The concept of cultural safety offers a unique approach to nursing practice, based on recognition of the power differentials inherent in any interaction. It is from within the context of nursing in Aoteaoroa/New Zealand (A/NZ) that the concept developed and was subsequently integrated into nursing education. Cultural safety is based within a framework of biculturalism, and is congruent with the tenets of the nation's founding document, the Treaty of Waitangi. Clarification of the concept is offered, together with a review of (...) the historical shift in nursing attitudes that has led to the emergence of ‘cultural safety’ as a viable and valued component of nursing practice.The argument is made that cultural safety has allowed for a more reflective, critical understanding of the actions of nursing to develop. This includes recognition that nurses’ attitudes and values have inevitably been influenced by social and political forces, and as such are in part reflective of those within the wider community. Comparison between the support given by nurses in the early 1900s to the theory of eugenics and the current acceptance of cultural safety is used to highlight this point. An examination of the literature identifies that ideological and conceptual changes have occurred in the approach of A/NZ nurses to issues with cultural implications for practice. A review of background factors relating to Maori health status and the Treaty of Waitangi is presented as a necessary context to the overall discussion.The discussion concludes with an acknowledgement that while the rhetoric of cultural safety is now part of nursing culture in New Zealand, there is no firm evidence to evaluate its impact in practice. Issues identified as impacting on the ability to assess/research a concept, such as cultural safety, are discussed. For cultural safety to become recognised as a credible (and indispensable) tool, it is necessary to further examine the ‘end-point’ or ‘outcomes’ of the process. (shrink)

Nursing migration: global treasure hunt or disaster‐in‐the‐making?International nurse migration — moving from one country to another in the search of employment — is the focus of this article. The majority of member states of the World Health Organization report a shortage, maldistribution and misutilisation of nurses. International recruitment has been seen as a solution. The negative effects of international migration on the ‘supplier’ countries may be recognised today but are not effectively addressed.Nurse migration is motivated by the search for professional (...) development, better quality of life and personal safety. Pay and learning opportunities continue to be the most frequently reported incentives for nurse migration, especially by nurses from less‐developed countries. Career opportunities were considered key incentives for nurses emigrating from high‐income countries. Language was reported to be a significant barrier. The positive global economic/social/professional development resulting from international migration needs to be weighed against a substantial ‘brain and skills drain’ experienced by supplier countries. The vulnerable status of migrant nurses is also of concern in certain cases. The focus on short‐term solutions as opposed to resolving the problem of a worldwide shortage of nurses causes great concern. Recent initiatives attempt to curb or channel international recruitment. The delicate balance between recognising the right of individual nurses to migrate and a collective concern for the health of a nation’s population must be achieved. (shrink)

The globalisation of the nursing workforce: barriers confronting overseas qualified nurses in AustraliaRecent decades have coincided with the rapid globalisation of the nursing profession. Within Australia there has been rising dependence on overseas qualified nurses (OQNs) to compensate for chronic nurse shortages related to the continued exodus of Australian nurses overseas and to emerging opportunities in other professions. Between 1983/4 and 1994/5, 30 544 OQNs entered Australia on either a permanent or temporary basis, counter‐balancing the departure overseas of 23 613 (...) locally trained and 6519 migrant nurses (producing a net gain of just 412 nurses in all). The period 1995/6–1999/2000 saw an additional 11 757 permanent or long‐term OQN arrivals, with nursing currently ranked third target profession in Australia’s skill migration program, in the context of continuing attrition among local nurses. This pattern of reliance on OQNs is a phenomenon simultaneously occurring in the UK, the US, Canada and the Middle East — the globalisation of nursing reflecting not merely Western demand but the growing agency and participation of women in skilled migration, their desire for improved quality of life, enhanced professional opportunity and remuneration, family reunion and adventure. (shrink)