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Nurses with Visas
and learn why nurses are coming to the States to work

By Mary Ann Hellinghausen
Illustration by Malcolm Garris/PhotoDisc
March 15, 1999

A heavy demand overseas for nurses in certain specialties is creating intriguing opportunities for American nurses who want to experience life abroad. And many find themselves boarding planes to distant destinations more for a love of adventure rather than for financial gain.

Hospitals in Saudi Arabia, the United Kingdom, and other countries are advertising for American nurses, particularly those trained in neonatal, pediatrics, intensive care, surgery, and psychiatry. Most advertising is done by recruiting agencies on the World Wide Web and in nursing journals and newspapers.

Pecking order?

"Although it’s not significant numbers, there’s been a steady inflow [of nurses] from the United States," said Jim Buchan, PhD, senior researcher and policy analyst on human resources in health care with Queen Margaret University College in Edinburgh, Scotland.

But some policy experts worry that countries attracting nurses from locales facing their own shortages are creating a domino effect of nursing shortages that could be detrimental in the long run. "Everybody’s robbing Peter to pay Paul," said Cheryl Peterson, MSN, RN, senior policy fellow in international affairs with the American Nurses Association. "We need to do some planning at international levels instead of hurting each other’s human resources."

Hospitals in Great Britain, for example, have been recruiting nurses from urban South Africa, which in turn recruits nurses from other parts of Africa, creating shortages in those areas. "There’s increasing concern that there is a sort of pecking order of recruitment," Buchan said.

Travel perks

A survey to determine the migration patterns of healthcare workers is now being conducted by the Geneva-based International Council of Nurses (ICN), the World Medical Association—which represents physicians worldwide—and the World Health Organization. Questionnaires were sent to national nursing associations in 118 countries and national medical associations in 80 countries, said Mireille Kingma, PhD, RN, an ICN consultant in nursing and health policy.

"The goal is to eliminate or at least reduce the negative impact of migration," she said. Kingma said the ICN is concerned with brain drain—when skilled professionals leave developing countries where they are greatly needed to purpose better working conditions and higher pay in developed countries where the need is not as found. Preliminary survey results are expected in June, she said.

Nursing salaries are generally lower in the United Kingdom than those in the United States, but nurses are attracted by the opportunity to travel and live in a different culture that shares the same language, Buchan said.

Experienced nurses can earn about $25,000 to $30,000 annually in the United Kingdom, but incentives such as paid five-week vacations, numerous paid holidays, and flexible work shifts—which allow time for travel—often are attractive to Americans, said Hugo Lyons, RN, manager of Health Professionals Recruitment Service in London. Many hospitals will also help subsidize rent for the first few months.

Sybil Bannister, RN, an American who has worked for eight months at Harefield Hospital in the outskirts of London, left her job as a general surgery and cardiac bypass nurse at the New Orleans VA Medical Center, where she was earning $54,000 a year. She now earns about $34,000 a year as a staff nurse at a heart transplant regional center.

"It’s not about money," she said. "You need to follow your dreams. My need was to travel," she said, adding that since arriving in England, she has been to Ireland and Holland and plans to travel more this year.

Cultural questions

The financial benefits in Saudi Arabia can be greater, and so are the cultural differences. Nurses in Saudi Arabia and the United Arab Emirates can earn $30,000 to $35,000 a year tax-free, plus receive free housing, transportation, health insurance, and 40 to 56 days of paid vacation a year, said Gus Ibrahim, president and manager of International Hospital Recruitment in Toronto.

"A lot of people don’t know much about Saudi. It’s a safe country," Ibrahim said. "The culture is different, but as long as you play by the rules, you will have a great time." For example, in public women must wear special attire to cover most of the body, but at work, nurses wear regular hospital uniforms, he said.

Licensure is rarely a problem for American nurses—most countries will accept an RN license and do not require additional training for American nurses, Lyons said. "Nurses coming from America do not need supervised training because [foreign hospitals] are happy with our training," Bannister said.

In the United Kingdom, foreign nurses register with the U.K. Central Council of Nursing by sending reference letters, information from their nursing school, and proof of further training and qualifications. Once these nurses obtain jobs there, the British government issues two-year work visas, which can be renewed if employment is maintained.

The registration process is similar in Saudi Arabia, Ibrahim said, adding that most jobs call for a minimum of two years’ experience in American hospitals. The technology in Saudi Arabian hospitals, which operate according to the standards of the Joint Commission on Accreditation of Healthcare Organizations, is not that different from technology used in U.S. hospitals, and in some areas is superior, he said. Saudi Arabian hospitals offer orientations to train foreign nurses in cultural differences.

"Basically, nursing is nursing," said Adrienne Pollack, RN, a New Yorker who works at Hungerford Care Center, south of London, and has been in the United Kingdom about a year. "I love the ability to travel the continent. I’m staying as long as they want me."

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