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Successful International Nurse Recruiting

Introduction

International nurse recruiting is one of the best solutions to a hospital’s nursing shortage; and must be considered in any nurse recruiting strategy. Simply put, the nursing programs in the United States cannot graduate enough nurses to replace those nurses that are leaving the profession. The most significant loss of United States nurses are those younger nurses that leave the profession to begin families. Other losses are due to nurses changing careers and retirement. A hospital can recruit and hire experienced international nurses in numbers that are unheard of in the United States by way of a well planned and executed international recruitment program that will assist the hospital to meet its nurse staff shortfalls.

What Countries to Recruit

In this writer’s opinion, the best country to recruit international nurses is the Philippines. The country has excellent nurses and English is a native language in the country. Also the transcripts can be easily obtained and are valid. The Filipino will sign an employment contract, and for the most part, honor it. Filipinos are a significant integrated culture in the United States; and Filipino nurses feel welcome in America. The Filipino wants to stay in America and become a citizen of the United States. They have no intention of moving back to the Philippines and the grinding poverty that exists there.

Korea and China are not the best choices because of the language barrier. Ireland and Great Britain, for international nurses is not the best choice for two (2) reasons: 1) First Ireland and Great Britain have a nursing shortage also; and, 2) CGFNS (Commission on Graduates of Foreign Nursing Schools) passers are scarce. India is a growing source of nurses, and you can expect it to become a more viable option in the future. Canadian nurses, while easy to bring to the U.S. on the Trade NAFTA visa, will not sign an employment contract and tend not to want to stay in America. Also with the Canadian dollar being at an exchange rate par with the American dollar, the Canadian has little reason to come to America to work, or stay.

The Recruiting Plan

The most successful international recruiting plans are the result of excellent planning and execution of that plan. The best plans are developed as follows:

  1. Understand that a low cost international recruiting program does not exist. What a realistic employer is looking for is a “best cost” international recruitment program. The turn key cost of an international recruitment program by an experienced recruiter is between $15,000.00 and $18,000.00 per CGFNS (Commission on Graduates of Foreign Nursing Schools), IELTS (International English Language Testing System) and NCLEX (National Council of State Boards of Nursing Licensure Examination) passed nurse. Be very suspect of a lower price quote. The quote should include the following:

    1. Expect a U.S. recruiter fee that includes the payments to the in-country recruiter, job fair costs, advertising and nurse screening costs of $7,500.00 to $8,500.00 per nurse.
    2. Expect that the immigration attorney will cost approximately $3000.00 to $4000.00 for professional services, plus visa filing fees, for a single nurse, depending on a variety of factors, such as multiple applications for the same facility at the same time. Not all law firms provide the same level of personalized service regarding the many complexities that can arise in a case, such as personal or family difficulties, visa retrogression, background checks, and other matters.
    3. Recruiting fulfillment for CGFNS, IELTS and NCLEX testing review and test taking of about $5,000.00 total cost. Re-testing may be necessary.
    4. You will also have visa physical, the country’s deployment fee and airfare costs to include in your cost planning.

  2. An employer can significantly lower its recruiting cost by attending in-country private and semi-private job fairs.
  3. The exhibition costs of a job fairs in foreign countries produced by American companies are usually quite reasonable. An employer can hire as many medical professional for one low job fair exhibit fee. All of these events supply a list of experienced U.S. attorneys to assist the employer with the visa process. Also the producers of these events provide a list of excellent and ethical “recruiting fulfillment” agencies in the foreign country to assist the U.S. hospitals in fulfilling the CGFNS, IELTS and NCLEX testing review and test taking requirements; embassy interview assistance and getting the nurses on the airplane to America.
  4. Insure that your recruiting expense, or job fair fee, includes recruiting registration with the foreign country government for that recruitment or job fair. Do not go to a country to recruit their medical professional without being registered and authorized to recruit by that country’s government.
  5. Be cautious of U.S. recruiters that also act as visa services. An experienced visa and immigration law firm best manages the visa and immigration process. Providing legal advice about immigration matters is practicing law, and the unlicensed practice of law is illegal.
  6. Understand that international recruitment has very little in common with domestic recruitment.
  7. The most important department for the success of your recruiting plan, after the nurses arrive, will be the education department. Upon arrival these international nurses will have to go through a more extensive orientation program than nurses educated in the United States and also a residency program will be helpful.
  8. Develop the expected total cost of the program and budget for that expected cost, plus a 20% contingency. Over runs do occur. Plan that after hire, it may take 2 years to get the nurse to America. Many uncontrollable factors, including English testing, credentials, and visa issues tend to lengthen the immigration time.
  9. Appoint a “point person” that receives all information from the various sources and vendors regarding the international recruitment plan, i.e. attorneys, recruiters, the nurses, government agencies; and from whom all decisions flow.
  10. Be flexible in the planning and execution of the plan.

Your Recruiting Team

These professionals are very valuable to the success of your international recruiting plan

  1. Attorneys. Experienced and competent visa and immigration attorneys are absolutely required for the success of any international recruiting program. Avoid in-house counsel doing the work – they do not have the experience and do not know the government officials in the various departments and embassies. Avoid “visa services” or bringing on a paralegal to do the work in-house. Employers require the services of experienced immigration lawyers for sorting out the complex issues that arise in any immigration plan.
     
  2. Recruiters – U.S. based. “Why re-invent the wheel?” An excellent recruiter is not expensive. His/her expertise will help to insure the success of your international recruitment program. The most expensive program is one where a hospital invests a great deal of money and no nurses arrive. An experienced recruiter knows how to make an international recruiting program engage and successfully complete.

    1. Make sure that the recruiter’s contract guarantees the placement for the life of the employment contract. Should the nurse leave the contract early, the recruiter will replace that nurse, with another international nurse, at no additional recruiting expense to the client hospital.
     
  3. Recruiters – In-country based. The U.S. based recruiter will have his own in-country recruiting firm in the foreign country and will pay this firm from his moneys. Do not employ the services of an in-country recruiter that you do not know, or one developed from a hospital staff member. Do not employ a hospital staff member that knows “many nurses back home” to be your recruiter. Reasons: 1) That in-house staff member will not be registered as a recruiter in the foreign country and thus cannot legally operate in that country; and, 2) The staff member knows nothing about getting a group of nurses through testing preparation, testing, visa procedures, embassy interviews and on the airplane to America.
     
  4. Job Fair Producers. An experienced job fair producer sets the recruiting environment that will help to insure that you have a successful event. Select a job fair producer that has years of experience in the country of recruitment. The job fair producer will insure: That you have access to a knowledgeable and ethical in-country recruiter in the country of recruitment; and, insure that the event venue is first rate. Also an experienced job fair producer will have the relationships with the various government agencies in the Philippines; excellent media placement experts; transportation captains; labor force and most and best of all, familiarity with the culture. The experienced job fair producer will take care of all registration and authorization requirements to enable you to recruit in that country by it’s government.

Recruiting the Foreign Country

When the hospital goes to the foreign country, to a job fair or with the U.S. based recruiter, to interview the nurses, this first contact with the foreign nurses is the most important contact.

  1. If a hospital is utilizing the services of a U.S. based recruiter and his/her foreign-based counterpart, they will develop a number of nurses for you to interview. These nurses will be developed according to the specifications that you established in your recruiting plan. In the minimum, you want the following qualifications:

    1. Commission on Graduates of Foreign Nursing Schools (CGFNS) passed.
    2. International English Language Testing System (IELTS) passed – if possible.
    3. Experience – 2 years at the time of hire. But RNs with more than 10-years experience often do not adapt well to modern high-technology situations.
    4. Employment at a hospital of 25 or more beds.
    5. A graduate of one of the 50 top BSN Colleges in the country.
    6. Your recruiting team should have completed IELTS and NCLEX diagnostic testing of each nurse, BEFORE that nurse is presented to you. Of course, only interview those nurses with a high probability of passing these tests.

  2. The Job Fair in a Foreign Country

    1. First of all, you must understand that everything overseas is much more expensive than in America.
    2. Insure that your fee includes your registration with the foreign government to be in the country recruiting its citizen for work abroad. You can bet that at the job fair in the Philippines that the Philippine Overseas Employment Administration (POEA) will come by to match up the employer-exhibitors names with their exhibitor registration list.
    3. You must decide whether you want to be the only employer at the event, or will you exhibit with other employers. Due to the costs of staging an event, we recommend that you exhibit with other hospitals. We find that up to 25-employer exhibitor at a job fair work out well for an event. The bigger the number of employer hospitals at an event, the better the job seeker turnout. If a job fair promoter can advertise 25-hospitals for the event, he will turn out more nurse job seekers that if the event only had 2-hospital exhibitors.
    4. Decorating the event, the carpet, tables, booths etc. is expensive. In foreign countries they utilize European Aluminum Framing System with White Versa Board Panel hard wall shell design booth. Pipe and drape are not employed. Insure that your job fair cost includes full decoration.
    5. The venues are grand – and very expensive. Space is at a premium in Asia. A high ceiling ballroom in Asia costs 4 to 6 times what the same venue would cost in America. We stage our job fairs – Job Expo Manila - at a lovely, secure, 5-star international hotel. Excellent food, service and amenities.
    6. As event producers we employ cable television advertising to bring out the crowds in foreign countries, as well as newspaper. For example, when we advertise an event in the Philippines we cable television advertise on a 24-hour rotator basis on 18-channels. For newspaper advertising we only use the Manila Bulletin. The Manila Bulletin is distributed through out the archipelago and is seen as the newspaper advertising employment resource for jobs in America.
    7. Advertising the event in foreign countries on cable television and in newspapers is also more expensive than the most expensive markets in America.
    8. Turnouts for a properly marketed event in Manila are huge. Expect 1,000 to 1,500 nurses for a 2-day event. For your first event, you will see more prospective employees than you expected to see.
    9. Higher levels of service, such as private interview suites and pre-screen nurse candidates are of course available.
     
  3. The nurses that you will meet will possess the following traits:

    1. They are usually young and unmarried. Expect many to be married by the time that they come to America.
    2. They are very enthusiastic.
    3. They are usually from lower-middle class or upper lower class families.
    4. They are hard workers. They worked very hard to graduate from nursing college. They volunteer their professional services (no pay), as necessary, at hospitals to gain the valuable experience that U.S. hospitals require.
    5. They have pointed to nursing since early childhood. The entire family has contributed to the cost of their education.
    6. Most have become nurses to serve the betterment of mankind and to raise the standard of living of their families.
    7. Some are in nursing only to gain immigration to America and for the income that a U.S. nurse earns.
    8. They have been well briefed on nursing in America and your hospital by relatives in America.
     
  4. Hiring the international nurse.

    1. Interview each nurse in person that you hire. Videos and telephone conference calls simply do not work out as well as face-to-face interviews.
    2. Only hire nurses that have excellent conversational English skills.
    3. Hire only the best nurses submitted to you for consideration. Do not settle simply because you have come half way around the world to interview them.
    4. Review the nurse’s resume and ask some interview questions based upon the declared experience in the resume. “Creative” resume writing exists overseas also.
    5. The hired nurse’s contractual obligation period should be based in hours worked, as a licensed nurse in the state of employment, not months or years worked after licensure. This prevents a nurse from completing a portion of the contract while out on sick, maternity or on vacation time. One year equals 2,080 regular work hours.
    6. Create a Promissory Note to evidence the moneys expended by the employer for expenses incurred with regard to the cost of recruitment, immigration, training, and related matters incurred by employer. This amount is usually $12,000.00 usd to $15,000.00 usd.
    7. Declare in the promissory note that amount of the money will be forgiven only upon the successful completion of the “at will” employment contract. Do not amortize this amount of money over the life of the contract. State in the promissory note that if the nurse should leave the employment of the employer before the completion of the employment contract for any reason including “for cause” that the full amount of the promissory note shall become due and payable.
    8. Before you meet the nurses to be interviewed, have your recruiter have all of the nurses fill out an “Emergency Notification Form.” Make this form to list the several next of kin and friends in the United States to be contacted if an emergency occurs. This form goes in the recruitment file for later use to track the nurse should his/her not complete the employment contract.
    9. Make a photocopy of the hired nurses’ passport information page, and each page with visa stamps.
    10. Foreign citizens have some unusual customs with their names. Make sure that all documents connected with the hiring, immigration, testing or licensing process name that the nurse has in his/her passport. Instruct the lady nurses that they are not to change their name on their license or passport during the immigration process.
    11. Do not reimburse a nurse for testing that she/he has completed until after they have reported for work. One of the best ways to reimburse is to designate a portion of the pay “educational and testing reimbursement.” Example: Say the nurse is worth $25.00/hour to your hospital upon arrival. Well, in the contract call out that $22.00/hour is the wage, and $3.00/hour is for “Educational and testing reimbursement.”
    12. Insure that the results of any testing paid for by the hospital are sent to the hospital, and not the nurse. The application is made out: The nurse’s name, c/o the H.R. Director at the hospital. This way all test certificates and licenses are in the hospital’s possession and not to the nurse.
    13. Housing. Fully furnished housing for 90-days is the norm for international recruiting. The apartment or home comes with an initial stock of food also. This is housing with other nurses, no spouses or children. Have a housing agreement that spells out the housing program to the nurse for his/her signature. The usual requirement is that while living in employer provided housing, spouses cannot live there. The reason is that you will bunk 2 -nurses in each bedroom; there are no accommodations in this plan for spouses and children. If you provide 90-days of housing and include housing for spouses and children, charge the nurse a premium for the housing. For example, charge the nurse $1,000.00 per month for the family housing.
    14. NCLEX passage. To gain EB-3 (green card) immigration to the United States, basically a nurse must have a sponsor, a nursing license in her country of birth, have passed CGFNS, have passed IELTS or TOEFL and TSE. The nurses do not have to be NCLEX passed. Many hospitals bring their nurses to America not NCLEX tested. They employ these nurses as nurse assistants, or CNAs, for up to 6-months while the nurse becomes comfortable in America, improves his/her English and is free from the “distractions” to studying for the NCLEX examination in his/her foreign country.
     

Preparation For The Nurses Arrival in America

  1. Have the Education Department set up to manage the extensive orientation of the international nurses.

    1. These nurses are from a different hospital culture and will need serious coaching on patient privacy, speaking English on the floor, paperwork requirements, pharmaceutical names different from those in their homeland.
    2. If the hospital is NCLEX review and testing the nurses after their arrival in America, the Education Department must plan to manage this chore.
     
  2. Have the apartments fully furnished, initial supply of food in the apartment.

    1. Room Filipinos together with 2 to a sleeping room. A 2-bedroom apartment can house 4 nurses. No spouses or children.
    2. If possible, do not house nurses in apartments that back up to or open onto forests or woods. The guerillas in their country operate from the forests and woods and they are uncomfortable living next to these areas.
     
  3. Make contact with the Filipino community, churches and Mosques so that their memberships and congregations will welcome them.

    1. Remember these nurses have traveled halfway around the world and left the only life that they have known to settle in America. They are also culturally different from us. Help them.
    2. Seek out good employees of the international nurses’ homeland to welcome them and help them along.
     

Nurses Arrival in America

  1. Meet them at baggage claim at the airport in your city. Do not try to catch up with them at the Port of Entry.
  2. Give them a couple days to accommodate their systems to the new time zone.
  3. Expect them to have some challenges adjusting to different food, customs, etc.
  4. Be patient.


C. Philip Slaton - the president of The Icon Group. The Icon Group is a noted producer of U.S. and International Job Fairs having produced job fairs in Asia, Canada, Great Britain and Ireland, and the United States for over 10-years. At this writing, Icon has recruited 524 nurses from the Philippines for hospitals across America by way of international job fairs staged in Manila since year 2000. Icon’s expertise is in representing healthcare employers to develop international recruiting strategies. For questions regarding the information in the article and international recruiting, please contact Philip and The Icon Group at 2916 NW Bucklin Hill Road, # 178, Silverdale, WA 98383 Website: www.iconnetwork.org Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
 
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