Foreign-Educated Nurses in Texas

By Roy Herron, MSN, RN

Nurses are a diverse group of professional caregivers. We share a common choice to care for others, but we come from many backgrounds. Both the United States and the state of Texas are currently experiencing a shortage of registered nurses, which is expected to get increasingly worse. Foreign-educated nurses — those who receive their basic nursing education and initial licensure in another country — may be an excellent source of professional RNs to augment our nursing workforce and help our state address the nursing staffing shortage.

FENs in Texas

FENs make up 9.6 percent (32,623 nurses) of our current Texas nursing workforce (Texas BON, July 2020), making Texas fourth in the nation. As of 2012, five states employed 66% of all FENs: California (26 percent), New York (14 percent), Florida (11 percent), Texas and New Jersey (6 percent).

Among FENs in Texas, 18,140 (56 percent) are from the Philippines — comparatively, nationwide 28 percent of the 512,000 FENs are Filipino. The remaining Texas FENs mostly come from India (17 percent), Nigeria (5 percent), Canada (5 percent), Nepal (2 percent), and Kenya (2 percent). Over half of all FENs are between the ages of 30-49, and 84 percent are female.

FENs make a significant contribution toward taking care of Texas’s patients, especially in the most challenging nursing hospital inpatient specialties. Over 90 percent of Texas FENs are full-time employees, and almost 70 percent perform bedside hospital inpatient care with most working in med–surg and intensive care (TCNWS, August 2020).

Future Workforce Considerations

Texas’s reliance on Filipino nurses may encounter problems in the future. Due to the broad reaching and terrible effects of the COVID-19 pandemic throughout the Philippines, Rodrigo Duterte, the president of the Philippines, placed an embargo on nurse emigration in April 2020, which was later lifted to allow 5,000 nurses to emigrate, a significant reduction from the average annual number of emigrating nurses.

In 2014, 19,815 nurses migrated from the Philippines to work abroad. While the number of emigrating nurses from the Philippines has been increasing over time, fewer are choosing to come to the United States. All this impacts and limits the number of Filipino nurses available to work in the United States and Texas.

Ultimately, there are excellent reasons to focus on FENs. An article from Healthcare Finance suggests: “Hospitals with internationally trained nurses have a more stable, educated nursing workforce.” The author cites a study that found internationally trained nurses often possesses a BSN or higher, were more likely to be certified in their nursing specialty and tended to stay with a single employer longer than US-educated peers. From a staffing and unit stability standpoint, FENs may be the foundation of dependability within a nursing workforce. While the paper was on a limited correlational, cross-sectional study, it had a large sample size, finding that up to 480,000 nurses are foreign educated, of the over 3 million nurses in the US.

Research Limitations

While the Texas Board of Nursing and the Texas Department of State Health Services Texas Center for Nursing Workforce Studies both track data on FENs, the data is not published nor available online on either website. The data for this article was obtained via an open records request. Considering the importance of a diverse nursing workforce and the role FENs already play in nursing in Texas, the data obtained by both these state agencies should be made widely available to the public.

There is also a limitation on diversity data for FENs in Texas as the Texas BON dataset is inconclusive about the breakdown of ethnicity related to country of origin and unclear on where each nurse achieved their initial RN training and education. For example, if the ethnicity of an FEN from Canada or the Czech Republic is Caucasian, they are not captured in diversity data but are captured in the FEN dataset. Ethnicity alone cannot signify country of origin and vice versa. Of the 137 countries of origin, it is probable Texas has a significant number of Caucasian FENs, but ethnic data is not captured on the BON or TCNWFS datasets.

In addition, the data presented here only came from two distinct snapshots. Having multi-year, longitudinal data would help identify trends and assist with analysis. Future analysis of this data should also consider other important components related to Texas FENs, such as barriers to immigration. The identification and study of barriers could make it easier to bolster our workforce with FENs.

References:

Texas Board of Nursing. (2020 July 22). Copy of LVN and RN licenses current foreign education. [Data Set] Received via open records request July 22, 2020.

Texas Department of State Health Services Texas Center for Nursing Workforce Studies. (2020 August 24). Internationally Educated Nurses. [Data Set]. Received via open records request August 24, 2020.