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Why do U.S. hospitals recruit foreign nurses?

  • Publish Date: Posted almost 5 years ago
  • Author:by Kate Andrews

The appeal of recruiting foreign-born nursing talent to work in the American healthcare system is not a new thing. In fact, the practice has its roots in many different facets of the history of the United States. 

  • Politically, as an empire.

  • Socially, as a commitment to health services amongst a growing population.

  • Economically, as a solution for financially conservative healthcare providers.

  • Culturally, as a cultural melting pot.

Conexus MedStaff has worked with clients nationwide to provide all of this (save the political factor, of course). So we take time today to discern: why do U.S. hospitals recruit foreign nurses?

1. The Politics

So-called Manifest Destiny of the American expansion in the 1800s did not quite reach the United Kingdom’s levels of an empire. For the uninitiated, the saying went that “the sun never sets on the Empire.” But there’s no question that US influence in the world has been buoyed by expansion and flag-planting as a way of life and a higher calling. 

Think of the mere scope of it. Today, there are five main US Territories: in the Pacific, these include American Samoa, Guam, and the Northern Mariana Islands. In the Caribbean, the U.S. encompasses both Puerto Rico and the U.S. Virgin Islands. 

It was even larger than that for a time. From the Panama Canal Zone to the Philippines (more on that chain of islands in a second), the reality of American political influence is unavoidable throughout the world’s hemispheres. 

So what does this mean to nurse practice? Great question, one partly rooted in the United States’ relationship with the Philippines, as told by the Berkeley News and Cal-Berkeley professor Catherine Ceniza Choy.

The Exchange Visitor Program was created in 1948 to bring people from other countries to the U.S., where they would work and study for two years, and learn about American culture. The program didn’t specifically target the Philippines or nurses. Rather, it was created to combat Soviet propaganda during the Cold War by exposing foreigners to U.S. democracy. 

“The intent was to learn about the progressive ways of the United States, and then the exchange visitors would return to their countries of origin and sort of serve as U.S. cultural ambassadors because of their experience in the United States,” says Choy.

Filipino exchange nurses and other health care workers soon began to dominate the program.

The article also revealed that this was far from a Cold War effort by the US and its hospitals. In fact, Filipino nursing in America had roots in the 1898 colonization of the Philippines. 

“This Americanized nursing curriculum inadvertently prepared them to work in the United States. They were trained, oftentimes, in English instruction. Even their early nursing licensure examinations had an English language component.”

The legacy for US nursing has clearly been established in the Philippines. Regularly, the nation is the leader amongst nations that pass the NCLEX-RN examination, a prerequisite for all immigrant nurses hoping to work in the United States. In fact, outside of North America, the Philippines has the most NCLEX-RN passers of any country. 

Thousands of capable nurses pass from other countries, too, including (but not limited to):

  • Canada

  • South Korea

  • India

  • Jamaica

  • Nigeria

  • Puerto Rico

  • Kenya

  • Nepal

American hospitals should take note.

2. The Social and Economic Aspects

As you’ll read in our Appalachian Case Study, Conexus Medstaff staffs healthcare organizations with nursing solutions. One of those we like to emphasize is in a quality of life and patient satisfaction.

Our work for one healthcare provider in Kentucky/West Virginia is proof of this. As a region typically affected by high rates of diabetes, drug addiction, and heart disease, quality of life can suffer in areas that are underserved, hard to reach, and heavily multi-cultural. For healthcare organizations trying to make the books work, quality of staff and care that delivers ROI is a must.

So why Conexus Medstaff? Well, look at what the case study revealed about our service to their hospitals and their patients.

Staff Continuity

  • By ensuring our nurses were integrated into their new workplace and the local community, staff turnover decreased. 

  • We employ two dedicated operations managers that really help international nurses get acquainted into the community. For example, finding places of worship and social functions like rock climbing, karaoke and pottery classes.

  • We staffed over 100 nurses to their hospitals as a long-term financial solution, reducing the cost and dependency on costlier travel nurses.

Availability and ROI

  • In bill rates, we save the client more than $15 per hour compared to travel nurses.

  • We introduced a shuttle service that enabled nurses to get to work easily, despite remote locations. 

  • We promoted a car share initiative and found residency close to the hospital for our staff.

3. The Cultural Factors

Regardless of, or even in spite of, an empirical past, America prides itself as a melting pot, with influences from all regions of the globe. Such diversity has come home to America’s shores over the last century.

Consider: according to Pew Research, 47% of the U.S. population (yes, less than half) will be non-Hispanic white in 2050, compared with 67% in 2005. That means other nationalities of all races, creeds, and colors will make up the majority difference.

Now couple that diverse reality with the needs of American healthcare systems. Increasingly, the nursing population is retiring, with younger generations less intrigued by the possibilities of a nursing career path. As a result, hospitals need to turn elsewhere for RNs and LPNs. Domestically, DACA is emerging as a viable option, as well as our commitment to international students studying nursing best practices at American universities. We’ve stated our vision to become the #1 partner with universities and international graduates in the US. 

And now more than ever, the tried-and-true international nurse or nursing graduate familiar with US regulations and the English word is the predominant solution. As evidenced by the results of our Appalachian region health services offering.


  • The addition of qualified overseas nurses diversified the hospital’s workforce. 

  • This elicited a positive response from the region’s seven different cultural classifications of patients.

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