Mission and History

Our Mission

The mission of the Alliance for Ethical International Recruitment Practices (Alliance) is to facilitate the adoption and compliance with voluntary standards that aim to ensure recruitment practices of foreign-educated health professionals to the United States are ethical, responsible, and transparent.

These standards are set forth in the Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Health Professionals to the United States (Code). The Alliance has developed a monitoring, remediation, and verification process to ensure that these standards are upheld by subscribing organizations. Through public reporting, the Alliance provides foreign-educated health professionals and health care organizations with credible information to make responsible decisions when they are considering contracting with a recruiter*.

Consensus on Ethical Standards of Practice

With funding from the MacArthur Foundation, an initiative was launched in 2006 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 health professional recruitment for source countries and to ensure that the rights of migrants are considered throughout the recruitment process. The project evolved over two years and included two complementary activities.

During Part I, the emergence, current structure, and practices of the nurse recruitment industry was researched. 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 (FENs). 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 (CGFNS) focus groups were organized that explored FENs' experience in the recruitment process and solicited their suggestions for improving the process. These research findings were published in the report, U.S.-Based International Nurse Recruitment: Structure and Practices of a Burgeoning Industry.

During Part II, a consensus-building process was launched 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 the offices of Senator Edward Kennedy and Senator Richard Durbin, 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 interests. Although this group had differing - and sometimes conflicting - perspectives, they nonetheless were able to identify common principles. 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 (Code) on September 4, 2008 at the National Press Club in Washington, D.C. View Video

Implementation of a Voluntary Code of Conduct

With additional funding from the MacArthur Foundation, in September 2008 a new project was launched to maximize the benefits and minimize the potential harm resulting from the recruitment of foreign-educated nurses (FENs) to the United States for three primary stakeholder groups: source countries, FENs, and U.S. patients. The project's goal was to increase the transparency and accountability of the industry by implementing the Code. Key to ensuring that the Code actually modifies conduct is the establishment of a monitoring entity. A Stakeholder Transition Group consisting of representatives from unions, health care organizations, educational and licensure bodies, and recruiters was created and assisted in the development of a strategic plan that formed the basis for this entity and led to the creation of the Alliance.

The Alliance advances the implementation of the Code by inviting employers and recruitment organizations to subscribe. Subscribers must provide a copy of the Code to all FENs with whom they enter into a contract, and must  agree to allow those nurses to be surveyed by the Alliance. A list of subscribers will be available for consultation by FENs and health care organizations that are considering contracting with a recruiter or an employer.

The pilot phase of subscriptions operated between May 2010 - May 2011. During this time leading employers and recruiters participated in the subscription and monitoring process at no cost.

The original title of this document was the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States, published in September 2008. In 2011, the Board of the Alliance for Ethical International Recruitment Practices expanded its work to include other health professionals, replacing the tearm "foreign-educated nurse" (FEN) with "foreign-educated health professional" (FEHP). All other content is identical to the original publication.

*A recruiter can be a staffing agency, a placement agency, or an employer (i.e. hospitals, health care systems, long-term care facilities) that recruits directly.

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