Give me your tired, your poor, your huddled masses...." The immortal words of Emma Lazarus have welcomed generations of immigrants to American shores. But the Statue of Liberty is not the only one greeting today's immigrants. Hundreds of healthcare organizations, from acute care hospitals to long-term care facilities, have opened their doors to foreign-trained nurses.

Employing international clinicians, however, is not a staffing strategy without controversy. Proponents advocate it as a means to bring in qualified staff. Opponents argue that luring providers away from their home countries, which may also be suffering from a nursing shortage, only further complicates a global crisis. Regardless of which side of the debate you take, importing care is an issue at the forefront of American healthcare, with more and more facilities adding this option to their staffing mixes.

Gaining momentum For more than 50 years, international clinicians have been recruited during times of domestic staffing shortages. As the current crisis gained momentum, nursing directors and staffing agencies again turned to faraway lands to supply RNs to American hospitals.

Between 1994 and 2001, this segment of the workforce grew an average of 6 percent annually, substantially greater than the 1.5 percent of growth among domestic nurses for the same period. But during the past three years, the numbers of foreign-trained nurses more than doubled, topping out at 14 percent growth in 2003. That equates to 66,000 international RNs working in the U.S. since 2001. This trend far surpasses prior waves, which averaged 3,000 to 4,000 immigrant nurses recruited during staffing crises.

Foreign-trained practitioners as a group have never exceeded 5 percent of the total number of nurses in the U.S. However, experts agree that record will most likely be broken in the near future. "The nursing shortage is not going to get any better soon," states Cathi Brunner, a recruiter for University Community Medical Center (UCMC), San Diego, California, "and the reality is either executives come up with new staffing ideas or look elsewhere for nurses."

A land of opportunity Many of the countries from which the nurses are recruited, such as the Philippines, India, and some of the former Soviet Union territories, have more clinicians than nursing jobs. Additionally, their economies pale in comparison with that of the U.S. Take the Philippines as an example: According to the U.S. Department of Labor, the median annual earnings for an American RN in 2002 was $48,090, which far out-paced the salary of a Filipino nurse—at less than $2,500 per year.

"Coming to America is a chance for nurses to pursue their careers and to get the respect, salary, and benefits they deserve, but often don't receive in India," asserts Lalit Pattanaik, JD, chief executive officer of RN India, an international staffing company headquartered in Costa Mesa, California, that specializes in recruiting Indian providers. "They are here for a better life for themselves and their families."

"Entire families can survive on a nurse's salary in the United States, which would have been impossible in my native country," adds Natasha Copeland, RN, a 15-year veteran from Port Elizabeth, South Africa, who has worked in intensive care units (ICUs) for 11 years. Currently on her second assignment at McKee Medical Center in Loveland, Colorado, she has been traveling with Core Medical Group since her arrival in May 2003. The Windham, New Hampshire-based staffing firm has placed international nurses for the last four years, actively recruiting from five countries including South Africa and India.

Another reason professionals decide to emigrate is to escape political or socioeconomic turmoil. Ms. Copeland, who travels with her husband, 3-year-old son, and 6-year-old daughter, also saw the chance to leave behind a violent community. "Our neighborhood was suffering from increasing incidents of carjackings and house break-ins, so when I learned of the opportunity to go to the United States, we decided to take it."