ArticlePDF Available

Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers: The Case of Nova Scotia, Canada

Authors:

Abstract

Mobility and movement is an increasingly important part of work for many, however, Employment-Related Geographical Mobility (ERGM), defined as the extended movement of workers between places of permanent residence and employment, is relatively understudied among healthcare workers. It is critical to understand the policies that affect ERGM, and how they impact mobile healthcare workers. We outline four key intersecting policy contexts related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova Scotia: international labour mobility and migration; interprovincial labour mobility; provincial credential recognition; and, workplace and occupational health and safety.
[12] HEALTHCARE POLICY Vol.14 No.2, 2018
Intersecting Policy Contexts of Employment-
Related Geographical Mobility of Healthcare
Workers: The Case of Nova Scotia, Canada
Intersection des contextes politiques liés à la mobilité
géographique des travailleurs de la santé : le cas de la
Nouvelle-Écosse, Canada
SHIVA NOURPANAH, PHD
Department of Sociology and Social Anthropology
Dalhousie University
Halifax, NS
IVY BOURGEAULT, PHD
Telfer School of Management
University of Ottawa
Ottawa, ON
LOIS JACKSON, PHD
School of Health and Human Performance
Dalhousie University
Halifax, NS
SHERI PRICE, PHD
School of Nursing, Dalhousie University
Halifax, NS
PAULINE GARDINER BARBER, PHD
Department of Sociology and Social Anthropology
Dalhousie University
Halifax, NS
MICHAEL P. LEITER, PHD
School of Psychology
Deakin University
Melbourne, Australia
DISCUSSION AND DEBATE
Abstract
Mobility and movement is an increasingly important part of work for many, however,
Employment-Related Geographical Mobility (ERGM), defined as the extended movement of
workers between places of permanent residence and employment, is relatively understudied
among healthcare workers. It is critical to understand the policies that affect ERGM, and
how they impact mobile healthcare workers. We outline four key intersecting policy contexts
related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses
HEALTHCARE POLICY Vol.14 No.2, 2018 [13]
(RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova
Scotia: international labour mobility and migration; interprovincial labour mobility; provin-
cial credential recognition; and, workplace and occupational health and safety.
Résumé
La mobilité et les déplacements sont de plus en plus importants au travail, cependant la mobilité
géographique pour le travail (MGT) – soit le déplacement des travailleurs entre le lieu de rési-
dence permanente et le lieu de travail – est relativement peu étudiée chez les travailleurs de la
santé. Il est primordial de comprendre les politiques qui affectent la MGT ainsi que leur impact
sur les travailleurs de la santé. Nous dégageons quatre contextes d’intersection politique liés à
la MGT des travailleurs de la santé, notamment pour la mobilité des infirmières autorisées, des
infirmières auxiliaires autorisées et des préposés aux soins prolongés en Nouvelle-Écosse. Ces
contextes sont : la mobilité et la migration de la main-d’œuvre internationale; la mobilité de la
main-dœuvre interprovinciale; la reconnaissance provinciale des titres de travail; et la santé et la
sécurité au travail.
T
E-   ()    
mobility and extended travel or movement of workers between places of permanent
residence and employment (Cresswell et al. 2016; Roseman et al. 2015). This mobil-
ity may range from travel across international and interprovincial borders to secure work,
to extended local and regional movement conducted as part of regular daily work schedules
(e.g., home care workers). Scholars from across disciplines are paying increasing attention to
ERGM and relevant theoretical perspectives in various sectors (Cresswell et al. 2016; Green
2004; Haan et al. 2014). The literature on the migration and mobility of healthcare work-
ers both globally (for example, Kingma 2006; OECD and WHO 2010; OECD 2008) and
locally (Fitzpatrick and Neis 2015) is also flourishing. These studies point to a variety of
challenges and concerns arising from the ERGM of healthcare workers, ranging from brain-
drain, labour shortages and surpluses, and de-skilling, to the isolation and exclusion faced by
foreign workers, as well as the specific vulnerabilities associated with healthcare work in the
domestic sphere, as faced by home care workers.
It has been noted that geographical mobility among healthcare professionals takes place
at higher rates compared to the general workforce, however, this mobility is mostly intrapro-
vincial, rather than interprovincial, or in other words, between communities within the
same province or territory (CIHI 2007). Relatively little is known, however, about the full
spectrum of ERGM from international to local among healthcare workers in the Canadian
context and the policies that influence and shape their mobility.
We focus on the mobility of Registered Nurses (RNs), Licensed Practical Nurses
(LPNs) and Continuing Care Assistants (CCAs) into, within, and out of Nova Scotia, while
Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers
[14] HEALTHCARE POLICY Vol.14 No.2, 2018
acknowledging that healthcare workers with a range of professional and paraprofessional
backgrounds engage in regular ERGM. These intersecting policy contexts are: international
labour mobility and migration; interprovincial labour mobility; provincial credential recogni-
tion; and, workplace and occupational health and safety. There are important shortcomings
in these policy contexts that render workers engaging in ERGM vulnerable to a range of
challenges.
Setting the Stage: Nova Scotia and the ERGM of Healthcare Workers
Many of the demographic characteristics of Nova Scotia are similar to those facing other
provinces but are sufficiently exacerbated to warrant the label “canary in the coal mine”
(Tutton 2008). Specifically, the ERGM of healthcare workers in Nova Scotia is occurring
in a context characterized by:
a large rural population;
a declining and aging population;
a declining and aging workforce;
high rates of chronic diseases;
out-migration; and
an ongoing restructuring of the healthcare system.
Arguing from differing policy and academic perspectives, commentators suggest that a
combination of these features produces a variety of labour shortages in the healthcare work-
force (Province of Nova Scotia 2013b; Valiani 2012). Concurrently, workers’ movements and
mobility patterns into, out of, and within the province are occuring and may be increasing.
The literature indicates that healthcare labour issues such as downsizing, casualization, the
replacement of steady and stable jobs with shift work and the lack of guaranteed work hours
and standardized patient-to-nurse ratios all make healthcare an “unfriendly” and difficult
place to retain staff. Such factors may contribute to mobility, with Canada witnessing high
rates of out-migration of nurses to the US (MacMillan 2013; McGillis Hall et al. 2013;
Grinspun 2003).
Methods
Policies and policy-related literature of relevance to the ERGM of healthcare workers was
gathered between September 2012 and December 2015 yielding over 30 relevant English
language documents and website content.1 There were no limits placed on the dates of publi-
cations. Two main strategies were used to gather information:
1) Keyword searches in Google Scholar, JSTOR, EBSCOhost, MEDLINE, and
ScienceDirect amongst others.2 Keywords included (but were not limited to) health-
care, human resources, Nova Scotia, labour mobility, demographics, immigration,
Shiva Nourpanah et al.
HEALTHCARE POLICY Vol.14 No.2, 2018 [15]
Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers
outmigration, healthcare jobs, temporary foreign workers, mobility, vehicles, road,
driving, commuting, motor vehicle accidents, and occupational safety and various
permutations thereof.
2) Review of the official websites of government agencies, research institutions and
think tanks. These agencies/institutions/think tanks included Statistics Canada,
Health Canada, Citizenship and Immigration Canada, the Labour Mobility
Coordinating Group, the Government of Nova Scotia, and the Healthcare Human
Resource Sector Council.
Our study is limited to public documents and to key policies related to ERGM during
the period of data collection. Four people from relevant stakeholder agencies were consulted
during the final phases of this study as our research clarified the key agencies and their
role. These agencies include the provincial College of Registered Nurses, the Nova Scotia
Nurses’ Union, the Nova Scotia Office of Immigration, and the Department of Health and
Wellness. Our consultations augmented the policies extracted through our online searches
and provided additional insight. Although the original project design included physicians,
midwives and social workers, we limited ourselves to the study of nurses and CCAs, where
information was more readily available. We acknowledge our study does not capture all poli-
cies that may affect the ERGM of healthcare workers, but it provides an overview of some
general concerns and relevant policy contexts. We identified four key policy contexts fol-
lowing our review of the literature and websites, and discuss each of these contexts from the
international to the local level, in turn below.
a) International Labour Mobility and Migration
One of the key policy contexts related to the international mobility of healthcare workers
is the Temporary Foreign Worker Program (TFWP), which is administered federally, and
aims to fill labour shortages in the Canadian work force. Employers wishing to hire foreign
workers under the TFWP need to obtain a Labour Market Impact Assessment (LMIA),
which documents that an employer has searched for and failed to find a Canadian recruit,
and has obtained a work permit for the worker they intend to hire. The TFWP is utilized by
employers across Canada, in a variety of industries.
TEMPORARY FOREIGN WORKERS TFWS IN HEALTHCARE IN NOVA SCOTIA
Nurses utilize the TFWP to move into Nova Scotia from overseas and work in the province.
During the 2008–2015 period, there were 1,022 TFW positions on approved LMIAs –
that is, where the request of the employer to hire a TFW was approved by the federal
government – in the health occupations in Nova Scotia (Government of Canada 2016).
Information requested from Citizenship and Immigration Canada (CIC – renamed to
Immigration, Refugees and Citizenship Canada in 2015) suggests a limited number of work
[16] HEALTHCARE POLICY Vol.14 No.2, 2018
permits have been issued in Nova Scotia. Between the years 2009–2014, the CIC issued
135 work permits for the following three categories: RNs and registered psychiatric nurses;
general practitioners and family physicians; and LPNs. Of these three categories, LPNs were
the most populous (95 permits). Further details about the employers of these workers were
not available for analysis. However, statistics reported by the College of Licensed Practical
Nurses, Nova Scotia, indicate that during the period 2012–2016, the profession registered
an average of 302 new LPN registrants a year, thus it can be deduced that the figure provided
by CIC represents a significant portion of newcomer LPNs (CLPNS, 2016).
FEDERAL AND PROVINCIAL REGULATION OF TFWS
CIC and Employment and Skills Development Canada regulate the entrance of workers into
the country; however, once they are working in Nova Scotia, provincial labour legislation
applies. The Worker Recruitment and Protection Act has portions that amend the Labour
Standards Code to provide protections for foreign workers. These portions include provi-
sions such as prohibiting the charging of recruitment fees to foreign workers coming to Nova
Scotia, prohibiting employers from reducing wages or any other condition of employment
that the employer agreed to provide at the time of recruitment, and prohibiting a recruiter or
employer from retaining a worker’s property, e.g., a passport or work permit.
b) Interprovincial Labour Mobility
The constitutional right to move for employment for Canadian citizens and permanent resi-
dents within Canada is supported at the national level through the Agreement on Internal
Trade (AIT). The AIT has the explicit aim of eliminating unnecessary interprovincial barri-
ers to the free movement of workers, goods, services and investments, including achieving full
labour mobility for workers in regulated occupations in Canada. This applies to the labour
mobility among healthcare workers. The implementation of the AIT remains problematic,
with each province listing occupations where exceptions to full labour mobility are main-
tained. Nova Scotia maintains seven such exceptional occupations. LPNs are the only one of
these seven exceptional occupations relevant to this study. Practitioners in these exceptional
occupations must undergo additional procedures before they can practice in Nova Scotia
(Province of Nova Scotia 2013b).
c) Credential Recognition, Provincial Licensure and Fairness Legislation
Credential recognition and provincial licensure as it relates to ERGM is particularly impor-
tant for healthcare providers entering the country or crossing provincial boundaries. Health
professions that are regulated (medicine, nursing, etc.) are regulated through provincial
Colleges; each College has its own standards for assessing qualifications. Although com-
petency exams for regulated health workers are delivered nationally (except in Quebec),
practitioners are licensed and registered to practice by provincial/territorial professional
regulatory bodies.
Shiva Nourpanah et al.
HEALTHCARE POLICY Vol.14 No.2, 2018 [17]
In Nova Scotia, the College of Registered Nurses of Nova Scotia is the regulatory
body for almost 10,000 RNs and nurse practitioners. LPNs are regulated by the College
of Licensed Practical Nurses of Nova Scotia.3 CCAs are not regulated, but since 2006, the
provincial Department of Health and Wellness has required certification. Because of the
challenges of credential recognition, regulatory bodies themselves have come under increasing
oversight. In Nova Scotia, the Fair Registration Practices Act (FRPA) “governs the process
a regulatory body follows to register a person who applies to practice as a member of that
occupation” (Province of Nova Scotia 2013). According to FRPA, “registration must follow a
fair procedure and be transparent, objective, and impartial” (Province of Nova Scotia 2013).
d) Workplace and Occupational Health and Safety
LEGISLATION AND COLLECTIVE AGREEMENTS
General workplace safety in Nova Scotia is governed by two complementary pieces of
legislation: the Workers Compensation Act and the Occupational Health and Safety Act.
The healthcare sector is also regulated through the Co-ordinated Home Care Act, that sets
out the legal framework through which services may be offered to eligible Nova Scotians in
their homes (NS Legislature 1990: 1–2). These pieces of legislation, however, do not contain
any direct mention of geographic mobility of healthcare workers.
The Nova Scotia Government and General Employees Union maintains collective
agreements with the Nova Scotia Health Authority and other healthcare workers such as
schedulers, home support, and long-term care. The Nova Scotia Nurses’ Union negotiates
collective agreements for nurses in their union employed in acute care, long-term care and
home care. In these agreements, the basic parameters that govern travel for work duties are
set, including reimbursements, monthly allowances and mileage. There are also many pri-
vate agencies offering home care services in Nova Scotia, not all of whom employ unionized
workers. For these agencies, the private contract between the employer and worker governs
the conditions of their mobility.
WORKPLACE AND OCCUPATIONAL HEALTH AND SAFETY OF TFWS IN HEALTHCARE
Many TFWs are in-home caregivers, who are trained healthcare professionals or para-pro-
fessionals, and they face a unique set of workplace safety issues. Several scholars considered
TFWs to be “precarious migrants” (Goldring and Landolt 2013: 207; Sikka et al. 2011).
Their international ERGM prevents them from having rights similar to local workers and
thus potentially affecting their safety concerns. The intersection of precarious migration
and low-status domestic work leads to a potentially vulnerable labour situation: “… given
domestic workers’ precarious economic and (often) immigration status, many workers would
minimize the problems they encountered” (Hanely et al. 2010: 430–31).
Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers
[18] HEALTHCARE POLICY Vol.14 No.2, 2018
SAFETY IN HOMES AND ON THE ROAD: LOCAL MOBILITY AND OCCUPATIONAL AND
HEALTH SAFETY
ERGM-related occupational health and safety concerns for healthcare workers arise par-
ticularly in home care. Fitzpatrick and Neis (2015) note that musculoskeletal disorders, the
potential for facing violence and abuse (verbal, physical or sexual), and exposure to commu-
nicable diseases and allergens are common. They draw attention to how “[v]iolence in these
workplaces is under-reported, and is often tolerated by workers when the clients have demen-
tia” (Fitzpatrick and Neis 2015: 49).
In the Occupational Health and Safety Act, Section 82.15 exempts “employers with mul-
tiple temporary workplaces” from conducting violence risk assessments at each individual
workplace if an assessment and prevention plan covering all “similar workplaces” is drawn
up and “takes into account the circumstances and interactions that an employee is likely to
encounter in the performance of their work” (NS Legislature 2015). Employers of home care
providers would fall into this category.
Lippel and Walters (2014) have examined occupational health and safety policy chal-
lenges in different “facets” of mobile workers’ lives, such as “getting to work” (p. 6). They note
the health and safety challenges in getting to work by car, including “the quality and main-
tenance of vehicles, the road conditions, the abilities of the driver, and the challenges of the
road for particular workers” (p. 6). They argue that there are regulatory gaps in each of these
areas and there is a need for regulations. They suggest that there are “a broad range of mobile
workers” who are “invisible to regulators and, to some extent, to unions,” (p. 86) such that
there is a lack of adequate regulation and health and safety concerns.
Discussion
The four policy contexts noted above indicate a lack of congruence and critical blind spots,
findings supported in the broader health workforce literature (Bourgeault et al. 2014). This
may arise from the fact that policies are often developed in different policy communities
(international, interprovincial, provincial and the workplace), and there may be little or no
knowledge concerning the impact on mobile health workers.
In international migration, cross-border mobility has long-reaching impact on the
worker’s residence, labour protection rights, and occupational health and safety. Credential
recognition affects both international and interprovincial mobile healthcare workers. Federal
arrangements that are put in place to facilitate interprovincial mobility do not require
mandatory compliance, leaving provinces to develop their own monitoring mechanisms.
Consequently, no measures are in place to ensure these mechanisms operate consistently.
In regards to the workplace and occupational health and safety, regular ERGM con-
ducted by healthcare workers raises a number of issues that various policies address in a
haphazard or arbitrary manner. For unionized workers, some protections are afforded by
their collective agreements, however, for non-unionized workers, the conditions of their
mobility are governed by private contracts.
Shiva Nourpanah et al.
HEALTHCARE POLICY Vol.14 No.2, 2018 [19]
These concerns are situated within a burgeoning literature exploring the unique features,
challenges and concerns regarding ERGM. Given that the demographic and policy trends
affecting ERGM in Nova Scotia have not significantly changed since the original research
was conducted, we suggest our findings have continued relevance. Our research highlights
the need for a more comprehensive, consistent and inter-sectoral set of governance mecha-
nisms for ERGM of healthcare workers, by identifying points at which current practice
places responsibility on individuals that would be better placed on institutions. For example,
mobile employees carry disproportionate responsibility for occupational safety when driv-
ing or at remote settings. Inconsistencies across employers and across jurisdictions serve
to aggravate that imbalance by introducing greater uncertainty for employees. Consistent
policies would help to sustain a mobile workforce while reducing undue strain on individual
employees regarding their mobility along the spectrum of ERGM. We call for congruence
between policies to encourage greater harmonization across jurisdictions. Comprehensive
and consistent policies and processes are needed to address the many challenges confronting
mobile health workers and to support them to meet both the health system demands and the
health needs of the population.
Notes
1. This time frame reflects the first phase of the SSHRC-funded project “On The Move:
ERGM in the Canadian Context.” During this phase, the research team gathered informa-
tion to provide some understanding and background of policies influencing ERGM among
Nova Scotia healthcare workers. A version of this paper was presented at the Annual
Canadian Sociology Association, Ottawa, June 6, 2015, and subsequently revised for the cur-
rent ‘Discussion and Debate’ paper.
2. A full list of the databases maintained by Dalhousie Libraries, where the keyword searches
took place, can be found at http://dal.ca.libguides.com/az.php.
3. A draft Act for a new nursing regulator combining these two colleges was sub-
mitted to government on February 12, 2018 (https://crnns.ca/about-crnns/
creation-of-one-nursing-regulator-in-ns/).
Acknowledgements
The On the Move Partnership: Employment-Related Geographical Mobility in the Canadian
Context is a project of the SafetyNet Centre for Occupational Health & Safety Research
at Memorial University. On the Move is supported by the Social Sciences and Humanities
Research Council through its Partnership Grants funding opportunity (appl. ID 895-2011-
1019), the Research and Development Corporation of Newfoundland and Labrador, the
Canada Foundation for Innovation, and numerous university and community partners in
Canada and elsewhere. The authors would also like to acknowledge funding provided by
Canadian Institutes of Health Research Institute of Gender and Health Research Chair in
Gender, Work and Health Human Resources.
Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers
[20] HEALTHCARE POLICY Vol.14 No.2, 2018
Correspondence may be directed to: Shiva Nourpanah, Department of Sociology and Social
Anthropology, Dalhousie University, Halifax, NS; e-mail: shiva.nourpanah@gmail.com
References
Bourgeault, I., C. Demers, Y. James and E. Bray. 2014. The Need for a Pan-Canadian Health Human Resources
Strategy. Conference White Paper – Working Drafts. Retrieved October 15, 2018. <https://smith.queensu.ca/
insight/system/files/2014-WhitePaper-Bourgeault.pdf>.
Canadian Institute for Health Information (CIHI). 2007. Distribution and Internal Migration of Canada’s
Physician Workforce. Ottawa, ON: Author. Retrieved November 12, 2018. <https://secure.cihi.ca/free_
products/2007_phys_EN_web.pdf>.
College of Licensed Practical Nurses Nova Scotia (CLPNNS). 2017. Annual Reports 2016. Retrieved May 15,
2018. <http://clpnns.ca/wp-content/uploads/2015/09/2016-Annual-Report.pdf>.
Cresswell, T., S. Dorow and S. Roseman. 2016. “Putting Mobility Theory to Work: Conceptualizing
Employment-Related Geographical Mobility.” Environment and Planning A: Economy and Space 48(9):
1787–18 03.
Fitzpatrick, K. and B. Neis. 2015. “On the Move and Working Alone: Policies and Experiences of Unionized
Newfoundland Home Care Workers.” Policy and Practice in Health and Safety 13(2): 47–67.
Goldring, L. and P. Landolt. 2013. Producing and Negotiating Non-Citizenship: Precarious Legal Status in Canada.
Toronto: University of Toronto Press.
Government of Canada. 2016. “Annual Labour Market Impact Assessment Statistics 2007–2014.” Retrieved
October 27, 2016. <http://www.esdc.gc.ca/en/reports/foreign_workers/2014/lmia_annual_statistics/skill_
type.page?#ns>.
Green, A. 2004. “Is Relocation Redundant? Observations on the Changing Nature and Impacts of
Employment-Related Geographical Mobility in the UK.” Regional Studies 38(6): 62941.
Grinspun, D. 2003. “Part-Time and Casual Nursing Work: The Perils of Healthcare Restructuring.”
International Journal of Sociology and Social Policy 23: 54–80.
Haan, M., D. Walsh and B. Neis. 2014. “At the Crossroads: Geography, Gender and Occupational Sector in
Employment-Related Geographical Mobility.” Canadian Studies in Population 41(3–4): 6–21.
Hanley, J., S. Premji, K. Messing and K. Lippel. 2010. “Action Research for the Health and Safety of Domestic
Workers in Montreal: Using Numbers to Tell Stories and Effect Change.” New Solutions: A Journal of
Environmental and Occupational Health Policy 20(4): 421–39.
Kingma, M. 2006. Nurses on the Move: Migration and the Global Health Care Economy. Ithaca, NY: ILR Press.
Lippel, K. and D. Walters. 2014. Employment-Related Geographic Mobility and Occupational Health and
Safety Policy. (Draft Report).
MacMillan, K. 2013. “Not Dead Yet: The Spectre of Nursing Human Resource Shortages.” Nursing Leadership
26: 1–4.
McGillis Hall, L., J. Peterson, S. Price, M. Lalonde and S. Macdonald-Rencz. 2013. “Stemming the Flow of
Canadian Nurse Migration to the US.” Nursing Leadership 26: 8–19.
Nova Scotia Legislature. 1990. Co-ordinated Homecare Act. Retrieved November 22, 2016.
<http://nslegislature.ca/legc/statutes/coordhc.htm>.
Nova Scotia Legislature. 2015. Violence in the Workplace Regulations. Retrieved November 3, 2016.
<https://www.novascotia.ca/just/regulations/regs/ohsviolence.htm>.
Organization for Economic Cooperation and Development (OECD) and World Health Organization (WHO).
2010. International Migration of Health Workers. Retrieved Nomvember 22, 2016. <http://www.who.int/hrh/
resources/oecd-who_policy_brief_en.pdf>.
Shiva Nourpanah et al.
HEALTHCARE POLICY Vol.14 No.2, 2018 [21]
Organization for Economic Cooperation and Development (OECD). 2008. The Looming Crisis in the Health
Workforce. Retrieved Novmeber 22, 2016. <http://www.who.int/hrh/migration/looming_crisis_health_
workforce.pdf>.
Province of Nova Scotia. 2013a. Fair Registration Practices. Retrieved May 2, 2016. <http://novascotia.ca/lae/
rpllabourmobility/frp.asp>.
Province of Nova Scotia. 2013b. Labour Mobility. Retrieved May 2, 2016. <https://novascotia.ca/lae/
RplLabourMobility/LM.asp>.
Roseman, S.R., P.G. Barber and B. Neis. 2015. “Towards a Feminist Political Economy Framework for
Analyzing Employment-Related Geographical Mobility.” Studies in Political Economy 95(1): 175–203.
doi: 10.1080/19187033.2015.11674951.
Sikka, A., K. Lippel and J. Hanley. 2011. “Access to Health Care and Workers’ Compensation for Precarious
Migrants in Quebec, Ontario and New Brunswick.” McGill JL & Health 5: 203.
Tutton, M. 2008 (June 23). “Lost Generation? Exodus of Youth Presents ‘Scary’ Challenge on Aging East
Coast.” The Canadian Press. Retrieved May 2, 2016. <http://forum.skyscraperpage.com/showthread.
ph p ? t =1 53190>.
Valiani, S. 2012. Rethinking Unequal Exchange: The Global Integration of Nursing Labour Markets. Toronto, ON:
University of Toronto Press.
Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers
Help Advance Nursing informatics knowledge by supporting
this first-ever scholarship named in honour of an
internationally recognized nursing informatics pioneer,
Dr. Kathryn Hannah.
Nurses are the biggest users of Health
Informatics Solutions, delivering care
24/7 in every setting, in every region
across Canada and around the world.
Nurses impact the outcomes of
care, enabled by information and
communication technologies.
We need more nurses prepared at the
graduate level with experience in health
informatics.
104276_CNF_PC.indd 2 15-05-14 4:29 PM
... Many Canadians and some international migrant workers work in mobile workplaces such as those in trucking, fishing, shipping, or the airline sector. Others come from local regions, different parts of Canada, or internationally to work in the service sector including in a hotel or outfitting lodge in rural areas or in major tourism centers like Banff in Alberta, 8 as health care and live-in caregivers, 9,10 or as high or lowskilled workers in occupations in such sectors as construction, agriculture, seafood, and meat processing in urban and rural areas. 11 The challenges to effective OHS protections and for fair access to workers' compensation differ according to the specific situation. ...
... The workers had worked or were working in meat processing, hotels, food service, or construction in Canada. Cedillo et al. 11 Scotia on Canada's east coast, 10,44,45 and tourism workers in Banff, Alberta. 8 A core message from this work is that protecting the health and safety and dignity of workers requires attention to not only conditions at work, but also at home and on the road, as well as to how these intersect to affect risk, recognition and compensation. ...
Article
Full-text available
Globally, employment-related geographical mobility (mobility to and within work) is a pervasive aspect of work that has potential health and safety implications. As an introduction to this special issue, this article defines the mobile workforce as those who engage in complex/extended mobility to and within work encompassing >two hours daily, less frequent but more extended mobility between regions and countries, and mobility within work such as between work sites or in mobile workplaces. Focusing on the Canadian context, we discuss the challenges associated with developing a statistical profile for this diversely mobile workforce and provide an overview of articles in the special issue identifying key health and safety challenges associated with extended/complex employment-related geographical mobility. We estimate that up to 16 percent of Canada’s employed labor force (including those commuting > one hour one-way, temporary residents with work permits, and transportation workers) engage in extended/complex mobility related to work.
... I have discussed elsewhere the policy contexts that impact the labour mobility of healthcare workers generally in the province of Nova Scotia (Nourpanah et al. 2018). Here, I show how these policy contexts operate in disjointed, unpredictable, and time-consuming ways, creating "riskiness" and uncertainty for the nurses, and producing particular forms of migration temporality. ...
Article
Full-text available
Drawing on ethnographic fieldwork done between April 2015 and August 2016 in Halifax, Canada, with nurses employed on temporary work permits in the healthcare sector in the province of Nova Scotia, Canada, this research contributes to contemporary literature on certain forms of migration temporality and emotionality. I employ policy analysis of credential recognition procedures for nurses and ethnographic research methods to demonstrate how a complex array of intersecting and sometimes contradictory policy contexts in labour, migration and healthcare regulate the movement and work of foreign nurses, including their transition into permanent Canadian residents, and ultimately, citizens, and the lived experienced of this regulation as it extends through time and space.
... Failure to act could literally kill us. The time of reckoning for clawing back social supports and safety nets under the name of neoliberal restructuring, at global (Shore and Wright 1997), national (Armstrong 2001), and provincial levels (Nourpanah et al. 2018), had arrived with the pandemic. ...
Article
Full-text available
Women and children subject to violence. Refugees. The incarcerated and criminalized. The homeless. Ethnic and racialized minorities. When a global pandemic hits populations that are already vulnerable, racialized, marginalized, historically subject to oppression, and underserved, the civil society organizations mandated to serve them need all their ingenuity and resourcefulness to provide support while following public health guidelines. As the COVID‑19 global pandemic forced the closure of many workplaces and the re-direction of public social life, the daily lives of vulnerable people, many already struggling on the margins of society, and those mandated to serve and support them changed shape drastically in some ways, and in other ways, not so much. My main argument is that the pandemic of 2020 and consequent imposed restrictions brought about a moment of difference in how our society treats those who are usually and in “normal” times pushed to the margins, invisible and overlooked. Policy spotlight, propelled by panic and a global public health crisis, shone on them, rendering them sharply visible.
Article
Full-text available
Although the “mobility turn” has captured the critical imaginations of researchers studying an array of topics, its possible contributions to analyses of the spectrum of employment-related geographical mobility have only begun to be defined. Studies of work have engaged with the growing body of mobility theory in limited ways; by the same token, mobilities studies have taken a somewhat narrow and sometimes uncritical view of work, labor, and employment. This article draws on a major interdisciplinary research project into the socio-historical patterns, contexts, and impacts of employment-related geographical mobility in Canada to build a conceptual bridge between these two literatures. We re-visit established bodies of work on migration, work, and political economy and look at new avenues for conceptualizing employment-related geographical mobility. We then examine a case study from the Alberta Oil Sands and suggest an agenda for future research on mobility and work.
Article
Full-text available
In Canada, patterns of employment-related geographical mobility (E-RGM) are becoming more complex and nuanced, with implications for employers, workers, and their families. This article introduces the concept of E-RGM, and argues that because mobility is a pervasive aspect of working lives in Canada, it deserves more systematic and extensive research. To date, most studies of labour mobility have focused on permanent relocation or short-distance daily commuting. We argue for more research that disaggregates the socio-economic characteristics of those engaged in E-RGM and untangles its complexity. Using the 2006 Canadian confidential master file to create a statistical portrait of E-RGM reveals considerable variation among the Canadian working population, particularly those engaging in more extensive work journeys.
Article
Full-text available
The migration of nurses from Canada to the United States has occurred for decades, although substantial increases have been noted since the 1990s. A survey of 4,295 Canadian-educated nurses in the US identified that this trend in mobility is largely unchanged. Almost half the nurses in this study migrated to the US in search of full-time work, often after unsuccessfully seeking employment here in Canada prior to leaving. Incentives to migrate were provided, although the opportunity for full-time work was often perceived as an incentive to move. While some intent to return is apparent, this is unlikely to occur given the levels of satisfaction with work and the high value attributed to Canadian nurses by US employers. Policy makers and nurse leaders are urged to use these data to formulate strategies aimed at retaining Canada's nurses in this country.
Book
Rethinking Unequal Exchange traces the structural forces that have created the conditions for the increasing use, production, and circulation of temporary migrant nurses worldwide. Salimah Valiani explores the political economy of health care of three globally important countries in the importing and exporting of temporary migrant nurses: the Philippines, the world's largest supplier of temporary migrant nurses; the United States, the world's largest demander of internationally trained nurses; and Canada, which is both a supplier and a demander of internationally trained nurses. Using a world historical approach, Valiani demonstrates that though nursing and other caring labour is essential to human, social, and economic development, the exploitation of care workers is escalating. Valiani cogently shows how the global integration of nursing labour markets is deepening unequal exchange between the global North and the global South.
Article
Homecare work is female-dominated, generally precarious, and takes place in transient and, sometimes, multiple workplaces. Homecare workers can engage in relatively complex employment-related geographical mobility to, from, and often between work locations that can change frequently and are remote from the location of their employer. Like other precarious workers, homecare workers may be more likely to experience work-related health and safety injuries and illnesses than non-precarious workers. Their complex patterns of employmentrelated geographical mobility may contribute to the risk of injury and illness. This paper explores patterns of employment-related geographical mobility and ways they influence the risk of injury and illness among unionised homecare workers living and working in two regions of the province of Newfoundland and Labrador, on Canada’s east coast. It uses Quinlan & Bohle’s ‘pressure, disorganisation, and regulatory failure’ model to help make sense of the vulnerability of these workers to occupational safety and health risks. The study uses a qualitative, multimethods approach consisting of semi-structured interviews and a review of government and homecare agency policies, as well as 20 Newfoundland and Labrador homecare collective agreements. It addresses two main questions: What are the work-related health and safety experiences of interviewed unionised homecare workers in Newfoundland and Labrador?; How do policies (government and homecare agency) and collective agreements interact with employment-related geographical mobility to mitigate or exacerbate the occupational safety and health challenges confronting these workers? Findings show that these workers experience numerous work-related health and safety issues, many of which relate to working in remote, transient and multiple workplaces. While collective agreements mitigate some health and safety issues, they do not fully address particular occupational safety and health risks associated with working alone, working remotely from employers, and working in transient workplaces, or the risks associated with commuting between workplaces. More active union engagement with these issues could be a mechanism to improve the health and safety of these and other homecare workers.
Article
This article develops a feminist political economy framework for analyzing employment-related geographical mobility. We emphasize the relevance of political economy studies of class, neoliberalism, and globalization as well as feminist research on the interconnectedness between paid employment and social reproduction. Overall, we make the case for attending to how class, gender, racialization and/or ethnicity, citizenship, and other forms of difference are core constitutive elements in employment-related mobility processes. At the end of the paper, we illustrate our approach with short empirical case studies of two mobile workers who came to Canada from the Philippines.
Book
Most examinations of non-citizens in Canada focus on immigrants, people who are citizens-in-waiting, or specific categories of temporary, vulnerable workers. In contrast, Producing and Negotiating Non-Citizenship considers a range of people whose pathway to citizenship is uncertain or non-existent. This includes migrant workers, students, refugee claimants, and people with expired permits, all of whom have limited formal rights to employment, housing, education, and health services. The contributors to this volume present theoretically informed empirical studies of the regulatory, institutional, discursive, and practical terms under which precarious-status non-citizens - those without permanent residence - enter and remain in Canada. They consider the historical and contemporary production of non-citizen precarious status and migrant illegality in Canada, as well as everyday experiences of precarious status among various social groups including youth, denied refugee claimants, and agricultural workers. This timely volume contributes to conceptualizing multiple forms of precarious status non-citizenship as connected through policy and the practices of migrants and the institutional actors they encounter.
Article
Focuses on nursing in the context of a broader analysis of flexible labour markets, with a focus on part-time and casual work, which thousands of nurses in Canada have been forced into through health care restructure. Discusses the subject in great detail and concludes employers lost control of their own strategy with regard to the restructure of employment for their staff.
Article
In 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we-the university researchers-offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.