United States

This overview paper highlights the key messages and issues presented in the country reports submitted by national nurses’ associations (NNAs) at the 12th International Council of Nurses (ICN) Workforce Forum held in Copenhagen 25-26 September 2006. Participating NNAs submitted written reports on major agenda items: environmental scan; outsourcing; alliances; occupational health and safety; private sector for profit health enterprises; positive practice environments; and future options. [from introduction]

The story of the international nurse in the U.S. workforce is generally one of perserverance - not only in obtaining a visa and a state license, but in adjusting to living and working in the United States. [author’s description]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]

Since World War II, foreign-educated nurses have been a significant part of the U.S. nursing workforce. They continue to be aggressively recruited to fill health care vacancies, especially during times of nursing shortages. Yet many graduates of foreign nursing schools have come to the United States to practice nursing only to discover that they are unable to pass the U.S. licensure examination and thus cannot work as registered nurses. [author’s description]

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates in the US, and compared their characteristics to those of US medical graduates and other international medical graduates. [abstract]

The present study reviews and analyses major known national guidelines and strategies for prevention and management of workplace violence. The purpose is to get a detailed picture of strategies recommended, a better knowledge on existing guidance for employers and employees. Another objective is to obtain information on the implementation processes and the impact of the reviewed guidelines. Identification of good practices as well as gaps shall serve as a basis for lessons learnt for the development of future guidance materials. The comparison of the guidelines will cover different aspects which can be summarized as background of the guidelines, strategies which are recommended, implementation and impact of guidelines and strategies.

This report summarizes the findings of AHRQ-funded and other research on the relationship of nurse staffing levels to adverse patient outcomes. This valuable information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment while optimizing quality of care and improving nurse satisfaction. [author’s description]

This report analytically and comparatively reviews international models and experiences in the development and implementation of health care regulations. The study commences with an introduction to the concept of health care regulations, and then describes the most universally common approaches for putting them into practice: licensing, accreditation, and certification. Depending on the country and its economic and political structures, different governmental and voluntary regulations over health services have evolved. Traditionally, in most countries, official licensure of health personnel has been the favored approach.

This presentation was part of the “Call to Action: Ensuring Global Human Resources for Health” conference. It covers the uneven distribution of physicians throughout the world, IMGs in the US physician workforce and the future composition of the US workforce. [from author’s description]

The objective of this study was to examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. [author’s description]

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States.

The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.

This report describes a pilot program aimed at transplanting a pioneering workforce change process developed in the United Kingdom to the United States to address the growing health care workforce shortage. The program includes numerous techniques that have helped hundreds of English hospital teams learn a structured process for generating new ways of working. The program ensures that good human resource processes and change management techniques are incorporated in a series of activities that help clinicians and their support staff plan and implement improvements to services. [adapted from au

This summary report provides information on nurse wages and the comparitive buying power of these wages in select countries in North America, Western Europe and Japan. The data are results from a survey of 10 National Nurses’ Associations. [from introduction]

This is a summary of statistics about the nursing workforce in Canada, Denmark, Germany, Iceland, Ireland, Japan, New Zealand, Norway, Sweden, UK and USA.

The Indian Health Service (IHS), a division of the US Public Health Service, provides care to Native Americans, including the Navajo Nation. The service suffers from understaffing of physicians and midlevel health care providers; this can restrict the range and quality of services provided. A survey of Navajo Area IHS physicians and midlevel health care providers was conducted to determine what factors were associated with provider recruitment and retention. [from introduction]

Functioning health services are key to making the community of New Orleans livable again. Conversely, a livable community is key to attracting a stable healthcare workforce to New Orleans. Hurricane Katrina forced the entire healthcare workforce to evacuate the City of New Orleans and a large majority of these workers have since found jobs elsewhere, such as in neighboring parishes and Texas. This brief summarizes policy options to create and maintain a healthcare workforce, as well as options to bridge the transition from the current situation to the point at which the interventions will show an effect.

Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs’ perspective. This article presents the CHWs’ points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. [introduction]

This report was commissioned by OECD to examine the evidence on role change and delegation from physicians to advanced practice nurses (APN), nurse practitioners and nurses in other advanced roles in the hospital setting and primary care. The report has three components: a literature review, an assessment of country responses to an OECD questionnaire, and two more detailed country case studies, on England and the US. [author’s description]

This paper provides a brief overview of some programs and issues related to the use of technology and distance education to train community health workers in frontier areas. Issues include the use of consistent definitions, the appropriate technology format for the learner and access to that technology, cultural competency /proficiency of faculty, support for faculty and students, and the assurance of quality. [from executive summary]

This article reviews estimates of U.S. nurse supply and demand, documents trends in nurse immigration to the United States and their impact on nursing shortage, and considers strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries. [from abstract]

International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. This article describes the historical trends and compare the characteristics of IMGs to United States medical graduates in the United States. It also recommends that policymakers consider the consequences for both the United States and source countries. [adapted from abstract]

This report summarizes the results of the first year of the two-year project entitled International Recruitment of Nurses to the United States: Toward a Consensus on Ethical Standards of Practice. It examines the structure and basic practices of the U.S. based international nurse recruitment industry. The purpose of the project is to facilitate consensus among stakeholders on how to reduce the harm and increase the benefits of international nurse recruitment for source countries and for migrant nurses themselves. [from author]

The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign educated nurses. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict. It affirms that a careful balancing of those individual and collective interests offers the best course for maximizing the benefits and reducing the potential harm to all parties.