Abstract for: The cause of growing foreign-trained nurse concentration and its impact
Working with a group from Singapore’s Ministry of Health we were presented with the dilemma of an ever increasing fraction of foreign nurses despite efforts to increase domestic nurse training capacity. To understand why this might occur we developed a model embodying the hypotheses put forward by the group. The resulting model shows how drifting goals and a focus on rates instead of levels can lead to the observed behavior. We find that as foreign nurse hiring increases, the pressure to educate domestic nurses decreases. Thus, as the burden to reduce a nurse shortage gradually shifts to an external supply of trained nurses, longer term domestic training capacity dissipates. Establishing a fixed desired fraction of foreign nurses keeps the focus on maintaining domestic training capacity. In addition, with an enrollment that is based on the stock values of students and domestic nurses, average residence time of domestic nurses, and delays in training, the system demonstrates greater stability.