Health services delivery: reframing policies for global nursing migration in North America--a Caribbean perspective.

Countries of the Caribbean face critical challenges in nurse migration and health services delivery. They are experiencing two types of migration-country-to-country migration within the Caribbean and migration from the Caribbean to developed countries, including the United States, Canada, and the United Kingdom. Aggressive international recruitment practices in the Caribbean resulted in a dramatic loss of nurses in the region and had an adverse impact on health-services delivery. A Managed Migration Program is being developed with two guiding principles-observing the rights of individual nurses to choose where they want to work and live while balancing individual rights with a country's obligation to provide quality health services to its citizens. It is a multi-country, multi-agency, multi-interventional strategy to increase intake, production, and retention of nurses. Various efforts designed to balance nursing supply and demand are underway, with the goal of providing universal, effective, and quality health care in the Caribbean.