Mission and History


The mission of the Alliance for Ethical International Recruitment Practices (Alliance) is to facilitate the adoption and compliance with ethical, responsible, and transparent practices; with voluntary standards that aim to ensure ethical recruitment of foreign-educated professionals to the United States.


The Code

These standards are set forth in the Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Health Professionals to the United States (Code). The Alliance has developed a monitoring, remediation, and verification process to ensure that these standards are upheld by subscribing organizations. Through public reporting, the Alliance provides foreign-educated health professionals and health care organizations with credible information to make responsible decisions when they are considering contracting with a recruiter.*

*A recruiter can be a staffing agency, a placement agency, or an employer (i.e. hospitals, health care systems, long-term care facilities) that recruits directly.

Consensus on Ethical Standards of Practice

With funding from the MacArthur Foundation, an initiative was launched in 2006 to examine the growing practice of international nurse recruitment that has emerged in response to the U.S. nurse shortage. The project sought to reduce the harm and increase the benefits of international health professional recruitment for source countries and to ensure that the rights of migrants are considered throughout the recruitment process. The project evolved over two years and included two complementary activities.

Part I:

Research begun concerning the emergence, current structure, and practices of the nurse recruitment industry. This process included interviews with chief nurse officers and other hospital administrators to understand how they make decisions about recruiting foreign-educated nurses (FENs). Interviews were also conducted with recruiting agencies to solicit information on the history of the industry and its current business models. Additional data sources included a review of recruiter Web sites and the subsequent development of a database of companies. CGFNS focus groups were organized to explore FENs’ recruitment experience and solicit their suggestions for improving the process. These research findings were published in the report, U.S.-Based International Nurse Recruitment: Structure and Practices of a Burgeoning Industry.

Part II:

A consensus-building process was launched with the goal of drafting a “standards of practice.” In collaboration with the O’Neill Institute for National and Global Health Law, a Task Force was convened that included over 30 high-level representatives from the hospital, union, nurse training and licensure, foreign nurse, and recruiter sectors. The consultative process was observed by several governmental sectors. High level staff from the offices of Senator Edward Kennedy and Senator Richard Durbin, as well as representatives from the U.S. Department of State and the Health Resource Services Administration (HRSA) provided comments and support, but did not form part of the deliberations.

There was widespread agreement among Task Force members that international recruitment needs to be conducted in an ethical way that balances diverse stakeholder interests. Although this group had differing – and sometimes conflicting – perspectives, they nonetheless were able to identify common principles. This phase of the project concluded with the official release of the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States (Code) on September 4, 2008 at the National Press Club in Washington, D.C.

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Code for Health Care Professionals Implementation

With additional funding from the MacArthur Foundation, in September 2008 a new project was launched to maximize the benefits and minimize the potential harm resulting from the recruitment of foreign-educated nurses (FENs) to the United States for three primary stakeholder groups: source countries, FENs, and U.S. patients. The project’s goal was to increase the transparency and accountability of the industry by implementing the Code. Key to ensuring that the Code effectively modifies conduct is the establishment of a monitoring entity. A Stakeholder Transition Group consisting of representatives from unions, health care organizations, educational and licensure bodies, and recruiters was created and assisted in the development of a strategic plan that formed the basis for this entity and led to the creation of the Alliance.

The Alliance advances the implementation of the Code by inviting employers and recruitment organizations to subscribe. Subscribers must provide a copy of the Code to all FENs with whom they enter into a contract, and must agree to allow those nurses to be surveyed by the Alliance. A list of subscribers will be available for consultation by FENs and health care organizations that are considering contracting with a recruiter or an employer.

Pilot Phase

The pilot phase of subscriptions operated from May 2010 – May 2011. During this time leading employers and recruiters participated in the subscription and monitoring process at no cost.

Code for Teachers Implementation

Similar dilemmas of unethical recruitment practices occur in the education sector. Efforts to join the education sector was based on AFT’s landmark study in 2009. The Alliance joined this effort with a multi-stakeholder group of educators to form a Steering Committee that reports to the Alliance Governing Board. The Teachers’ Code for Ethical International Recruitment and Employment Practices is required to promote fairness in hiring, recruiting, and retaining these professionals to uphold and support their roles. We commemorated this new partnership with a launch event in Washington, D.C. in June 2015.


The original title of this document was the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States, published in September 2008. In 2011, the Board of the Alliance for Ethical International Recruitment Practices expanded its work to include other health professionals, replacing the term “foreign-educated nurse” (FEN) with “foreign-educated health professional” (FEHP). All other content is identical to the original publication.