Foreign Nurses in the US: second class or not

[Corey Narry, MSN, RN, NP]

In a previous thread that is now closed by the admin, it was mentioned that a foreign nurse will always be behind a US-trained nurse in the US health care culture. This reference was made in comparison to physicians who are international medical graduates (IMG's) as this group does get last priority behind US-trained physicians in terms of finding residency program slots across the United States.

My opinion is that the above assumption does not apply to US nursing in general. Once a foreign nurse meets the qualifications to work in the US (as in the case of a Filipino nurse who passed the NLE, CGFNS in states that still require it, NCLEX-RN, and obtained the legal immigration documents allowing the nurse to be employed) that nurse is on equal footing with a US counterpart who possesses the same background qualifications.

I understand that some healthcare facilities in the US do not recognize nursing experience in the Philipines and will hire the foreign nurse just like they would a newly graduated nurse from the US. However, the "second class" designation if you will, does not stick with the foreign nurse forever. A foreign nurse who has gained years of US experience is just as qualified to apply for management positions as their American counterparts. In fact many foreign nurses with Bachelor's degrees in nursing have furthered their career by obtaining master's and doctoral degrees in the US and have assumed high level positions both in clinical practice and in academic settings.

Care to comment?

[suzanne4, RN]

It is not a point of being second class or anything like that but a drastic decrease in clinical skills is what we are now seeing. When you have documentation of 15 to 18 students per patient, there is going to be lack of procedures that one can complete when they are in school.

And I have met quite a few RNs over the past couple of years that got here just before the last retrogression started that had never started an IV, inserted a foley catheter, or even an NG tube. These are fundamentally basic nursing skills that everyone that holds a BSN should be able to perform. Have also come across nurses that had never mixed medications or even given an IM injection.

Passing of the NCLEX exam in no way determines the clinical skill level of the RN. It was never designed to be used for that, but only check that the nurse would start their practice safely.

This is why there is a such a difference in the training now, things are quite different from when you went to school.

[Corey Narry, MSN, RN, NP]

...you're absolutely right. I agree that the way nursing is being taught in majority of nursing schools in the Philippines makes it hard for Philippine graduates to meet the intellectual and technical demands of US-based hospital environments. Not being able to do physical assessments and relying on the physician to do it, not knowing how to do basic nursing skills -- these definitely do not meet the standards of US-based hospitals even when it comes to a newly graduated and newly licensed RN.

I would have to admit that I also lacked the skills in inserting foleys, IV's, and NG tubes coming out fresh from nursing school. However, I worked in the Philippines for two and a half years prior to coming to the US and in that period of time, I must have inserted hundreds of foleys, IV's, and NG tubes while working in the Neurosurgery ICU at Philippine General Hospital. I don't recall us relying on physicians for physical assessments. In fact, we were the eyes of the physicians and we were quick to alert them of changes in the patients' physical exam that warranted a physician's evaluation especially because the unit admitted fresh neurosurgical patients direct from the OR.

The sad part is that fresh RN's eager to learn like I did at the time are being shunned and turned away by many local hospitals there. The only way most are able to get experience is by volunteering and the experience one gets as a volunteer can be doubtful. There surely is much to be done if only our Philippine nursing leaders would care and fix the problem even if the government remains blind to these realities. I think nurses should self-regulate themselves. Nursing as practiced in the Philippines has become blatantly unethical and our nursing leaders need to take action to reclaim the lost pride and honor in nursing there.

The real intent of my above post, however, is in response to a blanket statement from a closed thread (https://allnurses.com/forums/3007784-post55.html) particularly the part that said: In the US, my daughter was applying to medical school. It is extremely difficult. She graduated top in her class, high gpa 3.9, and had a masters degree in clinical research. At one point she was considering going overseas to medical school. She was told, even if she went to the best over seas school she would always be considered second rate. My point is it is similar in nursing, coming from the best school you will always be behind a US nurse. For the current grads the out look coming to the US is slim to none, especially if you have zero nursing experience. No one would hire a US nurse who passed the boards 5 years ago and never practiced, now add English as a second lanuage and foreign training in my opinion it means very unlikely to work in the USA except for an employer who wants cheap labor and doesn't care about the quality of care.

I am not one to start an argument and I do agree with most of what was said in that post. However, I question the statement that a foreign nurse will always be behind a US nurse. This statement mentioned "foreign nurse" and did not even single out Filipino or not. I think it's a sweeping generalization that doesn't always hold true in the US setting.

[Ginger's Mom, MSN, RN]

In my opinion, any nurse, myself included would be behind a local nurse as far as practicing in a foreign country.

I am basing this on the fact of cultural differences, lanuage issues, and the fact the country I would be practicing in would have no way to know what kind of training my nursing program provided

My sister works for the UN- WHO division. Before going to any country they have to attend an immersion program as well as show competency in the local culture. If I went to another country, I daon't see any program available to provide a structured compentency based that I could attend.

Lanuage is another issue, most of my students English is a second lanuage. I often have to repeat, rephase my comments, and sometimes another student has to translate what I said. All my students have

passed the college level English test.

Last issue is the training provided, a foreign country would have no way to verify the training I had to compare with their local programs. In The US we use the state , CCNE, and the NLN, this would be meaningless to a foreign country.

Would the nurse be second class, of course not. In my opinion if an employer hires them they are duty bound to ensure they are treated equally. I think most would find there inital positions very challenging and would require extra support to work competently in their area.

In my opinion any foreign trained nurse would be behind any country which was not the country they trained in. Second class nurse, only if the employer does not provide the support to ensure their success,

Alex, RN-BC, BS, MSN, CCM, NSQIP SCN, MCAP

[Daly City RN]

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Admittedly when I started my nursing career in the U.S. 27 years ago I needed to learn a lot of things to transition from a new-grad to a seasoned staff nurse. I was very confident that the education I received in the Philippines in the 1970's prepared me very well to be a safe nurse.

Because I received my education from a refutable nursing school in the Philippines that prepared me very well to work in any U.S. hospital, or in any other hospital in the world for that matter. I became a relief charge nurse within six months, then a full time charge nurse in a very busy Neurology/ Neurosurgery/ Otolaryngology/ Oncology unit for over a dozen years. I transfered to another busy unit in 1996 and I'm contentedly working as a staff nurse and as a relief charge nurse. I have never felt as a second class nurse in all my years as an RN here in California, even when I worked part-time in other hospitals. Once you acquire the necessary number of years working as a professional RN you will become a hot commodity here in the U.S. Your skills as an RN will always be sought after by the hospitals.

Also many RNs here in the U.S.A. enjoy a high standard of living after initially working hard for several years. Yes, even foreign-grad RNs can achieve and enjoy a high middle income type of lifestyle. I have a Caucasian brother-in-law who kind of envy me for being an RN. Well, I have told him that I'm just lucky to have chosen a profession that is in high demand.

One caveat though: You as an RN here in the U.S. will work hard for your money.

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[Corey Narry, MSN, RN, NP]

In my opinion, any nurse, myself included would be behind a local nurse as far as practicing in a foreign country.

I am basing this on the fact of cultural differences, lanuage issues, and the fact the country I would be practicing in would have no way to know what kind of training my nursing program provided

My sister works for the UN- WHO division. Before going to any country they have to attend an immersion program as well as show competency in the local culture. If I went to another country, I daon't see any program available to provide a structured compentency based that I could attend.

Lanuage is another issue, most of my students English is a second lanuage. I often have to repeat, rephase my comments, and sometimes another student has to translate what I said. All my students have

passed the college level English test.

Last issue is the training provided, a foreign country would have no way to verify the training I had to compare with their local programs. In The US we use the state , CCNE, and the NLN, this would be meaningless to a foreign country.

Would the nurse be second class, of course not. In my opinion if an employer hires them they are duty bound to ensure they are treated equally. I think most would find there inital positions very challenging and would require extra support to work competently in their area.

In my opinion any foreign trained nurse would be behind any country which was not the country they trained in. Second class nurse, only if the employer does not provide the support to ensure their success,

Alex, RN-BC, BS, MSN, CCM, NSQIP SCN, MCAP

I started a new thread so that we can exchange thoughts on this matter as the succeeding posts in the other thread were becoming irrelevant to the original post and was closed. I'm glad you you were able to state your side on the issue. I would just like to clarify that whatever I state is based on my own personal experience as a former immigrant to this nation and a current US citizen.

I think the ball is on the foreign nurses' court as soon as they step in US soil and gain legal authorization to work. The English language was never an issue with me. True, I did not speak many colloquial terms in the American lingo but I was quick to pick up on them early on. Although not brought up American, the prevailing culture in the US was not entirely foreign to me. I've watched Sesame Street since I was five years old and although there was a time during my teeenage years when American TV shows were not available on Philippine TV, I had American cinema to turn to.

Now more than ever, I think of myself as more American than Filipino. I keep abreast with American politics and vote on issues that affect not only the nation but the immediate community I am in. I have adopted many American ways thanks to my significant other whose family was born and raised in the US spanning more than three generations ago. Don't get me wrong, I look back at my Filipino heritage and take pride in it and still get deeply affected when bad things happen to the Philippines and its people.

Although I received my entry-level nursing degree in the Philippines, my years of being a nurse in the US have more than made up for any deficiencies my Philippine education may have had. Nursing is not a stagnant field. One does not complete the basic requirement to be a nurse and stop there. All nurses in this country, foreign or not, continue to acquire and update their knowledge in more ways than one. My graduate school degree was obtained in a state university in Michigan but I think that is irrelevant. There are Filipino nurses whose highest degree is a BSN from the Philippines and yet have become absolutely competent in the clinical setting and were role models for many nurses, foreign or not.

Lastly, I would like to point out that although NLN and CCNE are designated accrediting bodies for nursing programs around the US, some states do not require programs to be accredited to allow graduates to sit for the licensing examination for RN's and LPN's. In the State of Michigan, the Board of Nursing has a list of approved programs that train RN's and LPN's:

http://www.michigan.gov/documents/mdch_nurse_approve_ed_prog_98366_7.pdf

A few of the programs listed are not accredited by NLNAC:

http://www.nlnac.org/Forms/directory_search.htm

and CCNE:

http://www.aacn.nche.edu/CCNE/reports/rptAccreditedPrograms.asp?state=MI&sFullName=Michigan.

But more importantly, what I am trying to point out is that while I started out as an immigrant and still regarded as foreign by many, I am no longer behind any US nurse, in fact, not only have I caught up with many of them, I am ahead of some of them.

[Ginger's Mom, MSN, RN]

Absolutely once a nurse gains professional experience ( past Benner's stage of novice nursing), in my mind they are no longer a "foreign" trained nursee" . I feel all nurses are equal since years of professional experience will over ride education.

I have big issues with people who assume a person who speaks with an accent is deficient, my father spoke with a very thick accent, had full command of the English lanuage and people did treat him as if he was stupid ( He graduated from Columbia University ), my point is that I don't assume when I hear an accent the person is foreign trained or diminished. My dad was very proud of his hertiage but thought of himself as a American.

It is rare in my neck of the woods to question where one went to school, so the issue of foreign training in the real world is a none issue, since all the nurses in the past decade are either seasoned nurses or newly licensed nurse. In fact nurses from the Phillpines are a step up of many nurses since to advance at most hospitals require a BSN. In my opinion there work history and education would help them advance.

To answer your initial question,how would I view your credentials, the fact you are an advanced practice RN and many years experience nurse, I would see you nursing expert. As far as the foreign training I would see that as an enhancement to your cultural competency.

My issue is any foreign trained nurse s intially behind especially if they have no clinical experience. Many my students work as CNAs , while this is not professional experience, it gives them time management experience. My impression is many of the foreign grads have very little experience in their clinical rotations. Based on my past experience,thee places that will petition these foreign nurses do not give them the support to transition to there role as a nurse. Being in a foreign country they are afraid to speak up this is a reciepe for disaster.

As far as US schools not being accreditted, that is sad, I counsel my students to check the schools they are applying to........

[salr]

The post by Alexk49 was well said about "foreign nurses".

Being a "foreigner" I thought I give my two cents worth of opinion. I applause the nursing profession in this country; the level of academic qualification and training is truly high. I was truly impressed and decided to change my career and go back to college to become a nurse and possibly go further after that.

Whether foreign or local, every nurse is required to pass the NCLEX, therefore I dont see any difference between a foreign or local nurse. What is most important is whether they are able to demonstrate compassion.

With regards to speaking with an accent... I have my share of experience. I was looked upon like an "alien from another planet", and was ostracized in class. No matter how I tried, I simply found it not easy to get into their groups. It took me a long time before I managed to break that barrier.

There was another incident when I posted in a forum on the internet. There was a lady who repeatedly posted remarks and criticisms on every one of my posts. Finally, I gave her a piece of my mind and she apologized.

Though these were unpleasent but they could never erode my self-esteem. I might speak with an accent but I am proud to say that so far I have achieved excellent grades for all my classes. In fact, recently when my husband was hospitalized, I met a Korean lady who was an RN who spoke with a strong accent. She was one of the best nurses during the 10 days my husband was there. We could see that she was also the doctors' favorite. She even shared with us her academic success in her RN studies; she was a straight A's student and she told me I could be one if I give it all. I was impressed with her attitude.

Everybody is the same; what is the difference is the attitude. Good and bad attitude is what matters.

[Ginger's Mom, MSN, RN]

My original post was about Foreign education and being a nurse in another country. Even nurses who are citizens of country but train in a foreign country they have issues with practicing in their home country.

Once the nurse moves from the novice stage to the competent stage I agree , there is no difference.

But there have been numerous posts which nurses express concern that nurses with no experience can't practice at the same level that the home trained nurses practice at. That is a huge issue since remedial work has to be done.

As I have stated I hate people who hate have no patience for people accents. I had heard people who learn a second lanuage after puberty have difficultly getting rid of their accent. We should be tolerant of differences, but I also want to point out it doesn't help when the foreign nurses speak there home tongue in patient areas, sometime I have witnessed often.

[wishiwereanurse, BSN, RN]

"Credentials can never accomplish what character can." I believe the reason why foreign nurses will always amount to, or even surpass, US nurses is because of the character-building they undertake, going through hurdles just to achieve what an American can only take for granted...

[Silverdragon102, BSN]

"Credentials can never accomplish what character can." I believe the reason why foreign nurses will always amount to, or even surpass, US nurses is because of the character-building they undertake, going through hurdles just to achieve what an American can only take for granted...

This I respectfully disagree with. Lots US nurses go through many hurdles to get where they want and with the high costs on training to be a nurse most do not take things for granted and many ties put themselves in high debt to do so.

[Corey Narry, MSN, RN, NP]

This I respectfully disagree with. Lots US nurses go through many hurdles to get where they want and with the high costs on training to be a nurse most do not take things for granted and many ties put themselves in high debt to do so.

...and I think that unfortunately is a common misconception held by some nurses coming from other countries. Some think that one can easily become a RN in the US because it only takes 2 years to finish the ADN degree, so why can't any American take advantage of this so that there would be no nursing shortage. But many do not realize that there is a sizable amount of interest in pursuing a career in nursing among Americans. However, many applicants to US nursing programs whether it's ADN or BSN have a hard time even getting in to a program. A lot of these hopefuls have to endure being waitlisted, being put on a lottery system for admission, or being denied admission even though they meet all qualifications because the school can only take a certain amount of students. Nursing school in the US is very competitive to get into and very rigorous once you do get into a program. And even the so-called 2-year ADN program can last up to 4 years with all the pre-requisite courses required for entry.