Nurse Practitioners on the Move: The Journey to the United States

Barbara Sheer DNSc, FNP-C, FAANP


Topics in Advanced Practice Nursing eJournal. 2007;7(2) 

In This Article

Nurse Migration to the United States

A worldwide nursing shortage has fueled a phenomenon known as nurse migration, whereby nurses from developing countries are hired to fill nursing vacancies in more developed countries. Foreign-educated nurses now make up 5% to10% of the nursing workforce in Canada, the United Kingdom, and the United States.[1]

Nurses around the world migrate to other countries in search of new experiences, adventure, better working conditions, and improved salaries. Aside from the ethical considerations of nurse migration, international migration can be challenging for the individual wishing to relocate and practice nursing in a different country. It is a particular challenge for the advanced practice nurse (APN) migrating to the United States.

International Advanced Practice Nurse Models

Nurse practitioners (NPs) have been delivering primary care for over 40 years in the United States. In the 1990s the first NP program was developed in the United Kingdom. The model was adopted in Australia, and is now a global phenomenon. Currently, over 50 countries have been identified as developing or having existing advanced practice nurse (APN)/NP roles. APN models are being developed within the context of each individual nation, and the model of practice, scope and standards of practice, titling, education, and regulation vary widely from country to country.

Nursing in general does not have a long history of mutual recognition of professional credentials. One barrier to international migration is the lack of standardization of nursing education throughout the world. Steps to remove this barrier and ease migration are now being taken. The European Federation of Nurses Associations is working to achieve a system of comparable degrees for nurses from European Union countries by 2010.

Australia and New Zealand have a Trans-Tasman Mutual Recognition Arrangement that covers the regulation of nursing licensure between these countries. Despite these early measures, it will likely be years before mutual recognition is accomplished at the professional nurse level. Credentialing requirements for registered nurse (RN) migration are reviewed in "Foreign-Educated Nurses: An Overview of Migration and Credentialing Issues.[2]"

The APN practice level adds additional challenges to an already complex process. Mutual recognition at the advanced practice level does not currently exist among different nations, and will not be possible on the international level until standardization of nursing education is achieved. In the United States, many states now participate in mutual compacts at the professional nurse level, and a few states have provisions for future compact agreements for APNs.


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