TEXAS NURSING PROFILE

ILNs are not only professionals who have completed education and language training to obtain licensure in the U.S., they are also resilient and adaptable, demonstrating a capability to work in a new culture. However, the pressures of relocating to a new country are numerous and navigating the licensure process is one of many adjustments ILNs make as they enter the American healthcare system. Many ILNs come to the U.S. with years of work experience, often gained in more than one country. One’s national culture, as well as the culture of the work environment, plays a critical role in shaping a person’s professional work habits. As ILNs migrate to the U.S., they bring with them a cultural identity that contributes to the strength of the U.S. nursing workforce.

The experience ILNs gain outside of the U.S. healthcare system also highlights the importance of providing supportive mentoring as they transition to the U.S. It is understandable and expected that ILNs will bring professional practices developed in other healthcare systems that differ from those expected in the U.S. healthcare system. Just as a new RN requires orientation and support during the first years of their independent practice, so do ILNs. Some recruiting agencies offer ‘training or bridge programs’, to assist in this cultural transition, but there is no stipulation, again at the state or national level, that requires recruiting agencies to offer a training program. Furthermore, there is no curriculum or objectives created by any regulatory or accrediting body in the U.S. outlining what should be included in a cultural training program for ILNs. Some recruiting agencies may offer sophisticated, hands-on simulation practice labs to acclimated ILNs to the U.S. healthcare system while others may simply require an ILN to complete online modules while they sit in a hotel room or other housing waiting for employment paperwork to be completed.

The lack of uniform guidance and oversight to support ILNs professional and cultural transition to the U.S. healthcare system is contrary to what other developed economies such as the United Kingdom and Canada have created to support ILNs transition. In these two countries, bridging and mentoring curriculums have been created to guide the ILN, the employer and the healthcare team in learning how to work together. Another example is in Australia, where the Nursing and Midwifery Board approves accreditation standards and accredited courses of study for ILNs to support their transition to the new workplace environment.

In comparison, the U.S.’s National Council of State Boards of Nursing provides guidance on verifying an IENs credentials, focusing on concerns pertaining to fraud. There is no direction given to State Boards to adopt expectations of ethical recruitment standards or to inquire if recruiting agencies deliver cultural transition programs. Similarly, a review of publicly available American Nurse Association resources did not identify guidance focused on ethical recruitment practices, cultural transition programs for ILNs, or educational materials designed to help ILNs recognize potentially exploitative recruitment arrangements. The absence of such resources should not necessarily be interpreted as a lack of concern; rather, it may indicate that these issues have not yet received substantial attention within ANA’s current advocacy priorities. Collectively, these gaps in guidance from the nation's leading nursing organizations may contribute to inconsistent ethical recruitment and transition practices, with potential implications for workforce stability and patient safety. TruMerit, a private company performing credentialing of ILNs in the U.S., estimates that nearly 45% of ILNs in the U.S. may be recruited through agencies that do not adhere to recognized ethical recruitment standards (TruMerit/CGFNS, 2023). In the absence of national tracking, states and employers must fill the void. As a profession, we are ethically bound to ensure that our colleagues, including those from other countries, are recruited under transparent and fair practices. As an individual nurse, if you work somewhere that hires ILNs, advocate for them. Ask your employer if they provide ILNs with a cultural transition program and if they use ethical recruiting agencies. Consider developing a mentoring program, like new graduate mentoring, and provide the ILNs in your workplace with guidance as they learn a new culture as well as new work processes.

As a citizen, you can ask your Board of Nursing to make a public statement that outlines expectations for recruiting agencies to demonstrate ethical practices and provide cultural transition programs for the ILNs they recruit. By outlining expectations for recruiting agencies, Texas nurses can demonstrate leadership on the topic of ethical recruitment and the global issue of nurse migration. Promoting ethical recruitment and effective transition support not only benefits ILNs, but also strengthens workforce stability and helps create practice environments that support patient safety.

The recent political discourse unfolding over immigration in the U.S. appears new, but the reality is that America has long been without a national agenda on immigration. Regardless of one’s opinion about the topic, ILNs are a needed part of the nursing workforce, and employers, professional organizations and advocates for the aging recognize this need. Supporting ILNs transition and advocating for ethical recruitment practices is supporting the U.S. healthcare system. As ILNs fill critical shortage gaps and deliver care to our aging population, Texas nursing leaders have an opportunity to demonstrate leadership and vision in addressing the healthcare needs of its citizens by improving the oversight and accountability of those who recruit and hire ILNs. TN