International Nurses are Filling Frontline Roles at a Greater Rate Than U.S. Nurses

19% of international nurses work in intensive care units (ICUs) or in critical care, compared to 15% of all U.S. nurses, new survey says.

International nurses are filling roles in high-need, and, often, high-risk, and high-stress environments at a greater rate than all U.S. nurses in the workforce, says a new survey conducted by O’Grady Peyton, the International Staffing division of AMN Healthcare.

The 2021 Survey of International Nurses tracks the roles and experiences of international nurses working in the United States at a time when the nation is facing a profound health crisis. 

About 8% of all nurses providing care in the United States are internationally trained, which equates to about 300,000 nurses, the survey says. Most (77%) are from one of three countries: the Philippines, Jamaica, and India, while 10% are from Africa.  

Key findings include:

• 19% of international nurses surveyed work in intensive care units (ICUs) or in critical care, compared to 15% of all U.S. nurses.
• 8% of international nurses work in hospital emergency departments (EDs), compared to 5% of all nurses.
• 11% international nurses surveyed work in psychiatric care settings, compared to 4% of all U.S. nurses.

"At a time of prevailing nurse shortages, international nurses are providing a vital supplement to the workforce, filling some of the most demanding and critical patient care roles during the pandemic," Sinead Carbery, president of O’Grady Peyton. "Many hospitals would be on the brink of collapse without them."

Nearly 90% of international nurses providing care in the United States have treated COVID-19 patients, with most (56%) treating 21 or more COVID patients, the survey says.

Some 17% reported having themselves contracted the coronavirus.

Filipino nurses, in particular, have paid a high price working on the frontlines during the COVID-19 pandemic. Though Filipino nurses comprise only about 4% of all U.S.-practicing nurses, 24% of nurses who died of COVID-19 as of April 2021, were Filipino, according to the survey.

Levels of training

While 56% of all U.S. nurses hold a Bachelor of Nursing (BSN) degree or higher, that number is considerably greater for international nurses, with 90% holding BSN or higher, 12% holding a Master of Science in nursing (MSN), and 1% a Doctor of Nursing Practice (DNP), the survey says.

"International nurses are both highly trained and typically have multiple years of experience before arriving in the U.S.," Carbery said. "They are not simply filling open positions — they are contributing to the high quality of care U.S. patients receive."

Widespread acceptance—and burnout

International nurses are widely accepted by their patients and healthcare colleagues, they indicated in the survey:

• 86% are accepted by patients.
• 87% are accepted by other nurses.
• 85% are accepted by physicians.

A significant minority (36%) said they have "often" or "many times" experienced discrimination based on their country of origin or ethnicity.

Most (56%) said they are paid equitably compared to U.S. nurses, while 80% said their hours are equitable. 

However, as with all nurses, international nurses are subject to high levels of burnout, the survey said, with 81% indicating they sometimes, often, or always experience feelings of burnout.

Regardless, 79% said they are somewhat to very satisfied with their jobs. Of the respondents, 81% said they would choose to work in the United States again if they had their careers to do over, while only 5% would not (the remaining 14% were neutral).