Foreign-Trained RNs Are Paid Less/Taking Our Jobs - and Other Myths Debunked

[K Gardner]

If you're tired of reading guesswork and myths about nursing, foreign-trained nurses or the nursing shortage, this article is available. It is very long and full of FACTS; the reasons why foreign-trained nurses are hired and why they stay, the many procedures set in place to try to retain a viable work-force in the U.S., etc. I expect there is not as much interest here, however, in promoting the truth.

U.S. hospitals have 118,000 vacancies for registered nurses. The federal government predicts the accelerating shortfall of nurses in the United States will swell to more than 800,000 by 2020.


None of the reasons are that "foreign nurses are paid less".

http://content.healthaffairs.org/cgi/content/full/23/3/78


Foreign nurses must supply evidence that they completed prescribed amounts of didactic and clinical instruction as "first-level nurses." Defined by the International Council of Nurses (ICN), this is a measure of technical competence regardless of national background.31 The final step in the process is passing the NCLEX-RN. Passing nurse licensing and English proficiency tests remains the marker for establishing competence among foreign nurses. No studies to date have determined whether foreign nurses’ cultural orientation and technical competence produce differences in patient outcomes when compared with their domestic counterparts.

Although foreign-trained nurses now account for around 5 percent of the total U.S. nursing workforce, they represent a growing percentage of newly licensed nurses. Moreover, growth in the domestic production of nurses since 2002 did not diminish interest in foreign recruitment among employers. Indeed, Peter Buerhaus and his colleagues note sizable growth in the number of foreign-born nurses in the United States during this period.45 And while interest in foreign nurses accelerates during nurse shortages, it also appears to endure beyond shortage cycles. In 1988, during the last major U.S. nurse shortage, there were 3.7 foreign-trained nurses in the United States per 100 U.S.-trained nurses. In 1996, a time of record domestic nurse production and a slowdown in hospitals’ demand for nurses because of industrywide workforce restructuring, the ratio rose to 5.1.46 Consequently, if nurse vacancies continue in health care facilities, and domestic production falls short of the demand, then foreign nurses are likely to remain a viable and increasingly lucrative strategy for plugging holes in the U.S. nurse workforce.

[jody]

1. Do you have an article more current than 2004? n/t

[K Gardner]

2. The last NSSRN Survey was conducted in 2004, which is why all stats and articles

refer to that sampling. Main focus of article remains valid.

In eight National Sample Surveys of the Registered Nurse Population (NSSRN) conducted between 1977 and 2004, a disturbing trend emerged: “According to the 2004 survey, there were an estimated 2,909,467 registered nurses in the United States as of March 2004. Of these, 16.8%, or 489,790, were not employed in nursing. Of those RN’s who were not employed in nursing, many were retired and others had left for family reasons. However, an estimated 209,140 to 241,563 left “for personal career reasons…or reasons connected to the workplace”*.

The NSSRN found that there were several reasons why these nurses chose to leave nursing. Some found that their current position was more rewarding. Others cited better wages, better hours, and concerns about their personal safety as reasons for leaving nursing.

Hiring foreign nurses to address the nursing shortage is not likely to fix the problem. Eventually, foreign nurses will leave nursing for the same reasons that many nurses now leave the profession: low wages, long working hours, and concerns about their personal safety as well as dissatisfaction with working conditions. In the meantime, hiring foreign nurses to fill the gap will only drive down wages and force more domestic nurses out of the profession.

The cure for the nursing shortage may be to address the issues that are leading to job dissatisfaction and to make nursing, as a profession, more attractive to those contemplating nursing as a career.

[jody]

9. Thank you! n/t

[treestar]

3. They also have to be licensed by the state like any native born

nurse - it is a highly regulated profession.

No immigrant is paid less than Americans except those who come over the border illegally and are working outside the system. In which case they aren't protected by minimum wage and hour laws, etc.

[midnight]

5. Just like all our prescription drugs, and food, and other

items coming in from foreign countries. That's right. Everything is well regulated? If you believe this, then you have no idea why nurses are not filling these coveted slots. The licensed by the state technicality is easy to take care of, what becomes the real trouble is when these applicants from the Philippines, who are plentiful, will work for little, they are brought over here and put in a hotel. Probably not like the ones that we would typically stay at. The whole point is that this system is flawed because it does not address the real problem for American workers. This system is in line with the mentality of those who brought us NAFTA.

[midnight]

4. The more important fact.... Nurses salaries need and

should rise. They can't and won't as long as foreign nurses come in and they work cheaper than American trained nurses. The real important fact is that we need more nurses. This is the only truth that will never need to be argued. The very horror of it is that Nursing schools can't afford to teach more nurses. They cut Chemistry lab sections, they have only a few clinical positions here at the University of Wisconsin Milwaukee. And those slots are competed for by two tech. college, students from Milwauakee Area Technical college, and Waukesha technical college. We don't need foreign nurses bringing down the negotiating for better treatment, benefits, and wages.....The paper work for your post is lacking in reality. This argument has gone the way of Weapons of Mass Destruction. It is all a fabrication. But my hunch is this article is distracting you from the fact that when Nurses have access to unions non of this will matter. Right now, there is a campaign on for all workers to unionize. No one wants that more than Nurses.

[eilen]

6. The article also does not discuss price fixing

which is what hospitals in most regions do-- the executives meet and agree to fix wages. Otherwise state hospitals would lag farther behind private hospitals in wage scales as any salary hikes need to be approved by the legislature, a time consuming process which is not responsive to changes in the marketplace.

[K Gardner]

7. Absolutely true, Price-fixing does occur, but that has nothing to do with

"foreign trained" nurses. Most egregious of the offenders here are the hospital "associations" which unite hospitals, sometimes dozens across state lines, into salary-regulated businesses. One such association in AZ was recently sued and, I believe, disbanded.

[K Gardner]

8. All nurses have access to unions. I assure you, I'm not distracted and the fact remains

that foreign trained nurses do NOT make less than US trained RNs.

I work in a hospital where there IS a nurses union. Only 40% of the RNs in this particular hospital have chosen to join in my "right to work" state. 60% want the union to go away.

Deal with the mentality of non-union nurses, get the majority of nurses to WANT a union, and we'll see the salaries commensurate with the work done.

[uppityperson]

11. All nurses do NOT have acces to unions. Maybe at your hospital, but not everywhere

Or do you mean that all nurses have access to getting a union set up where they work yet chose not to?

[Hannah Bell]

10. The article doesn't debunk either of the items in the headline.

It makes no direct comparison of wages for foreign & US trained nurses, nor any judgement on the matter.

It doesn't address the question of foreign-trained nurses "taking jobs away" from native-trained nurses.

It does, however, note that foreign-trained nurses constitute an increasing % of total nurses, notes that this can save institutions $$, & suggests it may not be the best strategy to address the nursing shortage.




"Although hospitals agree that the initial cost of recruiting foreign nurses is higher than that of hiring domestic nurses, many feel that they save money in the long run because of reduced turnover and the agency’s assurance of full or partial remuneration if recruited nurses fail their contractual obligations. (Note: The recruiting fees that jack up the initial cost, btw, go mostly to the recruiting agencies, not the nurses - money that could be put into training more nurses in the US).

Recruiting abroad may also be less costly than raising salaries, increasing benefits, and providing other economic incentives needed to retain domestic nurses. Under the terms and conditions of hiring foreign nurses from recruiting agencies, therefore, hospitals enter into a relatively risk-free arrangement that provides further incentive for procuring staff abroad. Strategies for such recruitment at one facility are described in a 2003 AHA report on workplace innovations.38

The advantages of recruiting foreign nurses have had particular appeal for long-term care facilities. Since 1989 nursing homes have secured foreign nurses through an "attestation" process stipulated in the Immigration Nursing Relief Act (INRA).39 In recent years recruitment agencies have capitalized on the crisis in long-term care staffing, partnering with nursing home operators to provide nurses from several countries.40 Long-term care institutions will likely continue to look abroad to fill nearly 14,000 staff RN and 2570K100 licensed practical nurse (LPN) vacancies.41"

http://content.healthaffairs.org/cgi/content/full/23/3/78


Median full-time wage for RN's = $57,280. 10% make less than $40K, 10% make over $80K. 60% make between $47-$70K.

http://www.bls.gov/oco/ocos083.htm

You understand there are many ways to hold down wages: pay some people less than the going rate, price-setting cartels, recruiting docile workers who are unlikely to make waves, etc.

all are currently in use.