The profession of Nursing – approbated as one of the key roles of health care sector- is focused on providing a wide range of health care services to individuals, their families as well as to the community as a whole. Florence Nightingale, an English nurse who was serving during the Crimean War, had laid the foundation for the professional nursing through her famous book titled “Notes on Nursing”.

The duties and responsibilities of nurses diverse across different countries and in specialties, thus defining ‘nursing’ is quiet challenging. Among other definitions, International Organization of Nurses defined that is “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”

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Services of a nurse

The service of nurses witnessed in wide range of settings; starting from hospitals to home visits and also places such as schools, home for elders, military camps, cruise ships, free-standing clinics and pharmaceutical research companies. Even the scope of practice of nurses spread from assisting other health care workers to a certain level of prescriber authority. The key factors on which nursing profession emerged or can be categorized are their role, knowledge and attitude.

Compared to other health care providers, nurses must possess traits that help them get on with people by communicating effectively, being empathic and patient. Further, they require standard level of education followed by a clinical training as well as legal recognition (through registering as nurse practitioners at different levels) in performing their role. The ability to be efficient and self controlled in decisive situations, problem solving skills, right attitudes, same careful attention on each individual without any prejudice and the willingness to work any time shift during the day are some of the ingredients of a professional nurse.

Working environment of nurses

In modern world, a serious scarcity of nurses reported in many countries. One of the major reasons is the poor work related environment. Lucia et al (2009) highlighted the fact that nursing professionals are overloaded with work due to shortage of nurses. The high ratio between nurses-to-patients and the number of tasks handled by a single nurse resulted in cognitive work load. A high incidence of musculoskeletal disorders (MSDs) reported among nursing professionals due to long working hours and demand for handling multitasks with frequent interruptions.

The United Kingdom, USA, Australia, France, Germany, Canada and Ireland are some of the leading developed countries that attract the largest numbers of migrant nurses in their health sector in bridging the employment gap. Between 1995 and 2000 Australia received 11,757 nurses from various other nations. More than 10,000 foreign nurses were accepted to enter the United States, while 1998 to 2002, United Kingdom admitted 26,286 foreign nurses. The American Hospital Association reported 168,000 open positions in 715 US hospitals and 126,000 (75% of total) positions were vacant for registered nurses (Kline, 2003).

Challenges and rewards in working abroad

Nurses having opportunities to work overseas are two-fold; those who work in developed countries with advanced technical environments and in remote areas with less facility under local & international development organizations. There will be many more motivation factors for nurses to work abroad such as better standard of living, higher salaries, good climate conditions, and the experience of working in different culture in another country.

Kline (2003) depicted the fact that both push and pull factors resulting in nurse migration. On one hand, nurses migrate due to the desire of developing their professional skills and knowledge that would not be achievable in their current position or the country. On the other hand, nurses are attracted to countries with higher standards of living, personal safety and better wages compared to their native countries.

The reality of nursing abroad could be very different from what it first appeared.  Though there are many personal rewards and development opportunities in the profession of ‘abroad nursing’, many challenges and risks also involved in the work. Every day across the world, humanitarian aid activities take place in many locations where there are potential risks of serious accidents and life losses for aid workers. These include exposure to war torn areas, exposure to natural diseases, risk of travelling unsafe routes, and also threat of sexual abuse, abduction or permanent disability.

Nurses are supposed to work long hours that doubles the risk of developing a cancer. Charles (2013) concluded the potential risk of breast cancer among shift-working nurses, based on research conducted among total sample of 2313 women in Canada. UK health authorities introduced a compulsory test of HIV for all foreign health staff recruiting in the country, after discovering 10 South African nurses with HIV positive(Stubbings et. al.2004).

There is a great concern of the possibility for exploitation of foreign nurses. Brubaker (2001) stated that hospitals in Washington have paid less salary to overseas nurses that were less than those paid to comparable US nurses. Foreign nurses are excluded from jobs in leading facilities and tended to fill entry level positions as they are not US origins. (Brown et al, 1998)

The job satisfaction and perceptions among current nursing professional would set the trend for future generations to enter in to the profession. In a survey conducted among Registered Nurses, 36% of respondents claimed that they would not recommend nursing as a career option for young people (Charles, 2013). In another study, Stubbings et. al. (2004) reported that 25% of nurses actively discourage someone from going into nursing.

Even though there are many risk factors involved in abroad nursing, many find it as a life changing experience to gain many personal rewards to their life. At the same time it will add an extra value to the country that they are working for. Migrant nurse is a good source for knowledge transferring. The knowledge experiences and health practices which brings from the native country can be merged with the existing county health care facilities and finally go to a better methods or well organized health services.

With the developed skill set of abroad nurses will be extremely resourceful in terms of having direct impact on individuals and communities. While providing the healthcare services there are chances to experience the culture of an international locale. Exposing to traditions and customs as well as rituals and believes of a foreign country will be added benefit.

Most of the time nurses who are working for humanitarian organizations, recruited for under development countries suffering from many issues. Personal skills and attributes some of less tangible benefits can be absorbed from abroad nurses to develop those poorly resourced communities while paying them high salaries.

The effect on receiving countries is positive in that countries receive skilled nurses who can enter the workforce with minimal preparation to fill critical shortages. On an average day, the UK uses 20,000 temporary or agency nurses to fill shortage positions in hospitals, costing the NHS $1,235 million USD a year ( Stubbings et al, 2004;Kline,2003).

In the US, agency nurses can earn $50 per hour or $104,000 per year. Nurses who work as traveling nurses can earn $75 per hour or $156,000 per year (Gamble, 2002). The cost of employing foreign nurses is a much less expensive method of filling vacant positions. One hospital in Kentucky recently recruited 50 nurses from the Philippines at the cost of $300,000, which was roughly what the hospital paid for agency nurses for 1 month (Brown, 1998).

Abroad nurses are truly impacted by the developed, industrialized countries and there are many learning opportunities for them. Before returning back home they are able to develop and sharpen their skills. The medical case and extreme circumstances that nurses may come across in host countries prepare them to   overcome obstacles, handle emergencies and tackle challenges.

Working abroad often produce unique challenges as many underdeveloped, impoverished regions without adequate running water or electricity – sense candle light may use to deliver a baby or stitch wounds.

Hibbert (2003) mentioned to the “First trip of many for volunteer nurse”, in the Australian Nursing Journal article about the prevalence of ‘jiggers’ (a type of parasitic flea) burrow under the skin.  He further stated that   cutting jiggers from under the skin of locals is not something nursing courses taught, but a challenge that volunteer nurses face.

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All things considered, there is no doubt that the duties and responsibilities of nurses working across different countries and in specialties are quite challenging. They have to face a lot of challenges during their work. Though, they got personal rewards and development opportunities but risks are also involved in their work. They gain experiences and health practices which brings from the native country can be merged with the existing county health care facilities and finally go to better methods or well organized health services.




Brubaker, B (2001), ‘Hospitals go abroad to fill slots for nurses; wide pay gap exists between US foreign workers in D.C. area’, The Washington Post, June, pp. A.1.

Charles, S (2013), ‘Nurses working night shifts at greater breast cancer risk’, ‘Viewed 23 August 2013 <>.

Donna S. Kline., (2003),’Push and pull factors in international nurses migration’, Journal of Nursing Scholarship.Vol.35, No.2, pp.107-11.

Gamble, D (2002), ‘Filipino recruitment as a staffing strategy’, Journal of Nursing Administration, Vol.32, No. 4, pp. 175-177.

Glaessel-Brown, E. (1998), ‘Use of immigration policy to manage nursing shortages’, Journal of Nursing Scholarship, Vol.30, pp. 323- 327.

Hibbert, R (2003), ‘First trip of many for volunteer nurse’, viewed 24 August 2013.


Liz Stubbings and Janet M. Scott, (2004), ‘NHS workforce issues: Implications for future practice’, Journal of Health Organization and Management, Vol. 18, No.3, pp.179 – 194.

Lucia, PR, Otto, TE. and Palmier, PA, (2009), ‘Chapter 1 Performance in Nursing’. Reviews of Human Factors and Ergonomics, Vol.5, pp. 1–40.