Internationally-Educated Nurses and Their Impact on Patient Satisfaction

By Shari Dingle (Sandifer) Costantini, RN, MBA

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January 20, 2016

Shari Dingle Sandifer, RN, MBA, CEO of Avant Healthcare Professionals

According to a recent study published in the journal BMJ Open titled “Patient satisfaction and non-U.K. educated nurses: A cross-sectional observational study of English National Health Service Hospitals,” every 10-point increase in the percentage of non-U.K. educated nurses at the hospital bedside is associated with 10% lower odds of patients giving their hospital an excellent or very good rating. As someone who has had the pleasure of working in the field of international healthcare recruitment for nearly two decades now, I can affirm that the satisfaction results we’re receiving in the U.S. for Avant’s internationally-educated nurses differs dramatically from those in the U.K. as found in this study.

From critical access to academic teaching hospitals, Avant Healthcare Professionals places highly skilled, internationally-educated nurses on assignment within healthcare facilities throughout the U.S. Our nurses are continually recognized as DAISY Award winners and Employees-of-the-Month, are positively named on patient satisfaction surveys, and contribute to higher HCAHPS for our clients. As a matter of fact, an Avant nurse from China recently received three patient accolades on surveys within the first six weeks of her hospital assignment.

We believe these positive outcomes are a direct result of the significant time we spend instructing our nurses prior to and upon their arrival in the U.S. We thoroughly educate our healthcare professionals in the differences between other countries and the U.S., such as professional practice, clinical environment and expectations, interdisciplinary team communications. We also fully prepare our clients, and more importantly, the nurse preceptors, on how to most effectively orient and transition our internationally-educated nurses into their facilities. The unique educational programs and support we provide for both our nurses and clients have been proven to effectively bridge the gap between the healthcare roles, practices and environments of facilities in the U.S. and of those abroad.

Results of the aforementioned study clearly support the need for a more comprehensive approach to the education and support of international nurses. No two countries have the exact same professional practice standards, communication expectations, clinical environments, etc. Therefore, a different strategy must be taken to equip internationally-educated nurses to ensure their success in caring for their patients.

Perhaps this is what the study’s authors are alluding to when they suggest that professional norms in a nurse’s country of origin could influence care and patient satisfaction outcomes. Despite the authors’ attempts to control for potential confounders, they note that they’re unable to rule out variables not included in their model which may account for their associated findings. It’s quite possible that these unknown variables were introduced as a result of comprehensive clinical and cultural transitions programs not being available to the international nurses within the study.

At Avant, we understand what leads to patient satisfaction from excellent quality of care and how that can vary from country to country. For example, a primary role of a nurse in the U.S. is to be a patient advocate. To that end, as a part of our Clinical Transitions Program, we instruct all of our nurses in listening carefully and communicating frequently when providing information on plans of care, and medications and their possible side effects. We also educate our nurses on ways to continually encourage patient involvement which creates higher levels of patient satisfaction. These are areas the researchers noted as examples of care most frequently left undone that can influence a patient’s perception about their overall hospital experience.

As a part of our Cultural Transitions Program, we educate our nurses on how showing respect and dignity to others can vary by culture. For example, many people in certain Asian countries consider looking someone in the eye as a sign of disrespect. However, not maintaining eye contact in the U.S. may lead a patient to doubt the information being provided or the nurse providing it. We’ve found that by empowering our nurses with such cultural knowledge, more trust is built between our nurses and their patients. As a result, patients are more likely to feel assured and are satisfied with their care. The absence of a similar cross-cultural educational program for U.K. nurses under this new study may have greatly influenced patients’ responses to questions about being treated with respect and dignity.

Studies like these are certainly thought-provoking and further highlight the need for a more comprehensive approach to the utilization of internationally-educated nurses. It is incumbent upon us as healthcare leaders to fully support our staff so they can be effective in all aspects of their role as care providers. Our successful approach to healthcare staffing thoroughly equips our internationally-educated professionals to handle the myriad of clinical and cultural differences they will encounter in the field. Only through such training can we ensure their success and the satisfaction of their patients.

Globalization of our workforce is here to stay. Although I do not feel that international recruitment is the answer to any country’s workforce supply shortages, I do support an individual’s right to migrate. International healthcare mobility contributes immensely to the increasingly diverse patient population both here in the U.S. and around the world.

About the Author

Shari Dingle (Sandifer) Costantini, RN, MBA, is CEO and founder of Avant Healthcare Professionals, a healthcare staffing company focused on international recruitment and recognized for its innovative clinical and cultural programs offered to internationally-educated nurses, physical therapists and occupational therapists, as well as client facilities.

About Avant Healthcare Professionals

Need nurses? Avant Healthcare Professionals is the premier staffing specialist for internationally educated registered nurses, physical therapists and occupational therapists. Avant has placed thousands of international healthcare professionals across U.S. facilities to help improve the continuity of their care, fill hard-to-find specialties, and increase patient satisfaction, revenue and HCAHPS scores. Avant is a Joint Commission accredited staffing agency and founding member of the American Association of International Healthcare Recruitment (AAIHR). Avant Healthcare Professionals is a member of the Jackson Healthcare® family of companies.


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Avant Healthcare Professionals is a member of the Jackson Healthcare family of companies.