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Do foreign-educated nurses displace native-educated nurses?


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Figure 1

Changes in the number of registered nurses as a share of the initial population. (A) US-educated nurses and (B) Foreign-educated nurses.Note: The data are from the US Censuses and the American Community Survey multiyear aggregates. The samples are restricted to employed registered nurses aged 25–70 years old, and we plot the maps for the US mainland only. These maps show that growth in number of foreign-educated nurses is not randomly distributed across the United States.
Changes in the number of registered nurses as a share of the initial population. (A) US-educated nurses and (B) Foreign-educated nurses.Note: The data are from the US Censuses and the American Community Survey multiyear aggregates. The samples are restricted to employed registered nurses aged 25–70 years old, and we plot the maps for the US mainland only. These maps show that growth in number of foreign-educated nurses is not randomly distributed across the United States.

Displacement effects of foreign-educated RNs on US-educated RNs

Dependent variable: US-educated nurses per 1,000 population
1990–20152000–2015
(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
OLS
Foreign-educated nurses per 1,000 population–1.730***–0.636**0.215–0.0200.605–1.816***–0.466*0.205–0.0350.605
(0.347)(0.250)(0.286)(0.261)(0.381)(0.339)(0.254)(0.263)(0.398)(0.381)
Observations700700700420280560560560280280
R20.3900.7780.9320.9540.9680.3900.7900.9460.9750.968
2SLS (single instrument)
Foreign-educated nurses per 1,000 population–1.988***–1.902***2.182**0.1070.970–2.223***–3.018*1.878*0.2370.970
(0.465)(0.737)(0.995)(0.740)(1.487)(0.476)(1.734)(1.355)(1.495)(1.487)
Observations700700700420280560560560280280
R20.3830.7460.9090.9540.9670.3740.6640.9310.9750.967
ControlsXXXXXXXX
Year FEXXXXXXXXXX
Area FEXXXXXX
Pre-Great RecessionXX
Great Recession and Post-Great RecessionXX

Wage effects of foreign-educated RNs on US-educated RNs

Dependent variable: Log (average hourly wages of US-educated nurses)
1990–20152000–2015
(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
Employed US-educated nurses (2SLS – single instrument)
Foreign-educated nurses per 1,000 population0.218***0.232–0.141–0.007–0.0910.230***0.389–0.1190.048–0.091
(0.046)(0.169)(0.135)(0.084)(0.242)(0.049)(0.290)(0.173)(0.119)(0.242)
Observations700700700420280560560560280280
R20.5320.6320.9310.9630.9770.3610.2120.9350.9710.977
Full-time employed US-educated nurses (2SLS – single instrument)
Foreign-educated nurses per 1,000 population0.210***0.202–0.096–0.0350.0250.220***0.342–0.071–0.0100.025
(0.039)(0.142)(0.109)(0.081)(0.161)(0.041)(0.249)(0.134)(0.129)(0.161)
Observations700700700420280560560560280280
R20.5870.6910.9410.9600.9780.4200.3320.9420.9660.978
ControlsXXXXXXXX
Year FEXXXXXXXXXX
Area FEXXXXXX
Pre-Great RecessionXX
Great Recession and Post-Great RecessionXX

Displacement effects of the foreign-educated RNs on US-educated RNs by education, 2000–2015

Dependent variable: US-educated nurses per 1,000 population
Associate’s degreeBachelor’s degreeGraduate degree
(1)(2)(3)
2SLS (single instrument)
Foreign-educated nurses per 1,000 population0.7150.0410.924**
(0.105)(0.730)(0.647)
R20.9020.9010.724
2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population0.771–0.2790.882*
(0.775)(0.939)(0.497)
Lagged foreign-educated nurses per 1,000 population0.041–0.232–0.030
(0.530)(0.380)(0.310)
R20.9000.8950.734

Displacement effects of foreign-educated RNs on US-trained RNs by education

Dependent variable: US-educated nurses per 1,000 population
1990-20152000-2015
(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
Less than high schoolHigh schoolAssociate's degreeBachelor's degreeGraduate degreeLess than high schoolHigh schoolAssociate's degreeBachelor's degreeGraduate degree
Foreign-educated nurses per 1,000 population0.0190.2070.8400.1580.658*0.0240.1750.7150.0410.924**
(0.039)(0.249)(0.829)(0.668)(0.431)(0.053)(0.288)(0.105)(0.730)(0.647)
Observations700700700700700560560560560560
R20.4210.8900.8530.9000.7550.3830.8780.9020.9010.724

The first-stage regressions

Dependent variable: Foreign-educated nurses per 1,000 population
1990–20152000–2015
(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
Predicted foreign-educated RNs per 1,000 population2.414***0.521**0.296**0.574*0.2412.493***0.369**0.232*0.3620.241
(0.604)(0.220)(0.166)(0.308)(0.348)(0.628)(0.214)(0.183)(0.415)(0.348)
ControlsXXXXXXXX
Year FEXXXXXXXXXX
Area FEXXXXXX
Pre-Great RecessionXX
Great Recession and Post-Great RecessionXX
F-statistics496.7332.0510.2123.762.35341.6420.6310.235.432.35
Observations700700700420280560560560280280
R20.4530.8170.9430.9670.9730.4100.8130.9470.9770.973

Displacement effects of foreign-educated RNs on US-educated RNs, 2000–2015

Dependent variable: US-educated nurses per 1,000 population
(1)(2)(3)(4)(5)
2SLS (single instrument)
Foreign-educated nurses per 1,000 population–2.223***–3.018*1.878*0.2370.970
(0.476)(1.734)(1.355)(1.495)(1.487)
R20.3740.6640.9310.9750.967
2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population–1.837*–2.2451.3890.8780.333
(1.010)(1.701)(0.797)(1.890)(1.899)
Lagged foreign-educated nurses per 1,000 population–1.426*–1.236*–0.0350.0683.025
(0.552)(0.749)(0.825)(1.439)(1.602)
R20.3790.6580.9380.9720.938
ControlsXXXX
Year FEXXXXX
Area FEXXX
Pre-Great RecessionX
Great Recession and Post-Great RecessionX

Demographic and labor supply characteristics of US-educated and foreign-educated nurses, 1980–2015

US-educated RNs
198019902000200720102015
Age, mean, in years39.2540.0142.9044.7144.9944.60
Gender
     Female95.9194.4892.4491.2991.1290.20
     Male4.095.527.568.718.889.80
Race
     White90.1488.1885.0183.3882.2281.17
     Black7.978.668.719.349.9510.10
     Asian1.461.943.644.335.115.41
     Native American0.300.390.400.450.400.40
     Other races0.120.832.252.502.322.93
     Hispanics1.842.673.264.175.105.96
Marital status
     Married67.1367.5368.1465.8865.4063.96
     Widow/divorced/separated18.2618.7919.5620.5620.2519.09
     Single14.6113.6812.3013.5614.3516.95
Educational attainment
     Less than high school12.350.560.210.070.210.19
     High school6.0615.4311.276.456.696.00
     Associate’s degree48.5138.3835.9637.3237.4034.65
     Bachelor’s degree21.9132.4538.7542.0142.6644.83
     Graduate degree11.1813.1913.8014.1513.0414.33
     Spanish speaking1.982.913.623.914.154.50
     Part time31.0030.2226.3225.1323.3721.70
     Hourly wage (US $), mean16.2420.6522.8924.4224.4723.97
     Hours worked/week, mean34.6736.2437.1137.4637.5237.72
Number of observations51,73981,944100,10272,88678,993137,429
Estimated number1,034,7801,638,8802,002,0402,429,5332,633,1002,748,580
Foreign-educated RNs
198019902000200720102015
Age, mean, in years41.1544.0045.7446.6147.1248.16
Gender
     Female93.6393.8889.4886.7586.3684.33
     Male6.376.1210.5213.2513.6415.67
Race
     White36.3327.2224.0220.6619.3619.50
     Black16.5618.5220.6521.5720.1422.84
     Asian45.9652.3049.1454.3957.1954.03
     Native American0.160.220.180.060.180.20
     Other races0.991.746.013.323.143.43
     Hispanics8.497.255.125.115.345.62
Marital status
     Married64.2768.7471.6871.5373.3272.86
     Widow/divorced/separated14.5515.6315.0316.2715.3216.79
     Single21.1815.6313.2912.2011.3610.34
Foreign-educated RNs
198019902000200720102015
Educational attainment
     Less than high school17.501.420.800.600.580.53
     High school5.0915.3011.196.065.155.05
     Associate’s degree26.1224.9822.7720.4519.8518.92
     Bachelor’s degree27.4643.5751.0657.9861.1561.01
     Graduate degree23.8414.7414.1914.9113.2714.48
     Spanish speaking6.296.155.445.275.115.77
     Part time17.6016.8915.1412.0712.8913.77
     Hourly wage (US $), mean18.3624.4127.4928.1627.5227.87
     Hours worked/week, mean37.2938.6039.0440.1239.4839.10
Number of observations3,2414,4595,4604,9555,87110,332
Estimated number64,82089,180109,200165,167195,700206,640

Top 10 source countries for employed FENs in the United States, 1980–2015

1980 (N = 3,241)1990 (N = 4,459)2000 (N = 5,460)
BirthplaceN%BirthplaceN%BirthplaceN%
Philippines88327.25Philippines1,56635.11Philippines1,76732.37
Canada35410.91Jamaica3447.72India3987.29
India1996.15Canada2986.69Canada3736.83
Jamaica1956.01India2706.05Jamaica3556.51
Korea1484.56Korea1543.46Nigeria2173.97
England1073.29Ireland1152.57Korea1502.75
Ireland1013.11England1022.29Guyana/British Guiana1162.13
Thailand742.28Trinidad and Tobago892.00England1162.12
Trinidad and Tobago641.99Thailand771.73China1122.05
West Germany591.83Barbados601.34Trinidad and Tobago961.77
Percentage of total FENs accounted for by top 10 source countries67.3868.9667.79
2007 (N = 4,955)2010 (N = 5,871)2015 (N = 10,332)
BirthplaceN%BirthplaceN%BirthplaceN%
Philippines1,79236.17Philippines2,33539.77Philippines3,91037.84
India4218.49India4768.11India7977.72
Canada2515.07Jamaica26654.53Nigeria5935.64
Nigeria2294.63Nigeria2624.46Jamaica4043.91
Jamaica2204.44Canada2293.91Canada3813.69
Korea1623.26Korea1913.26Korea2822.73
Haiti1422.86China1452.47China2322.25
China1222.47Haiti1212.06Haiti2031.97
Trinidad and Tobago741.49Guyana/British701.20Ghana1961.90
Guiana
England701.42Cuba701.19Cuba1481.44
Percentage of total FENs accounted for by top 10 source countries70.3070.9669.09

Displacement effects of foreign-educated RNs on US-trained RNs by age, 2000–2015

Dependent variable: US-educated nurses per 1,000 population
25–2930–3435–3940–4445–4950–5455–5960–6465–70
(1)(2)(3)(4)(5)(6)(7)(8)(9)
2SLS (single instrument)
Foreign-educated nurses per 1,000 population0.906**–0.0680.431–0.514–0.0470.0400.1350.5690.125
(0.761)(0.391)(0.594)(0.489)(0.450)(0.397)(0.429)(0.545)(0.181)
R20.4970.7360.7030.7830.8080.8240.8630.7430.691
2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population0.533–0.1340.673–0.3460.003–0.0810.3230.3790.039
(0.508)(0.375)(0.549)(0.439)(0.284)(0.319)(0.280)(0.480)(0.116)
Lagged foreign-educated nurses per 1,000 population–0.488*–0.0480.1750.1220.036–0.0880.136–0.138–0.062
(0.308)(0.219)(0.295)(0.145)(0.211)(0.206)(0.221)(0.181)(0.088)
R20.7210.7340.6480.8110.8100.8240.8430.7950.721

Numbers of commuting zones with few nurses

19902000200720102015
USENZero00000
>0 & <5550322
>0 & <10593339
FENZero215180197193217
>0 & <54041323685
>0 & <1066635048109

Reduced form and first stage results, 2000–2015 (multiple instrumentation)

(1)(2)(3)(4)(5)
Reduced Form
Past settlement–1.945**–0.523*0.4820.753–0.461
(0.791)(0.285)(0.353)(1.843)(1.163)
Lagged past settlement–4.004***–1.218**0.2330.8541.915
(0.838)(0.605)(0.631)(2.227)(2.861)
First stages
Dependent variable: foreign-educated nurse inflows
Past settlement0.961***0.282**0.291**0.4740. 631
(0.178)(0.171)(0.194)(0.674)(0.570)
Lagged past settlement1.705***0.1800.2930.1440.215
(0.466)(0.205)(0.256)(0.761)(1.160)
Sanderson–Windmeijer multivariate F-statistics36.5010.9610.156.301.05
[0.000][0.000][0.000][0.059][0.307]
Dependent variable: lagged foreign-educated nurse inflows
Past settlement0.420*–0.088–0.2220.5120.170
(0.216)(0.169)(0.216)(0.558)(0.570)
Lagged past settlement2.046***0.660***0.492**0.110*–0.609
(0.527)(0.252)(0.329)(0.601)(1.239)
Sanderson–Windmeijer multivariate F-statistics36.8025.4526.697.375.60
[0.000][0.000][0.000][0.008][0.458]
ControlsXXXX
Year FEXXXXX
Area FEXXX
Pre-Great RecessionX
Great Recession and Post-Great RecessionX

List of the 140 commuting zones (CZs)

CZStateMetro statusCZState Metro status
302TennesseeMixed19600New JerseyMetro
401North CarolinaMixed19700PennsylvaniaMetro
500North CarolinaMixed19800DelawareMetro
900North CarolinaMixed19902MarylandMixed
1100North CarolinaMixed20001MaineMixed
1203North CarolinaMixed20003MaineNonmetro
1701North CarolinaMixed20100MaineMixed
1900North CarolinaMixed20200VermontMixed
2000VirginiaMixed20302VermontNonmetro
2400VirginiaMetro20401Rhode IslandMetro
2500VirginiaMixed20500MassachusettsMetro
2700MississippiMixed20600New HampshireMixed
3003MississippiMixed20800MassachusettsMetro
3300LouisianaMixed20901ConnecticutMixed
3901LouisianaMixed21501MinnesotaMetro
4200ArkansasMixed23100WisconsinMixed
5202TennesseeMetro23500IllinoisMixed
5600TennesseeMetro23801IllinoisMetro
6000AlabamaMixed23900IllinoisMixed
6700FloridaMetro24100WisconsinMixed
6800FloridaMixed24300IllinoisMetro
6900FloridaMixed24400IllinoisMixed
7000FloridaMixed24701MissouriMixed
7100FloridaMixed24802IllinoisMixed
7200FloridaMetro28401ColoradoMixed
7300FloridaMetro28900ColoradoMetro
7400FloridaMixed29301KansasMixed
7500FloridaMixed29502MissouriMixed
7600FloridaMixed30601TexasMixed
7800FloridaMixed30802TexasMixed
7900FloridaMixed31201TexasMixed
8202South CarolinaMixed31301TexasMixed
8401GeorgiaMixed31401TexasMixed
8800GeorgiaMixed31600TexasMixed
8900GeorgiaMixed31700TexasMixed
9100GeorgiaMixed31800TexasMixed
9400GeorgiaMixed31900TexasMixed
9701GeorgiaMixed32000TexasMixed
9900FloridaMixed32100TexasMixed
10900FloridaMixed32201TexasNonmetro
11101AlabamaMixed32801TexasMixed
11302MarylandMetro32900TexasMetro
11304MarylandMixed33000TexasMixed
11600MichiganMixed33100TexasMixed
11700MichiganMetro33300TexasMixed
11900MichiganMixed33803OklahomaMixed
12200MichiganMixed34102AlaskaMixed
12501OhioMixed34701HawaiiMetro
12701OhioMixed34901New MexicoMixed
13501OhioMixed35001ArizonaMixed
13600IndianaMixed35100ArizonaMixed
14200IndianaMixed35600HawaiiNonmetro
14900IndianaMetro36100UtahMixed
15200OhioMixed37000CaliforniaMixed
15900OhioMixed37100CaliforniaMetro
16300PennsylvaniaMixed37200CaliforniaMetro
16400OhioMixed37300CaliforniaMixed
16600VirginiaMixed37400CaliforniaMixed
17400PennsylvaniaMixed37500CaliforniaMetro
17600VirginiaMixed37604NevadaMixed
17700New YorkMixed37700CaliforniaMixed
17800New YorkNonmetro37800CaliforniaMetro
17900New YorkMixed37901NevadaMixed
18000New YorkMixed38000CaliforniaMetro
18600New YorkMixed38200CaliforniaMetro
18800PennsylvaniaMixed38300CaliforniaMixed
19100PennsylvaniaMixed38601WashingtonMixed
19300New YorkMixed38801OregonMetro
19400New YorkMetro38901OregonMixed
19500New JerseyMetro39400WashingtonMixed

Wage effects of foreign-educated RNs on US-educated RNs, 2000–2015

Dependent variable: log (average hourly wages of US-educated nurses)
Employed USENsFull-time employed USENs
(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
2SLS (single instrument)
Foreign-educated nurses per 1,000 population0.230***0.389–0.1190.048–0.0910.220***0.342–0.071–0.0100.025
(0.049)(0.290)(0.173)(0.119)(0.242)(0.041)(0.249)(0.134)(0.129)(0.161)
R20.3610.5120.9350.9710.9770.4200.5320.9420.9660.978
2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population0.117**0.1980.0430.008–0.1490.107***0.1690.1050.060–0.034
(0.046)(0.303)(0.100)(0.154)(0.372)(0.038)(0.261)(0.082)(0.157)(0.304)
Lagged foreign-educated nurses per 1,000 population0.125**0.306*0.118**–0.041–0.2770.125***0.277*0.127**0.071–0.278
(0.051)(0.184)(0.060)(0.108)(0.694)(0.046)(0.161)(0.061)(0.120)(0.160)
R20.3710.4700.9500.9710.9350.4330.4110.9390.9660.932
ControlsXXXXXXXX
Year FEXXXXXXXXXX
Area FEXXXXXX
Pre-Great RecessionXX
Great Recession and Post-Great RecessionXX

Displacement effects of foreign-educated RNs on US-trained RNs by age

Dependent variable: US-educated nurses per 1,000 population
1990–2015
(1)(2)(3)(4)(5)(6)(7)(8)(9)
Age, years25–2930–3435–3940–4445–4950–5455–5960–6465–70
Foreign-educated nurses per 1,000 population0.818**–0.1550.387–0.0570.3940.2180.1640.3310.081
(0.380)(0.314)(0.383)(0.269)(0.292)(0.294)(0.302)(0.303)(0.105)
Observations700700700700700700700700700
R20.6310.7570.7270.7920.7930.8470.8770.8020.709
2000–2015
Age, years25–2930–3435–3940–4445–4950–5455–5960–6465–70
Foreign-educated nurses per 1,000 population0.906**–0.0680.431–0.514–0.0470.0400.1350.5690.125
(0.761)(0.391)(0.594)(0.489)(0.450)(0.397)(0.429)(0.545)(0.181)
Observations560560560560560560560560560
R20.4970.7360.7030.7830.8080.8240.8630.7430.691