*3.4. Technologies: Steering the Migration of Foreign-Trained Nurses*

An essential element in the functionality and stabilization of new forms of managing migration is devising specific technologies for steering migration in politically desirable ways. In line with Rose and Miller, what we have in mind here are those "programmes, calculations, techniques, apparatuses, documents and procedures through which authorities seek to embody and give effect to governmental ambitions" (Rose and Miller 1992, p. 175). As socio-technical processes, technologies for steering migration are a manifestation of a biopolitics that aims to influence the composition of the population (Georgi 2007, p. 64). Moreover, such technologies obscure the political background of migration management by directing attention to management tools and issues of technical viability. Steering through technology engenders a depoliticization of the social relations of migration (Georgi 2007, pp. 72–73; de Jong 2016, p. 348).

One of the key technologies for steering migration are the processes for the recruitment of nurses from abroad that were established through legal reforms. Of particular relevance to migration in nursing was the departure from a fixation on university degrees: § 6, para. 2 of the Employment Regulation, which entered into force on 1 July 2013, enabled the immigration of individuals with vocational education and training credentials in occupations considered relevant to the labor market (Kolb 2014, p. 79). Technically, this key objective of migration management was implemented by determining (1) "recognized credentials" in (2) regulated vocational training occupations listed on the Federal Employment Agency's so-called "positive list (Positivliste)". It is compiled biannually on the basis of an analysis of shortages of skilled labor and lists occupations in which filling positions with applicants from abroad is considered "justifiable from a labor market and integration policy point of view" (Bundesagentur für Arbeit 2018b, p. 17). Steering migration via a list of occupations issued by the Federal Employment Agency attests to the high priority given to migration policy as an instrument to optimally coordinate labor supply and demand (Rand et al. 2019, p. 37).9

Another important technology in the care sector is the standardization of qualifications via the recognition of occupational credentials, which was regulated comprehensively in 2012. This has resulted in regional differentiation: first come applications from long-time EU member states; second come applications from new EU member states (accession since 2004), in which case the occupational credential must have been acquired after accession to the EU; and third come applications from third countries (Sommer 2014, p. 78). What Sommer failed to take into account, and our study has been able to show, is that applications from third countries with placement agreements benefit enormously from such structured arrangements compared to other third countries, despite the formally required case-by-case review. A requirement for the recognition of credentials in nursing regardless of region of origin is, however, proof of knowledge of the German language. Depending on the state in question, this may be level B1 or B2 according to the Common European Framework of Reference for Languages or also certificates related to specific occupations such as B1 + Nursing.

Recently, the technologization of the steering of migration has also entailed digitization: the 2016 amendment of the EU Recognition Directive introduced the so-called European Professional Card. In combination with the Europe-wide Internal Market Information System (IMI), the card intends to expedite recognition procedures and thus the transfer of formal qualifications. This involves, for instance, digitizing and reviewing documents in advance so that, given sufficient language proficiency, recognition of credentials within Europe is granted at the click of a mouse (European Union 2019). In this way, digital communication technology, which was previously primarily discussed as a means of monitoring illegalized migration (Dijstelbloem and Broeders 2015; Sontowski 2017), has now also found its way into the management of labor migration.

The 2012 Recognition Act intended to facilitate recognition procedures, yet third country nationals are still subject to case-by-case reviews in the field of care, which poses a considerable obstacle. This illustrates the extent to which recognition authorities function as gatekeepers and, in the nursing field in particular, how the construction of differences in job tasks and training has an impact (Krawietz and Visel 2014). Research with case workers shows that, when assessing the equivalence of credentials, they looked for "substantial differences". The standard that they often applied in the process was that equivalence required "identical" content. Differences in training content were almost exclusively seen as deficiencies that needed to be offset and not as potential to be tapped (Sommer 2014, pp. 69–71). Resulting from the relevance of case worker decisions, as well as a differing legal basis, we can see that granting recognition is handled very differently depending on the certificates' region of origin (cf. Figure 3). For example, recognition procedures take considerably longer for third country diplomas and, in most cases, make recognition conditional on meeting certain compensation requirements.

<sup>9</sup> In recent legislative procedures, the German parliament (Bundestag) resolved that, for the time being, the positive list would no longer be applied as an instrument of selection. The new law intends for immigration to be possible for all occupations in which professional or vocational credentials are recognized.

Therefore, while our research shows how crucial recruitment programs like Triple Win are to streamline these processes with some success, the recognition of professional credentials remains the main obstacle to increased recruitment and migration of nurses from third countries.<sup>10</sup> As the opposing trends in the number of applications from the EU versus the third states show, these stark differences in recognizing credentials swiftly and fully will only become more pertinent in the future.

**Figure 3.** Decisions issued in new credential recognition procedures for registered nurses and total number of applications by region of origin, 2012–2018.

#### **4. Discussion and Outlook**

In this contribution, we used the example of recruiting nurses from abroad to demonstrate that analyses of migration management can be systematized along four dimensions: a first level of analysis shows that steered migration is widely considered a legitimate solution to the societal problem of the care crisis. The common reasoning underlying this perspective is exemplary for a demographization of social relations that involves obscuring the structural roots of the nursing shortage. Second, in the process of migration, categorizations of migrants come into play. Nurses are objectified in terms of language skills, as well as subjective requirements, and turned into the commodity of "nurse". Depending on the region of origin, this involves granting them different privileges, legal paths of access, and paths of migration. Third, their recruitment is increasingly organized in diversified actor networks in the context of changing statehood. In the care sector, this involves state initiatives as important initiators and loci of coordination that bring together additional private and intermediary actors, put the structures of recruitment in place, and set the process in motion. Fourth, it has proven fruitful to interpret the concrete instruments used in recruitment as technologies for steering migration. Apart from specific legal provisions and instruments such as the positive list, which make migration into regulated vocational training occupations possible in the first place, one of the main technologies is the standardization of nurses via recognition procedures.

The present contribution has shown that a migration policy oriented toward potential that takes the form of migration management finds paradigmatic expression in the recruitment of nurses as a strategy

<sup>10</sup> On the problems inherent in the contemporary practice to require candidates to apply from abroad, see Best et al. (2019).

to address the societal care crisis and the shortage of skilled personnel. These four distinct dimensions, which are of central importance to migration management, are intertwined via a shared rationality of economic utilitarianism (Rose and Miller 1992): the productive steering of migration and mobility in light of the increasing flexibilization of work and the economy. If we consider these developments from the viewpoint of critical migration research, we can confirm the thesis that migration management is dominated by a logistics mindset. The management of nurse recruitment analyzed here reflects the idea of being able to accomplish a sector-specific steering of migration just in time and to the point (Altenried et al. 2017, pp. 24–27).

We assume that the four dimensions of analysis outlined in this article can be transferred to other studies in the field of migration management as well. Such research could examine, for instance, recruitment projects in other shortage occupations or in other areas of migration management, such as programs for voluntary repatriation (Dünnwald 2010), or could probe in more detail single or several dimensions.

We predict for the future that recruitment will continue to increase, professionalize, and include market actors to a greater degree. The previously strictly regulated field of nurse recruitment will be subject to fewer and fewer legal restrictions. Moreover, those involved in recruitment are currently gaining experiential knowledge and are adapting the structures in public administration and private enterprises. In the event that the new immigration act (Bundesregierung der Bundesrepublik Deutschland 2019) is implemented as planned, this would make other third countries interesting targets for exclusively privately organized recruitment endeavors. In the near future, precarious recruitment could thus loom increasingly large, as standards (such as the Global Code of Practice in the recruitment of nurses) might be undermined if recruitment is guided by for-profit motives alone. The flipside of an increasingly positive connotation of migration in migration management discourse must also not be neglected: new programs for promoting 'desirable migration' go hand in hand with an increased exclusion and illegalization of 'undesirable' forms of migration, which are constructed as representing an economic burden or a politico-cultural threat (Menz 2011, p. 120; de Jong et al. 2017, p. 4). The relatively free movement of refugees through Europe in the summer of 2015 has additionally resulted in a shift in hegemonic discourses on migration and again unveiled racist and colonial continuities in the way we speak about 'migration' in general (Bhambra 2017; Jäger and Wamper 2017). To what extent these changes will also restructure the discourses on the migration of skilled labor remains to be seen.

**Author Contributions:** Conceptualization, J.K., R.P. and S.R.; Formal analysis, S.R.; Funding acquisition, R.P.; Methodology, R.P. and S.R.; Project administration, S.R.; Supervision, R.P.; Writing – original draft, J.K.; Writing – review & editing, J.K., R.P. and S.R. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received partial funding by the German Hans Böckler Foundation, grant number 2014-789-4.

**Acknowledgments:** The authors would like to thank Martina Blank and Mathias Rodatz for valuable comments on an earlier draft of this article, Annabell Baumgartner and Anna Lisa Jakobi for their support, and the anonymous reviewers for their thoughtful feedback.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

#### **References**


Winker, Gabriele. 2015. *Care Revolution: Schritte in eine solidarische Gesellschaft*. Bielefeld: Transcript.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
