PHILADELPHIA, September 11, 2025 – In a new survey, foreign-educated nurses and other healthcare professionals who migrate to work in the United States continue to give high marks to recruitment firms that are certified by the Alliance for Ethical International Recruitment Practices.
The Alliance, a division of TruMerit (formerly CGFNS International), in 2024 surveyed more than 8,000 foreign-educated health professionals who had used one of its 19 Certified Ethical Recruiters (CERs). Ninety percent of respondents indicated they had an overall positive experience with their recruiter, with 55% reporting it was very positive.
As the survey report shows, the high satisfaction rate essentially held steady from 2023 despite persisting delays and increased costs in the U.S. immigration process.
In an earlier TruMerit/CGFNS survey of its applicants who used non-certified recruiters, only 69 percent reported a positive or very positive experience.
“As U.S. healthcare systems continue to look to foreign-educated nurses and other health professionals to help resolve chronic staffing shortages, it is essential that we work to protect those who have made the life-altering decision to migrate. This overall rate of positive experience remains a testament to the work of the Alliance’s Certified Ethical Recruiters in their adherence to ethical practices and transparent policies,” said Rodrigo Gouveia, TruMerit’s Chief Global Affairs Officer.
The Alliance was created nearly two decades ago in response to concerns some recruiters were using unfair and deceptive practices such as charging unreasonable fees to the recruits, withholding passports and other documents, and pressuring recruits to sign unfair and complex contracts without giving them an opportunity to read and understand them. On such issues, survey respondents had the following responses about their recruitment experiences:
- 82% agreed (68% strongly) that their CER regularly communicated with them and addressed their concerns.
- More than 97% said they received a copy of their contract and suitable time to review it before signing, with 92% reporting that they were not pressured to sign.
- 95% said their recruiter did not withhold their passports or any other critical documents.
- 91% said they knew what their pay rate would be prior to arriving in the U.S., but a lower proportion (72%) said they knew the location of their new job in advance of emigrating.
TruMerit/CGFNS had previously found that four out of five (79%) nurses who recently immigrated to the U.S. used a recruitment firm, either to place them directly with an employer or, under a staffing model, fund their migration costs in return for their commitment to work for the recruitment firm itself, which then assigns them to work at their client healthcare facilities.
To be designated a Certified Ethical Recruiter, firms must undergo a rigorous evaluation of policies and practices and agree to Alliance oversight that they remain in compliance with its Health Care Code for Ethical International Recruitment and Employment Practices, which outlines specific best practices for ensuring fair, ethical, and transparent treatment of health professionals migrating to the U.S.
The Alliance Code is aligned with the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel. In its recent State of the World’s Nursing Report, the WHO called for reinforcing adherence to its Code and for ethically managing international mobility and migration as key policy priorities for strengthening global nursing workforce development.
“The results of this survey indicate the potential for recruiter certification to advance WHO’s goals and in serving as a model for both source and destination countries of migrating health professionals,” said Gouveia.
More information on the Alliance and the Certified Ethical Recruiter program can be found at cgfnsalliance.org.
About TruMerit
TruMerit is a worldwide leader in healthcare workforce development. Formerly known as CGFNS International, the organization has a nearly 50-year history supporting the career mobility of nurses and other healthcare workers—and those who license and hire them—by validating their education, skills, and experience as they seek authorization to practice in the United States and other countries. As TruMerit, this mission has been expanded to building workforce capacity that meets the needs of people in a rapidly evolving global health landscape. Through its Global Health Workforce Development Institute, the organization is advancing evidence-based research, thought leadership, and advocacy in support of healthcare workforce development solutions, including globally recognized practice standards and certifications that will enhance career pathways for healthcare workers.