses are usually native English speakers. Due to their English fluency, Jamaican nurses passed the National Council Licensure Examination, a test used in the licensing of nurses, at higher rates than other international applications.
What attracts Jamaican nurses to positions abroad? The promise of higher salaries is an important factor. The average starting salary for a nurse in Jamaica is around $8,000 US dollars, and even experienced nurses may only make $20,000. Compare this to the the average starting salary of a registered nurse in the US, which in 2015 was $65,490. And while international medical centers often offer Jamaican-trained nurses lower salaries than they would to graduates of US and UK medical schools, these salaries are still significantly higher than in Jamaica. The World Bank found that only 6% of non-migrant nurses were satisfied with their salaries, compared to 85% of nurses who migrated out of Jamaica.
The Future of Jamaican Nursing
What does Jamaica’s nursing shortage tell us about the modern-day relationships between former colonizers and the formerly colonized world? It tells us that, even in a postcolonial world, relationships between colonizers and the colonized are complex and are still primarily an issue of inequity. The nursing shortage contributes to very real disparities in healthcare quality between Jamaica and many of the nations that are recruiting their nurses. Short-staffed clinics and hospitals and overworked medical staff can negatively impact the quality of life for many Jamaicans.
The migration of Jamaican nurses to other countries in search of better employment opportunities also benefits Jamaica economically, further complicating the relationship between the county and more developed nations. In order to get the most complete picture of Jamaica’s nurses working abroad, it is important to highlight the benefits that working abroad provides to the nurses and their families as well as to the nation as a whole. Surveys of migrating Jamaican nurses have found that those who migrate are considering a number of non-economic factors, including the chance to reunite with family members abroad, access better professional development opportunities, and have a better quality of life overall. Working abroad for higher salaries also allows nurses to send remittances home to their families. Remittances comprise an important part of the Jamaican economy, with an estimated $2 billion in remittances being sent back to the country each year. This money can be used to benefit Jamaican families and communities in a very real way.
How can Jamaica and the countries whose healthcare systems benefit from employing Jamaican nurses work together to reduce the nursing shortage? In response to the shortage, Jamaica has begun employing an international recruitment system of its own. The island is hoping to bring medical personnel from India and Cuba into its healthcare system in order to fill vacant positions. This outcome is ironic: as the developed world continues to lure away Jamaica’s nurses, Jamaica must try to attract its own nursing from elsewhere in the developing world. By recruiting nurses from other developing countries, Jamaica runs the risk of creating nursing shortages elsewhere in the world. Even countries that invite their nurses to find employment abroad are not immune to shortage. Under the 2001–2004 Medium Term Philippines Development Plan, the Philippines trained and actively encouraged its nurses to seek employment overseas. But within a few years of implementing this policy, the Philippines faced a nursing shortage of its own. Relying on the recruitment of nurses from even poorer countries can lead to a cycle of recruitment and shortage that strains healthcare systems across the world.
It is clear that the developed world must also take steps to reduce its dependence on nurses from Jamaica and other developing nations. Jamaican Minister of Health Dr. Christopher Tufton addressed the United Nations in January of 2017 to request the organization’s help in crafting multilateral and bilateral agreements to encourage the developed world to more responsibly manage their need for medical personnel without straining the healthcare systems of other countries. Writing for the Online Journal of Issues in Nursing, nurses Brenda Nevidjon and Jeanette Erickson offer several recommendations for reducing the nursing shortage in the developed world. These recommendations include increasing the number of nurse educators to allow for larger numbers of nursing students in medical schools and implementing a combination of long- and short-term strategies to improve the recruitment and retention of nurses.
When Mary Seacole’s offers to provide medical care for British soldiers injured on the frontlines were rejected, she probably could not have imagined the day when British hospitals would clamor over the opportunity to hire Jamaican nurses. The nursing shortage in Jamaica raises important questions about the future of the Jamaican healthcare sector and the relations between former colonizers and the formerly colonized in today’s postcolonial landscape. Jamaican nurses have been serving the healthcare systems of the United Kingdom and other developed nations for centuries. Now it is time for the developed world to support Jamaica’s healthcare system in return.