Objectives

Despite an increase in the number of foreign-educated nurses (FENs) working in US hospitals and nursing homes, very little is known about the industry that brought them here. Our objectives were to learn more about the size and scope of the international nurse recruitment industry, its business models, and the range of countries where companies actively recruit. Based on reports from focus groups of FENs in New York City, we also sought to identify some of the problems that have occurred in the areas of contracting and clinical orientation.

Methods

We used a combination of qualitative methods and secondary data sources, which included US-based international nurse recruitment company Web sites, interviews with 20 executives from international nurse recruitment companies, two focus groups with FENs in New York City, and letters sent to the Philippine Nurses Association of America by FENs seeking legal advice.

Results

Through a July 2007 Internet search, we found that at least 273 US companies were actively recruiting FENs. While most such companies focused on the Philippines and India, about 20 companies were active in Africa.(A second search revealed that, as of January, at least 211 US companies were actively recruiting FENs abroad.) Within the industry there is growing use of the staffing-agency model, which typically requires nurses to sign 18-to-36-month contracts and imposes high breach-of-contract fees. The focus group discussions with FENs in New York City revealed inadequate orientation programs and several types of labor abuses.

Conclusions

Concerns about recruitment practices, which were expressed by many industry executives and FENs, reveal the need for accountability within the industry.