title: Use of foreign-educated nurses and patient satisfaction in U.S. hospitals.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Olena Mazurenko, MD, PhD, is Assistant Professor, Health Care Administration and Policy, University of Nevada, Las Vegas. E-mail: olena.mazurenko@unlv.edu. Nir Menachemi, PhD, is Professor, Department Chair, Health Policy and Management, Indiana University.
authors.forename: Olena
authors.initials: O
authors.lastname: Mazurenko
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D003142:Communication; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D014481:United States