Examining Human Capital Among Foreign- and U.S.-Educated Nurses in Long-term Care

Background: Recruiting foreign-educated nurses (FENs) is a strategy to reduce staffing shortages of registered nurses (RNs) practicing in long-term care (LTC) in the United States. However, little is known about how FENs compare to U.S.-educated nurses (USENs) in their innate abilities and skills, also known as human capital. Purpose: To compare human capital among FENs and USENs practicing in LTC. Methods: This cross-sectional study used data from the 2018 National Sample Survey of Registered Nurses to compare human capital scores between FENs and USENs. Human capital scores consisting of highest nursing qualification, skill-based certifications, number of state licensures, years of experience, multi-state employment, and multilingual ability were constructed and compared using analysis of covariance. Covariates were race, ethnicity, marriage/partnership, adults at home, children at home, direct patient care, and practice scope. Results: The sample included 1,887 RNs (92.8% USENs and 7.2% FENs). Most RNs were female (92.3%), were aged ≥50 years (56.4%), were non-Hispanic White (78.3%), were married/partnered (68.0%), provided direct care (44%), and had full practice scope (71.7%). FENs versus USENs had a higher proportion reporting full scope of practice (80.7% vs. 71.0%, p =.0155). The mean human capital score for the total sample was 9.8 ± 1.3. Human capital scores were higher among FENs (M = 11.3, SD = 1.2) than USENs (M = 9.6, SD = 1.3, p <.0001). Conclusion: FENs bring a higher level of human capital to LTC settings, which suggests that they have an increased capacity to provide the needed person-centered care to positively impact care quality and improve outcomes in LTC.

Duke Scholars

Author Susan Gray Silva School of Nursing

Author Kirsten N Corazzini School of Nursing

Author Michael Paul Cary School of Nursing

Author Eleanor Schildwachter McConnell School of Nursing