Profession, market and class: nurse migration and the remaking of division and disadvantage.

AIMS AND OBJECTIVES: This article aims to analyse the part played by successive waves of nurse migration in changing patterns of division and disadvantage within nursing. We argue that migration has in part acted to reinforce disadvantage based on class and gender, race and ethnicity and identify the influence of changes in nursing structure and commercialization of care in these processes. BACKGROUND, DESIGN AND METHODS: The historical analysis of division within nursing and the impact of migration are based on secondary sources (literature review) and primary research undertaken by ourselves and colleagues. The paper develops a concept of 'remaking' disadvantage drawing on analysis in social history of the interplay between agency and economic position in the 'making' of class. It uses the extended case method to focus on the residential care sector, showing how global and national influences operate at the frontline of service delivery.

RESULTS: We show how social class and gender, race and ethnicity have interacted and are reflected in the division of labour within nursing. We demonstrate how the employment conditions of nurse migrants have reinforced patterns of disadvantage. The case study of the residential care home sector deepens our analysis of intersecting sources of professional disadvantage including aspects of commercialization, in a sector where they have severe effects for vulnerable staff and patients.

CONCLUSIONS: In the UK, migrant professional nurses have repeatedly acted both as a highly valued labour force on whom patients and clients rely and as involuntary contributors to remaking disadvantage. This situation is sustained by the current international labour market and rising commercialization which facilitate nurse migration and the segmentation of care work based on a 'pecking order' of specialties that reinforce existing divisions of social class, gender and race within nursing.

RELEVANCE TO CLINICAL PRACTICE: Migrant nurses play a key role in the delivery of 'frontline' care to patients. The role many currently play reinforces disadvantage within nursing in ways that are problematic for the profession, patients and clients. The recognition and valuing of their skills is critical to the promotion of their own morale which in turn has an impact on their relationship with colleagues and the delivery of patient and client care.