Quality of Care and Foreign Nurses
Importing foreign trained nurses is no new phenomenon, America has been importing nurses for over fifty years since 1965, according to B.L. Brush and A.M. Berger, "Sending for Nurses: Foreign Nurse Migration, 1965–2002"
I would like to examine evidence to see if foreign trained nurses have an impact on quality of care and wages.
There are numerous articles on importing foreign trained nurses and this article provides links to some interesting information.
Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities
This article states that...
"Quality issues. Little is known about whether the quality of nursing care differs between foreign- and U.S.-trained nurses. While the certification process assures competency in educational training and language, differential quality of clinical care has not been assessed. Quality of care could be affected by, among other things, poor orientation and training of new foreign nurses who are assimilating into the U.S. health care system. The development and evaluation of more comprehensive orientation and training activities are warranted and have been recommended by the AHA.50 An assessment of the quality of care and patient outcomes is likewise needed and should include an appraisal of the cultural competence foreign nurses bring to patient care."
From my own perspective I was given 2 weeks orientation and sent on my way as a foreign trained nurse I felt I was flying by the seat of my pants. Initially I was promised an eight week orientation but after 2 weeks I was on my own. Fortunately I received good reviews I was a very experienced nurse and could competently carry out my duties, I learnt by my mistakes and I avidly learnt by other peoples mistakes, making a mental note not to do anything which somebody else was reprimanded for. My mistakes were confined to paperwork, Dr's orders and learning what not to say.
However are others who are recruited so well informed and experienced in nursing. I have my concerns about orientation and the impact it can have on quality of care.
In the UK recruitment of nurses was obtained from India, Pakistan and African countries their orientation amounted to 6 months orientation, where they achieved a 'book' full of objectives before they were allowed to work as an RN-this obviously has cost implications. They were paid at a lower grade until their objectives had been achieved thus ensuring the nurses were fully familiar with nursing practices in the UK.
It is doubtful anything like this would be implemented in the US because of the cost implications this would involve. (work in progress)Last edit by Joe V on Jan 13, '15
About madwife2002, BSN, RN
Joined: Jan '05; Posts: 10,272; Likes: 6,113
Director of Nursing Services; from US
26 year(s) of experience in RN, BSN, CHDNApr 22, '09Great blog post, thanks for sharing your experience.
It's really too bad when health care facilities rush people into positions without a proper orientation. It is a terrible idea, increases the likelihood mistakes, staff quitting out of stress, risk patient safety etc...I could go on and on about the negatives.
The positive that one could come up with is probably in the short run, it appears to save $$$ because you get a nurse working 40 hours with little expense of orientation. Many would argue (me included) that it's a foolish waste of money, because the high expense of recruiting, hiring, training, (especially foreign recruitment) etc... It appears there are very little effective measures in place for improving retention, working conditions, proper training/orientation, a very common complaint from nurses, and/or errors that can be costly, deadly, and expensive in the long run.
I hope you get many responses from foreign nurses sharing their experiences as well.Apr 22, '09Great entry although i had the opposite experience my orientation was expected to last 12 weeks but by week 5 was already eager to get of orientation and did so, i do beleive the facility learned from those before me one of which was madwife thanks hun
Even now after being off sick for 14 weeks and returned they asked weather i needed orientation, nice offer but didnt want it and all the staff and management are always there for me anyway, i am so lucky to work were i do also the manager is English that may have something to do with the in depth orientationMay 1, '09I have seen both -- the facility rules on he amount of orientation the nurse recieves along with what is promised the new hire. Sometimes the doctors have a say but most often it is the nursing staff themselves that has the most power to say that the orientation needs to be extended or cut shorter depending on the learning curve of the individual.
The staff plays the biggest role of evaluating the new nurse for ability to function as a member of the team. This goes for all nurses. My hats off to the facilities that puts the power back to the current staff and preceptors.May 3, '09As a foreign nurse in the US, I also got a variety of orientations. My first job I probably got more then my 2nd. Unfortunately the most memorable orientation, took about 30 seconds.
"these are your rooms, you sound like you know what you are doing"May 3, '09Should probably move more to a system similar to Australia, where nurses have to complete a competency assessment or bridging program before practising if not from certain countries.Apr 12, '10When I first came to the US (I only came here by marriage), and got my Californian RN, I had already been an RN for about 7 years. The biggest transition issue I encountered, was the massive amount of paperwork we do about nothing..!! I was trained to chart by exception, not to document things that didn't happen or wasn't present. I soon enough learned the principles behind C.Y.A. (not that I like it).
Initially I was a bit concerned about English being my 2nd language, but quickly I realized that my English was much better than most of my colleagues. Most people simply think I'm from the Midwest (Wisconsin and Minnesota are where people most often think I'm from), not knowing I'm from Denmark.
On my unit we have a lot of Asian nurses, who are doing an awesome job and have great skills, but their people skills aren't comparable to Western standards, and often it leads to unhappy patients.Apr 18, '10i am in the opposite situation. i am going to school in the US (graduating in may) and want to work internationally. i am having difficulty figuring out what my options are, where to start looking. after i get my license, and having no experience might also be a setback.Apr 18, '10Having no experience is more than a setback, in my opinion. It is hard enough to work in a strange country and learn their environment etc, without having to learn nursing as well. I would advise anyone to get a least a few (and preferably more) years of experience after graduating before working overseas.
I think the reason I was able to assimilate so easily was because I already knew the work well, I just had to figure out the system, the paperwork, the personalities... and how to answer the "Where are you from!?" questions I get about a thousand times a day!!Apr 19, '10You may email at email@example.com.
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