Foreign nurses in the USA

An increasing number (up to one third) of US registered nurses (RNs) are foreign-educated nurses (FENs), coming from 74 source countries, notably the Philippines and India(1) They are recruited by at least 211 agencies and typically have 18 to 36-month contracts.

Health Care Organisations (HCOs), who employ FENs, benefit from a short-term solution to an American staffing shortage that has lasted since the late ‘90s, as well as reduced hiring and retention costs over the long-term. It is estimated that an HCO may save up to $50k over two years by employing a FEN over an American nurse.

→ Concerns over the recruitment and employment of FENs include :

→ The current lack of accountability within the recruitment industry ;

→ The FENs’ level of cultural competency(2) ;

→ Pay inequalities. (FENs may be paid as much as 25 % less than their American colleagues.) ;

→ The larger immigration policy context ;

→ The impact on poorer source countries. In 1997, Nelson Mandela told the United Kingdom to “stop poaching” South African health workers. The resulting shift in UK policy bans recruitment from less developed countries.

Many US recruiters do not agree with this policy but some now invest in source countries’ training and scholarships.

Speaking at focus groups for this study, FENs also shared fears about financial burdens : breach of contract fees may be as much as $20k.