The migration of internationally educated health care providers has become a popular topic worldwide. Researchers, policy makers, and general public are increasingly raising concerns about the mobility of health care sector workers and its consequences. Some favour macro perspective analysis, thus analysing cross‐national movement of health care providers through the prism of global market economies linking the decision to immigrate to “pushes” (economic, political, etc.) faced in the country of origins and “pulls” (higher living standards, political stability, and security) attracting travellers to the country of destinations. Other researchers engage in microanalysis and look at the personal stories of immigrant health workers identifying their reasons for migrating and the challenges they face in their destination countries. The book Nurses on the Move: Migration and the Global Health Care Economy by Mireille Kingma does both: it draws a comprehensive picture of nurses migration by situating micro experiences in macro social forces so as to provide insights about “driving forces, participants, stakeholders, and impact” (p. 8).
One of they key issues that Kingma raises in her book is nurses' motivation to migrate. She suggests a number of “ideal‐type” categories under which the motivation for migration can be placed. Among these categories are “economic migrant”, “quality‐of‐life migrant”, “career‐move migrant”, “partner migrant”, “adventurer migrant”, “survival migrant”, and “return migrant”. Yet, personalising reasons for immigration, Kingma situates nurses' migration in context. She shows how personal reasons and personal stories should be understood in light of changing local health care systems, states' political agendas, international policies, trade agreements, recruitment practices, and globalised world economy. Each chapter provides a unique perspective on one of the layers of stakeholders' interests and their role in regulation of nurses' migration carousel. This ability to build such comprehensive scheme of multiple relations between individuals, professional organisations, states, and businesses is one of the greatest strengths of Kingma's book.
Whereas the predominant immigration path was from North to North (i.e. from Canada to USA, or from UK to Canada), more recently the movement is increasingly from South to North (from Ghana to UK, or from China to USA). In this light, Kingma touches upon the issue of brain drain and losses the developing countries face due to health care workers flow to richer countries. She is critical of current political actions pursued both by wealthy countries and developing world: neither guides for ethical recruitment, nor the demands of developing countries, in her opinion, help to solve the problem of migration, establish ethical recruitment, or regulate nurses' working conditions. Instead, Kingma stresses the importance of retention policies, such as increasing nurses' salaries, providing more career and education opportunities, securing workplace, stabilising political situation, eliminating discrimination.
Calling for a political action, Kingma devotes last chapter of her book to recommendation and policy solutions which would help to understand and stabilise nurses' migration. For the research community, she points out to the need for more thorough data collection related to nurse migration. Kingma also broadens the definition of “migration” to include not only cross‐national movement but also intra‐national mobility, which reflects flow between urban and rural areas or country's geographic regions.
An interesting theoretical suggestion is made by Kingma with respect to brain drain vs brain gain rhetoric. These terms, she says, are locally constructed and while for some countries immigration of nurses is defined as a brain drain (for instance, South Africa) for others it is the way to maintain their economy (Philippines). In addition, personal accounts of nurses show that nurses' migration often does not stop after arrival into a new country: many nurses change countries in which they work, some of them return to their home countries. Kingma suggests using a term “brain circulation” instead as it does not necessarily imply negative connotation and allows for an inclusion of return migration, which she strongly believes could become a future for nurse migration once better retention policies are implemented.
The main purpose of Kingma's book is to draw a global picture of nurses' migration and her ability to provide a thorough and comprehensive analysis of stakeholders' interests involved in the migration of nurses is outstanding. But, by concentrating on the “big” picture, she inevitably leaves out some details, which are worth exploring in further research. For instance, she mentions that the (in)ability to find spousal employment often challenges family relations. Kingma also highlights the gendered implications of the nursing profession, and how women often leave their spouses and children when immigrating to other countries. Further inquiry into nurses' family dynamics and the impact their migration has on power distribution within nurses' families seems to be a promising avenue for future research.
Kingma also challenges the common assumption that a nurse is a nurse is a nurse which, in her opinion, explains why nurses are often offered positions which do not suit their qualifications, are denied appropriate training, or are expected to start working immediately after arrival. To identify common challenges experienced by immigrant nurses, Kingma collects accounts of nurses from different parts of the world. UK nurses, Filipino nurses, Caribbean nurses, nurses from Jamaica and Ghana all seem to suffer from the same problems and overcome the same difficulties. If the nurse is a nurse is a nurse assumption is wrong, then there is a possibility that for some nurses the immigration experience is more challenging than for others because of their skin colour, ethnic origin, or language skills. Kingma herself notes an established hierarchy in the global market for nurses. But is this hierarchy universal or does it differ from one country to another? Answers to these questions call for further inquiry.
These are but two examples of questions which arise while reading Nurses on the Move. Nurses' migration is a very interesting phenomenon, which is “pushed, pulled, and shaped by a constellation of social forces and determined by a series of choices made by a multitude of stakeholders” (p. 229). Kingma does an excellent work in identifying the stakeholders and defining their role in migration of nurses. Readers can pick up from this point and learn about policies that should be implemented, actions that must be taken, or research that can be done.
