As manufacturers and technology firms export jobs to China and India, the United States has ramped up its importation of foreign nurses.
In 1995, nearly 10,000 foreign nurses received their U.S. registered nurse (RN) licenses, representing nearly 10 percent of all newly licensed RNs that year.
Recruiting nurses from the Philippines, India and Nigeria, among other places, isn’t new—the United States has relied on foreign nurses for at least 50 years—but it is becoming more prevalent as a way to deal with the current nursing shortage, says Barbara Brush, associate professor of nursing.
“They’ve been a hidden part of our matrix for a long time,” she says. “And unless we have some major immigration policy changes, I think foreign nurses will be part of our system for the long haul.”
Brush, a nursing historian who has studied the issue for nearly 20 years, will receive about $150,000 from the National Library of Medicine for a book that documents the history of foreign nurse migration to the United States. It will build on research Brush published in a Health Affairs article, “Imported care: Recruiting foreign nurses to U.S. health care facilities.”
In 1992 California and New York were home to nearly half of all foreign nurses in the United States, but by 2000 their share of foreign nurses had declined to 38 percent while Florida, Illinois, Michigan, New Jersey and Texas saw the sharpest gains. Still, about 33 percent of the New York nursing work force comes from foreign countries.
Generally, foreign nurses are women who send money home to family members, as the salaries they earn here are significantly higher than what they could make at home, Brush says. A nurse in the United States makes an average of $50,000 a year; a nurse in the Philippines might earn $2,500.
Brush says that while recruiting foreign nurses might appear to address a need to introduce cultural diversity into the work force, one challenge is that the cultural background and language of foreign nurses often do not match those of the patients they serve in the United States. Filipino nurses may care for African-American or Hispanic patients in New York hospitals, for example, or for other immigrant groups such as Chinese or Vietnamese.
In the past, foreign nurses have worked predominantly in nursing homes and in hospitals in urban settings, out of sight of many white, middle-class patients, Brush says, adding, “I think they are going to become more visible across a wider array of institutions and areas in the United States and that might make the public nervous.” Brush surmises some patients could have concerns about nurses’ culture or language barriers or about the quality of the nursing education they received outside the United States.
Some recruiters charge as much as $10,000 for each foreign nurse they hire on behalf of American employers, and in response to communication concerns some Indian educators are offering accent reduction classes to help nurses sound more American. In the past, would-be foreign nurses had to travel to the United States to take the licensing exam, but now can take it in London and Seoul, Korea.
