Blog post

Is a nurse who migrates to work abroad an expat?

A female doctor talking to two female nurses.

Drawing on their research with Polish and Filipino nurses Marta Bivand Erdal and Lubomiła Korzeniewska reflect on the use of migration terminology and the implicit roles gender and race play in labelling people on the move.

By Marta Bivand Erdal and Lubomiła Korzeniewska

In this blog post, we reflect on a paradox: despite being highly educated workers coming from abroad, often on a temporary basis, nurse migrants to and within the Global North are rarely described as ‘expats.’ We wonder why? Who is described as an ‘immigrant’ and who as an ‘expat,’ is a topic of heated debate. It has been suggested that racial hierarchies continue to matter, often perpetuating negative stereotypes. There is reason to underscore that ‘expatriate’ (the full form of ‘expat’) is also a class-bound term, one that is linked to level of education and status of profession. Gender and race matter too.

High-skilled and in demand, but not an expat

Many migrant nurses from the Global South work filling shortages of nurses in the Global North. Among our interviewees, it was not uncommon to have worked as part of a highly specialised workforce in several different countries outside the country of origin. As high-skilled professionals moving to fill gaps in the labour market with their expertise, migrant nurses often fall into the broad ‘economic migrant’ category, which is often applied in public perception of migration. In many ways, this stays true to the logic that migrant nurses are indeed contributing to the labour markets of the countries they migrate to, and earning more than they would by remaining working as nurses in their origin countries. This underscores the international work opportunities for nurses and, considering their competence and experience, begs the question: why are migrant nurses not generally described as ‘expats’?

Expat as a racialised term

Could it be because ‘expat’ is a high-status category most commonly associated with white men, in which nurse migrants, who are predominantly racialised women, do not fit in? In fact, the term ‘expat nurses’ is in use and can be found in media reports by the Dubai-based Gulf News. The same media report lists the UK, the US, Norway, Canada, and Australia as the five top-countries for migrant nurses to consider, based more on salary-levels rather than ease of authorization. However, in these countries, which have a very clear need of migrants to support their nursing workforce, the term ‘expat nurse’ is rarely used.

Through our interviews with Polish and Filipino nurses, we found that they were to different degrees considered immigrants working in Norway and subject to racialization in Norwegian society. These nurses may varyingly identify as migrants, immigrants, or temporary workers abroad; this self-identification also changes over time. We find that the ways in which they are racialized matter both for their private and professional lives in Norway. Racialization and ‘othering’ as foreigners are experienced as very intertwined. Our nurse interviewees’ experiences suggest that racialization and othering among immigrant nurses in Norway challenges a clear-cut white/non-white binary. It is not the case that being white relieves nurses of experiences of racialization and othering. Rather, there are varying degrees of othering and different types of experiences. The avenues available to counter or cope with such experiences among nurses are often changing and unpredictable.

Expat status reserved for English-speaking employment?

Could another underlying reason for migrant nurses not being described as expats in Norway be that working in the nursing profession largely requires good communication in local language? For nurses coming from outside of the Scandinavian countries, this entails learning a new language, instead of benefitting from excellent command of English, as would be the standard procedure for expats working in larger corporations? This explanation is supported by the fact that migrant nurses in the rich Gulf states – who, as we have seen, are referred to as ‘expat nurses’, normally use English as their working language and are not expected to speak Arabic. It takes several years to become proficient in a new language, and as an adult one may not be able to learn to speak without a foreign accent. A foreign way of speaking can be a barrier to establishing effective communication and relationships of trust with patients. Simultaneously, an accent might also trigger discriminatory practices against nurses by patients and co-workers. In the Norwegian context, these are the experiences of the immigrant, not of the expat – as these categories are popularly, but also for research purposes, used.

What’s in a word?

Does it matter whether a nurse is regarded as an (im)migrant or as an expat? Does it matter to the nurses themselves? We find that our interviewees may or may not like to be described as migrant nurses: for some, their nursing identity prevails, for others, their migrant identity. This may also change according to the context and over the life-course. Meanwhile, through the example of migrant nurses as highly educated, specialised, and needed workers, the racial and gendered assumptions implicit in the term expat come into plain view. While there is no doubt that racial hierarchies continue to exist, we still find it interesting that neither Polish nor Filipino nurses are to any significant extent being referred to as expats in a Norwegian or European context.

Thus, who is or is not labelled an expat boils down not only to how race matters, but also to profession and to gender, in ways that are revealing of a relative down-playing of care work. Gender clearly matters when considering what types of labels are used for a feminized profession such as nursing. The ways in which care work, also when performed by health professionals – such as nurses – is relatively devalued, appears to underscore the need for careful scrutiny of both the language and labelling we implicitly and explicitly use in policy, practice, and research.

At the time of a global pandemic, the salience of such care work, not least performed by health professionals with a migrant background, appears more obvious than ever. There is therefore a need to confront gendered and racialized, often implicit, stereotypes which lead to the devaluation of essential workers’ contributions and roles in health care across the Global North.