Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing

Amid aging populations and the growth of chronic diseases, the demand for skilled health-care professionals is on the rise in the three countries of North America. In the United States alone, an estimated 5.6 million vacancies for health-care professionals at all skill levels will open up between 2010 and 2020, and the numbers in Canada and Mexico tell a similar story. At the same time, the countries of Central America, particularly El Salvador and Guatemala, are facing a critical nurse shortage. 

Thus far, regional approaches to increasing the supply of qualified nurses have been rare. One promising yet underexplored avenue is the harmonization of nurse qualifications across the region, a process by which countries that face similar health-care challenges work together to develop an understanding of one another’s training and education systems, identify gaps between these systems, and create strategies to bridge these gaps over time.

This report explores the policy implications, benefits, and challenges of harmonizing nursing qualifications in North America. The payoffs of such cooperation are substantial: it can decrease brain waste and deskilling among nurses, increase the quality of care in all countries involved, and expand opportunities for nurses to practice where their skills are needed and to take advantage of new job opportunities in medical tourism and tele-health. However, as the report discusses, policymakers and private-sector actors must first overcome a range of obstacles to harmonization. Challenges include differences among the countries involved in the educational requirements of entering into nursing programs, dispersal of decision-making power among a patchwork of institutions regulating the nursing profession, and administrative barriers to recognition of qualifications—the flurry of red tape that nurses must pass through to take up nursing again after moving across borders.

Despite the inherent challenges, the report emphasizes that the collection of experiences and best practices available today is rich enough to inform and underpin more concerted regional harmonization action, and notes that political will and commitment are necessary to take the next step of moving to the harmonization of licensing requirements and other standards, in the nursing field and beyond.