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We at CGFNS International (the Commission on Graduates of Foreign Nursing Schools, Philadelphia, Pa) noted with interest the article by Polsky et al.1 We agree with their conclusions that foreign-trained nurses are a substantial part of the US nursing workforce and that the impact of foreign-trained nurses is likely to grow in coming years. Our own findings suggest that the trend in US employment of foreign-trained nurses has continued to grow in this decade, with increasing numbers of foreign-trained nurses applying to the CGFNS VisaScreen Program, a federal screening program for nurses seeking US occupational visas. The Philippines, India, Canada, and South Korea were the primary source countries for 2003-2006 Visa Screen applications. 2 The important role of foreign-trained nurses in US health care delivery has been recognized for more than a decade3-5 and is clearly rooted in market forces.
Polsky et al. raised concern that the "aggressive recruitment of nurses from overseas will not be met with equally vigorous assurance of the quality and skills of the immigrating nurses."1(p895) As Polsky et al. indicated, foreign-trained nurses are more likely than their US counterparts to have a bachelor's degree, comparable work experience, and higher income. What was not noted in the article is that the US government has established rigorous steps for assuring that foreign nurses entering the US...