Alliance for Ethical International Recruitment Practices

1. Alliance for Ethical International Recruitment Practices www.fairinternationalrecruitment.org

2. Mission Statement Facilitate the adoption and compliance with voluntary standards that aim to ensure that recruitment practices of foreign-educated nurses to the United States are ethical, responsible, and transparent.

3. The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States (the Code) Grew out of concerns that: • The recruitment of health professionals from less developed nations should not weaken the capacity of those countries to deliver critical health services. • Health professionals recruited from abroad may be vulnerable to unfair labor practices due to limited information about their rights and difficulties in accessing affordable legal counsel. • In order to provide high quality care, most foreign-educated health professionals need adequate clinical and cultural orientation programs.

4. The Code It was based on: 1. Research: 2007 comprehensive study of U.S. recruitment of foreign-educated nurses (FENs) that described the size, scope, and practices of the emerging industry. 2. Negotiations: Among U.S. stakeholders: • Domestic and foreign-educated nurse professional associations • Employers • Unions • Recruiters • Nurse certification and licensure bodies

5. The Code • Acknowledges the rights of individuals to migrate. • Reflects the mutual recognition of legitimate interests and responsibilities of nurses, source countries, and employers of destination countries, and understands that these may be in conflict. • Affirms that a careful balance of these individual and collective interests is needed to maximize benefits and reduce potential harm to all parties.

6. The Code Best Practices Working jointly with local authorities in source countries to ameliorate negative impact on health services. Avoiding recruitment in countries or areas within countries experiencing severe health worker shortages. Minimum Standards • Compliance with laws in any country in which they operate. • Communicate and make representations in an honest, forthright and accurate manner. • Adhere to general principals of fair contract, immigration and labor practices. • Support FENs transition into the U.S. workforce.

7. Early Endorsements • National Association of Health Care Recruiters • National Association of Indian Nurses of America (NAINA) • National Center for Assisted Living (NCAL) • National Council for State Boards of Nursing (NCSBN) • New York State Nurses Association (NYSNA) • Nurse Alliance of SEIU Healthcare (SEIU) • O’Grady-Peyton, International, a division of AMN Healthcare • Philippine Nurses Association of America (PNAA) • PPR Healthcare Staffing • Procare USA, LLC (Nursing USA, Inc) • Realizing Rights • Reliable Healthcare Services, Inc. • RN India, Inc. • Sigma Theta Tau International • St. John’s Health Network • TKI Healthcare Resources, LLC • AFT Healthcare • American Association of Colleges of Nursing (AACN) • American Association of International Healthcare Recruitment (AAIHR) • American Federation of State, County and Municipal Employees (AFSCME) • American Health Care Association (AHCA) • American Healthcare Services • American Hospital Association (AHA) • American Nurses Association (ANA) • American Organization of Nurse Executives (AONE) • Assignment America Inc., an affiliate of Cross Country Healthcare, Inc. • Avant Healthcare Professionals • Cambridge Staffing Solutions, LLC • Cambridge Healthcare, A Division of Cambridge Global Services • Canadian Travel Nurses • DB Healthcare, Inc. • District of Columbia Board of Nursing • Hammond Law Group, LLC • HCCA International • Health Carousel, LLC • GlobalCare, Inc. • GlobeMed Resources • Guardian Healthcare Providers, Inc. • Institute of California, Bilingual Medical Staffing • International MedLink, Inc. • Johns Hopkins Health System • Lloyd Healthcare Staffing, A Division of Advantis Healthcare Solutions • Morrison Public Affairs Letters of Support • CAREX • Commission on Filipinos Overseas • Commission on Graduates of Foreign Nursing Schools (CGFNS) • Philippine Nurses Association, Inc. (PNA) • Philippine Overseas Employment Agency (POEA)

8. Subscribers to the Code Any organization that engages in the recruitment of foreign-educated nurses (FENs), directly or indirectly, should consider becoming an Alliance Subscriber. This includes: • Recruiting firms who contract with FENs in a source country to facilitate migration to the United States and placement in healthcare employment. • Staffing Agencies who recruit and employ FENs and lease them to healthcare organizations in the United States. • Hospitals, health systems and long-term care organizations who employ FENS (some recruit directly and others use recruiters or agencies). Subscribers to the Code are expected to: • Voluntarily agree to comply with minimum standards; • Strive to achieve best practices; and • Fully cooperate with the monitoring and remediation process.

9. Alliance Board Composition Domestic and Foreign-educated Nurse Professional Associations Nurse Licensure and Certification Bodies • National Council of State Boards of Nursing • Commission of Graduates of Foreign Nursing Schools • American Nurses Association • Association of Nurse Executives • National Association of Healthcare Recruitment • National Association of Indian Nurses of America • Philippine Nurses Association of America Recruiters • American Association of International Healthcare Recruitment • GlobalCare, Inc. • O’Grady Peyton International Employers • American Hospital Association • Federation of American Hospitals • Johns Hopkins Health System Unions • AFT Healthcare • National Federation of Nurses • Nurse Alliance of SEIU Healthcare

10. Subscription Process Free During Pilot (2010-2011) Interested recruiters and employers download Code and guidelines for developing administrative processes to ensure compliance. Application form and administrative plan for compliance completed and submitted to the Alliance. Provisional Subscriber status awarded. Within six months of application, Provisional Subscribers implement administrative plan for compliance. Provisional Subscribers interviewed by Alliance staff. If approved, Certified Subscriber status is awarded. Certified Subscribers initial and sign Code and sign an agreement consenting to be monitored, and if necessary, participate in a remediation process. Certified Subscribers gain access to the Seal which can be used on promotional materials and will be listed on Alliance Web site. In addition, nurses employed or recruited by subscribers can access the Nurse Survey Program. Phase I: Provisional Subscribers Phase II: Certified Subscribers

11. Monitoring Compliance of Subscribers • Anyone, including FENs, may use the OPEN REPORT function on the Web site to file comments on recruitment practices of Certified Subscribers. • Upon signing a contract with a subscriber, FENs will receive a copy of the Code and the subscriber will ask the FENs’ permission to provide the Alliance with their email. The email will be used to register them in the Nurse Survey Program. • If registered, nurses will be invited by the Alliance to fill out a series of three anonymous surveys: • at time of signing contract in home country • two weeks after arriving in the U.S. • one year after arriving in the U.S. • In the event that a nurse reports a situation of non-compliance with the Code, the survey will request supporting documentation and will ask the nurse if they would like Alliance staff to investigate the case. • FENs will be provided with an extensive list of resources and contacts that they may find helpful in resolving their own situation. • If the FEN would like the Alliance to open an investigation, the subscriber will be contacted and asked to provide documentation. • If the determination is made after reviewing materials provided by both sides that the subscriber is in non-compliance, Alliance staff will engage in a period of remediation (maximum 90 days) to work with the subscriber to correct the problem. • If the problem is not corrected, subscribers can be de-listed.

12. Handling Reports of Non-Subscribers • FENs recruited by companies that do not subscribe to the Code may report on recruitment practices they have experienced through the OPEN REPORT function of the Alliance Web Site. • In addition, employers, unions, and other U.S. health professionals may also use the OPEN REPORT mechanism to report recruitment practices they have either experienced or observed. • While the Alliance can not allocate resources to investigating and mediating problems with non-subscribers, if requested by the FEN the Alliance will: • Notify the company that the Alliance has received a report involving them and encourage them to read the Code and develop a plan to ensure compliance with its principals. • Refer FENs to relevant organizations for guidance and assistance.

13. What Are Stakeholders Saying? Unions “Regardless of nationality, no nurse should be exploited. It is imperative that the Alliance for Ethical International Recruitment Practices continue to be supported in its work to protect international nurse recruitments.”Norma Amsterdam, Executive Vice President, SEIU United Healthcare East Recruiters “The Code clearly demonstrates our commitment to ethical recruitment practices. It separates us from non-subscriber organizations and helps distinguish us in the eyes of our customers, the healthcare professionals we recruit, and the hospitals and healthcare facilities we serve.”Marcia Faller, Executive Vice President, O’Grady Peyton International/AMN Regulators “State boards of nursing believe ethical recruitment practices are important to ensure compliance with state nurse licensing laws and to help the newly licensed nurse understand his or her legal responsibilities”Kathy Apple, CEO, National Council of State Boards of Nursing

14. What Are Stakeholders Saying? Foreign-Educated Nurses “Recruiters and employers who are Certified Subscribers of the Alliance are required to meet recruitment standards that are ethical and transparent. These standards were developed to protect foreign-educated nurses throughout the recruitment process – employment/placement, migration, and acculturation. The seal of the Alliance should give nurses the confidence and assurance that they are dealing with a reputable vendor or recruiter.”Sara Gabriel, Immediate Past President, National Association of Indian Nurses of America Hospital HR Leaders “The Code represents a ‘Stamp of Approval’ to the healthcare community as well as external and internal stakeholders that your hospital is a preeminent healthcare leader and subscribes to transparent, ethical recruitment practices for international professionals. The Code sets your hospital apart from other organizations and clearly raises the bar for recruitment excellence as measured by objective evidence and established best practices.”Lydia Ostermeier, Vice President, National Association for Healthcare Recruitment