Preface

Human beings are social. Social, in the sense, that, as humans, we construct our realities through socialised values and symbols that we receive as children through our families, schools, peers, and communities.

For social constructionists, who had a strong influence on this book, taken-for-granted realities are formed through our social interactions. Through these social interactions, multiple realities compete for truth and legitimacy, and the way we speak about objects and people may not mirror reality but rather create it.

In this spirit, I would like to propose that we reflect for a moment on what it is to be a nurse. What are your reflections when asked these questions?

In my research journey for this book, these questions were continuously in my mind. During my research, I had many discussions and debates on what it is to be a nurse and what does nurse work entail, especially when it comes to something as intimate as care for oneself or loved ones. Who has the authority to define what it is to be a nurse or what is care? How does the way the nurse occupation is spoken about affect who is chosen to work as a hired nurse? How does talk affect the day-to-day working conditions of a nurse? And, what happens when a nurse is hired from outside a country in which the employers, thousands of kilometres away, have decided on what it is to be a nurse and what nurse work entails in the employers’ country?

In the situated story of this book, these questions were the essence of what I wanted to investigate. Who is claiming authority of how nurses should be transnationally recruited and placed into Finnish organisations? What type of talk and text are being used to socially construct the non-Finnish-educated nurse, and in this particular case, the Filipino nurse? How does talk and text influence practices of hiring and placement or future policies and practices on how to create and maintain a workforce?

This book, through maps of organisational social worlds, which are based on work commitments and actions, wants to metaphorically explain how nurses are produced for particular care networks in Finland. What I want to illustrate with the maps to the reader is that individual representatives and their associated organisations emerge onto the maps with particular organisational commitments such as providing care workers for paying clients, which made certain claims more dominant and others silent.

Finland is, in recent times at least, a relatively new destination for internationally educated nurses in particular and work-related immigration in general. Until the late 1990s, Finland was mainly sending nurses abroad, particularly to other Nordic and European countries like the UK, and the country continues to be a ‘source’ for nurses. Today, there are an estimated 9,000 Finnish-educated nurses living abroad.

Finland is a welfare state in which accessible, equal health care is constitutionally a guaranteed right to all its residents. The legislative aim is a socially sustainable society in which everyone is treated fairly, where social inclusion and participation are encouraged, and everyone’s health is promoted and supported through services equally available to all its citizens. In the Finnish health care sector, there is hardly any unemployment, rather a lack of workforce, especially in rural regions. It is estimated that, by 2025, 20,000 health care professionals will be needed but the figure might be as high as 59,000.

And yet, some scholars have argued that fewer people are being attracted or retained in the nursing occupation. For instance, over 38,000 Finnish-educated nurses are not working in the health care field. Similar to Finland, in both developed and developing countries, careers in health care are also becoming less attractive unless it is a means to migrate. With this in mind, however, research has also shown that many migrant nurses are unable to use all their existing skills, and that much of nurse migration has largely been associated with deskilling. In addition, although many nurses are able to transfer their qualifications across borders, they generally do not advance in their careers and experience downward mobility in terms of occupational seniority and overall financial status. Furthermore, contractual work permits in nursing, which are based on employers’ needs and nationalised standards of qualifications of the nursing profession, have created both female migratory tracks towards lower-status professional segments and new intra-professional divisions that reflect the status of citizenship and the place of graduation for migrant nurse workers.

Migrant and domestic nurses also struggle with a common assumption that a nurse is a nurse is a nurse, which entails that all nurses are the same in qualifications, education, and experience and that a nurse can be ‘substituted’ for another position. This leads to nurses being offered positions that do not suit their qualifications and masks the established hierarchy of global nurses that create experiences for migrating nurses based on their skin colour, ethnic origin, or language skills. Historically, nursing, an occupation that requires advanced education, skill building and experience, continuously struggles to identify its worth among traditionally male-dominated health care fields, such as medicine, dentistry, and public health in tangible ways: salary, prestige, and work conditions.

Today, the amount of internationally educated nurses living and working in Finland remains low, at 1.4% of the total personnel, of which 86% are women. Nonetheless, there has been a growing interest in foreign recruitment of nurses in Finland, especially since 2006 when immigration was adopted as a means to alleviate shortages in the Finnish labour market. In fact, since 2007, there has been a number of recruitment projects that have developed models for the international recruitment of social and health care personnel. The majority of foreign nurses in Finland come from the neighbouring and EU countries, but Asian and African countries are also significant source countries, including the Philippines.

Recent political and economic practices within the global health care industry have created a competitive market amongst countries that equates to big business. Parallel reforms within Nordic welfare regimes have shifted employer’s responsibilities from permanent, stable, unionised labour to more flexible and inexpensive labour.

However, some scholars have argued that although the private investment of recruitment, training and placement is extremely expensive, the profit may not be as high as the employers had hoped. It has been documented that some migrating nurses use countries as ‘stepping stones’ to acquire skills and experience in order to move to another country where the working conditions are deemed as better. This recognises the agency of the migrant nurse but also raises the question of the need to understand and change the local work conditions to better suit nurses in order to retain the nurses to sustain a future workforce, which is much needed in all countries.

In this book, I want to dig deeper into organisational practices of recruitment and placement that serve to construct internationally educated nurses and their day-to-day work. I also want to know who in these Finnish organisations, either directly involved or not, were claiming to be experts on how nurses should be selected and recruited and how the nurses should be managed once in the workplace. In general, I want to understand how the Finnish nursing occupation and the recruited nurses from the Philippines were being constructed through talk and text, and what implications would this have for inclusion of the recruited nurse in the workforce but also the type of care expected for the so-called Finnish clients.

I argue in this book that language does matter. Talk influences our local surroundings and expectations of each other and our institutions of democracy, as well as national and local security such as policing, education, and health and social services, to name a few.

In the case of public health care, there is not one individual who decides on the provision of care. Public health care materialises out of a historical evolution of institutionalised practices and constructed work roles of health care occupations that are legitimised through legislation and expectations for its presence and relevance. In Finland, the practice of accessible, equal health care for all its residents is constitutionally guaranteed and continues to serve as political and social issues within peoples’ homes, the media, and the public domain. When it comes to care, the issues are close to people as, in human nature, we all get sick. That is one thing about being human. Everyone gets sick. And, if life allows, most of us will get old and eventually our bodies will need care.

As pointed out in this book, nursing as an occupation is dominated by females all over the world. Care has also often been historically associated with women’s work, and these assumptions have served to legitimise and reproduce the structuring of care within the home and public organisations. The assumptions have also materialised in the form of global care chains that not only reflect the dominance of women but also hierarchies of race, nationalities, and classes in an unequal economy of trade and resource distribution.

Taken-for-granted assumptions should be problematised both within the practices of how nurses are selected and placed but also in the academic discipline of examining and discussing these practices. This reflective approach means going beyond what is considered the ‘normal’ expectations of care and the occupation and dig deeper in understanding the social and material implications of talk, texts, and interactions that promote either inclusion or exclusion. In order to have a workforce, we need to care about the workers and their work. This means valuing the worker’s time, their identities, and work but also striving for various ways of management that include workers that, in turn, retain and sustain the workforce. In other words, moving beyond human resources with a central focus on the nurses.