The Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Health Professionals to the United States (Code) provides a voluntary framework for corporate self-governance and sets forth practical standards and guidelines for promoting fairness, honesty, and corporate social responsibility in all recruitment practices. The Code is published, disseminated, monitored, and managed by the Alliance.
Implementation of the Code provides an opportunity to increase public accountability of recruiting agencies and health care organizations.
The following is a list of frequently asked questions about the Alliance for Ethical International Recruitment Practices (Alliance), divided into subject areas. We are continually updating this section so please check back. If you have a question that is not listed, please feel free to send us an email.
About the Alliance
- What is the mission of the Alliance?
- When was the Alliance created?
- How is the Alliance governed?
- How is the Alliance funded?
About the Code
- What is the Code?
- What does the Code cover?
- Why was the Code developed?
- Who authored the Code?
- How were these organizations selected?
- Who uses the Code?
- How was the Code developed?
- Who funded this work?
- How is compliance with the Code monitored?
- What is the difference between Endorsers and Certified Subscribers the Code
- What is the WHO Code of Practice on the International Recruitment of Health Personnel and how does it compare to the Alliance’s Code?
Alliance Certified Subscribers
- Who should become certified by the Alliance?
- Why do organizations decide to subscribe to the Code?
- How hard is it to become a Certified Subscriber?
- How is a Certified Subscriber’s compliance with the Code monitored?
- What happens when a report of non-compliance is received?
- When will subscriptions be open?
- What is the Pilot Phase?
- How long will the Pilot Phase last?
- How much will it cost to be a Certified Subscriber once the Pilot Phase is over?
- How can a Certified Subscriber cancel their subscription?
- Does the Alliance plan to rely exclusively on subscription fees in order to operate?
Foreign-Educated Health Professionals (FEHPs)
- Why should I work with a Certified Subscriber?
- Why should I participate in the survey?
- Are the surveys anonymous and confidential?
- What types of reported problems can the Alliance address?
- How will reported problems be handled by the Alliance?
- How long will the remediation take?
- What happens if the remediation is unsuccessful?
- How can I access the survey?
- Who will see my survey?
- Can I take the survey if I do not work for a Certified Subscriber?
- Can I submit an open report if I am participating in the Alliance Survey Monitoring Program?
- Can I submit an open report if I have submitted the same report to another organization?
- Whom should I contact with questions about the survey?
About the Alliance
What is the mission of the Alliance?
The mission of the Alliance for Ethical International Recruitment Practices (Alliance) is to facilitate adoption and compliance with voluntary standards which aim to ensure that recruitment of foreign-educated health professionals to the United States is ethical, responsible, and transparent.
When was the Alliance created?
The Alliance for Ethical International Recruitment Practices was created in 2009 to implement the Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Health Professionals to the United States (Code) which was created in 2008.
How is the Alliance governed?
The Alliance Board of Directors is currently comprised of 17 members representing six stakeholder groups: unions, professional associations, U.S.-based foreign-educated professional associations, employers, staffing/placement agencies, and certification and licensure bodies. In addition, the chair of the board is reserved for neutral leadership from outside the industry.
How is the Alliance funded?
The Alliance is a non-profit organization that is currently funded by a grant from The John D. and Catherine T. MacArthur Foundation. Following the Alliance’s pilot phase, it will be funded by a combination of grants, subscriber fees, and organizational support.
About the Code
What is the Code?
The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals to the United States (Code) provides voluntary standards that aim to ensure that the practice of recruiting foreign-educated health professionals (FEHPs) to the United States is done in a responsible and transparent manner.
What does the Code cover?
The Code sets standards for ensuring that the rights of FEHPs are protected, that clinical and cultural orientation programs are adequate, and that the practice of recruitment is not harmful to source countries.
Why was the Code developed?
The Code was developed in response to widespread recognition that international recruitment of health professionals needs to be conducted in an ethical way that balances diverse stakeholder interests. There is general acknowledgement that there is currently no mechanism for preventing or reporting unethical conduct in international recruitment.
Who authored the Code?
The Code was authored by a diverse group of stakeholders representing unions, health care organizations, educational and licensure bodies, and recruiters. A full list of authors is included with the Code.
How were these organizations selected?
Participating organizations were identified through a study on the structure and practices of the U.S.-based international health professional recruitment industry conducted by AcademyHealth. They include both stakeholders in, and experts on, the process of international nurse recruitment.
Who uses the Code?
Our goal is that all employers and recruiters will use the Code to influence their recruitment practices. Both employers and recruiters can apply to become certified by the Alliance as being in compliance with the Code’s standards. In addition, the Alliance uses the Code as a guiding tool when assessing applications for certification.
Foreign-educated health professionals are encouraged to use the Code to learn about their rights and to identify how recruiters and employers should be treating them during the recruitment process.
How was the Code developed?
AcademyHealth convened a diverse group of stakeholders for a year long consensus-building process. The group developed the Code with technical assistance from the O’Neill Institute for National and Global Health Law at Georgetown University.
Who funded this work?
The research and consensus building process were funded by the John D. and Catherine T. MacArthur Foundation.
How is compliance with the Code monitored?
A full description of the Alliance's monitoring program can be viewed here.
What is the difference between Endorsers and Certified Subscribers of the Code?
An endorser is an organization that does not engage in the recruitment of foreign-educated health professionals, but would like to show their support of the Code and the mission of the Alliance. Examples include unions, foreign health professional associations, and non-governmental organizations (NGOs). Endorsers are not subject to monitoring by the Alliance.
An organization that has been certified by the Alliance is directly involved in the recruitment of health professionals. In addition, their compliance with Code standards are monitored through the Alliance Survey Monitoring Program.
If you are interested in becoming an endorser, please download and submit the endorsement form. A list of endorsers can be viewed here.
What is the WHO Code of Practice on the International Recruitment of Health Personnel and how does it compare to the Alliance’s Code?
The World Health Organization’s (WHO) Code of Practice on the International Recruitment of Health Personnel aims to promote a balance of the interests of health workers, source countries and destination countries, while mitigating the negative effects of recruitment of international migration on countries experiencing health workforce crises. Signatories of the WHO Code are member states.
The Alliance Code, which pre-dates the WHO Code, is a market-based tool that is adopted and implemented by recruiting companies and employers. The Alliance believes that its goals and those of the WHO Code are in alignment and the two initiatives are complementary (See position statement).
Alliance Certified Subscribers
Who should become certified by the Alliance?
Organizations that engage in any phase of the recruitment process should consider becoming certified by the Alliance. Whether your organization participates in the process directly or indirectly, the Alliance welcomes your application and your commitment to the standards set forth in the Code.
Eligible organizations include:
- Recruiting organizations that contract with FEHPs in a source country to facilitate migration to the United States and placement in healthcare employment;
- Staffing agencies that recruit and employ FEHPs and assign them to healthcare organizations in the United States; and
- Hospitals, health systems, and long-term care organizations who employ FEHPs (either recruited directly or through recruiters or agencies)
Why do organizations decide to subscribe to the Code?
Organizations that seek certification by the Alliance demonstrate a commitment to self-regulation and recognize the benefits that stem from conducting business within a framework of social responsibility. Becoming certified during the Pilot Phase of the Alliance’s Certified Subscriber program indicates leadership and innovation in the field. Participation in the Pilot Phase offers your organization the unique opportunity to provide valuable insights, expertise, and recommendations as the Alliance develops the program.
- Submit the online application;
- Submit the Compliance Report;
- Schedule an interview;
- Demonstrate compliance with the Alliance Survey Monitoring Program; and
- Submit Subscriber Agreement.
For more details, please view How to Subscribe.
How is a Certified Subscriber’s compliance with the Code monitored?
The primary mechanism for monitoring Code compliance is the Alliance Survey Monitoring Program, a confidential survey that is completed by health professionals who have been through or are currently moving through the recruitment process.
The Alliance also accepts “open reports” via a portal on the Alliance Web site. Open Reports are secure and confidential comments on recruitment practices that have been experienced or observed by any interested party.
What happens when a report of non-compliance is received?
As part of our mission, the Alliance encourages all certified subscribers to contract with other organizations that have also been certified. We recognize that organizations engaging in international recruitment often partner with multiple entities, both in the United States and abroad. Therefore recruitment activities of certified companies are only monitored insofar as they relate to the provisions of the Code.
The Alliance only investigates and addresses reports of non-compliance related to the Code. Activities that are outside the scope of the Code are not monitored. Certified companies are not held accountable for parts of the recruitment process they did not facilitate directly.
The Alliance investigates all credible reports of non-compliance. Reports of non-compliance are validated by speaking directly with the individual who provides the information and reviewing all other potential sources of data. Certified companies will participate in mediation and/or remediation to address compliance issues that arise. If companies fail to maintain compliance with the Code, they may be de-listed.
As a rule, the Alliance compiles information provided by surveyed health professionals in a way that does not identify them. Therefore, the Alliance requires the express consent of individuals who provide information in order to disclose their identity during the mediation and/or remediation process.
For reports concerning organizations that are not certified, the Alliance may provide the party filing the report with contacts and information on resources available to them. In addition, the Alliance contacts the non-certified organization with information about the Code, steps they can take to become compliant with the Code, and information on becoming certified by the Alliance.
When will subscriptions be open?
Any organization that engages in the recruitment of foreign-educated health professionals (FEHPs), directly or indirectly, can apply to become an Alliance Subscriber beginning in May 2010. The Alliance operated a pilot phase through December 2012. During this time, employers and recruiters participated in the subscription and monitoring process at no cost. Upon completion of the pilot, subscribers began to be charged a fee on a sliding scale.
What is the Pilot Phase?
The Alliance Pilot Phase was intended to serve as a period in which to launch our certification and monitoring programs. It was also a mechanism to gather valuable feedback, insights, and expertise as we developed and tested programs, policies, and procedures. During this time, employers and recruiters participated in the subscription and monitoring process at no cost. Upon completion of the pilot, subscribers began to be charged a fee on a sliding scale. View fee schedule.
The Alliance is still currently accepting applications from organizations interested in becoming certified. Any organization that engages in the recruitment of foreign-educated health professionals (FEHPs), directly or indirectly, can apply to become an Alliance Certified Subscriber by submitting our Web-based application form and completing the application process. See How to Subscribe.
How long will the Pilot Phase last?
The Pilot Phase began in May of 2010 and is currently scheduled to run through December of 2012. The Alliance recognizes that the combined factors of visa retrogression and the slow economic recovery from the recession have reduced recruitment of foreign-educated health workers to the United States. As a result, the Alliance may extend the Pilot Phase if the factors currently influencing the drop in international recruitment continue beyond 2012. The Alliance believes that the slow down in international recruitment is likely to be temporary and that this period provides a unique opportunity for organizations that participate in the industry to implement best practices.
How much will it cost to be a Certified Subscriber once the Pilot Phase is over?
One of the purposes of the pilot phase is to determine categories of subscribers and a fee schedule in accordance with ability to support the initiative. In a preliminary planning exercise, the Board identified 4 categories: Health Systems, Individual Hospitals, Placement Agencies and Staffing Agencies, with the following ranges depending on size:
- Hospitals (based on number of beds) : $500 - $1,500
- Health systems (based on number of beds) : $500 - $2,500
- Placement agencies: $500 - $1,500
- Staffing Agencies (based on annual earning): $500 - $2,000
How can a Certified Subscriber cancel their subscription?
Subscribers have the right to cancel their subscription to the Code at any time. Cancellation requests must be received in writing. Subscription to the Code is non-transferable and no refunds will be issued after 30 days. Upon cancellation, the Subscriber shall be immediately removed from the Alliance Web site. The Subscriber shall immediately remove the Alliance certification seal from any and all Web sites and materials produced by the Certified Subscriber.
Does the Alliance plan to rely exclusively on subscription fees in order to operate?
In order to maintain independence, the Alliance Board believes that the financial support for this initiative should be shared by all interested parties. As a result, subscription fees represent just one portion of the Alliance’s operating budget with the balance coming from institutional donations, including founding professional associations and unions, and public and private foundation grants.
Foreign-Educated Health Professionals (FEHPs)
Why should I work with a Certified Subscriber?
The Alliance neither supports nor opposes the recruitment of FEHPs to the United States, but does strongly affirm that when recruitment takes place, it must be conducted in an ethical, responsible, and transparent manner. Certified Subscribers’ recruitment practices are monitored by the Alliance to ensure they meet these standards. These standards were developed to protect FEHPs throughout the recruitment process.
Why should I participate in the survey?
Participation in the survey is voluntary. However, all FEHPs are encouraged to share their recruitment experiences with the Alliance because it will help to ensure that the rights of all health professionals are respected. The Alliance will use the surveys to monitor whether recruiters and employers who have subscribed to the Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Health Professionals to the United States (Code) are consistently following its principles and guidelines.
Are the surveys anonymous and confidential?
Suveys are confidential, but not anonymous to Alliance staff. However, the Alliance will never disclose information submitted by a health worker without express permission. If a health professional chooses to have the Alliance act on an individual complaint, they will need to give permission to disclose his or her identity to the recruiter. The Alliance may be limited in both investigating and mediating/remediating if the health professional will not grant this permission.
What types of reported problems can the Alliance address?
The Alliance can only address reported problems that directly relate to Certified Subscribers' non-compliance with the Code. In order to act upon a complaint, whether it is received through the Open Report section of the Web site or the Alliance Survey Monitoring Program, the Alliance will contact the health professional making the report to discuss the situation in more depth. After talking to the health professional, the Alliance will contact the recruiter without revealing anyone’s identity if it is at all possible, in an effort to resolve the problem. The identity of a health professional will never be given to a recruiter without explicit permission.
How will reported problems be handled by the Alliance?
Alliance staff, in conjunction with a Compliance Committee appointed by the Alliance Board of Directors, will review and investigate problems reported to the Alliance pertaining to recruiting companies. If a problem is reported regarding a company that has subscribed to the Alliance, every effort will be made to review, validate and investigate reports within 90 days of receipt. The Alliance will then manage the investigation, adjudication, and crafting of proportional responses to unethical practices. Alliance subscribers have agreed to participate in the review process, and where necessary engage in mediation, remediation or both with the Alliance acting as a neutral facilitator.
The Alliance will encourage interested parties to resolve isolated incidents of minor Code violations through mediation and other forms of facilitated communication and negotiation. If a validated report reveals systemic problems embedded in a company’s business practices or culture that result in non-compliance with the Code, the Alliance and subscribing company will enter into a remediation process to correct the problem.
If a report is received about a recruiting company that is not a subscriber to the Alliance, the report will be documented and validated as thoroughly as possible and the recruiting company will be notified that a report is on record. The company will be invited to become familiar with the Code and consider subscribing to the Alliance.
How long will the remediation take?
Although each situation presents unique issues and challenges, the Alliance will make every effort to complete formal remediation processes within 90 days of the close of the investigation period. As a result, the Alliance intends for reports that lead to remediation to remain “active” for no longer than a total of 180 days (90 days for the investigation and 90 days for the remediation process). The remediation process involves working with the subscriber company to identify and address administrative practices and organizational norms that require modification in order to maintain compliance with the Code. In many instances practices can and will be corrected within a much shorter timeframe.
What happens if the remediation is unsuccessful?
The expectation is that companies that are certified by the Alliance will make every effort to come into compliance with both the Code our monitoring program. Should a company fail to successfully engage in the remediation process the Alliance will move to de-list the company, revoking their status as a Certified Subscriber.
How can I access the survey?
Health professionals who contract with organizations certified by the Alliance and are at the beginning of the recruitment process will be informed by the certified organization about the opportunity to participate in the survey. The health worker will receive an email from the Alliance containing a link to begin the survey process and will be prompted to complete additional parts of the survey via secure links sent by the Alliance at appropriate intervals.
In addition, any foreign-educated health professional that is currently under contract with a Certified Subscriber, but was recruited before their organization subscribed to the Code, can also participate in the Nurse Survey Monitoring Program by requesting a survey on our Web site.
Who will see my survey?
The Alliance regards the confidentiality of survey data to be of utmost importance. Surveys are confidential, but not anonymous to Alliance staff. However, the Alliance will never disclose information submitted by a health worker without express permission. Neither government nor employers/recruiters have access to individual surveys. However, if a health professional chooses to have the Alliance act on an individual complaint, they will need to give permission to disclose his or her identity to the recruiter. The Alliance may be limited in both investigating and mediating/remediating if the health professional will not grant this permission.
Can I take the survey if I do not work for a Certified Subscriber?
Any foreign-educated health professional recruited to work in the United States will be permitted to complete the survey. They must REQUEST A SURVEY from the Alliance. These health workers will then receive an email from the Alliance containing links to all three parts of the survey. They may also report on recruitment practices through an OPEN REPORT.
While the Alliance cannot allocate resources to investigating and mediating problems with non-subscribers, if requested by the FEHP the Alliance will:
- Notify the company that the Alliance has received a report involving them and encourage them to read the Code and develop a plan to ensure compliance with its principles.
- Refer FEHPs to relevant organizations for guidance and assistance.
Can I submit an open report if I am participating in the Alliance Survey Monitoring Program?
Yes. We invite you to submit an Open Report if you have completed a part of the survey and have additional information to share with the Alliance.
Can I submit an open report if I have submitted the same report to another organization?
Yes. If you have filed a lawsuit, submitted a complaint with a government agency, or contacted another organization for assistance/advice, please provide the Alliance with the details of your effort. Please let the Alliance know if they may follow-up with any identified organizations.
Whom should I contact with questions about the survey?
Please send all questions regarding the Nurse Survey Program to firstname.lastname@example.org.