Are Immigrant Nurses a Threat to the US Nurse?


Immigrant Nurses

Acute shortage of nurses has resulted in a large population of nurses from other countries being employed in health care settings in the United States of America. Statistics show that the total number of nurses working in the healthcare field in the United States has decreased from 2,669,603 in the year 2000 to 2,262,020 in year 2001(World Health Organization., 2006) with a simultaneous increase in nurse responsibilities, decrease in the number of applicants to baccalaureate programs and an aging workforce. Thus, the demand for nurses is greater than the supply. This shortage in the US has been managed by recruiting foreign nurses from India, Philippines, Japan and some African countries for the past fifty years (Brush, 2004).This shortage can be defined by either a need based approach or a ratio technique. The need based approach identifies the number of professionals needed to perform certain tasks based on the judgment of a nursing or a medical professional. The ratio technique compares the current professional population ratio to a projected future ratio, and identifies a difference as a shortage (Lane and Gohmann, 1995).

The Core Issues

The core issues such as clinical competencies of the immigrant nurses, their cultural sensitivity and ethics has been a hot topic in the process of recruiting foreign nurses (Stone, 2004). There are also arguments that view international migration of nurses into US as a brain drain of healthcare professionals in low-income countries. Many professional nurse / trade associations in US oppose the recruitment of such foreign nurses stating that the government should focus on strengthening the U.S. nursing education system rather than relying on this process (Dugger, 2006).These arguments point to the fact that the American nursing schools had rejected almost 150,000 applications from qualified people in 2005 alone due to lack of faculty to teach them (Dugger, 2006).

But, at the same time, research studies have shown that these immigrant nurses can help build healthy communities, by assisting other nurses and health care providers to function from a transcultural posture to develop culture competence, reconceptualize how immigrants are viewed and actualize human development as part of community development (DeSantis, 1997).Further, immigrant nurses have been identified as a potential population for nursing positions in long-term care in USA. A recent article has shown that immigrant nurses have higher levels of education and higher levels of labor force attachment than US-born nurses (Arends-Kuenning 2006). These immigrant nurses have been projected as an even more important source of labor although these workers have to overcome a variety of cultural and language barriers.

Studies have also highlighted the need for the institutions and agencies to exhibit a higher level of sensitivity to their cultural differences (Priester and Reinardy ,2003).Published literature also stress on the need for a right attitude among US nurse unions toward immigrants within the context of a globalized environment (Nissen and Grenier,2001). Dennis and Small (2003) see immigrant nurses as brokers of three cultures: their own; the health care system; and the client.

Recent studies have shown that with the hospitals experiencing shortage of registered nurses, the employment and earnings of the nurse work force has increased sharply in 2002 and one third of this nursing work force is composed of foreign nurses (Buerhaus, 2003). An economic analysis of the nursing labor market has revealed the short-term effects of changes in nursing wages and the number of hours they are willing to work based on data from the Current Population Surveys. The study warns that any cost containment measure in this care sector will lead to shortages. According to this study, foreign-born nurses account for 30% of the nurses in 2004 and predicts a higher number in the future (Buerhaus, 2007).

A study involving Korean immigrant nurses in USA has identified five challenges to an immigrant nurse, namely, Psychological stress, Language barrier, US standards of nursing practice, US style of problem-solving strategies and US style of interpersonal relationships (Myungsun and Jezewski, 2000).The immigrant nurses have also been shown to face the challenges of being an outsider needing to be in a different work culture (Magnusdottir, 2005). But, the immigrant nurses have more to accomplish professionally instead of thinking of being in distress during their initial adjustment phase when such barriers are common.

Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon in the context of nurse migration. Research studies have revealed that personalized and well-aimed training, preparatory language courses, predeparture exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve the process of recruitment of foreign nurses (Dubois, 2006). Buchan and Julie (2004) recommend improvement of working conditions, wages, creating multilateral agreements, maintaining a database of immigrant nurses to effectively manage the inflow of foreign nurses. Brush and Rukmini (2006) have highlighted the need for strategies to prepare female migrant care-givers to fit into the system. Language, specifically command of English and accent modification, has also been elucidated.

Immigrant Nurses-Need of the Hour

There is no second opinion that it is important to ensure that U.S. nurses are treated fairly in international trade agreements and foreign nurse recruitment does not threaten quality of health care. But it is equally important to recognize the fact that foreign Nurses recruitment is the Need of the Hour in US. The nurse shortage in US by the year 2020 is projected to be 1 million (Brush, 2004) and an American Hospital Association survey has revealed a shocking 1, 26,000 unfilled nursing positions in 715 hospitals in US (Trossman, 2002). A recent provision in the immigration law that raised the limit on the number of work permit visas has opened gates for 30,000 foreign nurses a year coming to the U.S (Dugger, 2006).


Acute nursing shortage is an issue in USA today. A steep in drop in nursing student applicants, factors like subordination of nurses to the medical profession, frequent schedule changes, overloads, burnout, shift work, lack of appreciation by superiors and colleagues, lower wages, short staffing and poor working conditions have contributed towards a reduction of nursing professionals in USA and nursing, as a profession, has failed to attract the younger generation. A more critical nurse undersupply is predicted over the next twenty years with the U.S. health care facilities already struggling to fill current vacancies.

It is not just recruitment but also retention which is the strategy of the day. Foreign nurses are not only the target for recruitment in USA but also retention in terms of the work contract agreements they are obliged to. With the advent of a competitive corporate health care market trend, there is no doubt that only competent foreign candidates who can accept and adapt high professional standards will find their way into USA.


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• Barbara L. Brush, Julie Sochalski and Anne M. Berger (2004). Imported Care: Recruiting Foreign Nurses to U.S. Health Care Facilities. Health Affairs, 23(3): 78-87.

• Barbara L. Brush, Julie Sochalski and Anne M. Berger (2004). Imported Care: Recruiting Foreign Nurses to U.S. Health Care Facilities. Health Affairs, 23(3): 78-87.

• Bruce Nissen & Guillermo Grenier (2001).New Issues for Labor Internationalism.Union Responses to Mass Immigration: The Case of Miami, USA. Antipode. 33(3); 567-592.

• Brush, B. L., Sochalski, J., & Berger, A. M. (2004). Imported care: Recruiting foreign nurses to U.S. health care facilities. [Electronic Version]. Health Affairs, 23(3), 78-87. Retrieved October 26, 2006 from

• Bulletin of World Health Organization (2004).82; 587-594.

• Celia W. Dugger (2006).U.S.Opens its arms to immigrant nurses.International Herald Tribune.May 31.

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• H. Magnusdottir (2005). Overcoming strangeness and communication barriers: a phenomenological study of becoming a foreign nurse. International Nursing Review.52 (4): 263-269.


• Julia Lane, Stephan Gohmann (1995). Shortage or Surplus: Economic and Noneconomic Approaches to the Analysis of Nursing Labor Markets. Southern Economic Journal, 61.

• Myungsun Yi and Mary Ann Jezewski (2000). Korean nurses' adjustment to hospitals in the United States of America. Journal of Advanced Nursing.32 (3): 721-729.

• Peter I. Buerhaus, David I. Auerbach, Douglas O. Staiger, (2007). Recent Trends in the Registered Nurse Labor Market in the US: Short-Run Swings on Top of Long-Term Trends. Nursing Economics.

• Peter I. Buerhaus, Douglas O. Staiger and David I. Auerbach (2003). Is The Current Shortage Of Hospital Nurses Ending? Health Affairs, 22(6): 191-198.

• Priester R, Reinardy JR (2003). Recruiting immigrants for long-term care nursing positions. J Aging Soc Policy. 2003; 15(4):1-19.

• Stone, P. W., Clarke S., Cimiotti J., & Correa-de-Araujo R. (2004). Nurses' working conditions: implications for infectious disease. [Electronic Version]. Emerging Infectious Diseases, 10(11), 1984-9. Retrieved October 12, 2006 from Pubmed (15550212).

• Trossman, S. (2002). The global reach of the nursing shortage: Electronic Version. American Journal of Nursing, 102(3), 85 – 87. Retrieved October 11, 2006, from Ovid database.

• World Health Organization. (2006). The world health report 2006 - working together for health. [Electronic Version]. Retrieved October 10, 2006 from

Copyright 2007- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved


Articles in this issue:


  • Masthead

    Editor-in Chief:
    Kirsten Nicole

    Editorial Staff:
    Kirsten Nicole
    Stan Kenyon
    Robyn Bowman
    Kimberly McNabb
    Lisa Gordon
    Stephanie Robinson

    Kirsten Nicole
    Stan Kenyon
    Liz Di Bernardo
    Cris Lobato
    Elisa Howard
    Susan Cramer

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