Date of Award

Spring 4-8-2026

Document Type

Honors Thesis

Department/Major

Nursing

First Advisor

Dr. Jessica Warren

Second Advisor

Dr. Helene Hegge

Third Advisor

N/A

Keywords

nurse migration, internationally educated nurses, U.S. nurse shortage, brain drain, nursing workforce

Subject Categories

Health and Medical Administration | Health Law and Policy | Nursing Administration | Public Health and Community Nursing | Quality Improvement

Abstract

As United States (U.S.) healthcare organizations face persistent staffing gaps driven by an aging population, burnout, and limited educational capacity, many institutions increasingly rely on internationally educated nurses (IENs) to stabilize their workforce. This reliance intersects with longstanding structural challenges in low- and middle-income countries (LMICs), where inadequate compensation and limited professional opportunities contribute to high migration intentions among nurses. Using a systematic literature review guided by PRISMA principles, this study synthesized evidence and five major themes emerged: (1) push factors driving nurse emigration from LMICs, (2) pull factors attracting nurses to the U.S., (3) digital globalization and post-COVID recruitment shifts, (4) consequences of migration for both LMIC and U.S. health systems, and (5) ethical tensions and policy gaps related to global recruitment. Findings showed that while migration offered individual nurses economic and professional benefits, it also intensified workforce shortages in LMICs, reduced service delivery capacity, and threatened health equity. The study concluded that the U.S. must strengthen domestic workforce strategies and adopt ethical recruitment practices aligned with the WHO Global Code of Practice. Recommendations emphasized bilateral agreements, improved working conditions, and coordinated global workforce planning to promote sustainability and protect vulnerable health systems.

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