Which Hospitals Hire Foreign Nurses?
in better paid units.
26
The estimated wage premium for other foreign nurses in the full specifi cation is small, positive, and only marginally signifi cant.
Using the California Survey of Registered Nurses, our estimate of the premium is similar to the one using the census even though we are focusing on just one state.
Interestingly, we fi nd that Filipino and other foreign- educated nurses have about 1.5 more years of experience than comparable natives but have a shorter tenure by close
to a year at their current position.
27
As expected, controlling for experience and its square reduces the premium but only by about 15 percent. Adding tenure and its
square has the opposite effect, such that controlling for experience and tenure leaves the premium basically unchanged. Differences between natives and foreign nurses in
the probability of working for a temporary agency, as a travel nurse, or in a job that offers health insurance or a retirement plan are small and have no sizable effect on the
premium when they are included as controls in the wage regressions.
C. Which Hospitals Hire Foreign Nurses?
In this section, we turn to hospital- level data to provide additional evidence in support of the idea that the wage premium is likely to refl ect real quality differences between
native and foreign nurses. Using data from the 1990 American Hospital Association AHA Nursing Personnel Survey NPS, we show that foreign nurses are hired dis-
proportionately by hospitals with better characteristics.
28
The 1990 NPS surveyed all hospitals in the United States and collected detailed information about RN employ-
ment and wages including foreign nurse hiring, education, unions, work schedules, and basic characteristics about the hospital. Close to 20 percent of hospitals reported
sponsoring RN recruitment from foreign countries, with the average hospital hiring close to ten foreign nurses in 1989, most of them from the Philippines. Table 6 com-
pares the characteristics of hospitals that hired foreign nurses to those that did not. As observed, hospitals that hire foreign nurses are more likely to be private, are much
larger as measured by the number of beds and RNs, hire more educated nurses, and have higher educational requirements for the nurse staff. They also pay higher wages.
Given that it is likely that part of the differences is explained by the geographic distri- bution of hospitals and foreign nurses for example, regions that attract more migrant
nurses could be areas with a denser and richer population and have larger and higher
26. In a separate analysis, we also examine whether foreign nurses tend to be assigned to skill- intensive units within hospitals. We proxy for skill intensity using the average education level of native nurses in the
hospital unit as measured by the share of native nurses with at least a bachelor’s degree working in that unit. Using the 1988–2004 NSSRN, we create a ranking of hospital unit skill intensity by regressing a dummy for
whether a native nurse has a bachelor’s degree of more on indicator variables for hospital unit, controlling for year fi xed effects and stateMSA fi xed effects. We fi nd that the intensive care unit ICU is by far the most
skill- intensive unit followed by labor and delivery. Using this ranking, we examine whether Filipino nurses and other foreign nurses are more likely to report working in the ICU the most skill- intensive unit and
labor and delivery unit. The results are reported in Table A3. We fi nd that Filipinos are about fi ve percentage points or about 30 percent more likely to report working in the ICU while other foreign nurses are about
two percentage points more likely to work in the ICU, even after adding all controls. However, they are less likely to work in the labor and delivery unit.
27. See Table A4. 28. Unfortunately, the NPS was only conducted from 1990–92. We use the 1990 sample because it has the
highest response rate.
The Journal of Human Resources 1026
Table 6 Which Hospitals Hire Foreign RNs, Controlling for Hospital Location and Type of Hospital
Private 1
Beds 2
Number of RNs
3 Fraction
of RNs with
Bachelor’s 4
Minimum BA
Required for Nurse
Supervisor 5
Minimum Masters
Required for Chief
6 Hourly Wages of RNs in:
ICU 7
Maternal- Child
8 Medical-
Surgical Unit
9 Outpatient
10 I. Foreign RN
0.143 117.571
115.833 8.211
0.174 0.225
0.113 0.111
0.113 0.118
[0.022] [9.256]
[10.160] [1.069]
[0.023] [0.024]
[0.008] [0.009]
[0.007] [0.009]
Controls no
no no
no no
no no
no no
no Observations
3,246 3,246
2,590 2,688
3,025 3,126
2,311 1,808
2,624 1,984
R
2
0.013 0.047
0.048 0.021
0.019 0.028
0.086 0.087
0.081 0.081
II. Foreign RN 0.075
68.767 63.557
4.384 0.058
0.085 0.01
0.010 0.011
0.02 [0.023]
[8.396] [9.963]
[0.976] [0.023]
[0.023] [0.006]
[0.006] [0.005]
[0.007] Controls:
Hospital type no
yes yes
yes yes
yes yes
yes yes
yes State x MSA size FE
yes yes
yes yes
yes yes
yes yes
yes yes
Hospital service code yes
yes yes
yes yes
yes yes
yes yes
yes Observations
3,246 3,246
2,590 2,688
3,025 3,126
2,311 1,808
2,624 1,984
R
2
0.240 0.457
0.396 0.447
0.305 0.378
0.679 0.707
0.688 0.664
Notes: “State x MSA size FE” refers to dummies for state interacted with MSA size six categories, resulting in a total of 209 groups. Other controls include 17 dummies for hospital type and 13 dummies for the type of service the hospital provides. Robust standard errors in brackets.
signifi cant at 1 percent, 5 percent, 10 percent.
quality hospitals, the bottom part of the table presents regressions of hospitals’ char- acteristics on a dummy for hiring foreign nurses that control for hospital location in
particular, we include state fi xed effects interacted with six city size dummies. We fi nd that the coeffi cients do go down once we control for location, but for most char-
acteristics the differences remain statistically signifi cant and the magnitudes are size- able. For example, ceteris paribus, hospitals that hire foreign nurses have on average
33 percent more beds, hire 42 percent more RNs, are 34 percent more likely to require a BA for nurse supervisors, and 20 percent more likely to require a master’s degree for
the chief of nurses. They also pay about 1 to 2 percent more.
29