Linda H Aiken1. 1. Center for Health Outcomes and Policy Research, University of Pennsylvania, Center for Health Outcomes and Policy Research, Philadelphia, PA 19104-6096, USA.
Abstract
OBJECTIVES: To review estimates of U.S. nurse supply and demand, document trends in nurse immigration to the United States and their impact on nursing shortage, and consider strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries. PRINCIPAL FINDINGS: Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations. CONCLUSIONS: Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.
OBJECTIVES: To review estimates of U.S. nurse supply and demand, document trends in nurse immigration to the United States and their impact on nursing shortage, and consider strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries. PRINCIPAL FINDINGS: Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations. CONCLUSIONS: Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.
Authors: Linda H Aiken; James Buchan; Julie Sochalski; Barbara Nichols; Mary Powell Journal: Health Aff (Millwood) Date: 2004 May-Jun Impact factor: 6.301
Authors: Carole A Estabrooks; William K Midodzi; Greta G Cummings; Kathryn L Ricker; Phyllis Giovannetti Journal: Nurs Res Date: 2005 Mar-Apr Impact factor: 2.381
Authors: Jessica M Gross; Martha F Rogers; Ilya Teplinskiy; Elizabeth Oywer; David Wambua; Andrew Kamenju; John Arudo; Patricia L Riley; Melinda Higgins; Chris Rakuom; Rose Kiriinya; Agnes Waudo Journal: Health Serv Res Date: 2011-03-17 Impact factor: 3.402
Authors: Linda H Aiken; Jeannie P Cimiotti; Douglas M Sloane; Herbert L Smith; Linda Flynn; Donna F Neff Journal: Med Care Date: 2011-12 Impact factor: 2.983