Ms. Brunner foresees international recruitment as a viable strategy for the future, adding, "We advertise the positions on our website and job fairs at the hospital, as well as utilizing direct mail. Our staff nurses tend to know other professionals who will fit into the program, so we also have referral bonuses. Additionally, we are in the process of hiring a new educator with a stronger background in critical care, so the Transition Program can be opened up to more candidates."

Making a choice Unlike travelers who accept 13-week assignments, most foreign-trained clinicians come to the U.S. with regular employment in mind. Says Mr. Foster, "Immigrating is a big life change and the majority of these nurses want to put down roots."

"After a 3-month assignment in South Carolina, I accepted my current contract in September of 2003 and hope to stay here permanently," notes Ms. Copeland. "Assigned to the float pool for 13 weeks, I extended my contract and am now working in ICU and telemetry, plus I float to the emergency department, obstetrics, and med/surg units."

Typically, lengths of employment vary from 12 to 24 months, depending on individual facilities' needs. "More than 80 percent of our assignments are for 18 months," remarks Mr. Foster. "We do have opportunities for foreign-trained clinicians if they want to continue on as travel nurses after their first assignment. And in 2005, we will be offering services that can assist clients with direct placement."

Because of the lengthy timeframe and expense required, it is critical that hospital management carefully reviews staffing partnerships and looks at international recruitment as a long-term strategy. "Unless the administration, nursing managers, and human resources are all on board, then this solution might not necessarily be successful," cautions Mr. Pattanaik. "There are many hurdles to overcome. While the nurses are excited to be here, the administrators must be equally excited."

Experts advise executives to ask plenty of questions, including ones pertaining to financial status. Mr. Foster says, "The staffing agency needs to have enough resources in order to sustain itself over a long time and to provide ongoing support to its clients."

"Length of service is another component that should be evaluated," comments Ms. Ramey. "I would also want to know the actual numbers of nurses a company has placed in the United States, not just percentages. If a firm has only placed two nurses, then that can be conveyed as 100 percent placement, but it is still only two nurses." She continues, "It is also crucial that the firm has an experienced nurse to review skills checklists and self-assessments completed by international nurses. A procedure may be the same, but be called something else in another country."

References are essential, as well. "Talk to previous clients to make sure they actually received the nurses on time and that the clinicians were as strong in person as they were perceived to be on paper," adds Mr. Foster. "Also, someone needs to own the program, like a senior representative or sponsor who will be the day-to-day contact."

Mr. Pattanaik mentions another critical point to avoid potential delays—make sure candidates hold CGFNS certification prior to extending any job offers. He also underscores the importance of having company presence in the countries from which the practitioners are pulled. "Look at the staffing firm's recruitment and retention strategies. Do personnel see the nurses for themselves? Executives should not rely solely on a third-party consultant. Is there an immigration attorney on staff? Or a prominent counsel on retainer? If not, the decision could be hugely problematic, given that immigration law is changing so rapidly."