Association of organizational and environmental factors with recruitment of foreign-educated nurses in u.s. hospitals

One of the key strategies to address nurse staffing issues in U.S. hospitals has been the recruitment and employment of foreign-educated nurses. Based on the resource dependence perspective, this study examines the organizational and environmental factors that influence hospitals to recruit foreign-educated nurses. Data regarding a hospital that is recruiting foreign-educated nurses are derived from the 2008 American Hospital Association's Annual Hospital Survey. They are also merged with several large secondary datasets to incorporate various environmental and financial variables, including the Area Resource File and Healthcare Cost Report Information System. Approximately one fifth (21%) of the final sample hospitals (n=2,998) responded that they did recruit foreign-educated nurses. Among them, about 21% indicated that they recruited more, whereas 29% answered that they recruited less, compared to the previous year. The multivariate logistic regression results suggest that hospital size and the Joint Commission accreditation are positively associated with recruiting foreign-educated nurses. Facilities that are located in Metropolitan Statistical Areas (MSAs) and those in the markets with higher levels of percentage of minority population and per capita income also are more likely to recruit foreign-educated nurses. In addition, percentage of minority in the market is found to have a higher likelihood of recruiting more foreign nurses, while bed size is significantly associated with recruiting less foreign nurses. The results suggest that larger, accredited hospitals have more slack resources, and thus, have a larger volume of job opportunities for foreign-educated nurses. This study also finds that a hospital's decision to recruit foreign-educated nurses is strongly influenced by its environment, particularly urban areas or markets with a higher percentage of minority population. Because of a cultural adaptation issue, location may have been an important factor for foreign-educated nurses when choosing where to work.