Background:

Migration of highly skilled workers from less developed nations to industrialized nations is an inevitable part of the process of globalization and provides both benefits and costs for the source countries. Benefits include professional opportunities for migrants, remittances and, when migrants return, the transfer of new skills back to the local economy. Costs are incurred when the departures leave major gaps in human capital and the ability to deliver vital services, such as healthcare.

With an estimated shortage of 800,000 nurses by the year 20201, U.S. hospitals and long term care facilities are increasingly looking abroad to hire health care professionals, especially nurses. While they know that international recruitment cannot entirely resolve the shortage, some employers view it as a partial solution.

International nurse recruitment companies are critical players in this growing phenomenon. Yet very little is known about the variations in their practices. Moreover, public debate to date has largely been polarized between those who see international recruitment of nurses as an opportunity for individuals seeking a better life, and those who are concerned about the exacerbation of nurse shortages in developing countries.

Origin of the Code:

AcademyHealth, a non-partisan, scholarly society for health services researchers, policy analysts, and practitioners, launched an initiative to examine the growing practice of international nurse recruitment that has emerged in response to the U.S. nurse shortage. The project sought to reduce the harm and increase the benefits of international nurse recruitment for source countries and to ensure that the rights of migrants are considered throughout the recruitment process.

The project evolved over two years, beginning in September of 2006, and included two complementary activities. During Part I, AcademyHealth researched the emergence, current structure and practices of the nurse recruitment industry. This process included interviews with chief nurse officers and other hospital administrators to understand how they make decisions about whether and how to recruit foreign-educated nurses. Interviews were also conducted with recruiting agencies to solicit information on the history of the industry and its current business models. Additional data sources included a review of recruiter Web sites and the subsequent development of a database of companies. In collaboration with the Commission on Foreign Graduates of Nursing Schools, AcademyHealth also organized focus groups that explored foreign-educated nurses' experience in the recruitment process and solicited their suggestions for improving the process. AcademyHealth's research findings were published in the report, "U.S.-Based International Nurse Recruitment: Structure and Practices of a Burgeoning Industry".

During Part II, AcademyHealth launched a consensus-building process with the goal of developing a draft "standards of practice". In collaboration with the O'Neill Institute for National and Global Health Law a Task Force was convened that included over 30 high level representatives from the hospital, union, nurse training and licensure, foreign nurse and recruiter sectors. The consultative process was observed by several governmental sectors. High level staff from Senators Edward Kennedy and Richard Durbin's offices, as well as representatives from the U.S. Department of State and the Health Resource Services Administration (HRSA) provided comments and support, but did not form part of the deliberations.

There was widespread agreement among Task Force members that international recruitment needs to be conducted in an ethical way that balances diverse stakeholder. Although this group had differing-and sometimes conflicting-perspectives, they nonetheless were able to identify common principals.

This phase of the project concluded with the official release of the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States on September 4 at the National Press Club in Washington, D.C.

1. Projected Supply, Demand and Shortages of Registered Nurses 2000-2020. Retrieved July 18, 2006 http:/bhpr.hrsa.govhealthworkforce/reports/mprojevt/efault.htm.