Discuss The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees

Discuss The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees
Nurs Admin Q Vol. 43, No. 1, pp. 10–18 Copyright c© 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees

Franklin Shaffer, EdD, RN, FAAN, FFNMRCSI; Mukul Bakhshi, JD; Niamh Farrell, MA; Thomas Álvarez, BA

Nurses and other health care professionals are in a unique position to shift the paradigm around migration debates. As caregivers and advocates for patients and other providers, nurses are crucial to the health and well-being of individuals, families, and communities. This is especially true for migrants, including increasingly vulnerable refugee populations around the world. As negotiations surrounding the Global Compact for Migration and Global Compact on Refugees come to a close, nurses’ roles are becoming more apparent. Nurses are facilitators of migration and can help ensure that the benefits of migration are maximized and the challenges are mitigated. Often, nurses are migrants themselves. Leveraging nurses’ knowledge, experience, talents, and compassion is cru- cial for attaining the objectives of both the Global Compact for Migration and the Global Compact on Refugees. Nurses are large contributors to the United Nations’ 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals. The global nursing workforce has enor- mous potential to advance the achievement of these goals and objectives. In a world that appears to be increasingly xenophobic and hostile to migrants, nurses stand out as professionals who can change the narrative while providing compassionate care for the most vulnerable. Key words: advocacy, Global Compact, migration, refugees, sustainable development, United Nations

NURSES AND THE GLOBAL COMPACTS FOR MIGRATION AND REFUGEES

Nurses and other health care profession- als are looking to amplify their voices in a variety of policy discussions. Many do this through their professional organizations. His- torically, nursing organizations have been ap- prehensive about wading into broader policy

Author Affiliations: CGFNS International, Inc, Philadelphia, Pennsylvania (Dr Shaffer, Ms Farrell, and Mr Álvarez); and CGFNS Alliance for Ethical International Recruitment Practices, Philadelphia, Pennsylvania (Dr Bakhshi).

The authors declare no conflict of interest.

Correspondence: Franklin Shaffer, EdD, RN, FAAN, FFNMRCSI, CGFNS International, Inc., 3600 Market St., Ste. 400, Philadelphia, PA 19104 (fshaffer@cgfns.org).

DOI: 10.1097/NAQ.0000000000000328

debates, as nursing advocacy has traditionally centered on patients and providers.1 How- ever, these organizations have begun to lever- age the credibility of—and public trust in— their profession. The relatively large number of nurses, combined with their considerable expertise, allows them to speak powerfully on a variety of issues that influence their abil- ity to adequately address the health needs of patients. One way to do this is through sup- port of the Global Compact for Safe, Orderly, and Regular Migration and the Global Com- pact on Refugees, discussed later in this arti- cle. The migration-related issues addressed in these compacts impact the very core of health care professionals’ work.

Organizations across the globe are advocat- ing on behalf of both providers and those they serve. The Salvation Army, Eurocarers

mailto:fshaffer@cgfns.org
Nurses in Advancing Global Compacts for Migration and on Refugees 11

(an organization that focuses on those who care for others in Europe, both as unpaid and paid caregivers), and a consortium of 14 other European organizations have released a state- ment lauding the Global Compact as an “op- portunity to commit to reforms and policies that provide social protection and sustainable and quality domestic and care services for those needing care, and decent work for those working in the sector.”2 In the United States, the American Nurses Association has not spo- ken directly on the Global Compact but has stated, “The Code of Ethics for Nurses with Interpretive Statements calls on all nurses to always act to preserve the human rights of vul- nerable groups such as children, women and refugees.”3 The American Nurses Association has also cited that Code in a statement oppos- ing the US policy toward migrants and asylum seekers that led to the separation of parents from their children.4

Nurses can leverage their favorable pub- lic perception to shift the paradigm around migration debates. Globally, many destination countries have highly politically charged en- vironments around immigration policy. Wor- ries about loss of national identity, jobs be- ing “stolen” by migrants, and crime have prompted increasingly xenophobic rhetoric along with the election of officials who fa- vor restrictive immigration policies. However, most countries are more welcoming of nurses and other health care providers. Even as coun- tries have generally moved against support- ing immigration, the skills of foreign nurses and health care professionals are still sought after.5

This phenomenon is not new—the global need for health care workers makes them pre- ferred migrants. Even when the US Congress was acting to restrict immigration through the Illegal Immigration Reform and Immigrant Re- sponsibility Act of 1996, nurses were kept on a shortlist of occupations with an assumed shortage,6 who would therefore be eligible for migration to the United States. Currently, while the Trump Administration has targeted categories of immigrants, such as those who are undocumented or under the H1-B pro-

gram for rule changes, it has not spoken about reducing the number of visas in the visa categories that include most nurses. Re- cently, in the United Kingdom, where con- cerns about migration were a motivation for the vote that the United Kingdom leave the Eu- ropean Union (known informally as “Brexit”), the British Home Office exempted doctors and nurses from the cap placed on the num- ber of skilled workers who could immigrate to the United Kingdom.7 By highlighting the importance of health care professionals to sys- tems and patients, the polarizing immigration rhetoric that paints migrants as criminals and job stealers can be mitigated, allowing for a more reasoned discussion of how to lever- age migration to strengthen the economies of both origin and destination countries.

REFUGEES AND MIGRANTS

International migrants include people who cross borders to live in another country for any reason. Refugees are a subset of that group. According to Dilip Ratha8 at the World Bank, there are 262 million migrants world- wide, including 19 million to 24 million refugees. The United Nations High Commis- sioner for Refugees states,

Under international law, refugees are persons out- side their countries of origin who are in need of international protection because of a serious threat to their lives, physical integrity, or freedom in their country of origin as a result of persecution, armed conflict, violence, or serious public disorder.9 (p1)

Many migrants who do not meet the stan- dards for refugee status leave countries of their own volition. Others are displaced be- cause of unfavorable circumstances such as drought, natural disaster, or poor economic opportunities. Migrants, both refugees and others, require certain protections and are en- titled to universal human rights. This issue is becoming even more urgent, because un- der some scenarios (eg, climate change), the number of migrants could more than triple to 875 million by 2050.8 The Global Compact for Migration and the Global Compact on

12 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2019

Refugees outline these protections and pro- vide pathways for more organized, stable, and safer migration for both groups.

THE GLOBAL COMPACTS

The Global Compact for Safe, Orderly, and Regular Migration and the Global Compact on Refugees stem from the 2016 UN General Assembly Resolution 71/1, New York Dec- laration for Refugees and Migrants.10 The New York Declaration states that, although refugees are a subset of the larger migrant population, the 2 groups are distinct. The New York Declaration contains commitments to refugees and nonforcibly displaced mi- grants (together); commitments to migrants (only); and commitments to refugees (only). It also contains 2 annexes that serve as the foundations for the 2 Compacts. Annex I outlines a Comprehensive Refugee Response Framework (CRRF). The CRRF explains that the United Nations High Commissioner for Refugees is responsible for creating a com- pact specifically for refugees, with the CRRF at its core, as well as programs of action that can be implemented around the world. An- nex II contains the basis for the Global Com- pact for Migration that will “set out a range of principles, commitments and understandings among Member States regarding international migration in all its dimensions.”10(p1)

The Global Compact for Migration is signif- icant because it is the first international com- pact of its kind to specifically address migra- tion. The Compact emphasizes “common un- derstanding, shared responsibilities and unity of purpose,” aiming “to facilitate safe, orderly and regular migration, while reducing the incidence and impact of irregular migration through international cooperation . . . .”11(p1)

Bi- and multilateral agreements between countries about how to achieve this aim are critical. However, civil society, academia, and other stakeholders also play an important role in helping migrants thrive in their current situations. The Global Compact for Migration stresses the importance of migrant empower- ment and its impact on inclusion and stability.

It also identifies the immense potential mi- grants possess, which can be used to attain the Sustainable Development Goals (SDGs).11

The cofacilitators of the Global Compact for Migration (the Permanent Missions of Mex- ico and Switzerland to the United Nations) outlined 23 objectives and commitments that must be attained for safe, orderly, and regular migration. These include—but are not limited to—supporting vulnerable groups within migrant populations, identifying and fighting human trafficking, improving migrant identi- fication and documentation, combating xeno- phobia, and tapping into migrants’ skills and resources to help improve stability, achieve sustainability, and provide a much-needed sense of purpose.10 While the New York Declaration was adopted by all United Na- tions member states, the Global Compact for Migration is not legally binding.12 Its efforts were hampered when the United States with- drew from the Compact in December 2017, stating that it interfered with its sovereignty and domestic immigration policy.13

Refugees, a particularly vulnerable popula- tion, have historically received international protections. This began on a global scale with the 1951 United Nations Convention Relat- ing to the Status of Refugees. The Conven- tion was born out of the atrocities and mass displacement caused by World War II. It ex- plains what determines refugee status, out- lines refugee rights, and explicitly states that a refugee should not be forced to return to a place where his or her life is endangered (nonrefoulement).14 It applied only to those displaced by violence or persecution within Europe before January 1, 1951. The 1967 Pro- tocol Relating to the Status of Refugees ex- panded the scope of the 1951 Convention to refugees around the world and from all time periods.15

The Global Compact on Refugees has 4 main objectives: “Ease the pressure on host countries; enhance refugee self-reliance; ex- pand access to third-country solutions; and support conditions in countries of origin for return in safety and dignity.”12 As pre- viously noted, the CRRF forms the basis

Nurses in Advancing Global Compacts for Migration and on Refugees 13

of the Global Compact on Refugees. Accord- ing to the CRRF, in the New York Decla- ration, “Through a comprehensive refugee response based on the principles of inter- national cooperation and on burden- and responsibility-sharing, we are better able to protect and assist host States and communi- ties involved.”10(p1) Similar to the Global Com- pact for Migration, the Global Compact on Refugees emphasizes the importance of pro- tecting vulnerable populations, promoting so- cial inclusion and cohesion, and encouraging refugee empowerment toward achieving the SDGs. It also emphasizes “burden-sharing” be- tween states, civil society groups, academia, and other relevant stakeholders.16

WORK OF HEALTH CARE ORGANIZATIONS TO ADVANCE FAIR RECRUITMENT

Objective 6 of the Global Compact for Mi- gration seeks to “facilitate fair and ethical re- cruitment and safeguard conditions that en- sure decent work.” The health care sector has been at the forefront of efforts to en- sure ethical recruitment. In 2008, a multi- stakeholder task force including recruiters, employers, unions, nurse representative orga- nizations, and credential evaluation organiza- tions established a code of standards of prac- tice to ensure that recruitment of international health care workers is ethical. From its incep- tion, the Code has been administered by the Alliance for Ethical International Recruitment Practices, now a division of CGFNS Interna- tional, Inc. It was updated as the Health Care Code for Ethical International Recruitment & Employment Practices in 2016.17 The Code was designed to set best practices to ame- liorate contract and other problems rampant during the 2003-2007 boom years for the re- cruitment of foreign-educated nurses (FENs) to the United States.18

The Alliance Code preceded the devel- opment of the World Health Organization’s (WHO’s) 2010 Code of Global Practice on the International Recruitment of Health Care Personnel, which provides voluntary guid-

ance for member states. Members promise to report on their progress on following this guidance every 3 years.

The two codes support each other and work sym- biotically, with the WHO Code articulating global principles and a framework for international aware- ness and cooperation, and the Alliance Code pro- viding detailed guidance to individuals and com- panies operating in the healthcare recruitment sector.19 (p1)

The Global Compact for Migration con- tains a number of objectives and priorities. Objective 1 cites the need for data as the basis of evidence-based policies. The Inter- national Centre on Nurse Migration, created by CGFNS and the International Council of Nurses, represents an effort to aggregate re- search in this sector.20 While these volun- tary initiatives have had challenges in gaining traction, they provide guidance as the United Nations, regional cooperatives, and individual countries seek to promote fair and ethical re- cruitment at both the national and grassroots levels.

NURSING CONTRIBUTIONS TO THE GLOBAL COMPACT FOR MIGRATION OBJECTIVES

Nurses play a critical role in achieving the goals and objectives of the Global Compact for Migration. Migrant nurses “address and reduce vulnerabilities in migration” (objec- tive 7).11 Migrant populations are largely com- posed of women and children, many of whom need medical attention.21 These groups are also at a greater risk for gender-based vio- lence and harassment. Certain cultural norms often prevent women from reporting violence and seeking help, particularly if the authority figure is male. Nurses can help bridge this gap. As the majority of nurses are female, women of vulnerable populations who experience vi- olence, harassment, or need medical attention can find refuge in a female nurse. As a re- sult, nurses are key to advancing objective 10: “Prevent and combat trafficking in persons in the context of international migration.”11(p1)

14 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2019

With proper education, nurses can identify and stop trafficking, in addition to providing medical care.22

Migrant nurse contributions are perhaps most apparent in objectives 15 and 16. Objec- tive 15 discusses “Provid[ing] basic services for migrants.” This portion of the Compact states that the following is supremely impor- tant: “Promote the implementation of the rec- ommendations of the WHO Framework of Pri- orities and Guiding Principles to Promote the Health of Refugees and Migrants.”11(p1) These priorities are not achievable without nurses, particularly priority 1: “Advocate mainstream- ing refugee and migrant health in the global, regional and country agendas and contin- gency planning.”23(p1)

Objective 16 seeks to “empower migrants and societies to realize full inclusion and so- cial cohesion.”11(p1) Migrant participation in the labor force provides a myriad of benefits for the migrant, the migrant community, and the host country. Migrant nurses contribute to the health and well-being of the migrant and host communities. Healthy migrants are better able to work and provide for their fam- ilies. More migrants in the labor force lead to increased interaction and cohesion between the migrants and host country and potentially increase the economic activity of the host country. The theme of the 2030 Agenda for Sustainable Development is “leave no one

behind”; migrant nurses are crucial in this fight.24

SUSTAINABLE DEVELOPMENT GOALS

The 2030 Agenda for Sustainable Develop- ment outlines 17 specific goals (SDGs) that the United Nations has set for the world to reach by 2030. The SDGs were promulgated in 2015, replacing the Millennium Develop- ment Goals. As indicated in the Figure, the SDGs cover almost every facet of life from “Clean Water and Sanitation” to “Peace, Jus- tice and Strong Institutions.”24(p1) The SDGs and the Global Compacts go hand in hand. The Global Compact for Migration seeks to “empower migrants to become full members of our societies, highlight their positive con- tribution, and promote social cohesion.”11(p1)

The Global Compact on Refugees seeks to pro- mote self-reliance and equitable burden- and responsibility-sharing.16 Both Compacts view migrant talents and experiences as resources that can be utilized to achieve the SDGs.

NURSING AND THE SUSTAINABLE DEVELOPMENT GOALS

Just as nurses have the potential to achieve many of the Global Compact for Migration’s and the Global Compact on Refugees’ objec- tives, they and their organizations have the

Figure. The Sustainable Development Goals are part of the 2030 Agenda for Sustainable Development, as promulgated by the United Nations.

Nurses in Advancing Global Compacts for Migration and on Refugees 15

potential to help achieve the SDGs.26 Nurs- ing’s most obvious contribution to the SDGs is through “Goal 3: Good Health and Well Being.” This goal seeks to “ensure healthy lives and promote well-being for all at all ages.”24(p1) As health care providers, nurses are on the front lines of community health and primary care. They are also available as family planning consultants, advocates for ma- ternal health, and health educators. Nurses’ work helps achieve other SDGs as well. A healthy population is better equipped to at- tend school, experience reduced inequalities, and focus on SDGs such as achieving “Sustain- able Cities and Communities.”24(p1)

Nursing also promotes gender equity (goal 5).24 Nursing is a female-dominated profes- sion. Furthermore, nursing is one of the few professions women are encouraged to pur- sue, as opposed to remaining in the home as wives and mothers. Female nurses are role models for younger generations of women. While nursing is not a well-respected profes- sion in many parts of the world, it is essen- tial for quality health care. Nurses in these countries not only provide extremely impor- tant health care but also serve as beacons of female empowerment.

Nursing is fundamental to the SDGs as a whole. Poverty cannot be eradicated without health care providers. Hunger cannot be sus- tainably eliminated without nutritional educa- tion. Sustainable cities will not develop with- out a strong, healthy workforce. A healthy workforce leads to the achievement of SDGs, such as caring for life below water and life on land. Development is impossible without health. Good health leads to better workers, and increased stability, which reduces the push to migrate.

NURSES AS FACILITATORS FOR MIGRATION

Nurses are on the front lines in serving the world’s most vulnerable populations, in- cluding refugees and migrants. As previously noted, there are an estimated 262 million international migrants, an increase from

155 million in 2000.8 Women represent 48% of all international migrants.27 Refugee and migrant populations possess a unique set of medical needs. A report on refugee patient outcomes in Geneva, Switzerland, found that language barriers and cultural differences be- tween patients and practitioners negatively impact the health deliverance outcomes.28

This study found that adequate (interpretive) language services are associated with a higher and more accurate reporting of medical his- tory, past trauma, and mental illness, as well as an increased level of psychological refer- rals. Similarly, when asylum seekers perceived their communication with nurses to be good, they reported 2 to 3 times as many symptoms as when they rated their communication to be poor.28

Migrants around the world, particularly women and children, are more susceptible to abuses such as extortion, sexual and physi- cal assault, and human trafficking. As previ- ously noted, nurses can help mitigate these abuses, particularly human trafficking, in sup- port of objective 10. In the case of hu- man trafficking, the nursing profession is in- volved in its prevention throughout the care continuum—from initial discovery and identi- fication to intervention and finally to restora- tion of health.29 Nurses are often the first to encounter victims of human trafficking, whether they are able to identify them or not. In the United States, for example, trafficking victims often do not speak English, are not fa- miliar with American culture, and are not in the position to ask for help. In many cases, they are threatened with physical or sexual violence should they disobey the demands of their traffickers.29 The same can be said for mi- grants and refugees who are victims of sexual or physical abuse and extortion. In general, migrants and refugees are incredibly vulner- able and are likely to underplay the abuses they may have experienced because of fear of repercussion or even deportation.

With proper training, nurses can recognize the unseen and nuanced signs of human traf- ficking and other abuses and then work to address them. In an interview with Nursing

16 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2019

Administration Quarterly, Kimberly Will- iams, Program Coordinator for Spiritual Care at Baylor St Luke’s Hospital, offered some ex- amples of red flags that may signal human trafficking. These include bruising, illness, or trauma caused by past negligence, a patient’s inability to answer common questions, and a patient’s lack of identification.22 While it can be painful and traumatizing for a patient to dis- cuss experiences of abuse, nurses are profes- sionally positioned and possess the emotional sensitivity to identify and treat these victims.

NURSES AS MIGRANTS THEMSELVES

Since its inception, the nursing profes- sion has crossed borders to deliver nursing care.30 Western nursing methods have been exported from the developed to the devel- oping world since the 1800s.31 American missionaries shared their nursing practices with Korea and China,32 as did British citi- zens with colonies throughout the world.33

During the World War II era, the United States introduced Western-style nursing meth- ods to the Philippines, which, in turn, became the global leader for creating and exporting nurses internationally.34

While international migration continues to intensify, international nurse migration in- creases in tandem. Globally, the demand for nurses has reached unprecedented heights because of factors that include aging pop- ulations, increased health coverage, and in- creases in chronic diseases worldwide. To ad- dress these challenges, many countries are relying more heavily on nurse migration to fill vacancies and address demand. Nurse mi- grants are highly skilled and have more re- sources and means to migrate than lower- skilled workers. In the United States, FENs make up between 6% and 15% of the RN workforce and women represent 83% of this number.35,36 FENs make up an estimated 7.9% of the nursing workforce in Canada, 15.2% in the United Kingdom, 18.3% in Australia, and 26.7% in New Zealand.37 As discussed ear- lier, these nurses are pivotal to advancing the

objectives of the Global Compacts and the 2030 Agenda for Sustainable Development.

NURSES AS REFUGEES

While highly skilled workers such as nurses are often the first to migrate in situations of conflict or natural disaster, they are not al- ways able to migrate. Some become forcibly displaced and forced to flee their countries, along with other refugees. The case of these nurse refugees is a topic that has become in- creasingly visible in discussions surrounding refugees around the globe. Global discourse surrounding refugees does not typically recog- nize nurses for the educational or professional competencies that they possess. The narrative around refugees and displaced persons needs to evolve to highlight their skill sets and their social and economic potential. The skills of nurse refugees should be better leveraged to further advance the goals and objectives of the Global Compacts. Nurse refugees possess the cultural, linguistic, and experiential skill sets to serve refugee populations, especially in populations from their countries of origin.

The Global Compact on Refugees empha- sizes refugee self-reliance and burden- and responsibility-sharing, which are particularly pertinent for refugee nurses. The Compact states that strengthening local capabilities is critical. Refugee nurses should be particularly valuable in serving other refugees in their communities. However, because of host coun- try restrictions, refugee nurses experience in- creased difficulty finding employment, even with organizations that serve their popula- tions and communities. CGFNS International, Inc, has developed a policy for refugee nurses seeking employment and the dignity of re- turning to the work of caregiving. CGFNS can help reconstruct their credentials for evalua- tion purposes when original documentation may not be available.

The Global Compact on Refugees also lists the protections refugees require during dif- ferent stages of migration.16 Nurses are nec- essary at each of these stages, particularly at reception and admission. Refugee nurses

Nurses in Advancing Global Compacts for Migration and on Refugees 17

stationed at the reception/admission point can be a comfort to new arrivals and can pro- vide care with a personal sense of understand- ing and compassion born of their own expe- riences. Vulnerable populations have unique health disorders and conditions and require specific health care needs. Refugee popula- tions may be more inclined to receive care from a fellow refugee health care provider. Often, noncommunicable diseases, such as mental health disorders, are the leading health issues facing refugee communities. In most cases, cultural and linguistic competency is key to delivering adequate care to these pop- ulations. A refugee nurse would be more qual- ified and appropriate to care for refugee pop- ulations than local or foreign volunteer health workers. Apart from gains to patient care delivery, tapping into this labor pool would bring desired economic benefits, including relief to strained health workforces in host countries.

CONCLUSION

The Compacts described in this article are an attempt to holistically address the chal- lenges and opportunities of migration, given current global realities. Nurses have a key role to play in advancing these objectives in a world where migration will continue to rapidly increase. Nurses are migrants in demand and can help shift the often toxic rhetoric around migration issues. They are at the front lines in helping migrant and refugee populations escape poverty or oppression and then integrate into their new countries. Nurses can use this opportunity and their piv- otal role to advance the core objectives of the profession’s advocacy—to support nurses and protect their patients—by ensuring that nurses’ expertise is embedded in efforts to ap- ply the principles of these United Nations’ ini- tiatives on the ground in both migrant source and destination countries.

REFERENCES

1. Shaffer F, Bakhshi M, Jacobs A. Advocating to pro- tect our nurses: addressing unethical recruitment of foreign-educated nurses. Nurs Adm Q. 2018;42(2): 107–114.

2. Eurocarers | European Association Working for Car- ers. The Global Compact on Migration is an opportu- nity to commit to reforms delivering a sustainable do- mestic and care model in the European Union. http:// www.eurocarers.org/Global-Compact-on-Migration. Accessed June 28, 2018.

3. American Nurses Association. Code of ethics for nurses with interpretative statements. https://www. nursingworld.org/practice-policy/nursing-excellence /ethics/code-of-ethics-for-nurses/coe-view-only. Pub- lished January 2015. Accessed September 7, 2018.

4. American Nurses Association. American Nurses As- sociation calls for an immediate end to immoral and cruel practice of separating children from their families. https://www.nursingworld.org/news/news -releases/2018/separation-of-children-families. Pub- lished June 19, 2018. Accessed June 28, 2018.

5. Erdal MB. Nurse Migration and the Global Compact for Migration—Migration Welfare (WELLMIG). Journalism and Media International Center (JMIC) Web site. https://blogg.hioa.no/wellmig/2018/03/06 /nurse-migration-global-compact-migration. Publis- hed March 6, 2018. Accessed June 28, 2018.

6. Siskind Susser PC. Visa options for nurses, part 2: Immigrant visa options. http://www.visalaw.com/ visa-options-for-nurses-part-2-immigrant-visa-options. Published May 9, 2014. Accessed June 28, 2018.

7. Lillywhite L. Relaxing visa caps will do nothing to address a worldwide shortage of medics. Chatham House Web site. https://www.chathamhouse.org/ expert/comment/relaxing-visa-caps-will-do-nothing -address-worldwide-shortage-medics. Published June 28, 2018. Accessed June 28, 2018.

8. Ratha D. Exchange of Views on Innovative Interna- tional Cooperation in the Implementation of the Global Compact for Migration. Washington, DC: World Bank; 2018.

9. United Nations High Commissioner for Refugees. The Refugee Concept Under International Law: Global Compact for Safe, Orderly and Regular Migration. Geneva, Switzerland: United Nations High Commis- sioner for Refugees; 2018.

10. United Nations General Assembly. Resolution 71/1, New York declaration for refugees and migrants (2016).

11. United Nations. Global Compact for Safe, Orderly, and Regular Migration DRAFT Revision 2. New York, NY: United Nations; 2018.

12. United Nations. Towards a Global Compact on Refugees. UNHCR Web site. http://www.unhcr.org/

http://www.eurocarers.org/Global-Compact-on-Migration
http://www.eurocarers.org/Global-Compact-on-Migration
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only
https://www.nursingworld.org/news/news-releases/2018/separation-of-children-families
https://www.nursingworld.org/news/news-releases/2018/separation-of-children-families
https://blogg.hioa.no/wellmig/2018/03/06/nurse-migration-global-compact-migration
https://blogg.hioa.no/wellmig/2018/03/06/nurse-migration-global-compact-migration
http://www.visalaw.com/visa-options-for-nurses-part-2-immigrant-visa-options
http://www.visalaw.com/visa-options-for-nurses-part-2-immigrant-visa-options
https://www.chathamhouse.org/expert/comment/relaxing-visa-caps-will-do-nothing-address-worldwide-shortage-medics
https://www.chathamhouse.org/expert/comment/relaxing-visa-caps-will-do-nothing-address-worldwide-shortage-medics
https://www.chathamhouse.org/expert/comment/relaxing-visa-caps-will-do-nothing-address-worldwide-shortage-medics
18 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2019

en-us/towards-a-global-compact-on-refugees.html. Accessed June 20, 2018.

13. Beavers O. US pulls out of Global Compact on Migration. The Hill. http://thehill.com/homenews/ administration/363014-us-pulls-out-of-global-compact -on-migration. Published December 3, 2017. Acces- sed June 26, 2018.

14. United Nations General Assembly. Resolution 429 (V), Convention relating to the status of refugees (1950).

15. United Nations General Assembly. Protocol relating to the status of refugees, Treaty Series, Vol 606, p. 267 (1967).

16. United Nations High Commissioner for Refugees. The Global Compact on Refugees DRAFT 2. Geneva, Switzerland: United Nations High Commissioner for Refugees; 2018.

17. Alliance for Ethical International Recruitment Prac- tices. Health Care Code for Ethical Recruitment and Employment Practices. Philadelphia, PA: Alliance for Ethical International Recruitment Practices; 2017. http://www.cgfnsalliance.org/wp-content/ uploads/2017/09/Health-Care-Code-for-EIREP-Sept- 2017_FINAL.pdf. Accessed October 16, 2016.

18. Pittman P, Herrera C, Spetz J, Davis CR. Immigra- tion and contract problems experienced by foreign- educated nurses. Med Care Res Rev. 2012;69(3): 351–365.

19. Shaffer FA, Bakhshi M, Dutka JT, Phillips J. Code for ethical international recruitment practices: the CGFNS Alliance case study. Hum Resour Health. 2016;14(suppl 1):31.

20. International Centre on Nurse Migration. About us. www.intlnursemigration.org. Accessed June 30, 2018.

21. UN Women. In focus: women refugees and migrants. http://www.unwomen.org/en/news/in-focus/women -refugees-and-migrants. Accessed June 26, 2018.

22. Sanford K. Advocacy for all—but especially for the most vulnerable. Nurs Adm Q. 2018;42(2):100–106.

23. World Health Organization. Promoting the Health of Refugees and Migrants: Framework of Priorities and Guiding Principles to Promote the Health of Refugees and Migrants. Geneva, Switzerland: World Health Organization; 2017.

24. United Nations General Assembly. Resolution 70/1, Transforming our world: the 2030 Agenda for Sus- tainable Development (2015).

25. United Nations. Sustainable Development Goals. https://www.un.org/sustainabledevelopment/ sustainable-development-goals. Accessed June 20, 2018.

26. Benton D, Shaffer F. How the nursing profession can contribute to the sustainable development goals. Nurs Manag (Harrow). 2016;23(7):29–34.

27. International Organization for Migration. World Mi- gration Report 2018. Le Grand-Saconnex, Swit zerland: International Organization for Migration; 2018.

28. Bischoff A, Bovier PA, Rrustemi I, Gariazzo F, Eytan A, Loutan L. Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral. Soc Sci Med. 2003;57(3):503–512.

29. Sabella D. The role of the nurse in combating human trafficking. Am J Nurs. 2011;111(2):28–37.

30. Smith P, Mackintosh M. Profession, market and class: nurse migration and the remaking of division and disadvantage. J Clin Nurs. 2007;16(12):2213– 2220.

31. Yeates N. Ireland’s contributions to the global health care crisis. In: Globalization, Migration and Social Transformation: Ireland in Europe and the World. Farnham, Surrey, England: Ashgate; 2011:35–50.

32. Shin SR, Shin KR, Li CY. Nursing education sys- tems in Korea, China and the United States of Amer- ica and its future directions. J Korean Acad Nurs. 2002;32(7):949–959.

33. Solano D, Rafferty AM. Can lessons be learned from history? The origins of the British imperial nurse labour market: a discussion paper. Int J Nurs Stud. 2007;44(6):1055–1063.

34. Yeates N. Production for export: the role of the state in the development and operation of global care chains. Popul Space Place. 2009;15(2):175–187.

35. National Council of State Boards of Nursing. 2015 National Nursing Workforce Study. https://www. ncsbn.org/workforce.htm. Accessed June 20, 2018.

36. Hohn M, Lowry J, Witte J, Fernandez-Pena JR. Immi- grants in Health Care: Keeping Americans Healthy Through Care and Innovation. Fairfax, VA: George Mason University Institute for Immigration Research; 2016.

37. OECD.Stat. Health workforce migration: % of foreign- trained nurses. https://stats.oecd.org/Index.aspx? DataSetCode=HEALTH_WFMI. Accessed on June 29, 2018.

Discuss The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees

develop a written implementation plan.

What cultures, other than your own, do you encounter in your workplace?

Discuss The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees