PhD, MS, MSN, APRN-BC
Nurses come in all colors, shapes, ethnicities, genders, and personalities. They also come from different countries, and often English is not their native language. Nursing is becoming more diverse, and we need them all.
We are still in a serious nursing shortage, and many states are recruiting nurses from abroad. According to a report in 2023 by the National Stage Boards of Nursing, the popularity of nurses soared during the COVID-19 pandemic. However, despite the public accolades of nurses, nursing enrollment continues to decrease, and up to 18% of newly licensed registered nurses quit the profession within the first year.
Some challenges our profession faces include: the increasing complexity of patient care, with sicker patients being admitted into acute care with fewer staff; nurse burnout; the emotional trauma and toil on nurses who feel unsupported by their employers; and patient violence toward nurses. We need more nurses, and inviting nurses to come from other countries is becoming a struggle.
An Internationally Educated Nurse (IEN) is a legally registered nurse who comes to work in the United States, but was trained as a nurse, and lived in another country. An IEN may even be a physician from another country who has been granted permission and legal licensure to work as a registered nurse in the U.S. According to the American Medical Association, 25% of the licensed physicians practicing in the U.S. are international medical graduates (IMGs).
To receive a legal license to practice medicine in the U.S. they must complete an IMG exam. To receive a legal license to practice medicine in the U.S., they must complete a residency program, which is highly competitive and expensive. An alternative is to take a less qualified position.
On the one hand, the U.S. needs more qualified healthcare professionals. But on the other hand, so do the countries they come from, potentially stripping educated workers from their countries of origin. It is a delicate issue.
Professional licensing organizations have developed training programs and requirements to help prepare internationally educated physicians and nurses. Some states that have invited international doctors to be granted an RN license with no additional training, have been blocked by outraged nurses. Opposition to these petitions is based on the professional pride nurses have for our unique training and skill set, which is required to deliver quality patient care. To find out what your state is doing contact your state board of nursing and let your voice be heard.
As international nurses and doctors are arriving in the country in record numbers, they must complete educational requirements for competency and follow evidence-based guidelines and practice standards here in the U.S. They bring bilingual abilities, valuable world views, and experience. Nurses need to be aware of legislation that may affect nursing practice for their state. Speak with your legislators to make your valuable nursing voice and opinions heard.
Once arriving to the U.S., internationally educated nurses have found challenges because their training was different or lower than what was needed in this country. In addition to the social and political differences, they found difficulty with acculturation into the American nursing culture. Racism continues to exist, even among nurses. The American Nurses Association is currently engaged in a national campaign to address racism in nursing and how it impacts nurses, patients, and our communities.
“The nursing shortage is real,” declared then-Tenet Healthcare Executive Chairman Ron Rittenmeyer in 2022, and it continues to persist. Efforts to address the challenges have included mental health counseling and awareness campaigns by hospital administration. Those have been helpful, but not enough to stop the outflow of bedside nurses.
An additional solution to the nursing shortage is recruiting international nurses to fill the gaps. In the past, a message to IENs was, “Your RN license is your visa.” Recruitment and the quality of training for these nurses varies by state boards of nursing. They all must still meet the state board requirements for licensure and successfully complete the NCLEX. Many IENs come to the US and take a refresher course in preparation for the NCLEX.
Once the IEN, or physician, arrives and is trained in your unit or work setting, remember they are needed, and nurses need to be welcoming. We need more qualified and competent registered nurses.
Invite the IEN to join you for breaks and make sure they have received a good orientation to the unit. Although they have worked as RNs before, Western medicine may be practiced differently in their home country. Do not assume they understand everything. Remember the time it took you to adjust and orient as a new nurse? Be generous with your kindness and assistance as the IEN gets up to speed.
Managers need to remind them that English is the primary spoken language spoken on the unit. Be curious about their home country instead of cautious. Welcome the much-needed diversity in nursing. It will make our profession stronger as we adopt ideas and insights from other cultures.
Internationally educated nurses are coming to the United States in record numbers. They are anxious to live the American dream and make a better living. They have been trained as registered nurses in their country, but must meet state board of nursing requirements for practice, and they must pass the NCLEX. They may speak with an accent or even be going through culture shock, and they need your patience and genuine friendship. We must change the mantra of nurses eating their young to welcoming new nurses.
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