Foreign-educated health professionals (FEHPs) in the United States are generally satisfied with their recruitment experience despite the persistence of certain unethical practices, the first major survey of the U.S. international nurse recruitment industry in more than a decade has found. While strides have been made in the realm of ethical international recruitment, there is still room for improvement.
Current estimates indicate that 8-15% of the U.S. nursing workforce is foreign educated, but those figures are projected to grow in the face of health worker shortages and increased demand as the Baby Boomer generation ages and retires out of the workforce.
The study, conducted by CGFNS International, Inc. and published in the American Journal of Nursing, found that 69% of FEHPs had a positive recruitment experience. But the findings also suggest lingering instances of mistreatment, as 30 respondents indicated that their recruiters exhibited dishonesty during the process. Moreover, while breach fees are part of the business models for recruiters who bear high upfront costs, they leave FEHPs vulnerable to coercion and exploitation.
This is a topic that all stakeholders must address in order to protect the rights of migrating health professionals and to ensure high-quality care delivery. We have to consider the impact of migration on the individual FEHP being recruited as well as on the countries they're leaving from and migrating to."
Franklin A. Shaffer, EdD, RN, FAAN, FFNMRCSI, lead author, President and CEO of CGFNS International, Inc.
For the study, the researchers surveyed 8,894 FEHPs recruited to the U.S. between 2015-2017 who used VisaScreen® -; a CGFNS service that establishes eligibility for employment-based visas -; with an 11% response rate, reflecting FEHPs from 56 countries. They also conducted detailed interviews with FEHPs and recruiters to illuminate the current state of the U.S. FEHP recruitment industry today.
Many of the issues examined in the CGFNS study first came to light in health care think tank AcademyHealth's 2007 report, U.S.-Based International Nurse Recruitment: Structure and Practice of a Burgeoning Industry, for which CGFNS International also conducted focus groups and surveys. That study was an impetus for the Alliance for Ethical International Recruitment Practices, a multi-stakeholder effort to develop a voluntary Code establishing best practices in nurse recruitment; founded in 2008, the Alliance has been a division of CGFNS since 2014. Since that time, there has been substantial progress on ethical practices industrywide, though problems remain.
Among the CGFNS study's other findings:
- 80% of FEHPs knew their wages before signing.
- 9% had to pay a recruiter fee.
- 47% had breach fees of at least $15,000 in their contracts.
- Some FEHPs who later tried to leave their job were threatened with prosecution for "immigration fraud" or having their visas revoked.
- Some FEHPs reported receiving lower pay than their domestic counterparts, with no added pay for working nights or weekends.
- While some FEHPs received comprehensive cultural orientation programs from recruiters to ease their transition, others did not.
"Workforce cohesion, and ultimately, the quality of patient care depend on ensuring that all colleagues are treated fairly, trained well, and positioned to succeed in demanding health care environments," the authors concluded.
Shaffer, F.A., et al. (2020) The Recruitment Experience of Foreign-Educated Health Professionals to the United States. American Journal of Nursing. doi.org/10.1097/01.NAJ.0000652024.67027.f7.