Why the US now pulls fewer nurses from abroad

A study examining a decade’s worth of data on internationally educated nurses seeking work in the US reveals some striking data to counter the “brain drain” narrative.

In what’s known as nursing “brain drain,” locally educated nurses would go to school but then seek employment in the US, leaving their home country without adequate nursing talent and resources.

Historically, the United States has been a top receiving country of internationally educated nurses (IEN). These nurses had often worked in areas where there were significant nursing shortages. Because of this, the US has been seen internationally as a major global contributor to a phenomenon of talent emigration.

A total of 177 countries were eligible for inclusion in the study, representing findings from 200,453 IEN applicants to the US between 2003 and 2013. Their work found that changes to the NCLEX-RN licensure examination (2008), the global economic crisis of late 2008, and the passing of the World Health Organization’s Code for Ethical Recruitment of Health Workers (2010), all played a part in the significant drop in IEN applicants.

“The data showed that the decrease in IEN applicants to the US was this perfect storm, a confluence of all these factors,” notes lead author Allison Squires, assistant professor of nursing at New York University Rory Meyers College of Nursing. “For example, the NCLEX exam questions shifted to a more complex assessment of the test-taker’s knowledge and critical thinking abilities and were revised to include questions of laboratory test interpretation, delegation of work, and pathophysiology. This appears to have caused a significant drop in pass rates of IENs on the exam.”

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The findings, published in Human Resources for Health, show that 70 percent of applicants for the exam came from two countries, India and the Philippines, suggesting that the US may contribute to brain drain from those countries but not others. Applicants from the WHO list of “do not recruit” countries represented a small fraction of the sample, only 4 percent, and the number of applicants continues to decline. Pass rates of candidates from those countries averaged around 20 percent. If a country did not have English as an official language, then candidates were also less likely to pass the exam.

“Overall, the data is showing IEN pass rates on the NCLEX-RN have steadily declined over time from an average of 58 percent in 2004 to 32 percent in 2015,” notes Squires. No significant changes were found in the number of candidates following the 2008 economic crisis or the 2010 WHO Code.

The researchers note that the results from the study suggest that if IENs are going to be successful in their efforts to migrate, they may need transitional education programs to pass the NCLEX exam. Many countries and sometimes organizations offer transitional education programs. These programs help prepare the candidate to take the exam and when appropriate, help build communication skills in ways that optimize patient safety.

Even graduates from schools in “sending countries” that are designed to produce professionals for export and not necessarily to work in their home countries may still need these programs to pass.

The researchers also report that the US is unlikely to repeat past methods of international nurse recruitment in the future, even in the 16 states that are forecasted by Health Services and Resources Administration (HRSA) to have critical nursing workforce shortages.

“Before, anyone could set up a nurse recruitment business and odds were, candidates could get successfully placed,” says Squires. “A lot of people made a lot of money in the industry before the global economic crisis caused the industry to collapse. Now, with changes in the visa allocation process for nurses and what this study’s results show, the chances of an IEN successfully entering the US labor market without a transitional education program is decreasing.”

Source: New York University