Aiken Linda H
Center for Health Outcomes and Policy Research, University of Pennsylvania, Center for Health Outcomes and Policy Research, Philadelphia, PA 19104-6096, USA.
Health Serv Res. 2007 Jun;42(3 Pt 2):1299-320. doi: 10.1111/j.1475-6773.2007.00714.x.
To review estimates of U.S. nurse supply and demand, document trends in nurse immigration to the United States and their impact on nursing shortage, and consider strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries.
Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations.
Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.
回顾美国护士供需的评估情况，记录护士移民美国的趋势及其对护理短缺的影响，并探讨在不负面影响低收入国家医疗保健的情况下解决美国护士短缺问题的策略。
护理院校的培养能力滞后于当前及预计的未来需求，这表明短缺情况将日益严重，并催生了对受过国外教育护士的需求。据估计，美国约8%的注册护士（约21.9万人）是受过国外教育的。其中80%来自低收入国家。菲律宾是主要来源国，占美国受过国外教育护士的30%以上。自1994年以来，移民到美国的护士数量增至原来的三倍，每年接近1.5万人。受过国外教育的护士主要集中在城市地区，最有可能受雇于医院，并且比本土出生的护士更有可能拥有学士学位。几乎没有证据表明，受过国外教育的护士比本土出生的护士更集中在医疗需求大的地区。尽管受过国外教育的护士在种族上比本土出生的护士更加多样化，但其中黑人或西班牙裔的比例相对较小。美国注册护士的就业增长给商业招聘机构和雇主带来了越来越大的压力，促使他们放宽对护士移民的限制，与此同时，由于容量限制，美国护理院校拒绝了大量本土申请者。
增加对移民的依赖可能在不解决美国短缺问题的情况下对低收入国家的医疗保健产生不利影响。目前对促进护士移民的关注偏离了美国在护士劳动力方面实现更大程度自给自足的需求。扩大护理院校容量以接纳合格的本土申请者，并实施基于证据的举措以提高护士留用率和生产力，可以防止未来出现护士短缺。
