Newswise —

January 3, 2020 - Foreign-educated health professionals (FEHPs) in the United States are generally satisfied with their recruitment experience despite the persistence of certain unethical practices, the first major survey of the U.S. international nurse recruitment industry in more than a decade has found. While strides have been made in the realm of ethical international recruitment, there is still room for improvement.

Current estimates indicate that 8-15% of the U.S. nursing workforce is foreign educated, but those figures are projected to grow in the face of health worker shortages and increased demand as the Baby Boomer generation ages and retires out of the workforce.

The study, conducted by CGFNS International, Inc. and published in the American Journal of Nursing, found that 69% of FEHPs had a positive recruitment experience. But the findings also suggest lingering instances of mistreatment, as 30 respondents indicated that their recruiters exhibited dishonesty during the process. Moreover, while breach fees are part of the business models for recruiters who bear high upfront costs, they leave FEHPs vulnerable to coercion and exploitation.

“This is a topic that all stakeholders must address in order to protect the rights of migrating health professionals and to ensure high-quality care delivery,” said lead author Franklin A. Shaffer, EdD, RN, FAAN, FFNMRCSI, President and CEO of CGFNS International, Inc. “We have to consider the impact of migration on the individual FEHP being recruited as well as on the countries they’re leaving from and migrating to.”

For the study, the researchers surveyed 8,894 FEHPs recruited to the U.S. between 2015-2017 who used VisaScreen® — a CGFNS service that establishes eligibility for employment-based visas — with an 11% response rate, reflecting FEHPs from 56 countries. They also conducted detailed interviews with FEHPs and recruiters to illuminate the current state of the U.S. FEHP recruitment industry today.

Many of the issues examined in the CGFNS study first came to light in health care think tank AcademyHealth’s 2007 report, U.S.-Based International Nurse Recruitment: Structure and Practice of a Burgeoning Industry, for which CGFNS International also conducted focus groups and surveys. That study was an impetus for the Alliance for Ethical International Recruitment Practices, a multi-stakeholder effort to develop a voluntary Code establishing best practices in nurse recruitment; founded in 2008, the Alliance has been a division of CGFNS since 2014. Since that time, there has been substantial progress on ethical practices industrywide, though problems remain.

Among the CGFNS study’s other findings:

  • 80% of FEHPs knew their wages before signing.
  • 9% had to pay a recruiter fee.
  • 47% had breach fees of at least $15,000 in their contracts.
  • Some FEHPs who later tried to leave their job were threatened with prosecution for “immigration fraud” or having their visas revoked.
  • Some FEHPs reported receiving lower pay than their domestic counterparts, with no added pay for working nights or weekends.
  • While some FEHPs received comprehensive cultural orientation programs from recruiters to ease their transition, others did not.

“Workforce cohesion, and ultimately, the quality of patient care depend on ensuring that all colleagues are treated fairly, trained well, and positioned to succeed in demanding health care environments,” the authors concluded.

American Journal of Nursing is published in the Lippincott journal portfolio by Wolters Kluwer.

Read the full article: The Recruitment Experience of Foreign-Educated Health Professionals to the United States


About CGFNS International, Inc.

Founded in 1977, to provide credentials analysis for nurses seeking migration, CGFNS International, Inc., based in Philadelphia, is an immigration-neutral not-for-profit organization proudly serving 194 countries as the world’s largest credentials analysis organization for the nursing and allied healthcare professions. Since its creation, more than 3 million nurses have used CGFNS’ services while migrating to the U.S. and Canada. CGFNS has NGO consultative status with the United Nations Economic and Social Council (ECOSOC) and is a member of the Conference of NGOs in Consultative Relationship with the United Nations (CoNGO). For more information, visit

About Wolters Kluwer

Wolters Kluwer N.V. (AEX: WKL) is a global provider of professional information, software solutions, and services for physicians, nurses, accountants, lawyers, tax specialists, and finance, audit, compliance, and regulatory sectors.

The company provides expert solutions - a combination of deep domain knowledge with specialized technology and services - that help professionals navigate change, solve complex problems, and deliver impact in their respective fields. 

Headquartered in Alphen aan den Rijn, the Netherlands, Wolters Kluwer holds market-leading positions in 40 countries globally, represents customers across 180 countries and employs 18,600 people worldwide. In 2018, it reported annual revenues of €4.3 billion.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

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Journal Link: American Journal of Nursing