Is recruiting international nurses to feed the US pipeline worsening the global nursing shortage?

Is recruiting international nurses to feed the US pipeline worsening the global nursing shortage?

Anne Dubrow Woods

By Ann Dubrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nursing Officer at Wolters Kluwer; Health teaching, research and practice.

It’s no secret that the U.S. has been struggling with a nursing workforce crisis for years, with healthcare organizations bringing in foreign nurses as a quick fix to fill bulging vacancies. During the pandemic, the inflow of international nurses from the Philippines, Jamaica, India, Canada and Africa increased significantly, up 44% from 2021 and 109% from 2018, according to O’Grady Peyton International Inc. 2021 International Nursing Survey. . Expected to continue into 2023, this trend may help curb our national shortage in the short term, but it also adds to the nursing shortages being felt overseas.

One country where we have seen a large number of nurses coming to the US to practice is the Philippines. However, this has left the Philippines with a shortage of more than 350,000 nurses, many who come to the US for better wages and working conditions, explained Health Department official Maria Rosario Verger. These nurses who want to make a major change in their careers raise a fundamental question. Is it ethical to recruit nurses from one country to fill a shortage of nurses in another country?

The migration of nurses from one country to another also reveals a larger problem. Today’s nursing shortage is global, not just domestic. Countries and global nursing organizations must work together to address the worldwide nursing workforce crisis. The International Council of Nurses and the World Health Organization are recognized leaders in the fight against the global nursing shortage. However, they need equal support from all nations to ensure that the shortage is addressed from a global perspective.

International Nursing Challenges

While recruiting internationally trained nurses may seem like a quick fix, it brings with it many challenges that are not always immediately apparent. One example is that international nurses must pass the NCLEX exam. and they must adapt to cultural and practical differences. CGFNS International, an immigration-neutral, non-profit organization, assists internationally educated health professionals who wish to live and work in a country of their choice. They evaluate and validate their academic and professional credentials, educating them about differences in language, culture and practice (CGFNS, 2023). This organization’s work has been instrumental for years in helping acute, long-term care and other health care organizations fill nursing vacancies with foreign candidates.

International nurses traditionally struggle to pass the NCLEX exam compared to US nursing graduates because of some of the roadblocks they encounter in their walk. In 2021, the first-time pass rate for the NCLEX-RN exam was 82.48% for US-trained nurses and 46.48% for internationally trained nurses (CGFNS, 2022). As nurses try to retake the exam, health systems can feel strained during the onboarding process for them. However, the bar is raised in April when the National State Boards of Nursing releases the next-generation NCLEX exam for RNs and LPNs. The new NCLEX exam, which assesses the clinical judgment and practice readiness of graduate nurses, could negatively impact the already weak flow of internationally trained nurses eligible to work in America.

Will Foreign-Trained Nurses Pass the Next Generation NCLEX Exam? Will their scores be better or worse than current NCLEX exam scores? Only time will tell what impact the test changes will have on the international nursing pipeline.

Taking a long look

While the US works to develop solutions to address the domestic nursing workforce shortage, the use of internationally trained nurses will undoubtedly continue. However, we must remember that for every international nurse gained, a valuable health professional is lost in their home country, affecting patient safety and quality of care; basic rights that should apply in any geography. Perhaps the US needs to take the long view, working more closely with the global community to find equitable solutions to nursing workforce shortages not just in our own backyard, but around the world.


Alibudbud, R. 2022. When heroes don’t care about themselves. Migration and resignation of Filipino nurses during the COVID-19 pandemic. Journal of World Health. 2022; 2: 03011. Doi: 10.7189/pop.12.03011

CGFNS International, 2023.

O’Grady Peyton International, 2021. O’Grady Peyton International, Inc. 2021 Survey of International Nurses.

By Scott Rupp Anne Dubrow-Woods, Fixing the Nursing Shortage, Walters Kluwer

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