Immigration policy and internationally educated nurses in the United States: A brief history

Since the 1980s, U.S. policy makers have used immigration policy to influence the supply of nurses by allowing or restricting the entry of internationally educated nurses (IENs) into the U.S. workforce. The methods pursued have shifted over time from temporary visa categories in the 1980s and 1990s to permanent immigrant visas in the 2000s. The impact of policy measures adopted during nursing shortages has often been blunted by political and economic events, but the number and representation of IENs in the U.S. nursing workforce has increased substantially since the 1980s. Even as the United States seeks to increase domestic production of nurses, it remains a desirable destination for IENs and a target market for nurse-producing source countries. Hiring organizations and nurse leaders play a critical role in ensuring that the hiring and integration of IENs into U.S. health care organizations is constructive for nurses, source countries, and the U.S. health care system.     

International nurse migration: U-turn for safe workplace transition

Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country. In this article, the authors report findings from an empirically grounded study that examines the experience of IENs who entered Ontario's workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as 'different' from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice and the role of patients and families in decision-making. In addition, problems with English language fluency cause work-related stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides important insights as policy and management decision-makers balance the tension between increasing the IEN workforce and the delivery of safe patient care.     

Comparative trend analysis of characteristics of internationally educated nurses and U.S. educated nurses in the United States

AIM: This study compares characteristics of internationally educated nurses (IENs) and US educated nurses in the USA and examines trends and implications. BACKGROUND: Internationally educated nurses have been an integral part of the US nurse workforce since the end of the Second World War, especially since the immigration reform in 1965. With the worsening nurse shortage, US employers are intensifying their recruitment efforts by targeting IENs. METHODS: Secondary analysis using datasets from the National Sample Survey of Registered Nurses conducted during 1977-2000 in the USA. RESULTS: Findings indicated that there were important differences between IENs and US educated nurses in their trends of demographical, educational and employment characteristics over time. As a group, IENs were younger but more experienced as nurses and better prepared educationally; worked more hours in both primary and secondary nursing positions; and were primarily employed in urban hospitals as staff nurses in direct care roles, with an increasing proportion working in extended care facilities. CONCLUSIONS: Inter-group and intra-group comparisons suggest that (a) IENs were likely to have longer, more productive nursing careers, (b) because of their demographical and employment characteristics, IENs had a greater impact on relieving the US nurse shortage per capita during 1977-2000, and (c) IENs were making increasingly important contributions to the care of Americans, particularly older Americans and those cared for in inner city hospitals.     

The downward occupational mobility of internationally educated nurses to domestic workers

Despite the fact that there is unmet demand for nurses in health services around the world, some nurses migrate to destination countries to work as domestic workers. According to the literature, these nurses experience contradictions in class mobility and are at increased risk of exploitation and abuse. This article presents a critical discussion of the migration of nurses as domestic workers using the concept of ‘global care chain’. Although several scholars have used the concept of global care chains to illustrate south to north migration of domestic workers and nurses, there is a paucity of literature on the migration of nurses to destination countries as domestic workers. The migration of nurses to destination countries as domestic workers involves the extraction of reproductive and skilled care labor without adequate compensatory mechanisms to such skilled nurses. Using the case of the Canadian Live‐in Caregiver Program, the study illustrates how the global movement of internationally educated nurses as migrant domestic workers reinforces inequities that are structured along the power gradient of gender, class, race, nationality, and ethnicity, especially within an era of global nursing shortage.     

Globalisation, localisation and implications of a transforming nursing workforce in New Zealand: opportunities and challenges

Severe staff and skill shortages within the health systems of developed countries have contributed to increased migration by health professionals. New Zealand stands out among countries in the Organisation for Economic Co-operation and Development in terms of the high level of movements in and out of the country of skilled professionals, including nurses. In New Zealand, much attention has been given to increasing the number of Māori and Pacific nurses as one mechanism for improving Māori and Pacific health. Against a backdrop of the changing characteristics of the New Zealand nursing workforce, this study demonstrates that the globalisation of the nursing workforce is increasing at a faster rate than its localisation (as measured by the growth of the Māori and New Zealand-born Pacific workforces in New Zealand). This challenges the implementation of culturally appropriate nursing programmes based on the matching of nurse and client ethnicities.     

The migration and transitioning experiences of internationally educated nurses: a global perspective

newton s., pillay j. & higginbottom g. (2012) Journal of Nursing Management  20, 534–550 The migration and transitioning experiences of internationally educated nurses: a global perspective Aim To comprehensively review recent literature related to the migration and transitioning experiences of internationally educated nurses (IENs). Background Many developed nations are redressing nursing deficits by recruiting IENs. Acquiring credentialing is historically recognized as a barrier to obtaining meaningful employment, yet broader issues of transition into global health care contexts are also significant. Methods A database search of CINAHL, Medline, Scopus and Web of Science, and a hand-search of key nursing journals produced 239 combined hits, with 21 articles meeting the inclusion criteria. Results Five common themes were extracted and synthesized including: (1) reasons for and challenges with immigration, (2) cultural displacement, (3) credentialing difficulties and ‘deskilling’, (4) discriminatory experiences and (5) strategies of IENs which smoothed transition. Conclusions Although major reasons for migration are related to improved income and professional stature, these have overwhelmingly shown to erode upon relocation. Cultural displacement appears to largely stem from communication and language differences, feelings of being an outsider and differences in nursing practice. The deskilling process and discrimination are also key players which hinder transition and demoralize many IENs. Implications for Nursing Management The present study highlights that the huge advantages in professional skill and cultural diversity that IENs can bring to any nursing unit will not be fully realized without substantial efforts to reduce practice limitations (deskilling) and discrimination. Individual strategies for easing the transition should be taught to IENs, probably through mentorship by experienced IENs.     

Supporting Indian nurses migrating to New Zealand: a literature review

WOODBRIDGE M. & BLAND M. (2010) Supporting Indian nurses migrating to New Zealand: a literature review. International Nursing Review 57 , 40–48 Background: New Zealand, like many other Western countries, is struggling to cope with increasing demands for nursing services. Registered nurses are being actively recruited internationally and New Zealand has become a popular destination for nurses who wish to emigrate, including those from India. These nurses have unique cultural, professional and educational needs yet it is unclear how to best support them as they move to their destination countries. Aims: The issues around nursing migration and its effects have been discussed in many forums, but there is evidence of a gap in understanding the issues around acculturation and socialization. This selected literature review sought to identify the significant factors that impact on migrating nurses becoming competent and confident registered nurses in the New Zealand practice environment. Methods: A bibliographical database search was undertaken (Web of Knowledge, Web of Science, CINAHL, Medline, Academic Search Elite, and Ebscohost EJS) along with national and international nursing websites for the period 2002–2009. Search terms included Indian nurse, international nurse, migration, experience, cultural safety, globalization, nurse migration, nurse recruitment, New Zealand and research. The search was limited to texts published in English, with preference given to peer‐reviewed research‐based articles. Results: A significant volume of literature was located. The key themes that arose were migration, education, language, nursing skills, competence, cultural safety and reflection on practice. Literature considered to best reflect these main themes, and of most relevance to New Zealand, was selected for this review, with preference given to research reports and official nursing publications. Conclusion: Strategies such as providing ongoing professional education, ensuring cultural safety and offering mentoring in practice environments will contribute to a safe passage for migrating nurses. Further research is required into the acculturation and socialization of Indian nurses, especially those moving to New Zealand.     

Overseas recruitment activities of NHS Trusts 2015–2018: Findings from FOI requests to 19 Acute NHS Trusts in England

Migrant nurses form an increasing proportion of the nursing workforce, with the United Kingdom (UK) being the third most popular destination for overseas nurses in the world. The migrant nurse workforce is highly susceptible to policy changes at the macro or professional level of the donor and recipient countries. Freedom of information requests were issued to 19 National Health Service [NHS] Trusts in England to determine their involvement in overseas nurse recruitment activity from 1998 onwards. These indicate a notable shift away from active European Union (EU) recruitment and towards overseas countries particularly the Philippines and India. Reasons given were as follows: diminishing returns from EU sources, high attrition among EU nurses and the introduction of English language tests for EU nurses in July 2016. This led to Trusts revisiting their recruitment strategies by increasing more direct/less resource‐intensive methods and expanding their focus outside of the EU. Trusts frequently utilised private recruitment companies for their recruitment drives, including consulting and influencing the Trusts’ workforce strategies. Policy adjustments have numerous influences on the composition of the overseas nursing workforce. While the NHS continues its efforts in expanding its international nursing workforce, this should not be at the expense of ethical and sustainable recruitment practices, which may be compromised indirectly as a result.     

International nurse migration: lessons from the Philippines

Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.     

Lived experiences of internationally educated nurses in hospitals in the United States of America

JOSE M. M. (2011) Lived experiences of internationally educated nurses in hospitals in the United States of America. International Nursing Review 58 , 123–129 Aim: The overall goal of this study was to elicit and describe the lived experiences of internationally educated nurses (IENs) who work in a multi‐hospital medical centre in the urban USA. Background: Since World War Two, US health care agencies have addressed the nursing shortage by hiring IENs. While other countries have produced substantial research findings about their IENs, much less research has been done about IENs in the USA. Findings from the limited US studies suggest that more research is needed and first‐hand reports of lived experiences must be added. Methods: Using a phenomenology of practice study design and Giorgi's principles of data analysis, narratives from the guided interviews with 20 new immigrant IENs who had migrated from the countries of the Philippines, Nigeria and India to the USA, were collected and studied for themes. Findings and discussion: Six themes that emerged from the stories of IENs together describe a trajectory of lived experiences that the IENs encountered during their adjustments to living and working in the USA. The emergent themes weredreams of a better life, a difficult journey, a shocking reality, rising above the challenges, feeling and doing better and ready to help others. Study findings are similar to studies done in other countries and highlight the needs of IENs. Conclusion: The study findings provide important first‐hand insights from the subjective perspectives of the IENs in US hospitals and will guide recruitment and retention of a diverse nursing workforce. Findings will enrich orientation and transition programs for IENs as well as strengthen the cohesiveness of a diverse nursing workforce in the USA.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

Nursing shortages and international nurse migration

BACKGROUND: The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. AIM: To predict the international migration of nurses to the UK using widely available data on country characteristics. METHOD: The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. RESULTS: The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. CONCLUSION: Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.     

The Ethical Recruitment of Internationally Educated Nurses: A Leadership Perspective on Labor Migration

The trend in labor migration depends on variables such as the country’s economy, immigration policy, aging and population health, and the health care industry’s supply and demand prospects. The World Health Organization (WHO) and the Migration Policy Institute reported a steady rise in hiring international educated nurses with developed countries relying on foreign-born nurses to fill vacancies. According to a survey conducted by the International Council of Nurses in 2020, the National Nurses Association reported a 20% increase in nurses leaving the profession. The aging nursing workforce, heavy workload, insufficient staffing, burnout, stress, mass trauma, and the growing effects of COVID-19 on nurses’ psychosocial and emotional health exacerbated the nurses’ intention to leave. Although health care organizations are strained dealing with the outbreak, nurses are either retiring or quitting, leaving administrators to rely on temporary employees while struggling to fill permanent positions. This cyclical nursing shortage in the past, now exacerbated by the global pandemic crisis, has prompted policymakers to revisit the WHO’s Code on recruitment of health workers and its impact on sending and receiving countries.     

Global nurse migration today.

PURPOSE: To examine emerging trends in global nurse migration and those effects on nurse workforce planning and development efforts in select donor and recipient countries. DESIGN AND METHODS: This integrative literature review is an analysis of current literature (journal articles, media, and press releases) and data from various sources (PUMS, NSSRN, CGFNS, Nurse & Midwifery Council) to explicate new trends in nurse migration. FINDINGS: Rapid changes in nurse migration are significantly challenging nurse workforce management efforts in both donor and recipient nations. CONCLUSIONS: As the market demand for nurses around the globe escalates, the changes and consequences associated with nurse migration are increasingly in need of policy solutions that indicate the needs and motivations of all stakeholders.     

Nursing migration: global treasure hunt or disaster‐in‐the‐making?

International nurse migration--moving from one country to another in the search of employment--is the focus of this article. The majority of member states of the World Health Organization report a shortage, maldistribution and misutilisation of nurses. International recruitment has been seen as a solution. The negative effects of international migration on the 'supplier' countries may be recognised today but are not effectively addressed. Nurse migration is motivated by the search for professional development, better quality of life and personal safety. Pay and learning opportunities continue to be the most frequently reported incentives for nurse migration, especially by nurses from less-developed countries. Career opportunities were considered key incentives for nurses emigrating from high-income countries. Language was reported to be a significant barrier. The positive global economic/social/professional development resulting from international migration needs to be weighed against a substantial 'brain and skills drain' experienced by supplier countries. The vulnerable status of migrant nurses is also of concern in certain cases. The focus on short-term solutions as opposed to resolving the problem of a worldwide shortage of nurses causes great concern. Recent initiatives attempt to curb or channel international recruitment. The delicate balance between recognising the right of individual nurses to migrate and a collective concern for the health of a nation's population must be achieved.     

Nurse migration: the effects on nursing education

This paper is an opinion piece based on experience and supported where possible with literature, which addresses an issue of both national and international interest. It focuses on one aspect of the multifaceted social phenomenon of nurse migration, i.e. nurse education.
Background:  Much has been written about the direct effects of nurse migration on the nurse migrant, the delivery of health care in the countries that supply the nurses, and the countries that receive them. However, there is little information regarding the direct effects of migration on nurse education within the literature.
Aim:  The aim of this paper is to raise awareness of the positive and negative effects of nurse migration on nurse education both in the countries that supply nurses and those which receive them.
Methods:  Both scholarly and 'grey' literature is used to support the discussion on the 'real' challenges faced by nurse educators and clinical nurses in those countries that supply or receive nurses. In addition, practical recommendations for nurse educators are presented. Furthermore, the nursing profession is challenged to become politically active, to become involved and to take responsibility for the decisions made about nurse education in order to protect the integrity of nurse education and patient safety.
Conclusion:  The quality of nurse education in many countries has been undermined as a result of rapid, mass migration. There is an urgent need to take practical steps to maintain the integrity of nurse education and the nurse's preparation for practice in order to protect patients' safety.