upon graduation. ethical concerns foreign nurses that migrate from developing countries to fill the nursing shortage of developed nations pursue their own economic, career, and lifestyle interests, but there are risks. the media and scholars have remained relatively silent on the ethical concerns involving the potential exploitation of foreign nurses. on the level of national sovereignty and global equality, there are ethical concerns about the pull of developed nations on developing countries' skilled workers and assets. u.s. incentives such as signing bonuses can be seen as promoting brain drain. activists have spread a new term for this: "brain drain in the south, brain waste in the north." the president of the philippines nurse association, george codero, was quoted in a new york times article as saying "the filipino people will suffer because the u.s. will get all our trained nurses". on an individual basis, foreign nurses are subject to exploitation by employers. in 1998 six americans were charged with falsely obtaining h-1a visas and using them to employ filipino nurses as nurse aides instead of registered nurses. in a case in 1996, a catholic archdiocese employed some of these foreign nurses as nurse aides instead of nurses. in 2000, filipino nurses in missouri received $2.1 million for failure to receive proper wages that an american in the same position would receive. while these cases were brought to court, many similar situations are left unreported thereby jeopardizing the rights of foreign nurses. foreign nurses have the tendency to receive less desirable jobs, such as entry-level positions, because of their immigrant status; they are excluded from jobs that would lead to facilities and are often not paid proper salaries. some u.s. health care facilities push to "ease restrictions" on the immigration law to increase the number of recruited foreign nurses. on the other hand, this recruitment practice is a temporary solution that does not fully address the nursing shortage as mentioned by american nursing association (ana). others have taken a stand on ethically recruiting foreign workers. new york university medical center was cited in the search for nurses ends in manila as believing that it is a "poaching exercise" to take nurses from countries in need of their citizens. the former health secretary, dr. galvez tan, in reference to the doctors and nurses working for an american green card said, "there has to be give and take, not just take, take, take by the united states." shortage by country canada main article: nursing shortage in canada across north america during the post-world war ii years, there was a serious shortage of registered nurses.: 16 by the mid-1940s in canada, the nursing shortage was approximately 8,700 and it was increasing along with health services in canada and the number of hospital beds and hospitalizations.: 12 it was so severe that vancouver general hospital's newly built pavilion remained out-of-service because there were not enough registered nurses to staff it.: 9 the number of hospital beds across canada increased from 1943 to 1952 by 26% and the number of admissions to hospitals increased by 74%. the nature of nursing was also changing with new and time-consuming responsibilities, such as the administration of penicillin.: 13 during that period, there was no unemployment for nurses, especially if they were willing to be mobile. however, working conditions for nurses were very poor, with low wages combined with long hours and nurse retention was challenging.: 9 as well, since almost all nurses were women, they had responsibilities at home they had to manage.: 13 by january 1943, 50% of vancouver general hospital's registered nurses were married women who had returned to work as nurses when encouraged by the hospital's administrators.: 9 in response to the shortage of nurses, volunteers were used and nursing courses were accelerated, and new categories of regulated nursing were added to registered nursing—"practical nurses" and "nursing assistants.": 9 because of the mid-twentieth century nursing shortage, nursing labour was reorganized and re-conceptualized.: 12 to expedite entry into nursing, debates were held across canada about auxiliary nursing roles for assistants and practical nurses. at that time, a "utopia of nursing" referred to teams of nursing staff which included registered nurses and other regulated nursing and hospital worker support personnel. some of these auxiliary positions were also open to first nations women and other racialized groups.: 25 since at least 1998, the canadian federation of nurses unions (cfnu) have been calling for solutions to the nursing shortage in canada. in 2005, registered nurses worked an estimated 18 million hours of overtime—both paid and unpaid, representing the "equivalent of 10,054 full-time positions". the nursing force had among the highest rates of "burnout, injury and illness." citing a 2002 canadian nurses association (cna) study, they said that without new policies and direction, the projected shortage of registered nurses in 2011 would be 78,000 rns and up to 113,000 by 2016. the report also noted that there was a "shortage of nursing faculty". based on various models used by employment and social development canada (esdc)'s occupational projection system (cops) team, some provincial governments, canadian nurses association (cna), and statistics canada on vacancies, the 2019 international journal of health planning and management article said that there was a shortage of nurses in canada. in 2012, it was 2.6% and the projection for nursing professional shortages across canada in 2022, was between 50,000 and 60,000. the article said that nursing shortages can be measured based on professional standards, projections, or supply and demand economics. professional standards set the nurse to patient ratio. according to the canadian federation of nurses unions (cfnu) in 2014 an average nurse to patient ratio for canada is 1:4. according to projection‐based shortage, a 2009 canadian nurses association (cna) report, the shortage of rns in canada would be approximately reach 60,000 full‐time equivalent (fte) by 2022. the economic concept of nursing shortages considers supply and demand—how many nurses are available and what is the actual demand. as of 2019, there were limited statistics on the nursing labour market, particularly as related to vacancies. the 2019 paper said that these concepts—professional standards, projections, or supply and demand economics— were not being sufficiently used to measure nursing shortages; instead, most often, the indicator was "essentially the number of nurses per 1000 inhabitants". shortage of nurse educators a 2014 study in canada and another in 2019 confirmed that along with the shortage of nurses in canada, there was also a national shortage of in academia, which reflects the global shortage identified in 2011 by the institute of medicine and in 2020 by the world health organization (who). a 1967 journal article in canadian nurse predicted a severe future shortage of nurses in canada unless the shortage of nursing faculty in undergraduate and graduate programs was remedied. in the mid-1960s some of the factors that contributed to a lack of retention and growth in nursing faculty included the rate at which professors reaching retirement age being matched by new and younger hires. there were much higher salaries for these individuals in non-academic professions. the workload for nursing faculty was excessive. pandemic-related nursing shortages a 2022 review of how the pandemic impacted the 400,000 nurses in canada, sponsored by the royal society of canada and published in the facets journal said that by 2021, health job vacancies had increased by 56.9% since 2019 in canada to a "record high of 100,300. the highest vacancy rate was experienced by hospitals. the report found that for decades, the "nursing labour market" was "under stress" but "widespread systemic change" did not occur. the pandemic-related workload increase combined with chronic stress represented a "tipping point of systemic burnout". some of factors leading to the exodus of the nursing labour force included "workload, burnout, lack of structural value, the need for leadership and mentorship, and lack of flexibility, autonomy and voice laced with overt racism, discrimination, and gendered inequities," according to annette elliott rose, one of the study's authors. due to a shortage of nurses, in march 2022, during the covid-19 pandemic in canada, the first of many unplanned closures of emergency rooms took place—the first such occurrence since 2006. by september 2022, across canada there were "dozens of forced closures of emergency rooms took place because of insufficient staff. by may, ontario health reported emergency department "record-high wait times and patient volumes." hospital administrators said that one of the reasons for hospital staff shortages is the retirement since 2018 of many healthcare workers who are over the age of fifty who cited "the pandemic and burnout as top reasons." other administrators said staffing issues were a concern before the pandemic. while some raised concerns that nurses who left their profession because of the vaccine mandate had contributed to the shortage, one hospital ceo said the number of those who left for that reason was so small, it was a "non-issue". a september 2022, new york times article said that nurses in canada left the profession because of "unsafe working conditions, wage dissatisfaction, and burnout from the pandemic". sixteen emergency departments had to close in september because of nursing shortages in canada's "most populous province", ontario. ontario council of hospital unions president said in august that the work force which had been working through the pandemic in an unsafe work environment, and had their wages cut, was "exhausted" and "demoralized". in 2019, during the pandemic, under the premiership of doug ford, bill 124—protecting a sustainable public sector for future generations act was enacted placing an annual cap of 1% on most public sector employees, including nurses. this is lower than the inflation rate and according to opposition critics, represented a cut in salary. according to health care workers' unions, this contributed to the staff shortages. according to a 17 july 2022 financial accountability office (fao) report, in ontario the government spent "$7.2 billion less than planned across all programs", including health. in 2019, the ford administration capped the wages of most public sector employees, including nurses, causing staff shortages, according to health care workers' unions. due to shortages in staffing, intensive care units (icu) reached full capacity in august 2022, forcing the uhn to announce a 'critical care bed alert' at the toronto general hospital affecting the cardiovascular (cvicu), cardiac (cicu), and medical surgical intensive care units (msicu). on 28 october the uhn announced that the toronto general hospital was again under a 'critical care bed alert' with the three intensive care units—cvicu, cardiac cicu, and msicu—at total bed capacity. in august 2022, with the province of ontario facing the peak of the seventh wave of covid-19, the university health network (uhn) in toronto, which operates the largest hospital in the city—toronto general–said that there were so understaffed that they were calling in nursing students. they put out a call for "volunteers" to fill nursing shifts. during the sixth wave they were forced to do this several times. in august, some patients waited 33 hours in er to get an inpatient bed in toronto. canadian federation of nurses unions (cfnu) said on twitter on 31 october 2022, that it had become normalized for hospitals to operate understaffed at overcapacity, with nurses regularly working 16 hour shifts—two nurses recently worked 30 hour shifts. by mid-october 2022, prior to the beginning of the "traditional flu season", across canada emergency departments were "under intense pressure". concerns were raised as in europe an eighth covid-19 wave was beginning. in the province of quebec, there were staff shortages of all health care personnel—but mainly nursing personnel—negatively affected all of the province's health-care network." largely because of the ongoing covid-19 pandemic, emergency departments were operating at overcapacity, which in montreal reached up to 200%. on 14 october, there were 4,000 health-care workers on leave because of covid. emergency departments overloaded during the seventh wave of the covid-19 pandemic, the lack of health care personnel, particularly nurses, along with the health system's backlog and a resurgence of hospitalized covid-19 patients were some of the factors contributing to the overloading of emergency departments and lengthening of ambulance off-loading times. by 27 october there were 1,921 covid-19 hospitalizations in ontario and 121 more covid-19 deaths. prior to that, the last time the numbers were so high was on 9 february with 2,059 hospitalized with covid-19. morocco morocco has far fewer nurses and other paramedical staff per