Solutions Needed for Unfair Labor and Recruitment Strategies, Including Health Care Sector

New Study Suggests Health Care Workers from Poor Countries Often the Target of Abusive Practices

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Kathy Fackelmann,, 202-994-8354

International recruitment of nurses and other workers, including health care workers, is a global phenomenon that is growing in scope, complexity and impact, according to a review of the practice published online February 11, 2015 in the journal International Migration Review (IMR). The traditional migration patterns are being fueled by changing economic, demographic, political and social conditions, according to the author of the paper, Patricia (Polly) Pittman, PhD, an associate professor of health policy and management at Milken Institute School of Public Health at the George Washington University.

 In the United States the growth of employment agencies is cause for special concern because these agencies often recruit health care workers from undeveloped counties who are poor and have little in the way of employment options. As the practice continues to grow, there have been widespread abuses, including outright fraud and deception--as well as contracts that require the worker to pay back large sums that can result in debt bondage, Pittman says.

A worker who wants to migrate from a poor country to the United States might have to pay for housing and travel costs, recruitment and other fees that can amount to between $5,000 to $60,000, Pittman said.

“In essence, these fees lock workers into low-paying jobs that can last for years,” Pittman says. “They make it difficult or impossible for workers to seek positions paying market rates—even if they have a green card.”

In the paper published in IMR and at a recent meeting held at the United Nations on the same topic, Pittman points out there are promising new strategies that could reduce unfair or abusive recruitment and labor practices. For example, a new law in California bans recruitment fees and mandates the registration of international recruiters and employment agencies. On a national level, the U.S. Department of Homeland Security has launched the Blue Campaign, which aims to raise public awareness of human trafficking and protect workers from unfair labor and recruitment practices.

And non-governmental organizations (NGOs) and labor unions have also jumped into this arena with potential solutions. For example, some labor unions are starting to educate their members about the dangers of recruitment fraud and abuse in the workplace. NGOs have also adopted a “watch-dog” stance in which they look out for abusive practices and file complaints or lawsuits.

Still, Pittman says that greater regulation and other efforts to protect workers must be put in place rapidly, especially if the United States is to continue to fill gaps in the healthcare workforce, including a nursing shortage in a subset of states. A previous paper published by Pittman in the American Journal of Nursing suggested that nurses recruited from other countries, especially those from poor countries, were often subjected to outright recruitment abuses or unequal treatment once they landed a job in the United States.

Read the study published in the International Migration Review,Alternative Approaches to the Governance of Transnational Labor Recruitment,” which is now online.

Read more about Pittman’s survey of nurses and unfair or discriminatory practices in U.S. health care facilities.


Milken Institute School of Public Health:

Established in July 1997 as the School of Public Health and Health Services, Milken Institute School of Public Health is the only school of public health in the nation’s capital. Today, nearly 1,400 students from almost every U.S. state and more than 43 countries pursue undergraduate, graduate and doctoral-level degrees in public health. The school also offers an online Master of Public Health, MPH@GW, and an online Executive Master of Health Administration, MHA@GW, which allow students to pursue their degree from anywhere in the world.