U.S. authorities have warned that the country could fall 275,000 nurses short of the numbers it will need by 2010, in part because of increasing health care demands from a growing elderly population.
Recruiters have long found help in the Philippines, which established schools to train nurses to work in the United States. The health care forces in India, South Korea and Nigeria have also been tapped.
But the latest focus is on Mexico, whose nurses could help serve the United States' rapidly expanding Hispanic population.
"The Mexican nurse understands, speaks and lives the culture of Latin America," said Guillermo Sanchez, president of MDS Global Medical Staffing, a Mexican company recruiting nurses to work at U.S. hospitals. "This is an advantage that has no price for the patient and the family of the patient."
Mexican nurses with advanced degrees can multiply their pay up to tenfold.
"My motivation, more than anything, is economic," said Sanjuana Sanchez, 40, who earns $350 a month on the night shift at a public hospital in Saltillo, a city in northern Mexico.
The mortgage takes half Sanchez's pay, and the rest helps raise two children. So she's begun studying English by day.
"My goal is to get to the United States for the salaries. My children are young, and you always want something better for your children," she said.
Recruiting of Mexican nurses is still in the early stages. Just 58 took the U.S. nurse licensing exam in 2002, according to the most recent statistics available from the National Council of State Boards of Nursing.
Only 16 of them - or 28 percent - passed, well below the 47 percent average for foreign test takers. Nurses from English-language countries generally fare better on the certification test, which is given in English.
But more Mexican nurses may be leaving soon.
MDS Global, a newcomer to nurse recruiting, is paying for Mexican nurses' extended English classes, visa applications and tests for certification in the United States. It plans to send its first group of about 30 nurses north to work in July.
Severino Rubio, director of Mexico's National School of Nursing and Obstetrics, said he signed certificates allowing 35 graduates to work outside Mexico in January alone.
Two nurse testing sites were set up in Mexico last year by a U.S.-based commission that helps predict whether foreign nurses are ready for U.S. certification.
Some health experts are alarmed, warning that Mexico can ill afford to lose highly trained nurses. Research sponsored by the World Health Organization has found the quality of health care can suffer in poor countries that become sources for nurses working in rich countries.
"There are not enough nurses to attend to the demand that we have right now in this country," said Nelly Maldonado, director of the National Cardiology Institute School of Nursing in Mexico City.
The institute trains its own nurses, providing multiyear scholarships to students who stay and work at one of Latin America's elite hospitals.
But one student nurse at the institute recently enrolled in a program to work abroad.
"They're asking for people with advanced degrees, already trained," nursing professor Guadalupe Martinez said. "Therein lies the threat."
In the United States, job dissatisfaction among registered nurses, who often complain of understaffing and inadequate pay and benefits, has contributed to the professional shortage, according to a study by the U.S. government's General Accounting Office.
Other rich countries face similar shortages and also have turned to poor countries to fill vacancies.
Responding to complaints from poor nations worried about damage to their own health systems, Britain and Ireland have set ethical guidelines for international nurse recruiting, and Norway put a cap on the number of foreign nurses the government may hire.
In Mexico, Maldonado recently went on a talk-radio program to denounce any government support for the recruitment of nurses bound for the United States.
But some government employment offices in Mexico are eager to help recruiters. The state of Mexico, which encircles Mexico City, is supplying classrooms and administrative assistance to one recruiting company.
State Labor Secretary Luis Ribera said individual nurses and their profession have everything to gain from foreign recruitment.
"The offers - despite the fact that they are coming from abroad -- represent an opportunity: Nurses who leave today to work open spaces for new nurses who are leaving the universities," he said.
Mireille Kingma of the International Council of Nurses, a federation of 125 national nurses associations, also says some emigration by nurses can be beneficial to the source country.
"Strangely enough, the promise of career opportunities abroad often stimulates the expansion of the training facilities, level of education and improves the image of the profession," said Kingma, a consultant on nursing and health policy at the council. "The evidence suggests that nurses most often do not migrate permanently. When and if they return ... they tend to bring with them advanced knowledge and skills."
Foreign educated nurses wanting to work at U.S. hospitals must pass a national licensing exam and English proficiency test and comply with requirements of state nursing boards, said Cheryl Peterson, a registered nurse and senior policy fellow for international affairs with the American Nurses Association.
Those requirements ensure high-quality health care, but concerns remain about the impact of foreign nurse recruitment on wages for U.S. nurses, Peterson said. She argues the United States wouldn't have to look abroad if the profession was paid better.
The American Nurses Association also expresses concern about the ethics of recruiting nurses abroad.
"The shortage here in the United States will never be as bad as it is in (many) developing countries," Peterson said.
By Morgan Lee