By Shawn Kennedy, AJN interim editor-in-chief
Pasig River, Manila, Philippines, by ibarra_svd / Bar Fabella, via Flickr
A significant number of foreign-educated nurses (FENs) come to the United States each year to work; although the exact number is unknown, consider that in 2009 alone, more than 14,000 FENs passed the NCLEX exam for licensure to practice here. Many come because they’ve been actively recruited by firms acting as agents for hospitals and nursing homes; others come on their own. Some are recruited from developing countries that, because of severe internal nursing shortages, can ill afford to send qualified nurses abroad. And some FENs learn that what they expected—or were led to expect—doesn’t match what they actually find when they arrive.
In the June issue of AJN, you’ll find a comprehensive study examining the international nurse recruitment business, an industry that’s gone through rapid growth in the last decade. Supported by a grant from the John D. and Catherine T. MacArthur Foundation, Patricia M. Pittman and colleagues conducted interviews with industry executives and focus groups with FENs. They also surveyed recruitment company Web sites to learn more about their business models and practices and where they recruit from. What the researchers learned and heard led them to expand the study’s focus to include an examination of the problems and issues that FENs reported. (See this related interview with a nurse who was one of the “Sentosa 27” who claimed unfair recruitment practices.) The bottom line: the industry has work to do; it needs to develop a system of accountability for its business practices.
This article appears just after the 63rd World Health Assembly, meeting in May in Geneva, Switzerland, approved the WHO Global Code of Practice on the International Recruitment of Health Personnel, a voluntary code of ethics that it is urging members to follow. The code contains guiding principles, reaffirms the right of individuals to migrate, and urges that member countries address their own workforce and retention issues and seek to mitigate any negative effects of recruiting on source countries. Many of these tenets are similar to those in another code recently developed by industry stakeholders, the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States.
The question is, will such voluntary codes suffice? And what’s this all mean for U.S. nurses working alongside colleagues from other countries? I think we must all be mindful that some of our foreign-educated colleagues may have been or are currently being treated unfairly. Some might not have adequate housing or compensation. If your foreign-educated colleagues seem unsure of themselves or lacking in skills, don’t be too quick to blame them—promises of good on-site orientation and training appear to be promises often broken. When FENs do have problems, they’re often afraid to speak up, afraid that if they do they will lose their jobs and be subject to fines. Learn more about how your facility recruits FENs—and advocate that it uses an agency that follows ethical recruitment practices.
Nurses should be allowed to practice nursing wherever they wish to if they are qualified and given the opportunity to do so. If a foreign country is willing to give nurses work visas to travel and work, there should be no issue in allowing them to leave. A professional should not have to be forced to work in lesser conditions just because their employer and or country cannot provide for them. Nurses that travel to different countries to work should be treated equally and not be discriminated in any way. Should they lack any skills or knowledge, they should be encouraged to voice their concerns to supervisors to obtain the proper education. There should be strict guidelines enforced by companies and unions to prevent discrimination in the workplace and assist these new nurses.
Perhaps there should be consideration for the work forces of these other countries. However, in some areas of the United States, the populations are incredibly diverse, and having a diverse nursing staff that is educated abroad and speaking a variety of languages is a valuable asset. The voluntary code of ethics might be a nice idea, particularly in this age of an increasingly globalized employment marketplace, as a way of trying to regulate transnational hiring practices. However, health care is one of few industries that continues to grow during these troubled economic times, and where there is big business and money to be made, employers will be tempted to disregard such nonbinding, voluntary codes in favor of what best serves their bottom line. Ethics consideration, aside
FYI – There is a bill that was introduced May 20, 2009, into Congress “H.R. 2536: Emergency Nursing Supply Relief Act”, the bill basically will allow foreign nurses to have an easier time to get a visa to work in the USA and give them grants to further their education. Right now the bill is in the first steps of the legislative process…so, now is the time to write/call your congress person and let them know the struggles us newly graduated RN’s are having securing a job and to quash the bill before it goes any further!
Of course we should also point out that for new grad nurses having difficulty finding jobs right now, it is a bit upsetting that hospitals would rather recruit nurses from other countries, instead of properly investing time and money in the glut of new nurses that currently exists and wants nothing more than to work.