1. Christmas, Kate RN

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Nurse managers play an integral role in creating successful international recruitment strategies. Prior to making the commitment to hire from abroad, focus on your facility's retention initiatives. Don't waste time and energy on international recruitment until your facility has its employee retention under control. You don't want to spend 18 months recruiting nurses only to have them leave shortly thereafter.


Land of opportunity

Globally, several countries are experiencing nursing shortages, including Canada, England, Ireland, and South Africa. Although these countries actively recruit from other nations, the United States remains the biggest draw for international nurses. Many nurses leave their countries of origin in search of a better standard of living, as well as to monetarily assist the families they leave behind. The quality of nursing here, the opportunities for education and advancement, the pay and benefits, and the lifestyle make our country an appealing destination.


Assess cultural fit

An initial assessment of both your system and your community will help you decide where to recruit. Start with your community. Is the population diverse? Do you have a variety of ethnic groups and the diversity support for a wide variety of cultures, or is your community somewhat insulated?


Assessing cultural fit will help you determine whether sufficient multicultural support services exist for the nurses you recruit. For example, the Philippine Nurses Association has many branches in U.S. cities and serves as a social and clinical adjunct to RNs relocating here from the Philippines.


What's the difference?

Although U.S. nursing practices are often used as the model in schools worldwide, there are many educational differences among nurses internationally. These differences begin with language and extend to divergent practice experiences and settings. Documentation also varies from country to country; for this reason, thoroughly explain U.S. documentation practices to new staff.


Just as you can't assume that all American nurses have the same level of experience, you can't presume that all international nurses will function like U.S. RNs in a clinical setting. For example, British RNs transition well to the United States, but they don't perform patient clinical assessment in their homeland, as that's considered a physician responsibility. Therefore, be sure to include physical assessment classes in their orientation.


In South Africa, RNs who work in specialty areas normally complete at least 1 year of study in their specialty prior to working in that clinical setting. South African ICU nurses have a scope of practice that surpasses that of the average U.S. RN. For example, their duties also encompass some of the functions of respiratory therapists in the United States. So, you'll want to clearly outline past experience and role expectations.


How to get started

Choose your sources carefully: There are many international recruitment opportunities available. If you begin your search independently, use a travel agency or select a company that provides international nurses on a contract basis.


Many hospitals and health systems recruit individually overseas. Most attend job fairs, but if you decide to go it alone, consider enlisting the services of a reputable immigration attorney. The Immigration and Naturalization Service has a very complicated web of regulations; a specialist can help you sort out these legal details.


Currently, the only way for nurses outside of Canada to relocate to the United States is with a green card. So, consider international recruitment a mid-range or long-term option. Even Canadian nurses, who are issued a Trade NAFTA (North American Free Trade Agreement) visa at the border, still have licensure issues that take time to sort out.


Placement and contract agencies provide a variety of options and often do much of the legwork. Some accept a flat fee from the hospital upon placing a nurse, provided that the facility pays benefits and salary. Other agencies offer long-term placements of 18 to 24 months. In this case, the RN remains an agency employee and the agency pays his or her benefits and salary.


Investigate agencies and research their references. Ask other facilities about their experiences and do some comparison shopping to find a reputable company. Inquire whether screening services, references, visas, and licensure are part of the package, and if costs such as nurse transportation are included. Review contracts carefully before signing them.


Mentoring and other considerations

Since more than just an orientation preceptor is required, consider enlisting a personal mentor to help international nurses and their families adjust both socially and professionally. Offer relocating spouses job assistance or refer them to your chamber of commerce. Everything from where to shop to how to enroll a child in school will be a new experience for the international nurse.


International nurses often don't have a U.S. credit rating, so health care facilities may want to consider providing housing and transportation in addition to salary and relocation costs.


Managers and recruitment staff will need to invest time and energy into successfully recruiting and retention of international nurses. This begins with the initial trip abroad and continues through the process. Emphasize the importance of relationship building to retain your valued nursing staff.


Why do it?

Although international nurses require careful orientation, they quickly show their value once becoming acclimated to their new surroundings. Many countries worldwide offer exceptional nursing programs and produce highly talented and motivated professionals.


Seasoned nurses who relocate to practice demonstrate great courage in their willingness to prove themselves all over again. Support them in every possible way to emphasize that the risk they took in relocating was well worth it. With good preparation, a reputable agent, and a solid plan, you can attract excellent, experienced RNs to your facility.