Wednesday, February 20, 2008

Foreign Nurses (Dallas-Fort Worth Hospital Council, 2005)



“The leading country where foreign nurses employed in the U.S. received their initial education is the Philippines, followed by India, Canada and South Korea.”
-National Foundation for American Policy, October 2007




Due to the nursing shortage in the United States, hospitals have resorted to international recruitment of nurses from foreign countries in order to fill vacancies. In 2003, The Bureau of Labor Statistics reported 400,000 vacant nursing positions in the U.S. Thus, many nurse recruitment organizations have emerged to recruit foreign nurses from developing countries (McElmurry et al., 2006). With a severe shortage of nurses in the United States, The Bureau of Labor Statistics projects that more than 1.2 million new and replacement nurses will be needed in the United States by 2014 (Hecker, 2005). As a result, hospitals have turned to recruiting foreign nurses, with approximately 90,000 foreign-educated nurses working in the United States (National Foundation for American Policy, 2007).


Nurses from Philippines (Asian CineVision, 2007)


According to Flynn and Aiken (2002), the Immigration Nursing Relief Act that was passed by Congress in 1986, 1989, and 1990, provided (H-1A) nonimmigrant visas to nurses who were hired from foreign countries. In addition, the Nursing Relief to Disadvantaged Areas Act of 1999 allotted 500 nonimmigrant visas (H-1C) per year to recruited nurses (Flynn & Aiken, 2002). Many internationally recruited nurses are drawn to the U.S. by the significant salary differentials and also seek personal and professional development (Kingma, 2006). However, after their recruitment to work in U.S. hospitals, many foreign nurses have reported experiencing discrimination as they practiced in U.S. hospital settings (McElmurry et al., 2006).
















Number of Project Open RN Positions (Buerhaus, 2000)

Many internationally recruited nurses experience a culture shock upon reaching the
U.S. It is often challenging for foreign nurses to transition into a new culture with differing values, practices, and expectations. Often times, foreign nurses must learn how to adapt to using new technology and equipment. In addition, most foreign nurses come from countries where nurses are more timid and less assertive (Stringer, 2002). Thus, many foreign nurses must adjust to the more autonomous and assertive nursing roles within U.S. hospitals. Hospital settings do not always provide the necessary programs to help those nurses make a successful transition to the U.S. hospital setting (McElmurry et al., 2006). According to a study done by the Commission of Graduate Foreign Nursing Schools, about 20% of foreign nurses claimed to have difficulties understanding health care terminology and communicating in U.S. hospitals. Sometimes these recruited nurses are taken advantage of and given lower wages and fewer opportunities for career advancements (Buchan et al., 2003). In addition, many recruited nurses claim that they were promised registered nurse positions, but end up working as only nursing assistants (Allan & Larsen, 2003). Working conditions and salaries maybe less than what was initially promised and foreign nurses are sometimes assigned undesirable work shifts despite being promised equal pay and working conditions (Stringer, 2002).













Philipino Nurses (The Olympian, 2007)

Also, patients’ perceptions of foreign nurses sometimes contribute to cases of discrimination. Some patients complain that internationally recruited nurses have foreign accents that are difficult to understand, which affects the care provided and ultimately results in dissatisfaction with the nurse (McElmurry et al., 2006). Thus, foreign nurses also experience ethnicity-based discrimination, as some patients only want to be under the care of a nurse of a specific ethnicity.













RNs in the U.S. Who are Foreign Educated (WHO Human Resources for Health, 2003)

Recruiting nurses from foreign
countries often causes the depletion of numerous nurses from the country’s supply of health care workers, causing a weakening of the country’s healthcare system. Many argue that the recruitment of nurses from foreign countries encourages a “brain drain” from those countries, and limits the advancement of those developing countries. Many recruited nurses often send their salaries back home. Lindquist (1993) found that the Philippines received over $800 million that was sent back home from nurses working in overseas countries. However, much of the money that is sent back to their home countries does not get put back into the health care system. With a shortage of nurses, foreign hospitals are understaffed and often struggle to meet the patients’ needs, forcing the nurses there to work double shifts (McElmurry et al., 2006). In severe cases, hospitals are forced to close leaving some communities without proper healthcare (Padarth, 2004).

In conclusion, the overwhelming nursing shortage within the U.S., causes many hospitals to rely on foreign nurses to fill bedside nursing hospital positions. Many foreign nurses are drawn by monetary incentives and job advancements, and thus eagerly apply to work overseas. However, foreign nurses often face numerous difficulties while practicing in U.S. hospitals because of differences in culture, language, and values.
Foreign Nurse Recruitment (World Health Resources, 2007)




"[Nursing]... it's a supply-and-demand issue, and we don't have the supply in the United States..."
- Paula Bradney, RN, director of staffing and recruitment at Mesa Lutheran Medical Center and Valley Lutheran Medical Center



Further Readings:

Campaign for Foreign Nurses

Empire of Care: Nursing and Migration in Filipino American History

Pilipino/as in Nursing

Basic Steps for Foreign-Educated Nurses to Enter the U.S. Job Market



References:

Allan, H. & Larsen, J. (2003). Learning from others: Overseas nurses' views of UK nursing. Nursing Education Today, (23), 393-395.

Buchan, J., Parkin, T. & Sochalski, J. (2003). International nurse mobility: Trends and policy implications, World Health Organization, Geneva

Bureau of Labor Statistics. Retrieved January 28, 2008, from http://www.bls.gov/home.htm

Commission of Graduate Foreign Nursing Schools. Retrieved January 28, 2008, from http://www.cgfns.org/

Flynn, L. & Aiken, L. (2002). Does International Nurse Recruitment Influence Practice Values in U.S. Hospitals. Journal of Nursing Scholarship, (34), 67-73.

Hecker, D. (2008). Occupational Employment Projections to 2014. Monthly Labor Review. Retrieved January 28, 2008, from
http://www.bls.gov/opub/mlr/2005/11/art5fu
ll.pdf

Lason, J. Embodiment of discrimination and overseas' nurses career progression. University of Surrey Guildford UK: European Institute of Health and Medical Sciences, 2007.

Lindquist, B. (1993). Migration networks: A case study in the Philippines. Asian and Pacific Migration Journal, 74-104.

McElmurry, B., Solheim, K., Kishi, R., Coffia, M., Woith, W. & Janepanish, P. (2006). Ethical Concerns in Nursing Migration. Journal of Professional Nursing, (22), 226-235.

Stringer, H. (2002, June 6). Foreign Investments. NurseWeek.