Characteristics of internationally educated nurses in the United States: An update from 2004 national sample survey of registered nurses

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Nursing Economics





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25, 43


The United States has been experiencing another cycle of nurse shortage (Buerhaus, 2008; Buerhaus, Staiger, & Auerbach, 2000). In fact, the gap between demand and supply of nurses is widening as the demand for health services is increasing while the aging trend of the U.S. registered nurse (RN) workforce continues (Buerhaus, Staiger, & Auerbach, 2003). For instance, the average age of U.S. RNs reached 46.8 in 2004, the highest average ever recorded since the first National Sample Survey of Registered Nurses (NSSRN) in 1977 (Health Resources and Services Administration [HRSA], 2007).

Internationally educated nurses (IENs) have become an integral part of the U.S. registered nurse workforce. According to the latest NSSRN, IENs accounted for 3.5% of the U.S. RN workforce (HRSA, 2007). However, it is believed that this number is grossly underreported (Aiken & Cheung, 2008; M. Fritz, Health Resources and Services Administration, personal communication, July 28, 2006; T. Criswold, Center for Education and Health Services Outreach, University of Nevada School of Medicine, personal communication, June 1, 2007) although the exact reasons remain speculative. To understand the U.S. RN workforce and conduct nurse workforce planning, it is fundamental to know the who, what, and where about IENs.

Several significant events happened after the 2000 NSSRN that may have influenced the characteristics of IENs choosing to come to the United States to work and live. First, several new overseas testing centers were established by the Commission on Graduates of Foreign Nursing Schools (CGFNS), notably in China and India. Second, international recruitment efforts by U.S. employers and recruitment companies, either directly or indirectly, have intensified because of the growing gap between demand and supply of the U.S. nurse workforce (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Brush, Sochalski, & Berger, 2004; Kingma, 2006; Xu & Zhang, 2005). However, immigration legislation and implementation of existing laws and regulations are unpredictable, confusing at times, and convoluted. This situation created intermittent delays and unexpected retrogressions of immigrant and work visas for IENs, especially for those from a few Asian countries such as the Philippines and India which are traditionally major suppliers of nurses for the U.S. market.

This study provides an updated profile of the characteristics of IENs in the U.S. RN workforce based on the 2004 NSSRN. Specifically, characteristics regarding their demographics, education, and employment are described. In addition, comparisons with their U.S. counterparts as well as with the 2000 NSSRN are made whenever appropriate. A similar profile of IENs was performed by Xu and Kwak (2005) based on the 2000 NSSRN.


Nurses; Foreign; Nurses—Supply and demand; Emigration and immigration law; Nursing – Study and teaching; United States


Nursing | Other Nursing




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