On the Job and Facing Bias: Study Looks at Foreign-Educated Nurses

Jan 7, 2014, 9:00 AM

Historically, the United States has relied on the recruitment of foreign-educated nurses (FENs) to fill gaps caused by widespread nursing shortages. Yet many FENs face unequal treatment on the job, according to a new study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

Forty percent of FENs, defined in the study as immigrants who are in the United States to work in hospitals and other health care facilities, say their wages, benefits, or shift assignments are inferior to those of their U.S.-born colleagues. The findings, which appear in the January issue of the American Journal of Nursing, suggest that FENs recruited by staffing agencies and from impoverished countries are especially vulnerable to potentially discriminatory treatment.

Lead author Patricia Pittman, PhD, an associate professor of health policy at SPHHS, called the findings “alarming” in a news release. Pittman added that “if confirmed by additional research, this survey raises a host of troubling ethical and practical concerns for health care facilities working to retain nursing staff and provide high-quality care to patients.”

Past studies raised questions about employment-based discrimination against FENs, including workplace bias and poor pay. Pittman and her colleagues wanted to do a baseline survey from which future improvements could be measured, so the team looked at 502 FENs working in the United States at the time of the survey.

The researchers found that many FENs reported inadequate job training or unequal treatment. For example, about one-third of survey respondents said they did not receive sufficient orientation to life in the United States or to the cultural differences they might have to deal with on the job—problems that can make it hard to fully acclimate in a U.S.-based workplace such as a hospital or nursing home, Pittman said.

The research yielded a high number of reports of discriminatory practices, especially for FENs who had been recruited by staffing agencies. Pittman and her colleagues found that 68 percent of nurses recruited by such agencies reported at least one discriminatory practice. Pittman said that nurses who had been actively recruited to the United States or who had come from developing countries tend to be especially vulnerable to problems such as low wages and placement on undesirable shifts.

The survey also found that FENs who perceived unequal treatment in the workplace were more likely to report job dissatisfaction, a problem that can lead to turnover, which generates significant costs to health care providers that must pay to recruit and train replacements.

The findings must be verified by additional research that can solidly link such results to discrimination or other factors that might explain the differences in treatment, authors say. For example, FENs might be paid less in some cases because they have less experience compared to U.S.-born nurses. At the same time, the study’s findings add to other evidence suggesting that FENs are, in many cases, discriminated against or treated differently than U.S.-born RNs.

Read the study in the American Journal of Nursing.
Download and listen to a December 26, 2013, interview with Pittman.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.