Introduction
The United States of America has the largest professional nurse workforce in the world, with this workforce almost reaching 3 million in 2004. However, there has been an increasing need for nurses and the local supply for them has been decreasing over the years. The growing nurse shortage in the U.S. has led to the intensification of efforts by U.S. healthcare providers to recruit nurses from other countries. Today, Internationally Educated Nurses (IENs) are an integral part of the U.S. nurse workforce and they continue to play a pivotal role in hospitals and nursing homes. Xu and Kwak (2007) documented that about 4% of the registered nurses in the US received their basic nursing education in other countries. Considering the fact that the number of immigrant nurses practicing in the USA will continue to rise in the coming years, an understanding of the impacts of immigration on nurses are important to healthcare providers, nurses, and patients. This paper will therefore set out to discuss the effects of immigration on nurses. It will begin by reaffirming the need for foreign nurses in the USA and proceed to give the reasons why nurses immigrate to the US. The advantages and disadvantages of immigrant nurses will then be reviewed.
The Need for Registered Nurses in the USA
The increase in need for nursing workforce in industrialized countries is caused in part by the increasing demands for health care and the aging of the nursing population. The average age of RNs in the U.S. was 46.8 years in 2004 and this average age was projected to increase with the years (Aiken, 2007). As a result, a significant number of RNs in U.S. are expected to retire soon creating a need for additional nurses to be added to the country’s workforce. These retirements compounded with the new jobs available for RNs signify that graduations of around 110,000 RNs a year would be required to ensure that the U.S. nurses’ workforce supply is sufficient. However, enrollment in nursing schools by U.S. citizens is highly sensitive to nurse labor dynamics since unlike in most western nations where the government fully funds nursing students; U.S. nurses pay for their own education (Aiken, 2007). Nurse turnover rates in hospitals and nursing homes are significantly high with many nurses opting to work outside hospital and nursing home settings. This high turnover rate is linked to the poor work environments and job dissatisfaction among RNs (Aiken, 2007). As a result of this, U.S. nurses are not enough to supply the demand that the health care industry requires. Foreign nurses provide the only feasible means with which this shortage can be dealt with.
Immigrant nurses have helped to alleviate the cyclic U.S. nurse shortage. This is because a high proportion of IENs in the U.S. are employed full time and has a second paid nursing position (Xu and Kwak, 2007). Research indicates that a high percentage of IENs works in critical care areas where U.S. nurse shortages are most acute. IENs also play a crucial role in long-term care facilities which have experienced shrinkage in the share of U.S. nurses working in these facilities over the years.
The Core Issues
Most professionals have claimed that global migration of nurses into Unites States as a brain drain of medical practitioners in developing countries. Several professional organizations in U.S. are against the employment of these immigrant nurses stating that the government should concentrate on supporting the U.S. nursing education structure instead of depending on foreign nurses. These disagreements point to the fact that the U.S. nursing institutions had rejected around 160,000 submissions from competent nurses in 2006 alone because of shortage of faculty to train them (Bodvarsson, 2009, p. 202).
However, all together, some statistics have reported that these foreign nurses may provide support to put up healthy communities. This can be achieved through supporting health care providers and nurses to work from a multicultural position to create culture ability, change the way foreign nurses are analyzed, and utilize human development to help the community. Latest article showed that foreign nurses have higher levels of skills, experience and workforce attachment than American-born nurses (Zhang, 2009, p. 65). These foreign nurses have been estimated as an essential source of employment even though these employees have to undergo various language and cultural challenges in Unites States.
A research relating Chinese immigrant nurses in Unites States has reported five challenges faced by foreign nurses. These challenges are language barrier, U.S. approach of interpersonal connections, U.S. way of problem-solving approaches, U.S. values of nursing practice, and psychological trauma. Several immigrants also experience challenges of being a foreigner and expected to be in a different work culture and ethics. However, the immigrant nurses have more to achieve at work rather than considering being in stress while in their first adjustment stage when these challenges are common.
Nursing institutions should be improved and updated to provide comprehensive training for all nurses. All-inclusive and personalized training, introductory language lessons, pre-departure experience of nurses to the practices and culture of the targeted country and appropriate receptions are among the essential strategies to enhance the course of employment for immigrant nurses. Zhang (2009) recommended enhancement of working standards, providing mutual agreements, addressing the issue of minimum wages, and managing the database of foreign nurses to control successfully the applications of immigrant nurses. Some strategies should be put in place to address female migrant healthcare professions to feature in the system. Language barriers should be addressed, particularly English and accent adjustment, to help immigrant nurses in coping with the culture of the host country.
The Long-Term Effects of Immigrants
The effects of immigrants on recruitment, earnings, and efficiency differ by job, profession, and business sector. However, it is likely to sum these impacts to obtain a total economic effect. If the average effect on empl006Fyment and earning per employee is optimistic, this means a collective surplus from migration of nurses. This can also signify that the sum gains accumulating to different United States employees are bigger than the sum losses experienced or endured by others.
First, studies have not provided any evidence showing that immigrant nurses would negatively affect U.S.-born employees now or in the future. However, studies have shown that U.S.-born employee recruitment involves minimal effects, with estimations pointing almost zero effects (Bodvarsson, 2009, p. 202). The effects of immigrant nurses on hours per worker are also minimal. Some studies have shown that there are less short run effects which are felt in U.S., but major positive impact will be experienced in the long run. Simultaneously, the movements of nurses into United States decrease a bit the skill capacity of employees in the short and long run, since immigrant nurses have a somewhat lower average qualification standard than Native American nurses.
Second, the positive long-run impacts on earning per Native American nurses accumulate over some time. In the short run, minimal insignificant impacts are reported and in the long run, a net inflow of the foreign nurses would be around 1% of professionals. This increases income per nurse by 0.5% to 1% in Unites States (Bailey, 2008, p. 40). This means that sum immigration of nurses to U.S. from 1990 to 2008 was linked with increase from 6.5% to 10% in real income per employed nurse. These figures equal a raise of around $5,000 in the annual income of the average United States’ employee in constant 2006 dollars (Bailey, 2008, p. 40).
The third outcome is that the long-term raise in income per employee, linked with foreign nurses, is mostly because of increases in the productivity and competence of country’s economy. This impact turns out as noticeable in the medium to long run in the health care system. This steady response of efficiency is associated with a steady response of the capital strength.
Nurse Immigration Requirement
Demand for IENs in the U.S. is growing and the country actively engages in the recruitment of IENs and in 2006, over 12,000 IENs took their initial licensing examinations in the U.S. These IENs are attracted by the financial enhancement that the US offers as well as the demand for nurses in the country. Singh and Sochan (2010) stated that the high numbers of migrating nurses are “creating pressures in recipient countries to standardize their incorporation into the professional workforce” (p.56). It is important for nursing competencies to be evaluated to ensure that standards of health care are not lowered as a result of including IENs.
The U.S. has through the Commission on Graduates of Foreign Nursing Schools made the process of certifying IENs simplified (Singh & Sochan, 2010). The credentialing process by this body involves; a review of home credentials of the nurse, passing qualifying exams, passing the exams to become a Registered Nurse and an English proficiency test. The U.S. has made arrangements for verification of educational and professional credentials by the IENs to be done in their home country through licensing examinations at secured agencies. IENs are then able to travel to the U.S. for completion of clinical examinations if needed and they can then serve as RNs.
Push and Pull Factor
Some studies revealed that nurses from developing countries are influenced to move to developed nations due to certain push and pull factors (Evans, 2011). Push factors are the conditions that provoke individuals to leave their countries. The push factors include the lack of opportunities to practice in their home countries as well as difficult in receiving advanced education. Buchan et al. (2003) outlines the main push factors as “relatively low pay and poor employment conditions, limited career opportunities, limited educational opportunities and economic instability” (p.10). In developing nations, the distribution and ratio of nurses is very unbalanced with a single nurse being required to care for up to 30 patients in some situations. Pull factors are those factors in the destination countries that attract nurses from their home countries. The pull factors include: higher wages, more employment opportunities, political stability, modern and well equipped hospitals, superior working conditions, and increased educational opportunities.
Advantage of Immigrant Nurses
Immigrant nurses gain significant economic benefits from their participation in the U.S. health care system. Most of the nurses come from developing countries where the pay for nurses is meager (Slote, 2011). In the US, they are offered competitive salaries and are therefore able to improve significantly their standard of livings. A large majority of the nurses send some of their money back home to help their family, therefore improving the living conditions for their kin in their native countries as well. The home country of the international nurse therefore gets to benefit from having its citizen working in the U.S. since some of the money is remitted back to the country.
The working conditions experienced by immigrant nurses in the U.S. in most cases more favorable than those of their home countries. The nurses are availed with the best technology which makes their work significantly easier (Buchan et al., 2003). In addition to this, immigrant nurses experience very reasonable patient-nurse ration in developed nations. This ration is so small in the U.S. that nurses who come from developing nations are impressed by the humane workload (Liou & Cheng, 2011). In developing nations, the patient-nurse ratio is very high with one nurse being required to cater for up to 30 patients in some instances.
Immigrant nurses often have a high level of education which makes them well suited for the U.S. market. IENs with baccalaureate degree, as their basic nursing education preparation, are consistently larger and the proportion of these nurses with graduate degrees has surpassed that of U.S. nurses (Xu & Kwak, 2007). This better educational preparation by the IENs and experience as resulted in increased quality and better patient care outcomes. The immigrant nurses are therefore able to serve proficiently in several specialized roles in the US health care industries.
Disadvantage of Immigrant Nurses
Increased recruitment of IENs has led to the rise in the number of non-English speaking nurses in the USA nursing workforce and this has posed some significant challenges in the health care field. Research indicates that some IENs had difficulties in adapting to the culture and language of the USA. Liou and Cheng (2011) revealed that lack of proficiency in English results in decreased efficiency as the nurse takes more time to understand or deliver information to patients and physicians.
The employment of several foreign nurses or health care professions has negative impact on the host country, since it reduces the number of jobs available for the U.S.-born nurses. In addition to this, focus on international recruitment reduces the need for investments in enhancing domestic retention strategies (Evans, 2011). Slote (2011) blamed the reliance on foreign nurses on the ineffective policies, which have failed to alleviate the perpetual nursing shortages experienced.
Many IENs come from developing countries where the technology used in health care system is at times modern. For such nurses, the high-tech equipment and added nursing responsibilities can be overwhelming. Nurses need more education and support so as to master the newer technology that is available in the U.S. This lack of knowledge may translate into incompetence which reduces the quality of health care offered by the IENs. Aiken (2007) noted that U.S.-born nurses have expressed concerns about the employment of IENs due to their competence to practice in highly technological environments and ability to communicate.
Immigration into the US has resulted in the rise in brain drain. Slote (2011) defined brain-drain as “the immigration of technically trained professionals from one country to another” (p.180). Brain drain results in the transfer of human capital from one country to another mostly as a result of monetary influences. The exact number of nurses who leave developing countries for employment in developed countries is unknown due to the lack of statistics, but there is an agreement that the number is significantly high (Slote, 2011). Without accurate statistics on the phenomena, it is hard for effective legislation to be enacted to contain the problem. Aiken (2007) revealed that the projected future shortage of nurses in the U.S. threatens to undermine health care delivery not only in the U.S., but also in low-income countries whose nurses migrate to the U.S. in significant numbers to look for better income opportunities.
Immigration also causes a disruption in family lives by the nurses who move from their home countries to the high-income countries. While some nurses come to the U.S. with their families, Jose (2011) noted that most of the female nurses who come to work in the U.S. leave behind their husbands and children. Since they sometimes spend many years before going back to their native countries, their family lives are disrupted since their children and husbands are forced to live without them. Some nurses also end up getting U.S. citizenship and hence are cut off from their families in their home country.
Most immigrant workers are provided with an opportunity to earn higher salaries in the foreign country, but they are also subjected to higher cost of livings. This proves to be a disadvantage especially when the immigrant workers have to take some extra nursing courses before they can become a registered nurse. In such a situation, the nurse is forced to take up extra work to be able to cater for the cost of living as well as pay for the tuition fee which is normally very high.
Conclusion
The paper started by demonstrating the rising need for internationally educated nurses in the U.S. This demand for nurses has led to international recruitment efforts by the U.S. as well as streamlining of the process of certifying IENs. International recruitment has been seen to have a negative impact on source countries in the developing world. Evidently, the discussion has shown some series of obstacles that immigrant nurses face in their work lives. However, there are also significant benefits that international nurses receive from the work environment provided in the U.S.
Immigrant nurses are not only the target for employment in America, but also maintenance relative to the employment contract agreements they are required to follow. With the establishment of an effective corporate health care market trend, there is certainty that merely experienced international applicants who can agree on and cope with high professional values will have a high possibility being employed in United States. Several studies reported that foreign nurses improve the U.S. economy’s output power, encourage specialization, and support investment that in the long term increases productivity.
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