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 www.cgfnsalliance.org. 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: https://www.cgfnsalliance.org/

Migration that Works: Our Rebranding Story


In October 2011, we formed as the International Labor Recruitment Working Group, a coalition of labor, migration, civil rights, research, anti-trafficking organizations, and academics. Since then, we have fought to end systemic abuse for internationally recruited workers across visa categories and promote quality jobs and labor standards across industries.

We have joined with migrant workers like Ingrid Cruz, a teacher, and thousands of others — from numerous sectors including construction, domestic work, agriculture, fishing, manufacturing, nursing, hospitality and others —  to advocate for laws that uplift workers and ensure that they are able to work with rights and dignity. From pushing to strike down harmful policies to informing stakeholders and policymakers about the experiences of guestworkers, we have made sure that the voices of the workers themselves are reflected in policy debates.

As our coalition has evolved and grown, we have worked relentlessly to shift the narrative on labor migration, recognizing that all workers deserve full labor rights and to be free from discrimination, regardless of immigration status. We have crafted a values-based alternative vision for existing guestworker models that is rooted in family integrity, worker power, and equity. Under this new model, workers, rather than their employers, will control their visas, and those workers will be able to access a pathway to long-term residency and eventual citizenship. 

As a collective of worker advocacy organizations, labor unions, academics, and individuals united by our commitment to promoting a just and equitable world, we believe that labor migration must be rooted in rights, values, and the needs of working people. 

Today, we are relaunching our coalition under a new name that better reflects our goals and expertise: Migration that Works. 

Migration that Works offers people-centered and values-based solutions to end the misuse of labor migration programs to exploit workers. Beyond a policy working group, we are a coalition committed to action, and we are engaging directly with workers, allies, and policymakers to advance a system that works for all of us, including migrant workers and their families. 

We invite you to support and partner with us in implementing this alternative for and alongside migrant workers across visa categories.