Leveraging Expertise From Abroad

How international nurses are alleviating the nursing shortage—and improving U.S. health systems.

By Tierney McAfee

The national nursing shortage is driving organizations in the United States to look outside the country for talent. But experts say recruiting international nurses is more than just a temporary solution—it’s a valuable opportunity to improve U.S. hospitals and health systems.

“Organizations are just beginning to realize that there are not enough experienced nurses in the U.S. to meet their needs,” says Liz Bickley, senior vice president of healthcare client services for Cielo, a strategic recruitment process outsourcing partner. “The only real option is to start to reconsider recruiting outside of the U.S.”

The nursing deficit in the U.S. is verging on a crisis as the healthcare system is strained by an aging population and increased access to public healthcare. With more than 500,000 RNs expected to retire by 2022, the U.S. Bureau of Labor Statistics has projected a need for 1.1 million new RNs to avoid a further shortage.

Some healthcare providers are responding to the problem by adopting nurse residency programs, or “grow your own” nurse programs, which help recent nurse graduates transition into clinical practice and continue to build skills while working alongside seasoned RNs. But Bickley says that in many places, there is still a need for experienced nurse care. That’s where international nurses have real potential for success.

Foreign-born nurses make up about 15 percent of registered nurses in the U.S., according to a June 2016 report by the Institute for Immigration Research at George Mason University and the Immigrant Learning Center. Bickley says she has seen a recent uptick of companies in the U.S. recruiting nurses from Canada, the Philippines, India, Australia, and South Africa—countries where nurses’ training is on par with that of U.S. RNs. While their skill level is similar, there is much to be learned from foreign nurses’ different experiences of practicing care, Bickley says, pointing to trauma and emergency room nurses from South Africa as an example.

“One of the benefits that I think often goes unrecognized is some of the complexity of care or different skillsets these nurses can bring to the U.S. that might not be here today,” Bickley explains. “The training and the level of care that nurses from the Philippines are providing is really strong, but it’s probably done differently. I think some fresh perspective and the ability for us to think differently could be really positive and help make our health systems even better.”

Bickley says it’s crucial for employers interested in hiring international nurses to consider their organization’s infrastructure and ability to support such employees, as well as obstacles such as providing visa sponsorship and ensuring foreign nurses meet licensure requirements.

“It isn’t easy to do from an immigration perspective, so you need to feel really confident that these nurses are going to be able to transition and be successful. The process is a lot more involved than what we usually do,” Bickley says. “So, we really push organizations to ask themselves, ‘Are we ready for this? Is our community ready for this? How are we going to be able to support nurses’ professional integration but also their personal integration into these communities and organizations?’”

Geography is also a consideration. Bickley recommends that international nurses be placed in U.S. locations similar in scale to their native communities to avoid further culture shock.

“If you take nurses from Manila [the capital of the Philippines], a huge urban city, and stick them in rural South Dakota without any kind of climatization or preparations for that, it’s going to be really hard on those people to just transition and be successful in that environment,” Bickley says.

While Bickley notes that recruiting international nurses doesn’t offer a quick return on investment, it can help organizations save time and money in the long run.

“Aside from the fact that we’re bringing experienced nursing talent to an organization, the retention tends to be really good, providing you’ve done everything right at the beginning,” Bickley says.