Employment Experiences of
Internationally Educated
Registered Nurses (IENs)
Salimah Walani, R.N., MSN, MPH
Felician College, Lodi, NJ
New York University
“Regardless of the opinions about the
desirability of using foreign-educated
RNs to supply the U.S. nurse labor
market, we anticipate the labor market
for RNs will become a global market.
Thus in a global market, free of entry
barriers, RNs would be able to move
freely to countries that offer the most
attractive wages, benefits, and working
conditions.”
Buerhaus, Staiger & Auerbach (2009, p.297). The Future of the Nursing
Workforce in the United States: Data, Trends and Implications
Purpose
To describe the employment experiences
of IENs in destination countries
– United States (US)
– United Kingdom (UK)
– Canada
Qualitative and quantitative studies
– Nursing practice values
– Income and job position
– Employment discrimination
Global Migration of IENs
Estimated shortage of health
professionals= 4 million worldwide
UK, US, Australia, New Zealand, Ireland:
↑ health professional migration
US: RNs- projected shortfall of 500,000 by
2020
– 3.5% - 9% of RNs in the US are IENs
– 1990-2000: 40% increase in IEN proportion in
the US
Significance
Civil Rights Act of 1964
– 2007: 9000 charges of national origin
discrimination (EEOC)
60% of IENs: non-white- race interaction
Ethics of migration
Recent legal cases involving IENs
– Missouri 1999 : 2.1 million settlement
– New York 2006 -2009
Literature Search
Proquest, CINAHL, Medline (10 yrs)
Grey literature - Google and Yahoo
Hand search of references
Keywords: wages, job inequalities, foreign
workers, immigrants, immigrant nurses,
foreign nurses, international nurses,
international healthcare professionals, nurse
migration, discrimination, employment
discrimination, human capital and returns to
education
Definitions of IEN
RNs born in another country but received
basic nursing education in the US
RNs born in the US but received basic
nursing education in another country
RNs born in another country and received
basic nursing education in another country
Terms used in the literature:
– Foreign, foreign-educated, foreign-born,
foreign-trained, immigrant, overseas and IEN.
Nursing Practice Values
Flynn & Aiken (2002)
– Survey of 252 RNs from collectivistic culture
with 547 IENs from individualistic culture
– 20 hospitals in 11 US cities
O’Brien-Pallas & Wang (2006)
– 6000 Canadian-born, 415 foreign-born
Both used Nursing Work Index
– no significant differences in the nursing
practice values of the two groups.
Income and Job Positions
United Kingdom
Royal College of Nursing Survey (2007)
– 64% of minority IENs in grade D compared to
26% of minority UK-qualified RNs.
– Rate of success in promotion 40-48% for IENs
compared to 53-54% for UK-qualified.
Buchan et al. (2006)
– 87% of IENs in London were in grades D & E
– IENs from Asia and Africa: more likely to be in
lower grades compared to IENs from Australia
and New Zealand.
Income and Job Positions
Canada
2001 Canadian Census data analyses
(Buhr, 2006)
– 29000 Canadian-educated & 1000 IENs
– Controlled human capital variables
– IENs earned 9% (p< 0.001) lower wages than
Canadian RNs
Income and Job Positions
United States
Two studies (Polsky et al., 2007 & Xu & Kwak, 2005)
US Census data and NSSRN data
Compared mean annual income of IENs
and USNs
Results: IENs earn $6000- $10,000 more
per year
No controls for work setting, education and
experience
Experiences of Employment
Discrimination, UK
1 quantitative survey (RCN, 2007)
– IENs reported ↑ bullying and harassment
– ↓ satisfied with employer handled the above
5 qualitative studies
– Reported discrimination, stigmatization
– Felt unwelcomed, unappreciated, devalued
– Unfair work distribution, ↓ equal opportunity
Reported national origin and race as
basis for discrimination experience
Experiences of Employment
Discrimination, Canada
Survey of 6,477 RNs (O’Brien-Pallas &
Wang, 2006) found that IENs reported:
– ↑ physical, verbal & emotional abuse
– ↓ unpaid time, tuition benefit, flexible schedule
Qualitative study (Hagey et al., 2001)
– Interviews of 9 IENs who filed separate
employment discrimination grievances
– marginalized, harassed and unsupported
Experiences of Employment
Discrimination, US
Two qualitative studies (Dicicco-Bloom, 2004; Yi
& Jesewski, 2000)
10 IENs from India
– Discrimination in job assignments, promotion
& Job assignments
12 IENs from Korea
– No mention of discrimination
Conclusions
Nursing Practice Values
– IENs do not differ from USNs
Income and Job Position
– UK- Strong evidence that IENs are in lower job
positions
– Canada- Moderate evidence of income inequality
– US- limited and inconclusive
Employment Discrimination
– UK - Strong evidence of IEN employment
discrimination
– Canada and US: Limited evidence
Research Gaps
Scarce research on employment
experiences of IENs in the US
No US studies were found about:
– Comparison of IEN and USN in terms of
wages and job positions in a well specified
model
– Comparison of hourly wages instead of
annual income
– Extent to which race impacts employment
outcomes of IENs
THANK YOU