Pathways to practice: Structural determinants of internationally educated nurses’ transition into the U.S. healthcare workforce

Background Nurse migration can create opportunities for career growth and financial stability; however, these nurses may face challenges related to cultural adjustment, workplace integration, and recruitment and employment practices. Purpose To describe the career pathways of internationally educated nurses (IENs) in the United States with a focus on the recruitment process and transition of newly hired nurses into the healthcare system. Methods A cross-sectional survey design was employed to understand the demographic and professional characteristics of IENs and to assess structural factors influencing the transition to practice, including recruitment, pre-departure preparations, and support received during the transition. Results Data showed that IENs experienced varying levels of support across recruitment, pre-arrival preparation, arrival, and onboarding. Travel and relocation assistance were commonly reported, whereas structured pre-arrival preparation, formal IEN orientation, cultural orientation, and ongoing follow-up were less consistent. These differences highlight opportunities to strengthen transition support across the pathway to practice. Conclusions Interrelated structural processes, rather than individual adaptation alone, shape the integration of IENs into U.S. practice. These findings highlight the important role of nursing regulation in promoting transparent recruitment, consistent preparation, and safe transition to practice. Strengthening these regulatory and organizational processes may improve workforce stability, patient care, and retention of internationally educated nurses.