Foreign Nurses as a Supplement to U.S. Born Nursing Staffs

November 9, 2006

Health policy analysts, academics and others who follow health care staffing trends are virtually unanimous in their belief that the United States is in the midst of a growing nurse shortage.

The shortage is serious today, but not nearly as serious as it will be in ten to fifteen years, should current projections hold true.  The American Hospital Association indicates that the nurse vacancy rate in acute care hospitals today stands at 8.5%.  This represents 118,000 vacant nurse positions.  According to the U.S. Department of Labor’s projections, there will be 275,000 nurse vacancies by the year 2010; 500,000 by 2015; and 800,000 vacancies by the year 2020.

Low nurse to patient ratios have been tied to increased patient morbidity, lower patient satisfaction rates, and a general decline in the quality of health care delivery.  For this reason the state of California has imposed mandatory nurse to patient ratios in its hospitals.  Other states such as Massachusetts may follow suit.

While it is clear that we need more nurses, it is not so clear where these nurses will come from.  There is one hopeful sign, which is that in recent years a growing number of students have gravitated toward a career in nursing.  According to the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania, 70,000 nurses graduated from US nursing schools in 1994.  According to CHOPR, for 2005 this number was 95,000—an increase of almost 36% over 10 years.

A concerted effort has been made by nursing associations and other groups to portray nursing in a positive light.  The numbers indicate that this effort is succeeding.  Unfortunately, interest in nursing is only part of the equation.  Another vital part is the system of nurse education and training system itself.  At present, nurse training programs are too restricted to accommodate many qualified applicants.  According to CHOPR, in 2005, 34,000 qualified Bachelor of Science in Nursing (BSN) applicants were turned away from U.S. nursing schools as a result of insufficient space and/or a shortage of teaching faculty.

This is a systemic problem that can only be addressed over time, and one which will also require considerable additional funding to remedy.

The Role of Foreign Nurses
Until further steps are taken to increase the domestic supply of nurses, US hospitals and other health care organizations can use foreign nurses to supplement their staffs.  Without using this source, many health organizations would face staffing challenges so severe that some would not only be forced to close beds, but entire hospital wings.

It is significant to note that in 2005 the United States became the world’s largest importer of nurses, supplanting the United Kingdom.  Some 14,000 foreign nurses entered the US in 2005, compared to approximately 4,000 in 1995.  According to CHOPR, by 2010, 10% of nurses working in the U.S. will be foreign born.

Like many other areas, the labor market in health care is also going international as a growing number of countries compete for skilled workers.  The United States has an advantage as far as nurses are concerned, because nurse education in major nurse “exporting” countries is organized with the US in mind.  Nurses in the Philippines, for example, train with US textbooks and use a curriculum based on the US model.  India also trains nurses with the expectation that many will work in the US.

In order to work in the US, foreign nurses must obtain a state nursing license and prove proficiency in English.  The qualification process is quite rigorous and is designed to filter out applicants who lack the necessary clinical and communication skills.

Recruiting Foreign Nurses
For those health care providers interested in utilizing foreign nurses, the challenge is finding qualified foreign nurses.  Usually health care organizations turn to companies which specialize in recruiting foreign nurses.  One such company is O’Grady Peyton International.  As the international division of AMN Healthcare, the largest health care staffing organization in the United States, O’Grady Peyton International specializes in recruiting highly qualified, licensed international nurses interested in relocating to the United States .  O’Grady Peyton, or OGP, has offices all over the world, including Australia, India, Ireland, Singapore, South Africa, and the United Kingdom. 

As part of the recruiting process, all foreign applicants are carefully screened by OGP.  Applicants must exhibit a high level of competence, excellent clinical skills, high English proficiency, and a sense of flexibility and adaptability in order to be considered as candidates for a client’s facility. 

Although clinical policies and procedures usually are consistent between countries, cultural and logistical acclimation can be an issue.  For this reason, OGP provides thorough support services including pre- and post-arrival clinical support, relocation and logistical support, and nurse orientation programs.  OGP also has programs in place that enable it to act as an ongoing liaison between the recruited nurses and the facilities employing them, making it easier for the nurses to transition into a new culture.

Bringing Foreign Nurses to the United States
The final phase of the process calls for the filing of the necessary immigration paperwork, allowing nurses to enter the US as permanent residents or “green card” holders.  Because nursing has been deemed a shortage occupation, the immigration process is relatively simple.  Government processing times and recent backlogs, however, have made it a lengthy process.  Despite the time it may take for a nurse to obtain permanent residency and enter the US, utilizing foreign nurses as a supplement to other nurse recruiting programs is a viable solution until such time as the United States can produce the qualified nurses it needs.

For additional information regarding foreign nurses, you may contact Linda M. Keck, Esq. at or (513) 651-6193.

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