Op-ed: Advancing equality for international nurses

In December 2024, 1,250 nurses at St. Joseph Medical Center in Tacoma, Washington, represented by the Washington State Nurses Association (WSNA), won a new contract with many significant gains, including better pay, stronger staffing provisions, controls on abusive on-call practices, and workplace safety protections.

Among these victories was the end of an unfair practice that disadvantaged nurses with experience in other countries. Before the new contract, most nurses hired at St. Joseph received year-for-year credit for prior registered nurse experience in their wage step placement. For example, a nurse with 10 years of experience would be placed on the 10-year step on the wage scale.

However, while this practice applied to nurses with experience in the United States or Canada, those with experience in other countries were credited with only half of their actual experience. This was despite the contract calling for all nurses to receive full credit. For instance, a nurse from the Philippines with 10 years of experience abroad would be credited with only five years. This unwritten hospital practice had no justification. The resulting pay inequality seriously disadvantaged nurses with international experience and undermined the bargaining unit by disregarding the negotiated salary scales.

Over multiple contract cycles, St. Joseph nurses demanded increased attention to racial justice issues for staff and patients. The hospital’s practice had effectively created a systemic wage disparity that intersected with national origin and race, as the affected nurses were all people of color.

The new WSNA contract ends this discriminatory practice. All nurses will now receive credit for prior experience on a year-for-year basis — one year of credit for one year of experience, period.

The economic impact of this change is significant. One nurse from the Philippines moved from salary step 16 to 24, resulting in a nearly 16 percent wage increase. Beyond salary adjustments, this change ends a practice that was unfair and demeaning — it literally devalued nurses from other countries. While the contract victory does not compensate for past years of unequal credit, it ensures international nurses are treated equitably going forward.

U.S. hospitals have long recruited internationally to address staffing shortages. Nurses from other countries work alongside their U.S. colleagues, providing expert care to the same patient populations. They are an integral part of the nursing workforce and deserve fair, equal treatment and respect. The new WSNA contract is a major step toward that goal.

Inequality in crediting prior nursing experience is not limited to St. Joseph Medical Center — it is a common practice nationwide. WSNA recognized this issue in a 2023 convention resolution, “Rights of Internationally Educated Nurses,” which supported equitable credit for nursing experience acquired abroad. In 2024, AFT, WSNA’s national labor affiliate, unanimously adopted a similar resolution.

Unfair treatment of nurses from other countries remains an ongoing problem, often extending beyond pay inequity to exploitative and abusive conditions. Some nurses have turned to the courts for relief. The Alliance for Ethical International Recruitment Practices developed a healthcare code to establish best practices and inform immigrant healthcare workers of their rights.

For the St. Joseph international nurses, it was the power of the union and collective bargaining that righted this wrong. It was also the power of solidarity — nurses standing together, regardless of nationality, understanding that ending this discriminatory practice was a step forward for all. An old labor slogan reminds us that “an injury to one is an injury to all.” Whether or not most nurses at St. Joseph knew this slogan, their actions demonstrated that they understood its principle.

I am incredibly proud of WSNA and our members at St. Joseph for successfully fighting to end this inequity. This victory is a prime example of what unions can accomplish in standing up for fairness and winning. I hope it will inspire further efforts to advocate for equity for our colleagues from other countries as we continue to fight for better conditions for our members, patients, and communities.

David Keepnews is the executive director of the Washington State Nurses Association.