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Methods: Ordinary least square regression was used to analyze the wages of IENs working in the U.S. healthcare system. Data from the 2008 National Sample Survey of Registered Nurses (NSSRN) was used to identify IENs working full time in the U. S. (n = 757). Variables selected for use were those typically associated with wage setting in a capitalist market and included human capital, market sector, and individual level variables. Multivariate regression analysis was used to determine relationships between variables and wages. Cohen’s d was used to determine the magnitude and direction of wage differences between groups along with their statistical and practical significance.
Results: Results from the analysis demonstrated that differences between wages are influenced by the interaction of gender and race. Additional results supported evidence that employer preferences for nurses is similar to the preferences found in other female-gendered occupations (specifically teaching). Analysis of the data revealed that white male IENs earned higher wages than all other immigrant groups, followed by nonwhite males and nonwhite females (R2 = .143; F(8,748) = 15.60; p =.000;). White female IENs earned the least, at 80%, 88%, and 91% of wages earned by white male, nonwhite male, and nonwhite female IENs, respectively (p < .005). The relationship between hourly wage and being a white female was negative and statistically significant (p = .006) and white females earned 19.6% less per hour than white male IENs. Working in tertiary care contributed 21.60% of wages for white IENs and 10.30% of wages for nonwhite IENs. Inequality in nursing wages was related to an interaction between race and gender for wages of white female IENs but not in wages for nonwhite female IENs.
Wages of IENs were highest for white males with wage preferences demonstrated for nonwhite males, non-white females, and white females respectively. White female IENs earned the same wage as the average wage of an RN reported in 2008. Wage differentials among IENs closely approximated differences in wages by race and gender for USRNs with white male IENs earning $8.00 more per hour than white female IENs. Based on market sector, white female IENs earned greater wages than nonwhite female IENs. However, white female IEN wages were negatively related to gender while nonwhite female IEN wage had no relationship with gender. These findings indicated that white female IENs pay a gender penalty while nonwhite female IENs did not. This penalty was enough to offset the gains in market sector made by white female IENs. No other variables were statistically related to IEN wage indicating that human capital variables such as educational level and technical skill and individual variables such as length of time practicing in the U.S. or an interrupted work history played no role in wage setting for this group of IENs.
Mean wages between groups of IENs by country of education did not reach statistical significance using regression analysis. However, mean wages of groups by country of education were both statistically and practically significant when compared using Cohen’s d. Nurses educated in the Philippines earned approximately $2.00 more per hour than other nurses while Canadian nurses earned approximately $2.00 less per hour. These difference were significant both practically and statistically. Mean wages for white male, nonwhite male, and nonwhite female IENs were practically and statistically different than the average wage of all nurses working in the US in 2008 while wages of white female IENs were neither practically nor significantly different. Finally, the difference in wages between white male IENs and all other groups of IENs were both practically and significantly significant; the difference with white female IENs being the greatest at $8.00 per hour with a large effect.
Conclusion: Wages for IENs differ in ways similar to those of USRNs and are largely based on an interaction between race and gender. Despite wage protections to ensure gender and racial parity, unexplained differences in wages of nurses continue in the health care system of the United States. Human capital investments had no significant relationship to wages earned by IENs. Length of time working in the United States, interrupted work histories, and country of education likewise had no significant relationship to wages earned by this group of IENs. There are groups of individuals within the IEN population whose earnings are significantly different than others. I hypothesize that these differences may play a role in research findings indicating that IENs out earn USRNs. Therefore, it is unlikely that more favorable wages earned by IENs signal a devaluation of a U.S. nursing education.