Nursing News

Foreign Nurses Need Special Support


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By Kelly Phillips, feature writer

Hiring foreign-educated nurses can provide benefits for nurse-starved hospitals and for the nurses themselves, but there are steps that hospitals should take to make sure the nurses assimilate well, according to the head of the testing body for foreign nurses.

"The thing to keep in mind is it’s more complex than simple to come to the United States," said Barbara Nichols, RN, MS, DHL, FAAN, and executive director of the Commission on Graduates of Foreign Nursing Schools (CGFNS).

Foreign nurses can encounter a host of difficulties, Nichols said.

First off, they must navigate the complex systems of immigration, nurse licensure—which can differ in frustrating ways from state to state—and employment situations.

"The foreign nurse has little opportunity for a collective voice," Nichols said. "They are stuck in the job they have. Don’t forget that they are new to this country, and unfamiliar with the customs and language."

Speaking at the Association of periOperative Registered Nurses’ 51st Congress in San Diego, California, Nichols delivered a primer on what nurse managers need to know about hiring nurses from foreign lands.

Nichols should know. She is a past president of the American Nurses Association and served on the board of the International Council of Nurses. She also was a member of the board of trustees of CGFNS before being named the commission’s executive director.

Like other immigrants, foreign nurses are often seeking social improvement and economic opportunity, Nichols said.

Nichols summed up her commission’s research on foreign-educated nurses who come to the United States:

· Most come from these five countries: the Philippines, Canada, India, Nigeria and Russia/Ukraine. Many are women who want to make life better for their family. But they often make the tough choice to leave that family behind, Nichols said.

· They have a baccalaureate degree.

· They speak English, as required by the CGFNS.

· They tend to work in a hospital setting, but may also work in a nursing home or rural setting.

· With an average age of 27, they are younger than the average American nurse.

· The top states where foreign-educated nurses are at work are California, Texas, New York, Florida and Illinois.

Foreign-educated nurses also report satisfaction with their work experience in the United States, Nichols said.

Their least favorite setting is pediatrics, Nichols said, with most favoring the operating room.

"This is because in the OR they don’t have to talk," Nichols said. "They just have to do. Language is an issue for them."

To deal with that reality, Nichols counseled hospitals to have extensive orientation procedures in place for foreign nurses. For instance, the foreign nurses may have medical terminology down pat, but need lessons in "medical slang" and the ubiquitous abbreviations used by nurses.

Foreign-educated nurses also should work in fully staffed units, though Nichols acknowledged that can be a problem since they are often brought in because of a shortage of nurses.

Employers should provide support for the nurses to ensure patients are receiving safe care, Nichols said.

Foreign nurses earn less than their American counterparts because their salary starts at ground level here no matter how much experience they bring from their home country, Nichols said.

Since the nursing shortage in the United States shows no signs of abating, and the United States is the top destination of choice for foreign nurses, the diversity of the health care labor work force will only increase, Nichols said.

That may cause a disconnect, she said, since most foreign nurses are Asian, while population growth is becoming dominated by Hispanics.

The CGFNS administers a test to foreign nurses to predict their success at taking the U.S. licensure exam. The commission checks the foreign nurse’s educational transcripts from the home country, reviews credentials and makes sure the nurse has appropriate clinical experience.

Then the nurse can apply to take the CGFNS test of nursing knowledge, which has a failure rate of about half, Nichols said. Some 85 percent to 90 percent of those who pass the CGFNS test will pass the NCLEX-RN, she said.

Nichols busted what she said is a myth that foreign-educated nurses are taking jobs from Americans.

"They fill long-standing vacancies and work shifts many U.S. nurses will not work," she said.

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