From Crisis to Pipeline: Building a Global Nursing Workforce When Borders Closed

Beyond Recruitment: An Evidence-Based Blueprint for Integrating International Nurses

The COVID-19 pandemic exposed a critical vulnerability: we simply didn't have enough nurses. With domestic pipelines unable to keep pace, exploring international recruitment became a necessity. But this path presented its own significant hurdles – long visa delays, cultural and practice differences, and the reality that even after arrival, nurses faced lengthy onboarding before they could practice independently. We were facing a crisis that demanded a radically different approach.

The Challenge: Reinventing the International Pipeline

How could we create a predictable, efficient, and effective pipeline for internationally educated nurses (IENs) that addressed the delays and integrated them seamlessly into our U.S. practice environment? Simply waiting wasn't an option.

The Solution: An Innovative Pre-Arrival Training Academy

Instead of waiting for nurses to arrive in the U.S. to begin their transition, we decided to build our own dedicated training academy in Manila, Philippines. This allowed us to:

• Utilize Visa Wait Times Productively: While nurses awaited their U.S. visas, our own expert U.S.-based educators delivered a comprehensive 16-week International Transition to Practice (ITTP) program using a blended learning model. This included virtual didactics and hands-on simulation supported by local educators .

  
  

• Bridge the Practice Gap Early: The curriculum focused specifically on U.S. healthcare standards, technology, team dynamics, communication, and ethical frameworks.

  
  

• Reduce Transition Shock: We built simulation rooms in Manila designed to mimic the exact look and feel of the U.S. hospital units where the nurses would eventually work, familiarizing them with the environment beforehand.

  
  

• Develop Custom Measurement Tools: Recognizing a lack of appropriate instruments, we rigorously developed and validated tools like the Simulation Self-Efficacy Scale (SIM-SES) to accurately measure confidence and readiness .

  
  

The Results: A High-Impact, Sustainable Workforce Model

This "build your own" global strategy transformed a crisis into a strategic advantage:

• Measurable Gains: The ITTP program resulted in statistically significant increases in both clinical competency (average scores jumping from 82% pre-program to nearly 95% post-program) and self-efficacy across all domains (with medium-to-large effect sizes). The program was particularly effective for those starting with larger knowledge gaps.

  
  

• Accelerated Integration: Graduates required 30-40% less time in preceptorship upon arrival in the U.S., getting them to independent practice faster.

  
  

• Exceptional Retention: We achieved an astounding 98% two-year retention rate for ITTP graduates, supported by a 3-year contract. This dramatically outperforms typical U.S. turnover rates.

  
  

• Significant ROI: By creating this reliable pipeline, we reduced our reliance on costly travel nurses by 40%, contributing to $14.57 million in organizational cost savings over three years.

  
  

The Takeaway for Leaders:

Facing unprecedented challenges requires unconventional thinking. By investing strategically in a pre-arrival education and integration program, we didn't just find nurses – we cultivated highly competent, confident, and loyal team members ready to excel from day one. This model provides a data-driven blueprint for building a truly sustainable global nursing workforce, proving that innovative education is a powerful solution to the staffing crisis.

Want to learn more? See our team's publication here: IEN Integration: A Tiered Skills Framework for Onboarding and Orientation