Is Recruiting International Nurses To Feed the U.S. Pipeline Worsening the Global Nursing Shortage?

Anne Dabrow Woods

By Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, chief nurse of Wolters Kluwer; Health Learning, Research & Practice

It is no secret that the U.S. has been struggling with a nursing workforce crisis for years, with healthcare organizations recruiting foreign nurses as a quick fix to fill swelling vacancies. During the pandemic, the influx of international nurses from the Philippines, Jamaica, India, Canada, and Africa increased significantly, up 44% from 2021 and 109% from 2018, according to the O’Grady Peyton International Inc. 2021 survey of International Nurses. Expected to continue in 2023, this trend may help to stem our national shortage in the short term but it also adds to nursing shortages felt abroad.

One country where we have seen a large number of  nurses coming to the US to practice from is the Philippines. However, this has left the Philippines with a shortage of over 350,000 nurses, many who come to the U.S. for better wages and working conditions, explained Maria Rosario Vergiere, officer in charge for the Ministry of Health. These nurses who are looking to make an important change in their career raise a fundamental question: Is it ethical to take nurses from one country to fill the nursing shortage in another?

The migration of nurses from one country to another also exposes a larger issue: today’s nursing shortage is global, not just domestic. Countries and global nursing organizations need to work together to solve the nursing workforce crisis globally. The International Council of Nurses and the World Health Organization are recognized leaders in addressing the global nursing shortage; however, they need equitable support from all nations to ensure the shortage is addressed from a global perspective.

International nursing challenges

While recruiting internationally trained nurses may seem like a quick fix, it brings with it a host of challenges along with it that are not always immediately clear. One example is that international nurses must pass the NCLEX exam; and they must adjust to cultural and scope of practice differences. CGFNS International, an immigration-neutral, nonprofit organization, assists internationally educated healthcare professionals wanting to live and work in a desired country. They assess and validate their academic and professional credentials, educating them on language, culture, and practice differences (CGFNS, 2023). The work of this organization has been instrumental over the years in helping acute, long-term care, and other healthcare organizations fill vacant nursing positions with foreign candidates.

International nurses have traditionally struggled to pass the NCLEX exam compared to U.S. nursing graduates due to some of the roadblocks they encounter in their move. In 2021, the first-time pass rate for the NCLEX-RN exam was 82.48% for U.S.-trained nurses and 46.48% for internationally trained nurses (CGFNS, 2022). As nurses attempt to pass the exam again, health systems could experience a strain in their onboarding process for them. However, the bar raises in April when the National State Boards of Nursing releases the Next Generation NCLEX exam for RNs and LPNs. The new NCLEX exam, which assesses clinical judgment and readiness to practice for graduating nurses, could adversely impact the already tenuous flow of internationally trained nurses eligible to work in America.

Will nurses trained in foreign countries be able to pass the Next Generation NCLEX examination? Will their scores be better or worse than the results on the current NCLEX exam? Only time will tell what impact the test changes will have on the international nurse pipeline.

Taking the long view

While the U.S. works to develop solutions to solve the domestic nursing workforce shortage, utilizing internationally trained nurses will undoubtedly continue. However, we must remember that for every international nurse gained, a valuable healthcare professional is lost in their home country, which impacts patient safety and quality of care – basic rights that should apply in any geography. Perhaps the U.S. needs to take the long view, working more closely with the global community to find equitable solutions to the nursing workforce shortage not only in our own backyard but across the globe.



Alibudbud, R. 2022. When the heroes don’t feel cared for: The migration and resignation of Philippine nurses amongst the COVID-19 pandemic. Journal of Global Health. 2022; 2: 03011. Doi: 10.7189/jogh.12.03011

CGFNS International, 2023.

O’Grady Peyton International, 2021.  O’Grady Peyton International, Inc. 2021 Survey of International Nurses.

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