Does International Nurse Recruitment Influence Practice Values in U.S. Hospitals?


  • Linda Flynn,

    Corresponding author
    1. Linda Flynn, RN, CS, PhD, Alpha Tau & Xi, Postdoctoral Research Fellow, Center for Health Outcomes and Policy Research
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  • Linda H. Aiken

    1. Linda H. Aiken, RN, PhD, FAAN, FRCN, Xi, Claire M. Fagin Leadership Professor of Nursing and Director, Center for Health Outcomes and Policy Research; both at University of Pennsylvania, Philadelphia, PA
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  • The parent study was funded by grant R01 NR 02280 from the National Institute of Nursing Research, NIH, Dr. Aiken, Principal Investigator. The current study was funded, in part, by an institutional postdoctoral fellowship (National Institute for Nursing Research, NIH, T32 NR 07104) to Dr. Flynn. The authors acknowledge and thank Dr. Douglas M. Sloane for his assistance with data analysis.

Dr. Flynn, Center for Health Outcomes & Policy Research, University of Pennsylvania, 420 Guardian Drive, Nursing Education Building, Philadelphia, PA 19104–6096. E-mail:


Purpose: To determine if both U.S. and international nurses place high value on organizational attributes that comprises the elements of professional nursing practice and if the absence of these attributes is associated with high levels of burnout in both U.S. and international nurses.

Design: A secondary analysis of survey data was conducted with a sample of 799 nurses; 547 were born in the United States (US) and 252 were from 34 other countries.

Methods: Culture of origin was coded according to Hofstede's classification system. Nursing values related to the professional practice environment were measured using the Nursing Work Index, and burnout was measured using the Maslach Burnout Inventory. Analysis of variance and least-squares regression procedures were used to test hypotheses.

Findings: No significant differences were found between U.S. and international nurses in the overall degree to which they valued a professional nursing practice environment. A professional practice environment had a significant, inverse effect on job-related burnout on both U.S. and international nurses.

Conclusions: These findings challenge a prevailing sentiment that international nurses hold values inconsistent with professional practice models as defined in the U.S. context. These findings also show that absence of a professional practice environment will produce similar high levels of burnout in both U.S. and foreign-born nurses. To address the nursing shortage, administrators should ensure that organizational attributes are consistent with a professional nursing practice environment.