Internationally Educated Nurses (IENs) in the U.S

Statistics of Internationally Educated Nurses in the US

In 2022, approximately 500,000 foreign-educated registered nurses were employed in U.S. healthcare facilities. This group represented about one-sixth (≈ 16 %) of the nation’s nearly 3.2 million total RNs, according to Becker’s Hospital Review. Over the past decade, U.S. hospitals have roughly doubled their reliance on internationally educated nurses. In 2010, only 16 % of hospitals reported hiring foreign-educated RNs; by 2022, that share had climbed to 32 % (Becker’s Hospital Review, 2024). This rising trend is evidence of not only sustained domestic labor shortage but also more aggressive abroad staffing efforts. According to the data provided by the New American Economy Research Fund in the analysis of the 2018 American Community Survey data, five source countries represent the majority of immigrant RNs in the United States. Nurses from the Philippines numbered 142,800 (29.3 % of all immigrant RNs), followed by India (32,400; 6.7 %), Nigeria (21,200; 4.4 %), Jamaica (21,200; 4.3 %), and Mexico (18,900; 3.9 %) (New American Economy Research Fund, 2019).

Economic Impact of Hiring IENs

When foreign-educated nurses begin working in U.S. health systems, their earnings become a powerful engine for local economies. A 2023 CGFNS opinion poll of more than 1,500 IENs revealed that such nurses devote approximately 60 percent of their salary towards housing, groceries, transportation, and other community-based goods and services and pay approximately 25 percent of their money in federal, state, and local taxes. Extrapolating these figures to the estimated 688,000 immigrant nurses in the U.S. workforce, CGFNS calculates an annual injection of at least $46.9 billion into the domestic economy, alongside $1.6 billion sent back to families overseas .

Despite low or average IEN salary rates behind the U.S. based RNs, it is still a significant consumer demand driver. According to the CGFNS report, the average annual earnings of foreign-educated nurses are indicated to be 71,800 dollars per year, compared to the 89,000 dollars average in all the RNs; interestingly, approximately a quarter of the surveyed IENs made cash incomes above 90,000 dollars during their initial years in the U.S. These wages not only bolster local housing markets and retail sectors but also underwrite spending on childcare, transportation, education, and other service industries .

Concerns that expanding the IEN workforce might depress native-trained nurse wages are largely unfounded.  A peer-reviewed labor-market analysis by Aydemir and Borjas (2011) found that a 10 percent increase in the supply of foreign-trained RNs within a state corresponded to only a 1–4 percent decrease in earnings for U.S.-trained nurses. This modest effect indicates that IENs primarily augment the overall labor pool—filling vacancies and helping hospitals avoid costly agency staffing or overtime—rather than displacing incumbent workers (Aydemir & Borjas, 2011).

Historical U.S.–Philippines Nursing Relationship 

The strong presence of Filipino nurses in the United States stems from over a century of intertwined educational and migration ties. After the Spanish–American War in 1898, the Philippines became a U.S. territory, and American public-health officials established U.S.- modeled nursing training almost immediately.  Philippine General Hospital School of Nursing was established in 1907 with English as its medium of instruction and closely following the curriculum in U.S. schools of nursing. This early program explicitly prepared Filipino graduates to meet American clinical standards and laid the foundation for future migration (Choy, 2003).

In the aftermath of World War II, the U.S. sought to promote cultural and professional exchange through its newly created Exchange Visitor Program. Filipino nurses were one of the earliest groups of individuals to do so; starting in 1948, Filipino nurses spent up to two years in U.S. hospitals undergoing short-term clinical training and then returned to the Philippines more skilled and equipped with credentials. These exchanges fostered professional networks and acclimated Filipino nurses to the workings of American healthcare systems, further smoothing the path for later, more permanent migration (U.S. Department of State, 1948).

A watershed moment arrived with the Immigration and Nationality Act of 1965, which abolished national-origin quotas and gave priority to skilled workers—including nurses (Pub. L. 89–236, 1965). In 1980, the Department of Labor placed professional nurses on its list of occupations in a nationwide shortage under the so-called Schedule A, to be exempted in the general labor-certification process. After these policy changes, the U.S. hospitals also started active efforts to recruit workers in the Philippines, by advertisements in local newspapers and nursing magazines. Between 1965 and 1985, more than 100,000 Filipino nurses migrated to the United States, cementing a robust and enduring migration corridor (Choy, 2003; USCIS, 2021).

Major Exporters of Healthcare Workers to the U.S

Most foreign-born healthcare workers in the United States originate from a small group of countries, with the Philippines supplying the largest share of immigrant registered nurses. In 2018, Filipino-educated RNs accounted for 28 percent of the 512,000 foreign-trained nurses in U.S. hospitals, far outpacing any other source country, according to the Migration Policy Institute.. India followed at 6.7 percent, Nigeria at 4.4 percent, Jamaica at 4.3 percent, and Mexico at 3.9 percent, meaning that just five nations together contributed over 47 percent of the immigrant nursing workforce.

The same trend is observed regarding physicians and surgeons, where India and the Philippines also lead in international migration. By 2017, more than 247,000 foreign-trained doctors were practicing in the U.S., representing just over one-quarter of the physician population. According to further analysis, more than 56,000 of these practitioners were medically educated in India, which means that it becomes the unquestionable country of origin of immigrant physicians in America.

In addition to nursing and medicine, immigrant workers play pivotal roles in allied health and long-term care. In 2018, 38 percent of home health aides and personal care workers were foreign-born, with many hailing from Mexico, the Philippines, and various Caribbean nations . These laborers assist to fill extreme home shortages in elderly care and incapacity services, demonstrating the wide financial and societal effect of healthcare migration.

Process for Bringing IENs to the U.S.

Before an Internationally Educated Nurse can practice in the United States, they must first have their foreign credentials evaluated against U.S. standard. Very few IENs receive a VisaScreen Visa Credentials Assessment by CGFNS International a review of their academic transcripts, professional licensure, and English-language ability. In fiscal year 2023, CGFNS issued nearly 27,000 VisaScreen certificates—the highest annual total on record—reflecting a more than fourfold increase since 2017 (CGFNS International, 2023). After the approval of credentials, IENs will have to take the NCLEX-RN, the national licensure exam, which all U.S. state boards of nursing demand. During the first half of 2024, internationally educated candidates passed the NCLEX-RN at a rate of 50.08 percent, compared to 78.35 percent for all first-time test-takers, highlighting the additional preparation IENs often need, based on data from the NCSBN.

IENs are required to demonstrate English-proficiency during their VisaScreen process, either concurrent with or before sitting the NCLEX-RN exam, and this is normally through the TOEFL or IELTS. U.S. Citizenship and Immigration Services mandates that noncitizen healthcare workers hold a valid VisaScreen certificate to qualify for employment-based visas, ensuring proficiency in clinical communication. Having completed the credential assessment and the licensure exam, the U.S. employer sponsors an immigrant petition under the so-called Schedule A, Group I, a Department of Labor determination of shortage occupation that exempts the usual PERM labor-certification requirement. Under the EB-3 visa category, hospitals file Form ETA-9089 and Form I-140 directly with USCIS, substantially reducing wait times for labor-certification approval.

Conclusion

To healthcare policymakers and administrators, these data highlight the importance of maintaining unobstructed well-circuit pathways to IEN assimilation, such as efficient visa screenings and visa services sustenance regarding credentialing services. Future studies need to investigate how the U.S. maintains a more in-depth career development analysis of IENs, the difference in outcomes remote or tele health nurses provide, and a comparative analysis of recruitment agency performance between varied regulatory frameworks.