Recruitment that Works for Nurses and Healthcare Professionals

By Mukul Bakhshi

There is a lot of surprise when people learn that foreign-educated professionals—such as nurses and other healthcare professionals—are subject to labor exploitation.  Labor contracts often require nurses to remain for several years with the staffing firm that originally recruited them. Given recruitment, immigration, travel, and training costs, some might concede that some type of binding contract requirement is necessary for the recruitment offoreign-educated health professionals (FEHP) to exist. However, these requirements leave workers vulnerable in the event they are harassed on the job or are retaliated against for complaining about working conditions. They also give little protection to workers who simply do not want to move thousands of miles away for a recruiting agency that they will be forced to remain with for more than three years.

The Alliance for Ethical International Recruitment Practices (Alliance), as a multi-stakeholder organization, established the Health Care Code for Ethical International Recruitment and Employment Practices (Alliance Code)available at The Alliance Code is a voluntary set of standards which ensure that international health worker recruitment is fair and transparent. Recruitment firms that agree to abide by the Code are certified.

The Alliance was created in 2008, after a study found that nurses encountered wide variance of experiences. To ameliorate the problems faced by those who had a bad experience, stakeholders– including nurse representative organizations, unions, recruiters, and employers–came together to find common ground encapsulated in the Code. The Alliance is immigration-neutral but is based on the common ground that if recruitment is going to happen, it’s in everyone’s interests that it is fair and ethical.

While these issues have been longstanding, a recent court case and an article further highlight the issues faced by FEHP. In October 2019, a federal judge held that Sentosa, a recruiter of foreign-educated nurses in New York, violated the Trafficking Victims Protection Act (TVPA). Sentosa recruited nurses from the Philippines and paid and treated them poorly. When workers complained, Sentosa threatened their livelihood and even criminal prosecution for abandoning patients.  Sentosa’s behavior was extremely problematic and well beyond the realm of general business practices by recruiters and employers of FEHP.In this case, the threat to revoke the nurses’ licenses to practice, criminal action, and lawsuits all further established a pattern of coercion that the district judge thought rose to the level of human trafficking. The decision is pending appeal but has nonetheless made waves.

In January 2020, the Alliance and its parent organization, CGFNS International, Inc., published an article in the American Journal of Nursing discussing the current state of recruitment of FEHP to the United States. This research showed that FEHP’s experience generally improved over the past decade since the research that led to the inception of the Alliance; nevertheless, issues of fairness and transparency faced by many FEHP, and the extreme issues evoked by the Sentosa decision, highlight the continued need for all stakeholders to support fair recruitment principles.

Mukul Bakhshi is the Director of the Alliance for Ethical International Recruitment Practices. You can visit their webiste at:

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