Use of foreign-educated nurses and patient satisfaction in U.S. hospitals

Research output: Contribution to journalArticle

2 Scopus citations


Purpose: In the context of value-based purchasing, this study examines the association between the utilization of foreign-educated registered nurses (RNs) and patient satisfaction among U.S. acute care hospitals. Data Sources/Study Setting: We utilized data from the Hospital Consumer Assessment of Healthcare Providers and Systems to measure patient satisfaction and data from the American Hospital Association regarding the utilization of foreign-educated RNs in 2012. Methodology/Approach: In this study, a cross-sectional design with propensity score adjustment to examine the relationship between use of foreign-educated nurses and 10 patient satisfaction outcome measures. Control variables include hospital size, ownership, geographic location, teaching status, system membership, a high-technology index, and U.S. region based on census categories. Findings: The utilization of foreign-educated RNs was negatively and significantly related to six patient satisfaction measures. Specifically, hospitals with foreign-educated RNs scored, on average, lower on measures related to nurse communication (β =-0.649, p =.01), doctor's communication (β =-0.837, p ≤.001), communication about administered drugs (β =-0.539, p =.81), and communication about what to do during their recovery at home (β =-0.571, p =.01). Moreover, hospitals utilizing foreign-educated RNs scored, on average, lower on overall satisfaction measures including rating the hospital as 9 or 10 overall (β =-1.20, p =.005), and patients would definitely recommend the hospital (β =-1.32, p =.006). Practice Implications: Utilization of foreign-educated RNs is negatively associated with measures of patient satisfaction pertaining to communication and overall perceptions of care. Hospitals that utilize foreign-educated RNs should consider strategies that enhance communication competency and aid improving perception of care among patients.

Original languageEnglish (US)
Pages (from-to)306-315
Number of pages10
JournalHealth care management review
Issue number4
StatePublished - Jan 1 2016


  • Foreign-educated registered nurse
  • Patient satisfaction
  • Quality

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Strategy and Management

Fingerprint Dive into the research topics of 'Use of foreign-educated nurses and patient satisfaction in U.S. hospitals'. Together they form a unique fingerprint.

  • Cite this