Effect of Immigration on Nurses


The United States of America has the largest professional nurse workforce in the world with this workforce almost reaching 3million 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 US has led to the intensification of efforts by US healthcare employers to recruit nurses from other countries. Today, Internationally Educated Nurses (IENs) are an integral part of the US nurse workforce and they continue to play a pivotal role in hospitals and nursing homes. Xu and Kwak (2007) document 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 impact of immigration on nurses is important to them, their employers and their 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 a 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 US was 46.8 years in 2004 and this age was projected to increase with the years (Aiken, 2007). As a result, a significant number of US RNs 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 means that graduations of around 110,000 RNs a year would be required to ensure that the US nurses’ workforce supply is sufficient. However, enrollment in nursing schools by US citizens is highly sensitive to nurse labor dynamics since unlike in most Western Nations where the government fully funds nursing students; US 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, US 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 US nurse shortage. This is because a high proportion of IENs in the US are employed full time and have a second paid nursing position (Xu & Kwak, 2007). They also work more hours in both primary and secondary nursing positions. Research indicates that a high percentage of IENs work in critical care areas where US nurse shortages are most acute. IENs also play a crucial role in long-term care facilities which have experienced shrinkage in the share of US nurses working in these facilities over the years.

Nurse Immigration Requirement

Demand for IENs in the US 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 US. 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) state 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 so as to ensure that standards of health care are not lowered as a result of including IENs.

The US 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 US 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 US for completion of clinical examinations if needed and they can then serve as RNs.

Push and Pull Factor

Research reveals 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, superior working conditions, political stability, modern and well equipped hospitals, and increased educational opportunities.

Advantage of Immigrant Nurses

Immigrant nurses gain significant economic benefits from their participation in the US 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 significantly improve their standard of livings. A large majority of the nurses send some of their money back home to assist 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 US since some of the money is remitted back to the country.

The working conditions experienced by immigrant nurses in the US 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 US 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 high levels of education which makes them well suited for the US market. IENs with baccalaureate degree as their basic nursing education preparation is consistently larger and the proportion of these nurses with graduate degrees has surpassed that of US nurses (Xu & Kwak, 2007). This better educational preparation by the IENs and experience as RNs results in increased quality and better patient care outcomes. The immigrant nurses are therefore able to proficiently serve in a number of 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 experienced difficulties in adapting to the culture and language of the USA. Liou and Cheng (2011) reveal 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 large increase in the employment of immigrant works also has a negative effect on the native population nurses. This is because they reduce the number of jobs available for this US born nurses. In addition to this, focus on international recruitment reduces the need for investments in enhancing domestic retention strategies (Evans, 2011). Slote (2011) blames the reliance on foreign nurses on the ineffective policies of the United States 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. Many need more education and support so as to master the newer technology that is available in the US. This lack of knowledge may translate into incompetence which will reduce the quality of health care offered by the IENs. Aiken (2007) notes that US nurses have expressed concerns about the employment of IENs due to their competence to practice in highly technological environments and their ability to communicate.

Immigration into the US has resulted in the rise in brain-drain. Slote (2011) defines 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 currently unknown due to the lack of statistics but there is agreement that the number is significantly high (Slote, 2011). Without accurate statistics on the phenomena, it is hard for effective legislation to be enacted in order to contain the problem. Aiken (2007) reveals that the projected future shortage of nurses in the US threatens to undermine health care delivery not only in the US but also in low-income countries whose nurses migrate to the US in significant numbers because of the better income opportunities.

Immigration also causes a disruption in family life by the nurse who moves from his/her home country to the high income country. While some nurses come to the US with their families, Jose (2011) notes that most of the female nurses who come to work in the US 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 US citizenship and hence are cut off from their families in their home country.

Inasmuch as immigrant workers are provided with an opportunity to earn higher salaries in the foreign country, they are also subjected to higher cost of livings. This proves to be a disadvantage especially when the immigrant worker has to take some extra nursing courses before he/she can become a registered nurse. In such a situation, the nurse is forced to take up extra work in order to be able to cater for the cost of living as well as pay for the tuition fee which is normally very high.


This paper set out to discuss the effect of immigration on nurses in the US. The paper had started by demonstrating the rising need for internationally educated nurses in the US. This demand for nurses has led to international recruitment efforts by the US as well as streamlining of the process of certifying IENs. Immigration has both a negative and positive impact on the nurses. Some of the positive impacts include; International recruitment has been seen to have negative impact on source countries in the developing world. From this paper, it is evident that there are a series of obstacles that immigrant nurses face in their work lives. However, there are also significant benefits that international nurses’ face from the work environment provided in the US.


Aiken, L.H. (2007). US nurse labor market dynamics are key to global nurse sufficiency. Health Services Research, 42(3), 1299-1320.

Buchan, J., Parkin, T., & Sochalski, J. (2003). International nurse mobility: trends and policy implications. Geneva, Switzerland: World Health Organization.

Evans, M. (2011). Nurse migration: what is its impact? Professional Issues, 20(6), 333-336.

Jose, M. M. (2011) Lived experiences of internationally educated nurses in hospitals in the United States of America. International Nursing Review, 58(1), 123–129

Liou, S. & Cheng, C. (2011). Experiences of a Taiwanese Nurse in the United States. Nursing Forum, 46 (2), 102-109.

Singh, D.M. Sochan, A. (2010). Voices of internationally educated nurses: policy recommendations for credentialing. Medsurg Nursing, 57(2), 56–63.

Slote, J.R. (2011). Pulling the plug on brain-drain: understanding international migration of nurses. Medsurg Nursing, 20(4), 179-186.

Xu, Y. & Kwak, C. (2007). Comparative trend analysis of characteristics of internationally educated nurses and U.S. educated nurses in the United States. International Nursing Review, 54(1), 78–84.

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