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22 N O V E M B E R 2 0 0 5 C A L I F O R N I A N U R S E EQUITY Employment legislation applies equally to national and non-national nurses under the principle of equal treatment outlined in the Conclusions of the General Discussion on MigrantWorkersattheInternationalLabour Conference(2004)andasmandatedbyILO Conventions 143, 97, 181, and the UN Con- ventionontheProtectionoftheRightsofMi- grantWorkersandMembersoftheirFamilies. Recruiters ensure that, while working abroad, migrant RNs are protected by the same employment regulations and have the same rights as equivalent grades of staff in the receiving country, for example rates of pay, professional development and continuing education, and, where possi- ble, access to training as specified in pre- vailing collective bargaining agreements. PROMOTION OF NURSING Recruiters and employers work closely with government initiatives to decrease the reliance on foreign healthcare work- ers as a temporary solution to health worker shortages. TRANSPARENCY Employment agreements between all re- cruiting countries and source countries, such as Memorandums of Understanding, are available to professional nurse bodies and nurse organizations. Recruiters are transparent about the type of skills, expertise, source country, the number of recruits, and grades of health pro- fessions recruited from overseas each year. Employers provide full and accurate in- formation to potential recruits (prior to departure to the degree possible) and to relevant nurse organizations in the recip- ient country in order to ensure that all em- ployment contracts with migrant workers cover issues such as: ■ Contractual requirements ■ The nature and requirements of the job ■ Rights of the recruit ■ Documentation required ■ Proof of equality of terms and con- ditions of work between national and migrant workers ■ Country conditions (including gen- eral socio-economic conditions) ■ Induction and workforce integration ■ Terms and conditions of any required supervision or transition period ■ Provision for right to return home ■ Prohibition of illegal extension of con- tract ■ Protection from unreasonable penal- ties for early termination of contract on the part of the migrant worker FAIRNESS Employers recruit nurses from those coun- tries whose governments (health min- istries) and nursing associations and unions support overseas recruitment. (Employers should refer to sources such as the Com- monwealth Secretariat or the UK Govern- ment's Department of Health for a list of countries from which nurses other health- care professionals should not be recruited.) Nurses are recruited from countries which are not experiencing shortages and/or where the effectiveness and quali- ty of healthcare systems in source coun- tries is not undermined by recruitment. Recruiters seek to recruit only those health workers who do not have an out- standing obligation to their own country, for example, contract of service agreed to as a condition of training. Recruiters and employers implement and promote measures of reparation (to all developing source countries) in the form of: ■ Technical assistance in nursing prac- tice (from recruiting countries to source countries) ■ Educational exchange ■ Incentives to return (including reen- try programs) ■ Financial compensation or reim- bursement for the training of health pro- fessionals Recommendations from Nurses to Promote Human Rights CNA calls on all governments, employers, and nurse organizations to promote: Adequate resourcing of healthcare in- stitutions in order that health workers can deliver quality health services. Adequate resourcing of healthcare in- stitutions in order that all health workers earn a living wage. Macroeconomic policies to significant- ly increase funding to the health sector from domestic and international sources, including debt relief. Equal treatment of all healthcare work- ers (without discrimination based on na- tionality, migrant status, gender, sexual orientation, or race). International harmonization of a sin- gle, universal standard of care. International harmonization of safe RN to patient staffing ratios. Improvement of workplace health and safety standards in healthcare institutions (including violence prevention and in- creased protections against communica- ble disease). Long-term planning strategies for the global nursing workforce, including meas- ures to improve terms and conditions of work, increase career opportunities, in- troduce flexible scheduling, develop men- torship programs, and recruit from minority populations underrepresented in the nursing workforce. Increased valuation of women's care work. Respect for the fundamental right of all nurses to serve as advocates for their pa- tients. Respect for the fundamental right of all nurses to establish and to join unions. California Board of Registered Nursing's Position on International Testing In 2002, the National Council of State Boards of Nursing approved a recommen- dation to proceed with the international administration of the NCLEX Examina- tion. The recommendation proposed to begin international testing Jan. 1, 2004 at the following international testing loca- tions: Hong Kong (People's Republic of China); London (England); and Seoul (South Korea). The California Board of Registered Nursing (BRN) opposed these plans for in- ternational testing, arguing the following: ■ Global nursing shortage. ■ Financial benefits for international recruiters. ■ Patient harm as a result of fraudulent licensure. ■ Licensing exams have high financial stakes. ■ High incentives to subvert exam se- curity. Conclusion: CNA/NNOC must take a leadership role in dealing with the critical issues facing international nurses. References: Commission on Graduates of Foreign Nursing Schools, www.cgfns.org, August 2005 International Council of Nurses, www.icn.ch, August 2005 California Board of Registered Nursing, www.rn.ca.gov, September 2005 Hedy Dumpel, RN, JD is Chief Director of Nursing Practice and Patient Advocacy for the California Nurses Association. CE Home Study Course