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.

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