Amid fierce competition for new nurses, hospitals have upped the ante on recruitment, offering perks like record-high sign-on bonuses.

Still, health care systems are struggling to find highly skilled nurses. It’s why Novant Health is expanding the areas in which it typically recruits.

Denise Mihal
Denise Mihal

"We are committed to providing remarkable health care and to do that, we need remarkable nurses," said Denise Mihal, Novant Health executive vice president and chief nursing and clinical operations officer.

Tracey Whitley
Tracey Whitley

In late July, the organization welcomed the first of about 300 registered nurses from the Philippines, Brazil, India, Jamaica and other countries. And most have at least 10 years of experience, said Tracey Whitley, a longtime nurse and manager of nurse residencies in Winston-Salem.

“The interview process has been a breath of fresh air. They just want to come to America to work,” Whitley said. “So, it allows us to fill these open positions, but it’s also an opportunity for them to have a better life.”

To ensure they are qualified, international hires must pass an English proficiency exam and take the same test U.S. students pass to get their nursing license.

"These are highly experienced nurses. They may need to learn electronic medical records or things of that nature, but their assessment skills, their ability to care for patients, is spot-on."

Tracey Whitley, a longtime nurse.

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Overcoming staffing challenges in health care

International recruiting isn’t new to health care. By some estimates, up to 15% of nurses working in the U.S. are foreign educated.

It is becoming more common, though, as health systems struggle to overcome a critical nursing shortage. To make matters worse, analysts predict about one-third of U.S registered nurses will reach retirement age by 2030, which means 1 million more nurses will be needed to fill their shoes.

Nursing schools are working to accommodate the rising demand for skilled nurses, but they too face challenges. Faculty shortages, for example, make it difficult to increase enrollment.

“We’ll always recruit from nursing schools – and our nationally accredited Novant Health Nurse Residency program is a big draw – but it can’t be our only solution,” Whitley said. “And if you think about it, we pride ourselves on having a diverse workforce at Novant Health. We want our patients to see nurses who look like them.”

How international recruitment works

Novant Health is working with three agencies to help source registered nurses from the Philippines, which adopted the U.S. standards for medical and nursing training, as well as India, Turkey, Ghana, Zimbabwe, Nigeria, Nepal, Jamaica, Kenya, Brazil, Israel and The Bahamas.

Novant Health team members welcome Seema George, the first international nurse to arrive in Charlotte.

It's not a quick process. From start to finish, it takes about 12 to 18 months for international nurses to go through the hiring process, which includes:

  1. While living abroad, they must secure employment and apply for a work visa, which allows people to come to the U.S. and work temporarily.
  2. They take an English proficiency test.
  3. They demonstrate their nursing education by passing NCLEX (the National Council Licensure Examination for Registered Nurses), the same test U.S. students take to get their nursing license.
  4. Three months prior to their arrival at Novant Health, they have an embassy interview where they are granted a work visa.
  5. Once they arrive, they can apply for a green card, which allows the holder to live and work here permanently.

Families come, too

Seema George
Seema George, a registered nurse from India, works at Novant Health Presbyterian Medical Center in Charlotte.

Most will be working in medical surgical areas, also known as adult acute care, at Novant Health Presbyterian Medical Center in Charlotte, Novant Health Forsyth Medical Center in Winston-Salem and Novant Health New Hanover Regional Medical Center in Wilmington, North Carolina.

"I am excited to have the international nurses join our health care family," Mihal said. "These experienced nurses will be a welcome addition to our teams adding their expertise and critical skills."

Seema George, a registered nurse from India (who worked in Canada most recently), was first to arrive. George toured Presbyterian Medical Center along with Whitley and others.

Eniskha Bain
Eniskha Bain, another international nurse, works at Novant Health Forsyth Medical Center in Winston-Salem.

Another RN, Eniskha Bain, arrived shortly after. Her nursing experience will benefit the team at Forsyth Medical Center. Most international nurses, however, will arrive in 2023.

A major benefit, Whitley said, is that their families can join them.

“They can bring their spouse or significant other and any dependent children,” she said. “So, we hope that will make their transition easier.”

A yearlong program of support

Nursing leaders have also created the Novant Health Nurse International Fellowship, a yearlong program to help the nurses better understand American culture.

“We want to help them feel comfortable in their new community,” Whitley said. “We’ll discuss taxes, our political system, religion and holidays, just to name a few aspects.”

The importance of respecting racial and cultural differences will also be emphasized, she added, so the Novant Health diversity and inclusion team will play an important role. Other seminars will cover teamwork and collaboration, self-care and resiliency, as well as conflict resolution.

“Conflict resolution is an important one, because a lot of our nurses are from countries where they don’t raise an issue. They just say, ‘Yes’ and move forward. So, it’s important for them to feel comfortable advocating for patient safety and to speak up, if necessary,” Whitley said.

Improving language skills

While all international nurses pass an English proficiency test, some have better language skills than others.

“I talked to a nurse in Qatar today and she spoke better English than me,” Whitley said, laughing.

For those who need more help with slang or pronunciation, one-on-one coaching is available.

“We have a physician who does dialect training,” she said. “Essentially, they take a small group, about 20 people, and coach and mentor them over six months. It’s not something everyone will need, but it’s an option should they want it.”

Why become a Registered Nurse at Novant Health in North Carolina?

  • Named one of the nation’s 150 best places to work in health care by Becker’s Hospital Review.
  • Leapfrog grade A ratings.
  • Leadership development programs.
  • Eight Magnet-designated medical centers.
  • Designated as Best Places for Diverse & Women Managers to Work by Diversity MBA Magazine.
  • Team Approaches in Quality Improvement Award Recipient from the Society of Hospital Medicine.
  • Recognized by CMS for quality and safety with six 4-star and two 5-star Acute Care facilities.