Are Foreign Nurses in U.S. Healthcare’s Future?

There has been much debate over the past several years regarding the current nursing shortage. The statistics are grim: the current shortage is projected to double to around 12% by 2010 and to quadruple to 20% by 2015. By 2020, it is expected that the shortage will amount to 800,000 nurses.

One of the suggested solutions to the nursing shortage crisis has been to hire foreign nurses to fill the void. In theory, this makes perfect sense – they need the work and we need the nurses. Foreign nurses often receive a free education in their country of origin and are willing to work for less wages than domestically trained nurses. Why is this a problem?

The law of supply and demand is the basic underpinning of economic theory. When there is a shortage of labor in a market economy, wages increase as employers compete with one another to attract workers. If the shortage persists, wages and other compensations rise until enough workers are attracted by the higher wages and compensation; at this point, equilibrium is reached and supply and demand is balanced.

The practice of hiring foreign nurses to address the crisis may be beneficial in the short term but may worsen the situation in the long term. Foreign nurses willing to work for less pay and benefits falsely lower wages below what they would be in a fair market. Driving down nursing wages will result in nurses leaving the profession to work in other occupations.

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.

*Elgie, R. “Politics, Economics, and Nursing Shortages: A Critical Look at United States Government Policies.” Nurs Econ. 2007;25(5):285-292.

12 comments to Are Foreign Nurses in U.S. Healthcare’s Future?

  • but caring for people is not for money for me, it is my own desire and i love to serve people……….

  • Jennifer Bunn

    From Nurse Job, “but caring for people is not for money for me, it is my own desire and I love to serve people….”
    That is why I went into the nursing profession as well, and why I am still in it.
    But there is nothing wrong with wanting to be recognized for what you do, and the sacrifices you make, in the form of adequate compensation. In the past 15 years, I have sacrificed my family for other people so many times…especially the last few years when nurses wanting to work in our hospital have been scarce. My kids dislike my job and have asked me in the past why I can’t have a “real” job like other mommies (meaning 9-5, no weekends, no holidays). This breaks my heart sometimes.
    Yes, I love my job and my patients, but I don’t feel one bit guilty about the money I make either….
    Thanks for your comment, dialogue makes the world go round!

  • Brian Grutman

    Jennifer, how would you feel if you were to learn that in order to hire foreign registered nurses that medical facilities were required to pay them at the very minimum the median range for that area? The problem with your argument is the assumption that foreign nurses leave the profession as well. This is largely untrue. The goal of the overwhelming majority of the nurses I’ve worked with has been to make a better life for themselves and their families, and to send money home. They train to become nurses with the intention of going overseas, whether it be to the US, the UK, Australia, or one of numerous Middle East countries. The foreign currency they earn is a huge part of the Philippino banking system and helps stabilize their institutions.

    The fact is that hospitals are dangerously understaffed, and that this trend shows no sign of slowing. The politics are unimportant to a critically ill person who needs nurses who have time to treat him. They just need someone qualified to be there to do their job. As it stands, most hospitals and nursing homes cannot provide the level of care that people expect because of a lack of staff.

    As the grandson of immigrants, my ancestors came to this country to fill a need for workers. This is the story of most immigrants in the United States, because the only non-immigrants are American Indians.

    Why can’t we get the healthcare we need? Our government has visas available for technologists, for fashion models, even for apple pickers. Why can’t they make visas available for a controlled amount of nurses who can provide relief to facilities that are suffering?

    Brian Grutman, formerly of Pilot Enterprises.

  • arianna filpina

    no need to worry about brian grutman, he did recruit foreign nurses , charged hospitals then did not bring them over

  • This post is not particularly helpful, I’m sorry to say. It’s essentially just a heavily biased complaint about how bringing in foreign nurses threatens to drive down wages-which doesn’t make any sense because the demand for nurses is such that there is a projected shortage of 800,000 by 2020. The increasing numbers of foreign nurses are just a drop in the bucket. While citing “low wages” as a reason why nurses are leaving the profession, what exactly constitutes “low wages” anyway? That’s very subjective. Jennifer acknowledges that she’s “not guilty” about the money she makes so I must assume that her wages are anything but “low.”

    While the so-called “cure” she proposes appears to be self-serving and more for the benefit of the nursing profession (much higher salaries, better work schedules, etc.) rather than for the health care system, as a whole-if that were to lead to a massive influx of new domestically trained nurses into the profession-enough to meet demand, that would indeed bring down wages, but that’s not likely to happen. If my observations are correct, there are just not enough affordable nursing schools in the country ready to accept any large number of eager students. In New York City for instance, there are only a few publicly funded institutions that offer RN programs and they are highly competitive. So it shouldn’t be a surprise that hospitals recruit foreign nurses.

  • People who are interested in nursing but cannot afford the fees should be given free training. That solves the problem to some extent. If you still have shortage for them, nurses from abroad can be given a chance, who do not work just for money, but for satisfaction as well.


  • Mark Romero

    @ Ariana Filipina…I know Grutman. He ripped my friend off in a most brazen manner. He does absolutely nothing in good faith and always intends to rip off his victims right from the start.

  • Brian Grutman

    @ Mark,

    That is a pretty libelous statement. I’m a tech recruiter, and I’ve placed hundreds of people in my career, it’s all been in good faith, and I would have no problem getting character references from some of the biggest and most reputable names in my industry. Unfortunately, when you’re active in business and you involve yourself in a lot of projects, not everyone can be made happy, and there are losers and complainers in the world who always seem to be the ones who bad mouth you on the internet. This is because the internet is anonymous and cowards don’t have to reveal themselves to be liable for their accusations.

    There is no Ariana Filipina, and I suspect there is no Mark Romero. Crawl back into your hole. Thanks.

  • Emmanuel Tabones

    I hate it when I hear suggestions that the “solution” to the nursing shortage is to give free training. Okay, I agree only if these newly graduated nurses are willing to work for “free” in exchange for the “free” tuition. So who many will take that offer? I often hate the way that word is used. The truth is, the shortage extends to slots for those wanting to avail of training at lower cost compared to what is offered in private institutions. There is also not enough instructors because pay is low compared to working in the field. Another point to consider, there are simply too many people not qualified to get into nursing school out of the many who want to do so.
    In many cases, it would be better to recruit outside the country.

  • chris

    Hi Mr. Brian Grutman, are you still active on hiring foreign professionals? Can I have your contact details please? You can contact me in my email add:
    Thank you.

  • Brian Grutman

    Christopher, I am no longer active in the industry, there were a number of factors that made it impossible to bring in more than 45% of the nurses that we filed the immigration work for. If you have already completed your requirements, I will be happy to refer you to a colleague of mine who is still in that business.

  • Scot Petralia

    I’m not sure where you’re getting your information, but great topic. I needs to spend some time learning much more or understanding more. Thanks for magnificent info I was looking for this information for my mission.

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