Do foreign-educated nurses displace native-educated nurses?

	US-educated RNs
	1980	1990	2000	2007	2010	2015
Age, mean, in years	39.25	40.01	42.90	44.71	44.99	44.60
Gender
Female	95.91	94.48	92.44	91.29	91.12	90.20
Male	4.09	5.52	7.56	8.71	8.88	9.80
Race
White	90.14	88.18	85.01	83.38	82.22	81.17
Black	7.97	8.66	8.71	9.34	9.95	10.10
Asian	1.46	1.94	3.64	4.33	5.11	5.41
Native American	0.30	0.39	0.40	0.45	0.40	0.40
Other races	0.12	0.83	2.25	2.50	2.32	2.93
Hispanics	1.84	2.67	3.26	4.17	5.10	5.96
Marital status
Married	67.13	67.53	68.14	65.88	65.40	63.96
Widow/divorced/separated	18.26	18.79	19.56	20.56	20.25	19.09
Single	14.61	13.68	12.30	13.56	14.35	16.95
Educational attainment
Less than high school	12.35	0.56	0.21	0.07	0.21	0.19
High school	6.06	15.43	11.27	6.45	6.69	6.00
Associate’s degree	48.51	38.38	35.96	37.32	37.40	34.65
Bachelor’s degree	21.91	32.45	38.75	42.01	42.66	44.83
Graduate degree	11.18	13.19	13.80	14.15	13.04	14.33
Spanish speaking	1.98	2.91	3.62	3.91	4.15	4.50
Part time	31.00	30.22	26.32	25.13	23.37	21.70
Hourly wage (US $), mean	16.24	20.65	22.89	24.42	24.47	23.97
Hours worked/week, mean	34.67	36.24	37.11	37.46	37.52	37.72

Number of observations	51,739	81,944	100,102	72,886	78,993	137,429
Estimated number	1,034,780	1,638,880	2,002,040	2,429,533	2,633,100	2,748,580

	Foreign-educated RNs
	1980	1990	2000	2007	2010	2015

Age, mean, in years	41.15	44.00	45.74	46.61	47.12	48.16
Gender
Female	93.63	93.88	89.48	86.75	86.36	84.33
Male	6.37	6.12	10.52	13.25	13.64	15.67
Race
White	36.33	27.22	24.02	20.66	19.36	19.50
Black	16.56	18.52	20.65	21.57	20.14	22.84
Asian	45.96	52.30	49.14	54.39	57.19	54.03
Native American	0.16	0.22	0.18	0.06	0.18	0.20
Other races	0.99	1.74	6.01	3.32	3.14	3.43
Hispanics	8.49	7.25	5.12	5.11	5.34	5.62
Marital status
Married	64.27	68.74	71.68	71.53	73.32	72.86
Widow/divorced/separated	14.55	15.63	15.03	16.27	15.32	16.79
Single	21.18	15.63	13.29	12.20	11.36	10.34

	Foreign-educated RNs
	1980	1990	2000	2007	2010	2015

Educational attainment
Less than high school	17.50	1.42	0.80	0.60	0.58	0.53
High school	5.09	15.30	11.19	6.06	5.15	5.05
Associate’s degree	26.12	24.98	22.77	20.45	19.85	18.92
Bachelor’s degree	27.46	43.57	51.06	57.98	61.15	61.01
Graduate degree	23.84	14.74	14.19	14.91	13.27	14.48
Spanish speaking	6.29	6.15	5.44	5.27	5.11	5.77
Part time	17.60	16.89	15.14	12.07	12.89	13.77
Hourly wage (US $), mean	18.36	24.41	27.49	28.16	27.52	27.87
Hours worked/week, mean	37.29	38.60	39.04	40.12	39.48	39.10

Number of observations	3,241	4,459	5,460	4,955	5,871	10,332
Estimated number	64,820	89,180	109,200	165,167	195,700	206,640

[i] RN, registered nurse; BLS, Bureau of Labor Statistics; CPI-U, Consumer Price Index for All Urban Consumers.

Source: The data are from the US Censuses and the American Community Survey (ACS) multiyear aggregates.

Notes: The Census samples and ACS sample for 2015 include 5% of the US population, while the ACS samples for 2007 and 2010 include 3% of the population. The samples are restricted to employed registered nurses aged 25–70 years old. Wages are deflated so that they are in terms of the 1999 wages using the BLS CPI-U.

Table 2

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)
Birthplace	N	%	Birthplace	N	%	Birthplace	N	%
Philippines	883	27.25	Philippines	1,566	35.11	Philippines	1,767	32.37
Canada	354	10.91	Jamaica	344	7.72	India	398	7.29
India	199	6.15	Canada	298	6.69	Canada	373	6.83
Jamaica	195	6.01	India	270	6.05	Jamaica	355	6.51
Korea	148	4.56	Korea	154	3.46	Nigeria	217	3.97
England	107	3.29	Ireland	115	2.57	Korea	150	2.75
Ireland	101	3.11	England	102	2.29	Guyana/British Guiana	116	2.13
Thailand	74	2.28	Trinidad and Tobago	89	2.00	England	116	2.12
Trinidad and Tobago	64	1.99	Thailand	77	1.73	China	112	2.05
West Germany	59	1.83	Barbados	60	1.34	Trinidad and Tobago	96	1.77

Percentage of total FENs accounted for by top 10 source countries		67.38			68.96			67.79

2007 (N = 4,955)			2010 (N = 5,871)			2015 (N = 10,332)
Birthplace	N	%	Birthplace	N	%	Birthplace	N	%

Philippines	1,792	36.17	Philippines	2,335	39.77	Philippines	3,910	37.84
India	421	8.49	India	476	8.11	India	797	7.72
Canada	251	5.07	Jamaica	2665	4.53	Nigeria	593	5.64
Nigeria	229	4.63	Nigeria	262	4.46	Jamaica	404	3.91
Jamaica	220	4.44	Canada	229	3.91	Canada	381	3.69
Korea	162	3.26	Korea	191	3.26	Korea	282	2.73
Haiti	142	2.86	China	145	2.47	China	232	2.25
China	122	2.47	Haiti	121	2.06	Haiti	203	1.97
Trinidad and Tobago	74	1.49	Guyana/British	70	1.20	Ghana	196	1.90
			Guiana
England	70	1.42	Cuba	70	1.19	Cuba	148	1.44

Percentage of total FENs accounted for by top 10 source countries		70.30			70.96			69.09

[i] FENs, foreign-educated nurses.

Source: The data are from the US Censuses and the American Community Survey (ACS) multiyear aggregates.

Notes: The Census samples and ACS sample for 2015 include 5% of the US population, while the ACS samples for 2007 and 2010 include 3% of the population. The samples for this table are restricted to employed foreign-educated registered nurses aged 25–70 years old.

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.

Table 3

The first-stage regressions

	Dependent variable: Foreign-educated nurses per 1,000 population
	1990–2015					2000–2015
	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)
Predicted foreign-educated RNs per 1,000 population	2.414***	0.521**	0.296**	0.574*	0.241	2.493***	0.369**	0.232*	0.362	0.241
	(0.604)	(0.220)	(0.166)	(0.308)	(0.348)	(0.628)	(0.214)	(0.183)	(0.415)	(0.348)

Controls		X	X	X	X		X	X	X	X
Year FE	X	X	X	X	X	X	X	X	X	X
Area FE			X	X	X			X	X	X
Pre-Great Recession				X					X
Great Recession and Post-Great Recession					X					X

F-statistics	496.73	32.05	10.21	23.76	2.35	341.64	20.63	10.23	5.43	2.35
Observations	700	700	700	420	280	560	560	560	280	280
R²	0.453	0.817	0.943	0.967	0.973	0.410	0.813	0.947	0.977	0.973

[i] RN, registered nurse; FE, fixed effect.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable in the first-stage regressions is the number of foreign-educated nurses aged 25–70 years as a fraction of a whole population in a commuting zone. The instrument is constructed by using the historical distribution of skilled immigrants (no restrictions on age or labor force status), excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 4

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

	Dependent variable: US-educated nurses per 1,000 population
	1990–2015					2000–2015
	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)
	OLS
Foreign-educated nurses per 1,000 population	–1.730***	–0.636**	0.215	–0.020	0.605	–1.816***	–0.466*	0.205	–0.035	0.605
	(0.347)	(0.250)	(0.286)	(0.261)	(0.381)	(0.339)	(0.254)	(0.263)	(0.398)	(0.381)
Observations	700	700	700	420	280	560	560	560	280	280
R²	0.390	0.778	0.932	0.954	0.968	0.390	0.790	0.946	0.975	0.968

	2SLS (single instrument)
Foreign-educated nurses per 1,000 population	–1.988***	–1.902***	2.182**	0.107	0.970	–2.223***	–3.018*	1.878*	0.237	0.970
	(0.465)	(0.737)	(0.995)	(0.740)	(1.487)	(0.476)	(1.734)	(1.355)	(1.495)	(1.487)
Observations	700	700	700	420	280	560	560	560	280	280
R²	0.383	0.746	0.909	0.954	0.967	0.374	0.664	0.931	0.975	0.967

Controls		X	X	X	X		X	X	X	X
Year FE	X	X	X	X	X	X	X	X	X	X
Area FE			X	X	X			X	X	X
Pre-Great Recession				X					X
Great Recession and Post-Great Recession					X					X

[i] RN, registered nurse; OLS, ordinary least squares; 2SLS, two-stage least squares; FE, fixed effects.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed US-trained nurses aged 25–70 years per 1,000 population in a commuting zone, and the main independent variable is the number of full-time employed, internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone. For the specification, the 2SLS model including controls and fixed effects is applied. The instrument is constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 5

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, years	25–29	30–34	35–39	40–44	45–49	50–54	55–59	60–64	65–70
Foreign-educated nurses per 1,000 population	0.818**	–0.155	0.387	–0.057	0.394	0.218	0.164	0.331	0.081
	(0.380)	(0.314)	(0.383)	(0.269)	(0.292)	(0.294)	(0.302)	(0.303)	(0.105)
Observations	700	700	700	700	700	700	700	700	700
R²	0.631	0.757	0.727	0.792	0.793	0.847	0.877	0.802	0.709

	2000–2015

Age, years	25–29	30–34	35–39	40–44	45–49	50–54	55–59	60–64	65–70

Foreign-educated nurses per 1,000 population	0.906**	–0.068	0.431	–0.514	–0.047	0.040	0.135	0.569	0.125
	(0.761)	(0.391)	(0.594)	(0.489)	(0.450)	(0.397)	(0.429)	(0.545)	(0.181)
Observations	560	560	560	560	560	560	560	560	560
R²	0.497	0.736	0.703	0.783	0.808	0.824	0.863	0.743	0.691

[i] RN, registered nurse; 2SLS, two-stage least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed US-trained nurses aged 25–70 years per 1,000 population by age groups in a commuting zone, and the main independent variable is the number of full-time employed internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone. For the specification, the 2SLS model including controls and fixed effects is applied. The instrument is constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 6

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

	Dependent variable: US-educated nurses per 1,000 population

	1990-2015					2000-2015

	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)

	Less than high school	High school	Associate's degree	Bachelor's degree	Graduate degree	Less than high school	High school	Associate's degree	Bachelor's degree	Graduate degree
Foreign-educated nurses per 1,000 population	0.019	0.207	0.840	0.158	0.658*	0.024	0.175	0.715	0.041	0.924**
	(0.039)	(0.249)	(0.829)	(0.668)	(0.431)	(0.053)	(0.288)	(0.105)	(0.730)	(0.647)
Observations	700	700	700	700	700	560	560	560	560	560
R²	0.421	0.890	0.853	0.900	0.755	0.383	0.878	0.902	0.901	0.724

[i] RN, registered nurse; 2SLS, two-stage least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed US-trained nurses aged 25-70 years per 1,000 population by education levels in a commuting zone, and the main independent variable is the number of full-time employed internationally trained nurses aged 25-70 years per 1,000 population in a commuting zone. For the specification, the 2SLS model including controls and fixed effects is applied. The instrument is constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 7

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

	Dependent variable: Log (average hourly wages of US-educated nurses)

	1990–2015					2000–2015

	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)

Employed US-educated nurses (2SLS – single instrument)
Foreign-educated nurses per 1,000 population	0.218***	0.232	–0.141	–0.007	–0.091	0.230***	0.389	–0.119	0.048	–0.091
	(0.046)	(0.169)	(0.135)	(0.084)	(0.242)	(0.049)	(0.290)	(0.173)	(0.119)	(0.242)
Observations	700	700	700	420	280	560	560	560	280	280
R²	0.532	0.632	0.931	0.963	0.977	0.361	0.212	0.935	0.971	0.977

Full-time employed US-educated nurses (2SLS – single instrument)

Foreign-educated nurses per 1,000 population	0.210***	0.202	–0.096	–0.035	0.025	0.220***	0.342	–0.071	–0.010	0.025
	(0.039)	(0.142)	(0.109)	(0.081)	(0.161)	(0.041)	(0.249)	(0.134)	(0.129)	(0.161)
Observations	700	700	700	420	280	560	560	560	280	280
R²	0.587	0.691	0.941	0.960	0.978	0.420	0.332	0.942	0.966	0.978

Controls		X	X	X	X		X	X	X	X
Year FE	X	X	X	X	X	X	X	X	X	X
Area FE			X	X	X			X	X	X
Pre-Great Recession				X					X
Great Recession and Post-Great Recession					X					X

[i] BLS, Bureau of Labor Statistics; CPI-U, Consumer Price Index for All Urban Consumers; USEN, US-educated nurses; 2SLS, two-stage least squares; FE, fixed effects.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the average log hourly wages of native nurses in a commuting zone, and the main independent variable is the number of full-time employed internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone. Wages are deflated so that they are in terms of the 1999 wages using the BLS CPI-U. Panel A examines the hourly wages of employed USTNs (both part time and full time), while Panel B focuses on the hourly wages of only full-time employed USTNs. For the 2SLS regressions, the instrument is constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 8

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

	(1)	(2)	(3)	(4)	(5)
Reduced Form
Past settlement	–1.945**	–0.523*	0.482	0.753	–0.461
	(0.791)	(0.285)	(0.353)	(1.843)	(1.163)
Lagged past settlement	–4.004***	–1.218**	0.233	0.854	1.915
	(0.838)	(0.605)	(0.631)	(2.227)	(2.861)

First stages
Dependent variable: foreign-educated nurse inflows
Past settlement	0.961***	0.282**	0.291**	0.474	0. 631
	(0.178)	(0.171)	(0.194)	(0.674)	(0.570)
Lagged past settlement	1.705***	0.180	0.293	0.144	0.215
	(0.466)	(0.205)	(0.256)	(0.761)	(1.160)
Sanderson–Windmeijer multivariate F-statistics	36.50	10.96	10.15	6.30	1.05
	[0.000]	[0.000]	[0.000]	[0.059]	[0.307]

Dependent variable: lagged foreign-educated nurse inflows
Past settlement	0.420*	–0.088	–0.222	0.512	0.170
	(0.216)	(0.169)	(0.216)	(0.558)	(0.570)
Lagged past settlement	2.046***	0.660***	0.492**	0.110*	–0.609
	(0.527)	(0.252)	(0.329)	(0.601)	(1.239)
Sanderson–Windmeijer multivariate F-statistics	36.80	25.45	26.69	7.37	5.60
	[0.000]	[0.000]	[0.000]	[0.008]	[0.458]

Controls		X	X	X	X
Year FE	X	X	X	X	X
Area FE			X	X	X
Pre-Great Recession				X
Great Recession and Post-Great Recession					X

[i] FE, fixed effects; OLS, ordinary least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The reduced form reports the slope coefficients from an OLS regression of the number of full-time employed native nurses aged 25–70 years per 1,000 population in a commuting zone on both instruments. The dependent variable in the first-stage regressions is the number of full-time employed foreign-educated nurses aged 25–70 years per 1,000 population in a commuting zone. The two instruments are constructed by using the 1980 distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. The p-values of the F-statistics are in brackets. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 9

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*	0.237	0.970
	(0.476)	(1.734)	(1.355)	(1.495)	(1.487)
R²	0.374	0.664	0.931	0.975	0.967

	2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population	–1.837*	–2.245	1.389	0.878	0.333
	(1.010)	(1.701)	(0.797)	(1.890)	(1.899)
Lagged foreign-educated nurses per 1,000 population	–1.426*	–1.236*	–0.035	0.068	3.025
	(0.552)	(0.749)	(0.825)	(1.439)	(1.602)
R²	0.379	0.658	0.938	0.972	0.938

Controls		X	X	X	X
Year FE	X	X	X	X	X
Area FE			X	X	X
Pre-Great Recession				X
Great Recession and Post-Great Recession					X

[i] RN, registered nurse; FE, fixed effect; 2SLS, two-stage least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed US-trained nurses aged 25–70 years in the respective age group per 1,000 population in a commuting zone, and the main two independent variables are the number of full-time employed, internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone and its lag. For the 2SLS regressions, two instruments are constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 10

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

	Dependent variable: US-educated nurses per 1,000 population
	25–29	30–34	35–39	40–44	45–49	50–54	55–59	60–64	65–70

	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)
	2SLS (single instrument)
Foreign-educated nurses per 1,000 population	0.906**	–0.068	0.431	–0.514	–0.047	0.040	0.135	0.569	0.125
	(0.761)	(0.391)	(0.594)	(0.489)	(0.450)	(0.397)	(0.429)	(0.545)	(0.181)
R²	0.497	0.736	0.703	0.783	0.808	0.824	0.863	0.743	0.691

	2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population	0.533	–0.134	0.673	–0.346	0.003	–0.081	0.323	0.379	0.039
	(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*	–0.048	0.175	0.122	0.036	–0.088	0.136	–0.138	–0.062
	(0.308)	(0.219)	(0.295)	(0.145)	(0.211)	(0.206)	(0.221)	(0.181)	(0.088)
R²	0.721	0.734	0.648	0.811	0.810	0.824	0.843	0.795	0.721

[i] RN, registered nurse; 2SLS, two-stage least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed US-trained nurses aged 25–70 years in the respective age group per 1,000 population in a commuting zone, and the two main independent variables are the number of full-time employed, internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone and its lag. For the 2SLS regressions, two instruments are constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 11

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 degree	Bachelor’s degree	Graduate degree

	(1)	(2)	(3)
	2SLS (single instrument)
Foreign-educated nurses per 1,000 population	0.715	0.041	0.924**
	(0.105)	(0.730)	(0.647)
R²	0.902	0.901	0.724

	2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population	0.771	–0.279	0.882*
	(0.775)	(0.939)	(0.497)
Lagged foreign-educated nurses per 1,000 population	0.041	–0.232	–0.030
	(0.530)	(0.380)	(0.310)
R²	0.900	0.895	0.734

[i] RN, registered nurse; 2SLS, two-stage least squares.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the number of full-time employed, US-trained nurses aged 25–70 years in the respective education group per 1,000 population in a commuting zone, and the two main independent variables are the number of full-time employed, internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone and its lag. For the 2SLS regressions, two instruments are constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table 12

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

	Dependent variable: log (average hourly wages of US-educated nurses)
	Employed USENs					Full-time employed USENs

	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)
	2SLS (single instrument)
Foreign-educated nurses per 1,000 population	0.230***	0.389	–0.119	0.048	–0.091	0.220***	0.342	–0.071	–0.010	0.025
	(0.049)	(0.290)	(0.173)	(0.119)	(0.242)	(0.041)	(0.249)	(0.134)	(0.129)	(0.161)
R²	0.361	0.512	0.935	0.971	0.977	0.420	0.532	0.942	0.966	0.978

	2SLS (multiple instruments)
Foreign-educated nurses per 1,000 population	0.117**	0.198	0.043	0.008	–0.149	0.107***	0.169	0.105	0.060	–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 population	0.125**	0.306*	0.118**	–0.041	–0.277	0.125***	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)
R²	0.371	0.470	0.950	0.971	0.935	0.433	0.411	0.939	0.966	0.932

Controls		X	X	X	X		X	X	X	X
Year FE	X	X	X	X	X	X	X	X	X	X
Area FE			X	X	X			X	X	X
Pre-Great Recession				X					X
Great Recession and Post-Great Recession					X					X

[i] RN, registered nurse; 2SLS, two-stage least squares; BLS, Bureau of Labor Statistics; CPI-U, Consumer Price Index for All Urban Consumers; FE, fixed effects; USEN, US-educated nurses.

Source: The data are from the US Censuses and the American Community Survey multiyear aggregates.

Notes: The dependent variable is the average log hourly wages of native nurses in a commuting zone, and two main independent variables are the number of full-time employed, internationally trained nurses aged 25–70 years per 1,000 population in a commuting zone and its lag. Wages are deflated so that they are in terms of the 1999 wages using the BLS CPI-U. For the 2SLS regressions, the double instruments are constructed by using the historical distribution of skilled immigrants, excluding those who are registered nurses, across commuting zones in 1980 to allocate the national inflow of foreign-educated nurses to each commuting zone. All specifications are weighted by the whole population in the commuting zone. Standard errors in parentheses are clustered at the commuting zone level. Significance is indicated by the symbol * at the 10% level, ** at the 5% level, and *** at the 1% level.

Table A1

List of the 140 commuting zones (CZs)

CZ	State	Metro status	CZ	State	Metro status
302	Tennessee	Mixed	19600	New Jersey	Metro
401	North Carolina	Mixed	19700	Pennsylvania	Metro
500	North Carolina	Mixed	19800	Delaware	Metro
900	North Carolina	Mixed	19902	Maryland	Mixed
1100	North Carolina	Mixed	20001	Maine	Mixed
1203	North Carolina	Mixed	20003	Maine	Nonmetro
1701	North Carolina	Mixed	20100	Maine	Mixed
1900	North Carolina	Mixed	20200	Vermont	Mixed
2000	Virginia	Mixed	20302	Vermont	Nonmetro
2400	Virginia	Metro	20401	Rhode Island	Metro
2500	Virginia	Mixed	20500	Massachusetts	Metro
2700	Mississippi	Mixed	20600	New Hampshire	Mixed
3003	Mississippi	Mixed	20800	Massachusetts	Metro
3300	Louisiana	Mixed	20901	Connecticut	Mixed
3901	Louisiana	Mixed	21501	Minnesota	Metro
4200	Arkansas	Mixed	23100	Wisconsin	Mixed
5202	Tennessee	Metro	23500	Illinois	Mixed
5600	Tennessee	Metro	23801	Illinois	Metro
6000	Alabama	Mixed	23900	Illinois	Mixed
6700	Florida	Metro	24100	Wisconsin	Mixed
6800	Florida	Mixed	24300	Illinois	Metro
6900	Florida	Mixed	24400	Illinois	Mixed
7000	Florida	Mixed	24701	Missouri	Mixed
7100	Florida	Mixed	24802	Illinois	Mixed
7200	Florida	Metro	28401	Colorado	Mixed
7300	Florida	Metro	28900	Colorado	Metro
7400	Florida	Mixed	29301	Kansas	Mixed
7500	Florida	Mixed	29502	Missouri	Mixed
7600	Florida	Mixed	30601	Texas	Mixed
7800	Florida	Mixed	30802	Texas	Mixed
7900	Florida	Mixed	31201	Texas	Mixed
8202	South Carolina	Mixed	31301	Texas	Mixed
8401	Georgia	Mixed	31401	Texas	Mixed
8800	Georgia	Mixed	31600	Texas	Mixed
8900	Georgia	Mixed	31700	Texas	Mixed
9100	Georgia	Mixed	31800	Texas	Mixed
9400	Georgia	Mixed	31900	Texas	Mixed
9701	Georgia	Mixed	32000	Texas	Mixed
9900	Florida	Mixed	32100	Texas	Mixed
10900	Florida	Mixed	32201	Texas	Nonmetro
11101	Alabama	Mixed	32801	Texas	Mixed
11302	Maryland	Metro	32900	Texas	Metro
11304	Maryland	Mixed	33000	Texas	Mixed
11600	Michigan	Mixed	33100	Texas	Mixed
11700	Michigan	Metro	33300	Texas	Mixed
11900	Michigan	Mixed	33803	Oklahoma	Mixed
12200	Michigan	Mixed	34102	Alaska	Mixed
12501	Ohio	Mixed	34701	Hawaii	Metro
12701	Ohio	Mixed	34901	New Mexico	Mixed
13501	Ohio	Mixed	35001	Arizona	Mixed
13600	Indiana	Mixed	35100	Arizona	Mixed
14200	Indiana	Mixed	35600	Hawaii	Nonmetro
14900	Indiana	Metro	36100	Utah	Mixed
15200	Ohio	Mixed	37000	California	Mixed
15900	Ohio	Mixed	37100	California	Metro
16300	Pennsylvania	Mixed	37200	California	Metro
16400	Ohio	Mixed	37300	California	Mixed
16600	Virginia	Mixed	37400	California	Mixed
17400	Pennsylvania	Mixed	37500	California	Metro
17600	Virginia	Mixed	37604	Nevada	Mixed
17700	New York	Mixed	37700	California	Mixed
17800	New York	Nonmetro	37800	California	Metro
17900	New York	Mixed	37901	Nevada	Mixed
18000	New York	Mixed	38000	California	Metro
18600	New York	Mixed	38200	California	Metro
18800	Pennsylvania	Mixed	38300	California	Mixed
19100	Pennsylvania	Mixed	38601	Washington	Mixed
19300	New York	Mixed	38801	Oregon	Metro
19400	New York	Metro	38901	Oregon	Mixed
19500	New Jersey	Metro	39400	Washington	Mixed

[i] Notes: Metro status indicates whether the individual resided within a metropolitan area and, for individuals in metropolitan areas, whether the individual resided within or outside of a central/principal city. If a commuting zone lies only partially within a metropolitan area or central/principal city, then its metro status is mixed.

Table A2

Numbers of commuting zones with few nurses

		1990	2000	2007	2010	2015
USEN	Zero	0	0	0	0	0
	>0 & <5	5	5	0	3	22
	>0 & <10	5	9	3	3	39
FEN	Zero	215	180	197	193	217
	>0 & <5	40	41	32	36	85
	>0 & <10	66	63	50	48	109

[i] USEN, US-educated nurses; FENs, foreign-educated nurses.

Notes: 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. The table shows the numbers of commuting zones with few nurses across the United States.

References

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Articles in this issue

DOI: https://doi.org/10.2478/izajolp-2020-0014 | Journal eISSN: 2193-9004

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Language: English

Published on: Nov 13, 2020

Published by: Sciendo

In partnership with: Paradigm Publishing Services

Keywords:

foreign-educated nurses,