1. Roush, Karen MSN, RN, FNP, BC


Map out a challenging, rewarding experience.


Article Content

Nursing can be your ticket to the world. You'll find numerous opportunities to use your nursing skills around the globe: working as a bedside nurse in a state-of-the-art facility, creating policy in a global arena, or caring for refugees in a makeshift clinic. Wherever you go and whatever you do, you're sure to gain a new perspective on health care and enrich your professional and personal life.


Employment opportunities. Many countries, including the United Kingdom, Australia, and Saudi Arabia, recruit nurses from the United States. Professional requirements vary, but for most countries you'll need at least a four-year nursing degree; many will require a test of your competency. The United Kingdom will require you to complete a practicum course before you're eligible to register for a license to practice. Language fluency is necessary if English isn't your primary or professional language. You'll also need to meet the immigration requirements of your intended country, which may include obtaining a work visa.


Expect to spend 12 to 18 months getting all the official pieces in place. Consider working with a recruiter who can facilitate the process and offer support once you get to your destination. Do your homework and find a reputable agency; ask to be put in contact with nurses they've worked with. If the agency charges you for its services, look elsewhere; fees are routinely paid by the hiring institution.


Working overseas can be lucrative. When you work and reside overseas for 330 days out of the year, your earnings aren't taxed by the United States. Neither are they taxed by the country where you work, because you aren't a citizen. Check with the Internal Revenue Service before finalizing your plans to ensure that your situation qualifies for a tax break. Hospitals in Saudi Arabia typically provide nurses with free housing or a housing allowance.


Learn all you can about the culture, work environment, professional roles, and social milieu of your intended destination. Think carefully about the implications of living in a non-Western culture where restrictions on dress and relations between the sexes can be challenging for someone used to Western ways. In Saudi Arabia, for example, housing is segregated by sex, and a woman must wear an abaya when outside of her housing compound. Women aren't allowed to drive, and unmarried couples must be accompanied in public by a married couple. Family and friends can't obtain a visa to visit Saudi Arabia, but you will typically be paid a travel allowance for airfare home once a year.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

The U.S. government also offers international positions. NPs can consider careers with the U.S. Department of State as Foreign Service Health Practitioners who provide primary care to government employees posted overseas. You must be prepared to go wherever they send you. Foreign Service nursing opportunities also exist with the United States Agency for International Development.


You might also find a career with the World Health Organization (WHO). The WHO is moving toward competency-based criteria for jobs, and nurses are increasingly qualified to fill positions that were previously limited to physicians. While few jobs are listed specifically for nurses, if you have a public health background and experience in developing countries, several opportunities are open to you, including those calling for a medical officer. Positions may be based at WHO headquarters in Geneva, Switzerland, or at regional offices around the world.


Many nongovernmental organizations (NGOs) offer paid or volunteer positions, but these usually require extensive experience. You can find online job postings for the International Rescue Committee, Catholic Relief Services, and the International Federation of Red Cross and Red Crescent Societies.


Volunteering or working in a developing country may well be the most rewarding experience you'll ever have. You'll make a difference in the lives of people struggling with extreme hardship, and you'll use all of your nursing skills in creative and demanding ways. But you will be most affected by the indomitable spirit, gratitude, and generosity of the people you care for. You'll return home thankful for the difference they made in your life.


Working in a developing country is not for the faint of heart. Coming face to face with the devastating realities of extreme poverty will shake up everything you believe about priorities and fairness. You must be able to handle your emotions while providing care. But if you have a sense of adventure, enjoy diverse experiences, and are adaptable and resourceful, you will thrive. Choosing where to go and whom to work with is an important step. Organizations vary widely in their expectations and requirements, the support they provide, and financial arrangements. You want to find the best match between your characteristics and requirements and those of the agency.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Hospitals and nursing schools often have international service programs. A group of nurses, physicians, and support staff will visit a region annually to provide care in a specialty area such as orthopedics, plastic surgery, or obstetric fistula repair. Such trips usually last a week or two and are a good first international experience.


If you can spend four weeks abroad, check out Health Volunteers Overseas (HVO), an NGO that works with hospitals and nursing schools in many countries to develop and implement educational programs or enhance existing programs. Volunteers teach nursing students and other health care providers and may also train teachers and develop curricula. The HVO doesn't pay for your travel or other expenses, though you may be provided with room, board, and local transportation once you arrive.


Another short-term possibility is Project Hope, an NGO that strives to create sustainable improvements in local health care in developing countries. Project Hope provides health education programs and medical and nursing care for individuals, communities, and health professionals.


If you're able to make a longer commitment you may want to consider the Peace Corps, a U.S. governmental organization; Medecins Sans Frontieres (MSF), an NGO known in the United States as Doctors Without Borders; and Voluntary Service Overseas (VSO), an NGO based in the United Kingdom.


The Peace Corps requires a two-year commitment. The minimum age is 18, and the Peace Corps seeks volunteers of 50 years old and older who can bring decades of valuable knowledge to their mission. Overseas experience and foreign language proficiency aren't required. Married couples can volunteer together. The government pays all expenses, provides health insurance and a stipend, and gives each volunteer a $6,000 transition payment at completion of service.


MSF provides medical services to areas devastated by armed conflict, natural disasters, epidemics, and extreme poverty. The group aims not only to provide care but also to bear witness to inequity and injustice. This is not the place to start your international nursing career; recruitment is very competitive, and you need to have overseas experience. Assignments are for at least six to 12 months; MSF pays all expenses associated with your service, a salary of $1300 a month, and a per diem expense allowance in the local currency.


The VSO places volunteers in Africa and Asia on assignments lasting from one to two years. Your partner or family can accompany you, but this limits the assignments you'll qualify for. The VSO pays your travel and health insurance and provides a living allowance while you're overseas.


Once you're ready to go, make an appointment with an NP or physician who specializes in travel medicine. Working in a developing country will require health measures such as vaccinations and malaria prophylaxis. Do this early; some vaccinations must be given months ahead of time. Visit the Web page on travel medicine provided by the Centers for Disease Control and Prevention. Also, check with your health insurance company to see if your policy covers overseas care.


A good source of general information about international opportunities is the International Volunteer Programs Association, an alliance of volunteer NGOs. Check out their online resources page to find numerous sources for volunteer Web sites, international jobs, and publications.


The International Medical Volunteers Association is another good resource. Its Web site provides links to available programs and extensive general information about volunteering.


Whether it's a lifetime career or a once-in-a-lifetime volunteer stint, working in another country broadens your view of the world, introduces you to some amazing people, and expands your notion of what's possible for your life. It will inform your practice and your life for long after you return home.




* U.S. Department of State:


* United States Agency for International Development:


* World Health Organization:


* International Rescue Committee:


* Catholic Relief Services:


* International Federation of Red Cross and Red Crescent Societies:


* Health Volunteers Overseas:


* Project Hope:


* Peace Corps:


* Medecins Sans Frontieres:


* Voluntary Service Overseas:


* Centers for Disease Control and Prevention on travel medicine:


* International Volunteer Programs Association:


* International Medical Volunteers Association: