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Hiring Foreign-Trained Nurses Leads to Patient Satisfaction Declines

PHILADELPHIA – Hiring foreign trained nurses might be the only option for hospitals struggling to find staff, but a new study suggests that the practice comes at a cost to patient satisfaction.

The study, conducted through collaboration between the University of Pennsylvania School of Nursing and United Kingdom nursing schools, finds that every 10-point increase in the percent of non-U.K. educated nurses providing direct care was associated with 10% lower odds of getting a good or excellent rating from patients.

Results were published recently in the journal BMJ Open.

For the study of more than 12,000 patients in a representative sample of 31 National Health Service (NHS) Trusts in England, researchers analyzed the annual patient satisfaction survey conducted by the NHS. Specifically, patients in hospitals with larger percentages of nurses trained abroad were significantly less likely to report being treated with respect and dignity, getting easy-to-understand answers to their questions, and having the purpose of their medications explained. The hospitals in the study employed anywhere from 1% to 50% of non-U.K. educated nurses for bedside care duties.

"This study was motivated by findings from a previously published U.S. study documenting higher mortality for patients in U.S. hospitals that employed more non-U.S. educated nurses, and evidence that NHS hospitals were increasing nurse recruitment abroad despite public concerns about quality," explained senior author Linda H. Aiken, PhD, RN, director of Penn Nursing's Center for Health Outcomes and Policy Research.

Study authors point out that nurses are in short supply in England because the NHS funds too few nursing school slots.

"National workforce planning in England has failed to consistently deliver enough professional nurses to work in the NHS,” added co-author Professor Peter Griffiths, chair of Health Services Research at the University of Southampton. “Relying on bringing in large numbers of foreign educated nurses to make up the shortfall is not a simple solution and may not be effective."

The study recommends that nursing education be expanded to meet the needs of the many qualified students in the U.K. and U.S. who want to enter the professions but can’t be admitted to a program.