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AJPH First Look, published online ahead of print Oct 30, 2007
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December 2007, Vol 97, No. 12 | American Journal of Public Health 2119
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2007.120550

LETTER

THE EXPORT OF NURSES FROM EUROPE TO THE UNITED STATES

Jozsef Betlehem, PhD, MEd, MSN, RN, Imre Boncz, MD, PhD, Ildiko Kriszbacher, PhD, Andras Olah, MSN, RN and Jozsef Bódis, MD, PhD, DSc

Jozsef Betlehem, Ildiko Kriszbacher, Andras Olah, and Jozsef Bódis are with the Institute of Nursing and Clinical Sciences, University of Pecs, Pecs, Hungary. Imre Boncz is with the Department of Health Economics, Policy, and Management, University of Pecs.

Correspondence: Requests for reprints should be sent to Dr Jozsef Betlehem, University of Pecs, Vorosmarty Street 4, H-7621 Pecs, Hungary (e-mail: betlehem{at}etk.pte.hu).

We would like to highlight the main conclusion by Polsky et al.1 on the similar qualifications of nurses trained within and outside the United States. The nursing shortage is an important phenomenon not only in the United States but also in Europe.2 Since the fall of socialism in Hungary in 1989, the country has become an important source of well-qualified nurses for Western countries. During Hungary’s economic reforms in the early 1990s, nursing education was elevated from diploma level to degree level to match that of other countries in Western Europe. Until 2005, the development of the bachelor of science in nursing program in Hungarian universities was supported by staff at Case Western Reserve University (Cleveland, Ohio) to make it more compatible with the degrees available in Western countries.3

In 1990 there were no degree-holding nurses in the Hungarian health care system (with the exception of the few nursing director posts); by 2000, 2567 out of 62000 nurses in Hungarian health care institutions (mainly hospitals) held a bachelor of science in nursing. Since the mid-1990s it has been compulsory for each hospital department in Hungary to employ at least 1 nurse with a bachelor’s degree. This requirement has accelerated the acceptance of degree-holding nurses in health care institutions. In 2000 nearly all leading domestic nursing posts were held by degree-holding nurses; in subsequent years, an increase in the migration of nurses (as a result of declining domestic opportunities) was detectable by the number of diploma supplements (a document issued to outline the education received) issued in English.4

Since 2000 the master of science in nursing degree has been available in Hungary in an attempt to make domestic nursing careers more attractive. The focus of this complementary degree is on management, education, and research.5,6 In 2006 the Doctoral School of Health Sciences at the Faculty of Health Sciences, University of Pecs (Pecs, Hungary), was established with the aim of strengthening research in nursing and in health sciences.7

In recent years, the number of new applicants to Hungarian universities who are interested in earning a nursing degree has slightly but steadily declined. If the experienced nursing workforce with bachelor’s or master’s degrees continues to move elsewhere for job opportunities, the Hungarian health care system will be threatened.8 The right of individual nurses to migrate and the ability of nations to keep nurses that are citizens both should be considered in order to find a sustainable balance in migration.


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  		Emma Trochez, with Goodwill Industries of South Florida in Miami, trims a US interment flag on March 24, 2003. This South Florida non-profit serves as a major supplier of fatigues for the US military, as well as the licensed maker of the interment flag of the United States for the US Veterans Administration.

Source. Printed with permission of AP Wide World. Photgraph by David Adame.

 
Footnotes

Contributors
All authors helped to conceptualize ideas and review drafts of the letter.

Accepted for publication June 14, 2007.

References

1. Polsky D, Ross SJ, Brush BL, Sochalski J. Trends in characteristics and country of origin among foreign-trained nurses in the United States, 1990 and 2000. Am J Public Health. 2007;97:895–899.[Abstract/Free Full Text]

2. Kline DS. Push and pull factors in international nurse migration. J Nurs Scholarsh. 2003;35:107–111.[CrossRef][ISI][Medline]

3. Modly MD, Fitzpatrick JJ, Poletti P, Zanotti R, eds. Advancing Nursing Education Worldwide. New York, NY: Springer Publishing Co; 1995.

4. Betlehem J. Hungary is already seeing an exodus of nursing staff. Nursing Times. 2003;99:14–15.

5. Betlehem J, Olah A. The development of Hungarian nursing education in the 20th century [in Slovak]. In: Sysel D, ed. Development of University Education in Nursing. Bratislava, Slovakia: Comenius University; 2004:37–41.

6. Olah A. Az ápolói kézségek fejlesztése az egyetemi szintü ápolóképzésben [The development of nurses’ skills in master’s education]. Egészségügyi Menedzsment. [Health Care Management.] 2003;5:74–77.

7. Kriszbacher I, Oláh A, Bódis J, Boncz I. Health science research in Hungary. CMAJ. 2007;176:809–812.[Free Full Text]

8. McElmurry BJ, Solheim K, Kishi R, Coffia MA, Woith W, Janepanish P. Ethical concerns in nurse migration. J Prof Nurs. 2006;22:226–235.[CrossRef][ISI][Medline]





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