Of foreign-educated nurses working in U.S. hospitals and other healthcare facilities, 40% say their wages, benefits or shift assignments are inferior compared with their American colleagues, according to a study.
The findings, which are scheduled for publication in the January issue of the American Journal of Nursing, suggest that nurses recruited by staffing agencies and from poor countries especially are vulnerable to potentially discriminatory treatment, reported researchers at the George Washington University School of Public Health and Health Services in Washington, D.C.
These findings are alarming, Patricia Pittman, PhD, an associate professor of health policy at SPHHS and the studys lead author, said in a news release. If confirmed by additional research, this survey raises a host of troubling ethical and practical concerns for healthcare facilities working to retain nursing staff and provide high-quality care to patients.
Past studies had raised questions about employment-based discrimination among foreign-educated nurses, including workplace bias, poor pay and discrimination. Pittman and her colleagues wanted to do a baseline survey from which future improvements could be measured. The team looked at 502 foreign-educated nurses working in the U.S. at the time of the survey. Nurses were asked about their country of origin, whether they were recruited by a staffing agency and a host of questions about their perception of treatment on the job.
Overall many foreign-educated nurses reported inadequate job training or unequal treatment, the researchers found. For example, about a third of all survey respondents said they did not receive sufficient orientation to life in the U.S. or to the cultural differences they might be dealing with on the job, problems that can make fully acclimating in a U.S.-based workplace difficult, Pittman said.
The researchers also found widespread perceptions of discriminatory practices, especially among foreign-educated nurses who had been recruited by staffing agencies. Pittman and her colleagues found that 68% of nurses who had been recruited by such agencies reported at least one discriminatory practice.
Pittman said nurses who had been actively recruited to the U.S. or who had come from developing countries tended to be especially vulnerable to potentially problematic aspects of the hiring process, including low wages and placement in inferior units or on undesirable shifts.
When Pittman and her colleagues zeroed in on discriminatory practices both overall and for nurses recruited by staffing agencies they found:
More than 27% of all RNs in the survey believed they did not receive pay comparable with that of U.S. peers. But for those hired by a staffing agency, that perceived discriminatory practice jumped to nearly 47%.
About 16% of all RNs said they did not think they were getting the same kind of benefits as their American colleagues. That number rose to 44% among foreign-educated nurses recruited by staffing agencies.
About 18% of all nurses in the study said they believed they received less desirable shifts or units compared to their peers. The number was nearly 29% for nurses recruited by a staffing agency.
Not surprisingly, the survey also found that foreign-educated nurses who perceived unequal treatment in the workplace were more likely to report job dissatisfaction, a problem that can lead to high turnover rates in hospitals and other healthcare facilities.
This studys 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, the researchers said. For example, foreign-educated nurses might be paid less in some cases because they have less experience compared with American nurses.
Whether it is real or not, Pittman said perceived discrimination takes a toll on individual workers and on the healthcare system. She said studies show workers who believe they are targets of unfair practices are more likely to get sick themselves and have higher rates of hypertension, depression and other signs of a high-stress working environment. Furthermore, poor orientation for foreign nurses may lead to a poor ability to work in teams or to communicate effectively, a problem that can threaten patient safety.
This is a problem that will not go away anytime soon, Pittman warned. She said tens of thousands of foreign-educated nurses already have signed contracts and are waiting for visas that will allow them to immigrate to the U.S. and begin working.