Ethical considerations in the UK-Nepal nurse recruitment: Nepali nurses' perspectives

Abstract

Background: The global migration of nurses from resource-constrained to affluent nations raises complex ethical concerns, often rooted in historical power imbalances and neocolonial legacies. The Nepal-UK Memorandum of Understanding (MoU) on nurse recruitment, while presented as a solution to workforce shortages, exemplifies this complex dynamic, prompting critical questions about its implications for individual nurses and the healthcare systems involved.

Aim: This qualitative study explored the ethical complexities and dilemmas associated with the Nepal-UK nurse recruitment Memorandum of Understanding (MoU). This bilateral agreement has sparked debate about its potential impact on both individual nurses and the healthcare systems of Nepal and the UK.

Research design: A qualitative exploratory design utilizing semi-structured interviews was employed. Data were analyzed using reflexive thematic analysis.

Participants and research context: Twelve Nepali nurses from two private hospitals in Kathmandu, Nepal, participated in the study.

Ethical considerations: The study was approved by the Nepal Health Research Council. All participants provided informed consent and were assured of confidentiality and anonymity.

Results: Four themes emerged from the data: (1) The lingering legacy of colonialism casts a shadow on the Nepal-UK relationship, raising concerns about potential exploitation and unequal power dynamics. (2) Nepali nurses grapple with the ethical dilemmas of pursuing personal dreams while acknowledging their responsibilities towards their communities and Nepal's healthcare system. (3) The MoU's claims of ethical recruitment are scrutinized, with nurses questioning its fairness and sustainability. (4) The agreement is challenged as a potential band-aid solution that may perpetuate global health inequities rather than fostering a genuine partnership.

Conclusions: The Nepal-UK MoU, while offering opportunities for individual nurses, also raises alarms about brain drain, exploitation, and the perpetuation of global health disparities. The study underscores the urgent need for a paradigm shift in international nurse recruitment practices, prioritizing genuine partnership, equitable distribution of benefits, and sustainable solutions that address the root causes of healthcare workforce challenges in both source and destination countries.

Keywords: Colonialism; ethics; exploitation; global health inequities; nurse migration.