While there is no "typical" international nurse, these professionals do share common characteristics. Most are relatively young with a few years of clinical experience, much like some of the domestic nurse travelers. "Realistically, this avenue is for candidates who have three to five years of experience," says Mr. Pattanaik. "There are many exams and certifications that must be completed, and it is difficult for nurses who have been out of the study mode for many years to put in the necessary time and energy."

"Our nurses have an average of seven years of experience, and we require a minimum of two years clinical experience in acute care to enter our program," states Paul Foster, president of O'Grady Peyton International Inc., a Savannah, Georgia-based staffing company that has been placing foreign-trained professionals for 23 years. "Also, about half of the candidates are married. One of the benefits of our program is that the nurse's family members are also eligible for Green Cards."

Indeed, many families make the move together. U.S. immigration laws are structured so that family members are generally able to submit their paperwork at the same time as the nurse candidate. "When Indian nurses go to work in the U.K. or the Persian Gulf countries for one or two years, they are not always able to take their families with them," explains Mr. Pattanaik. "With U.S. laws, family members qualify for immigration. Being able to bring the entire family unit makes a huge difference."

"I do not know if I would have been able to work and adjust to the American lifestyle without my family," confirms Ms. Copeland. "Fortunately, I have friends and extended family in Colorado. Also, initially, my husband looked after the kids while I worked. We have been here 18 months, and he now has a job with a printing company."

Attracting the best Advocates of international recruitment say that these nurses are highly qualified from a clinical perspective. In fact, many of the supplier countries structure their education programs to reflect those in the United States with the intent of exporting a large percentage of their graduates.

The Philippines, for example, sends an estimated 85 percent—or more than 150,000—of its graduates abroad. Historically, it has been the largest supplier of foreign-trained nurses. Now, other nations are following suit. "We have offices in the United Kingdom, South Africa, Singapore, and Australia," notes Mr. Foster, "and recruit from 15 countries." Mr. Pattanaik adds, "India has a very solid nursing program with education similar to that in the U.S., which makes Indian nurses very qualified candidates. Applicants are also used to cultural diversity, often caring for Hindu, Christian, and Muslim patients."

The downside of international recruiting

Clinically speaking, many international recruits start off in medical/surgical units where they adjust to the American healthcare delivery system. Says Mr. Foster, "We are able to place nurses in all specialties, with med/surg probably the biggest group." Mr. Pattanaik agrees, noting, "Our clients have stated their greatest needs are in medical/surgical, ICU, and emergency."

The type of facility employing these practitioners, however, is as varied as the countries represented. Traditionally, international nurses migrated toward urban medical centers in communities that already supported ethnic populations, such as those in California and New York. Today, a growing number of foreign nurses are practicing in Florida, Illinois, Michigan, New Jersey, and Texas. "There really is no specific concentration," states Mr. Foster. "We have had success in the urban environment as well as in rural communities."

"Placement should depend on where the nurses are trained and the type of facilities where they have gained experience," offers Donna Ramey, MSN, RN, CNAA, director of nursing for RN Network, a CHG company, in Boca Raton, Florida. While the firm does not currently place foreign-trained clinicians, Ms. Ramey, who is also in charge of credentialing, has worked with this population in prior positions. "As with domestic professionals, if the nurses had experience in rural hospitals but were placed in major medical centers, then those matches might not work well. Administrators have to rely on the practitioners being totally honest about their experiences, training, and responsibilities."