The inpatriation of foreign healthcare workers: a potential remedy for the chronic shortage of...

International Journal of Intercultural Relations

28 (2004) 127–150

The inpatriation of foreign healthcare workers:a potential remedy for the chronic shortage

of professional staff

Michael Harvey*, Chad Hartnell, Milorad Novicevic

University of Mississippi, School of Business Administration, Mississippi, MS 38677, USA

Abstract

The healthcare industry has been racked with inadequate supply of professionals in key

positions in the last decade. Healthcare providers have attempted to address this complex

problem in a variety of ways. One strategy that has recently gained a great deal of attention

has been the recruiting of foreign healthcare providers to relocate/immigrate to the US. While

this strategy has had mixed results, it is forecasted that the shortage of healthcare professionals

will necessitate healthcare providers to continue this practice and to develop a means to

improve the success rate of these professional transplants. This paper addresses the concept of

inpatriation of professional employees from foreign countries into the healthcare system in the

US.

r 2004 Elsevier Ltd. All rights reserved.

Keywords: Shortage of healthcare professionals; Inpatriation; Status consistency; organizational and

personal ‘‘fit’’

The National League of Nursing states that the number of nursing programgraduates declined 13 percent between 1995–1999... (and) one in seven hospitals isdealing with nursing vacancies exceeding 20 percent indicating that these vacancyrates have worsened at 60% of hospitals since 1990. (Update, 2002).

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*Corresponding author. Tel.: +1-662-915-5829; fax: +1-662-915-5821.

E-mail address: [email protected] (M. Harvey).

0147-1767/$ - see front matter r 2004 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ijintrel.2004.03.005

1. Introduction

Healthcare organizations in the United States (US) face significant challenges instaffing certain key professional medical staff positions. The Average nationalvacancy rates in 2001 were 11 percent for registered nurses (RNs), 21 percent forpharmacists, 18 percent for radiology technicians, 12 percent for lab technicians andnine percent for social workers (The Advisory Board Company, 2001). The shortageof RNs has been a contributing factor to burnout and/or growing dissatisfaction, inconjunction with other factors such as: mandatory overtime, high nurse-to-patientratio, too much paperwork with not enough patient contact, no recognition withinthe system, doctor bullying, inadequate compensation, unsafe working conditions(Barney, 2002; Mee, 2002; Mee & Robinson, 2003). Paradoxically, although thedemand for nurses is high, many nursing schools turn numerous qualified applicantsaway. In fact, according to a survey conducted by the American Association ofColleges of Nursing of 220 colleges, nursing programs turned away almost 6000qualified applicants in 2002 (Mee & Robinson, 2003).

To address this issue, Congress has approved a $20 million appropriation for theNurse Reinvestment Act as of February 2003, although this is only one part of the2003 omnibus spending bill, including a total of $113.5 million for nursing programs(Fong, 2003). Though some critics of the legislation feel that the appropriated fundswill not go far enough, healthcare providers believe that Bill is a step in the rightdirection. A majority of US healthcare organizations recognize the present supplyshortage and forecasted increases in the shortage of these workers within the UnitedStates and have begun to explore new organizational options.

Potential alternative strategies to address the shortage of nurses involve theprocesses such as: development of nursing leadership teams, building image and/orreputation of employee ‘‘friendly’’ organizations, recruiting new graduate nurses,socialization of new nurse (i.e., to reduce turnover and to increase commitment) andcreating a work environment as attractive as possible for newly recruited nurses (i.e.,reducing the third shift phenomena among new nurse) (Doverspike, 2000;McDonald, 2002; Gering & Conner, 2002; Cox, 2003). Another option that hasbeen explored by a number of major healthcare organizations is the recruiting ofnon-US citizens to augment the more traditional pools of candidates (Doverspike,2000; Shusterman, 2002).

One of the more radical option considered by healthcare providers is the option ofseeking to enrich the pool of potential candidates by recruiting foreign healthcareprofessional from overseas. The various immigration venues of this option include:(1) sponsoring for permanent residence; (2) temporary visas (restricted availability);(3) obtaining H-1B vista which requires at least a four-year college degree whichwould leave two-year associates degrees for many RNs; and (4) H-1C visa, atemporary visa established in 1999 by Congress especially to address the nursingshortage in the US, but due to the restrictive nature of the visa only 10 hospitalsnationwide can employ nurses using this type of visa (Shusterman, 2002). Thesevenues provide an opportunity for healthcare organizations to proactively recruitforeign nurses and other healthcare professionals. Each of these venues help to

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encouraging non-US healthcare workers to immigrate to the US; however, a numberof concomitant issues/problems can occur.

One of the major challenges that US healthcare organizations face when recruitingforeign healthcare workers is overcoming the ‘‘liability of foreignness’’, theinherent, non-monetary cost resulting from healthcare consumers’ perceptions thatthey will receive a sub-standard level of healthcare from the immigrant heathcare professional (Guisinger, 2002; Mezias, 2002). The liability of foreignnesshas a significant impact on the inpatriation of professional staff as the complexprocess leading to organizational integration of the foreign healthcare workerexperience into the domestic pool of professional talent. Here, inpatriation isdefined as the process of bringing host-or third-country nationals (i.e., healthcareworkers from outside the US) into the home/domestic market on a permanent orsemi-permanent basis (Harvey, 1997b). Harvey and Hartnell (2003) argue that themore effectively US healthcare organizations ‘‘inpatriate’’ foreign healthcareworkers, the more efficiently the liability of foreignness can be predicted andovercome.

The inpatriation of foreign healthcare workers in US healthcare organizationspresents significant challenges for the human resource management (HRM) inhealthcare organizations. One of the more important HRM issues is the challenge ofachieving integration of these healthcare workers into the organization, a task, thatwhen handled proactively (i.e., selectively targeting foreign healthcare workers,preparing those workers for a new life in the US, creating an environment for growthand learning, etc.), can translate into a competitive advantage and, ultimately,increased organizational performance (e.g., increased profit, increased employeesatisfaction, increased consumer satisfaction). This process of achieving organiza-tional integration works to limit the foreign healthcare worker’s inherent liability offoreignness (Mezias, 2002; Guisinger, 2002; Harvey & Hartnell, 2003). Thecomplexity and cost associated in achieving organizational integration may forcehealthcare organizations into foregoing the implementation of an internationalrecruiting program altogether or push them into simply recruiting foreign healthcareworkers, while avoiding the integration challenges altogether (e.g., general cultureshock, language challenges, housing challenges, etc.).

This paper applies the theory of status inconsistency to examine the HRM issuesassociated with the organizational integration of foreign healthcare workers into UShealthcare organizations. Recognizing and understanding the factors that engenderstatus inconsistency problem and developing appropriate strategies to solve thisproblem may assist US healthcare organizations when designing the inpatriationprocess. In this way, the benefits of predicting how well foreign healthcare workersmay be received into the organization and ultimately how well they integrate into theorganization can be achieved. This paper is divided into four sections that explorestatus inconsistency and its interaction with organizational integration of inpatriatedhealthcare professionals. First, a conceptual framework of status inconsistencytheory is explained. Second, the concept of organizational integration throughperson-organization ‘‘fit’’ is discussed. Third, the issues of targeting foreignhealthcare workers are explored through a matrix of ascribed and achieved status

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traits. Finally, a preliminary outline of an inpatriation program for foreignhealthcare workers is proposed.

2. Conceptual framework of status inconsistency theory

The basic concept of status inconsistency suggests that individuals recognize a lackof congruence, or conflicting rank, between two or more individuals as their statustraits. This lack of congruence (i.e., status inconsistency) forces the individual into astressful situation (Bacharach, Bamberger, & Mundell, 1993). If the individual’sassessment of inconsistency is stressful enough, it causes a reactionary or copingbehavior (Lenski, 1954, 1956; Homans, 1974; House & Harkins, 1975; McGrath,1976). Larger degrees of change between an individual’s former and current context/setting may make it increasingly difficult to adjust to the modified status of theindividual (i.e., inpatriate) in a new environmental setting (Erickson, Pugh, &Gunderson, 1972; McGrath, 1976; Koch, 1977; Starr, 1977).

The key variables of status inconsistency theory are status traits (McGrath, 1976).Status traits are defined as measurable or observable characteristics of an individualthat can be evaluated on the basis of honor, esteem or desirability (Homans, 1974).Lenski (1954) furthers this definition by suggesting that status traits are measurableon a hierarchical scale. Overall, status traits are subjective in the sense that the ‘eye ofthe beholder’ captures/defines them. In other words, as any party can make aconclusion(s) about an individual’s status traits, the traits are based on theconcluding party’s own evaluative criteria.

Status traits can be ascribed or achieved. Ascribed status traits are assigned toindividuals without reference to the innate characteristics or abilities of anindividual, whereas achieved status traits are based on individual achievement, thusrequiring special abilities or skills (Linton, 1936; Foladare, 1969; Bacharach et al.,1993). These definitions suggest that age, sex, birth order and race are examples ofascribed status traits (i.e., as the individual does not have the ability to change thesetraits), while at the same time there are a set of status characteristics such asoccupation, income, education and place of residence which represent achievedstatus traits (i.e., as the individual does have the ability to change these traits).

Relative to inpatriation of foreign healthcare workers into US healthcareorganizations, status inconsistency theory can be applied within the frameworkshown in Fig. 1, which illustrates the status inconsistency process. First, a foreignhealthcare worker (e.g., from the Philippines, for exampleythis example will beemployed throughout the article but does not imply that US has any advantage inrecruiting healthcare professionals from the Philippines) is selected for a positionwithin a US healthcare organization. When the foreign healthcare worker reachesthe United States, he/she will likely notice behavioral and/or work-relateddifferences due to the change in the cultural environments (e.g., the differentialperceptions of the Philippino’s healthcare workers that are particularly relevant arethose related to medical training). These differences may cause the foreign healthcareworker to experience feelings of insecurity in the new work environment despite


being qualified to deliver healthcare services in both, the United States and his/herhome country (e.g., from the example, the Philippines). Because of these insecurities,the foreign healthcare worker may become unsure of the social/professional statusthat he/she has in the new healthcare environment.

Second, the sense of a status inconsistency may be increased if the foreign worker’sfeelings of insecurity, when compared to a previous and/or another status profile, donot match the individual’s preconceived status profile (i.e., due to downwardassessment of their current status in comparison to their prior status held in theirhome country context). In other words, if the Philippino healthcare worker becomesinsecure about his/her knowledge, skills and abilities to perform his/her jobresponsibilities because of the perception of being less qualified (e.g., not having beeneducated/trained in the United States), a sense of status inconsistency is formed. Thismeans that status inconsistency feelings are associated with the subjective andobjective educational and job responsibility status profiles. Moreover, statusinconsistency may occur regardless of whether the individual is actually qualifiedto perform the responsibilities associated with the job position. For example, becausethe educational level achieved and occupational responsibilities granted may not fitthe preconceived status profile, the Philippino healthcare workers established priorto accepting the position in the US, the perceptions of their status inconsistencymight be shared by others.

Third, as status inconsistency increases, it may pass a threshold that will heightenthe stress in the foreign healthcare worker. The stress usually results in one or moreof the following psychological reactions: (1) cognitive dissonance; (2) embarrass-ment; and/or (3) a feeling of social disgrace. As a result, the foreign health workerwill normally develop some type of coping mechanism (e.g., increased education at aUS college or university) in order to respond to the stress (House & Harkins, 1975;Koch, 1977; Bacharach et al., 1993; Autry, 2001). Depending on which type of statustrait is the focus of the status inconsistency, ascribed or achieved, it may be possibleto anticipate specific coping mechanisms that will be adopted and behaviors that willbe exhibited by the foreign healthcare worker (Harvey et al., 2000a). This

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Step 2

Status inconsistencies are recognized by the

foreign healthcare worker

Step 3

Stress results producing a

coping response and behavior Step 1

Foreign healthcare workers becomes

aware of their social status in their new

surroundings

Ascribed Status Trait

Achieved Status Trait

Step 3

Stress results producing a

coping response and behavior

Foreign healthcare workers

selected for inpatriation

Fig. 1. Status inconsistency process.

M. Harvey et al. / International Journal of Intercultural Relations 28 (2004) 127–150 131

relationship is important for US healthcare organizations to understand, embraceand limit the effects of status inconsistency. It should be noted, however, that theformation of a status inconsistency causing stress is not an entirely negative outcomethat the individual may experience as individuals that have adjusted well to newenvironments create ‘stability zones’. These stability zones serve as a psychologicalescape/refuge zones when the new environment becomes too stressful (House &Harkins, 1975; Ratiu, 1983). In the context of status inconsistency, these stabilityzones can be viewed as the coping mechanism that the inpatriate can use to reducestress.

There are two variables associated with the status inconsistency formation that areworthy of noting when trying to understand the intricacies of the sources of stressand the resulting level of conflict that foreign workers (i.e., inpatriate workers) arelikely to experience due to the inconsistency. Both of these variables work to furtherexplain the coping mechanisms and human behavior aspects that individualsexperience. First, individuals tend to develop stereotypes under the conditions ofincreased ambiguity. Stereotypes are formed through interactions with otherindividuals and groups in society and these interactions form a basis from whichto measure and assess status traits (Geschwender, 1978; Osland & Bird, 2000).

Reinforcement of these repeated observations and interactions may lead to theconclusion that status traits naturally occur in this fashion (Geschwender, 1978;Autry, 2001). The end result is the formation of a stereotype. For example, theforeign healthcare worker may adopt these locally formed stereotypes to developstatus hierarchies in his/her new environment (Autry, 2001) which can then beapplied to other status hierarchies (e.g., pay, prestige, etc.). This process ofstereotyping is one of the first steps that a foreign healthcare worker will workthrough in the status inconsistency theory process. The ability to influence theformation of stereotypes may have an impact on the type of status inconsistencydeveloped (e.g., based on ascribed or achieved status traits) and the copingmechanisms and resulting behaviors that follow (Osland & Bird, 2000).

The second variable implies that the status inconsistency is formed from theindividual’s understanding of the context of situations in which he/she is placed (i.e.,where the set of interrelated actions/events creates each situation). The under-standing of specific situations then drives the individual’s behavioral response. Thesetwo variables, the understanding of the situation and the behavioral response, are aproduct of the individual’s perspective on interrelated status hierarchies (Hughes,1945; Osland & Bird, 2000; Autry, 2001). For example, a foreign healthcare workerexperiencing a status inconsistency in the realm of a lost promotion may perceive thecriteria used to justify the promotion decision as interrelated to his/her previousoccupational responsibility or past performance status hierarchies. However, itwould be difficult to interrelate the status hierarchy of his/her current place ofresidence as they are not related to any of the past promotion decisions and relatedstatus hierarchies. Rather, it seems likely that an individual’s understanding of theactions and events comprising this situation and his/her behavioral response occurafter the individual has formed stereotypes about the new environment (Welch &Welch, 1997).


The variables of status inconsistency theory (e.g., uncertainty of social status,stress, ascribed and achieved status traits, coping mechanisms, stereotypes, etc.) willlikely be influential in US healthcare organizations undertaking internationalrecruiting efforts. Moreover, these factors will provide considerable challenges wheninpatriating and integrating foreign healthcare workers into healthcare organiza-tions. Therefore, recognition and understanding of status inconsistency variables isthe overall inpatriation process, in order to limit the foreign candidates’ liability offoreignness (Mezias, 2002; Harvey & Hartnell, 2003). Such inpatriation programscould maximize foreign healthcare workers’ opportunities for organizationalintegration and contribute to the overall success within the organization and society(Harvey et al., 2000a, c; Harvey & Novicevic, 2001a, b). The description of anorganizational integration process for inpatriated healthcare workers is provided inthe next section of the paper.

3. Organizational integration through person-organization ‘‘fit’’

The model for integration of inpatriate healthcare workers into US healthcareorganizations is depicted in Fig. 2 (Berry, Kim, Minde, & Mok, 1987; Berry, 1990,1997). The model (following the theoretical foundation of Berry, 1990) suggests thatinpatriate healthcare workers will pass through four stages of integration in anorganization, where the outcome of each stage of integration contributes toimproved organizational performance in terms of increased profit, increasedconsumer satisfaction, and/or increased employee satisfaction, as well as reducedturnover. There have been hypothesized that there are three coping mechanisms usedby individuals acculturating to a new culture, these being: (1) Avoidant copingstyle—examples of which are behavioral disengagement, denial, venting of emotionsas well as, mental disengagement; (2) humor coping style couple with a approachcoping style (e.g., planning, active coping, and suppression of competing activities)—

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Inpatriation Program

Degree of Organizational Integration:

1. Survival 2. Assimilation 3. Acculturation 4. Pluralism

Re-integration Process Moving from Steps 1

through 4

Increased Organization Performance

Fig. 2. Continual re-integration process of inpatriate workers.


the combination of humor and proactive planning to address the stress en-countered in acculturation; and (3) social support—by locals to help the sojournerto adjust to the new cultural context (Cross, 1995; Ward, 1996; Ward & Kennedy,2001).

In order to achieve organizational integration of inpatriated healthcare profes-sionals, US healthcare organizations will have to modify some elements of theirorganizational structures, culture, processes, polices and control mechanisms (Berry,1990; Ward & Kennedy, 2001; Harvey et al., 2000a). This change will support theinpatriated healthcare worker during the integration process. Although the change iscritical in fostering organizational integration and increased organizationalperformance, it should not decrease the quality of healthcare services delivered.For this effect to be ensured, it becomes apparent that there must be an appropriate‘‘fit’’ achieved between the foreign healthcare worker and US healthcare organiza-tion at each stage of organizational integration. Unsatisfactory fulfillment of onestage of the organizational integration process by either or both parties shouldpreclude the start of the next stage of organizational integration.

The term ‘‘fit’’ in this employee–employer context can be interpreted ascompatibility between the foreign worker and the healthcare organization (Kristof,1996). It is noted, however, that there are two conceptualizations that are used aselements of this compatibility in terms of person–organization fit that can helpfurther explain organizational integration. One of these conceptualizations ofperson–organization fit, postulated by Kristof (1996), encompasses supplementaryand complementary fit. Supplementary fit is a congruence of characteristics sharedbetween two entities in an environment (e.g., employee and employer), whilecomplementary fit occurs when the characteristics from one entity fill a voidcharacteristic that is missing from the other entity (Muchinsky & Monahan, 1987).Kristof (1996) also offers another conceptualization of fit that comprises demands/abilities and needs/supplies congruence. Demand and abilities congruence suggeststhat an organization’s demands for a specific job are fulfilled by the abilities of anindividual. Needs/supplies congruence suggests that the individual uses theorganization to fulfill his/her needs (Kristof, 1996).

Combining the supplementary and complementary fit and demands/abilities andneeds/supplies conceptualizations together, Kristof (1996; pp. 4–5) defines fitbetween an individual and organization as, ‘‘the compatibility between people andorganizations that occurs when: (A) at least one entity provides what the otherneeds, or (B) they share fundamental characteristics, or (C) both.’’ Kristof’s (1996)definition of person–organization fit can be used to show various proposals of howperson–organization fit can be accomplished. For example, Cable and Judge (1994)theorized that employment satisfaction would result if an individual worked in anenvironment that fulfills his/her needs. Another hypothesis of these authors suggeststhat a match between an organization’s operations, structure and/or processes andan individual’s needs could establish person–organization fit (Cable & Judge, 1994).Additional conceptualizations of accomplishing person–organization fit surroundcongruency between an organization’s and individual’s values (Chatman, 1991),goals and personality (Burke & Dezca, 1982).


This discussion on the elements of person–organization fit relates to statusinconsistency theory in that they both are affected by two parties, the individual andorganization, and they share and/or have reliance on both parties for their respectivesuccesses. Thus, from the organization’s perspective, there seems to an opportunityto increase organizational performance by selecting workers who perceive lowerdegrees of status inconsistency, as thus worker’s organizational integration isfacilitated. From the individual’s perspective, there seems to be an opportunity todecrease the degree of status inconsistency perception and achieve personal goals byworking for an organization that fosters appropriate organizational socializationand integration. This relationship is important to maintain, as shown in Fig. 2, wherecontinual re-integration is necessary to accomplish the organizational goals ofcontinual organization integration and increased organizational performance. Thestress of acculturation occurring around the life changes taking place in inpatriatedhealthcare professionals, taxes the adjustment resources of both the individual aswell as the recipient organization through demands for coping responses and support(Ward, 1996).

Invariably, the impetus to promote the process of organizational integration is thehealthcare organization’s responsibility. The first rationale for this statement is thatonly the healthcare organization, as directed from the top management team, cancreate an organizational climate with an ‘‘absorptive capacity’’ conducive toorganizational learning. Cohen and Levinthal (1990; p. 128) define absorptivecapacity as an organization’s ability to ‘‘recognize the value of new externalknowledge, assimilate it, and apply it to commercial ends.’’ Assuming that a UShealthcare organization’s recruitment of foreign healthcare workers is done notsimply to fill vacant job positions, but also for organizational development, anabsorptive capacity must be nurtured within the organization. Creating anabsorptive capacity may cause a considerable amount of change in the organization(e.g., organizational structure, culture, processes, polices and control mechanisms),as mentioned previously, but that change will be the means by which a competitiveadvantage will be created and maintained.

The second rationale healthcare organizations need to have the impetus topromote organizational integration posits that they are responsible for therecruitment and employment of healthcare workers, domestic and foreign, for thechange in the healthcare environment. Therefore, healthcare organizations need toreexamine and potentially recreate their recruitment and employment policies andpractices in order to attract and employ healthcare workers who are comfortableworking in an ever-changing and diverse environment focused on learning andorganizational integration.

Healthcare organizations that foster organizational learning need to maintain thelinkage between organizational integration, person–organization fit and statusinconsistency. For example, if a foreign healthcare worker commences employmentwith a US healthcare organization, he/she may experience a job-related statusinconsistency that may also be large enough to cause stress (i.e., stress from a conflictwithin or between the organization, coworkers and/or managers). Seeking to relievethe stress, the foreign healthcare worker will enact some type of coping mechanism


that will produce a specific behavior designed to alleviate the stress caused from thestatus inconsistency (Jasinskaja-Lahti, Liebkind, Horenczyk, & Schmitz, 2003).Depending on the degree of the status inconsistency and severity of the behaviorassociated with it (e.g., a ‘‘heart-to-heart’’ discussion to overcome the conflict orresignation), a lack of person–organization fit may become apparent, which cansubsequently slow down or even halt the process of organizational integration. Thepossibility of this scenario occurring, coupled with the aforementioned charge that itis the healthcare organization’s responsibility for promoting the process oforganizational integration, may prompt US healthcare organizations to seek outthe best ‘‘match’’ between prospective foreign healthcare workers and theorganization. The achievement of this match should be examined through the lensof status inconsistency theory.

4. ‘Targeting’ foreign healthcare workers through ascribed and achieved status traits

There is no ‘perfect’ model for predicting the success of foreign healthcare workersin a new working environment, but by focusing on the status inconsistencydimensions (i.e. ascribed and achieved status), US healthcare organizations may beable to determine the optimal combinations of characteristics that lead to increasedlevels of person–organization fit. Simultaneously, these dimensions may help UShealthcare organizations limit the degree of status inconsistency perceived by foreignhealthcare workers. Consequently, US healthcare organizations may be able topredict the coping mechanisms and resulting behaviors the foreign healthcare workermay arise through the inpatriation process. This competence can be furtherleveraged towards effective and efficient organizational integration.

4.1. Targeting foreign healthcare workers using ascribed status traits

This aforementioned relationship between coping mechanisms and subsequentbehaviors does not imply that US healthcare organizations should avoid therecruitment and employment of individuals with certain ascribed status traitsbecause these individuals may undertake the monumental task of attempting tochange the context of their organizational role or position. Rather, US healthcareorganizations could use ascribed status traits as a tool (i.e., a ‘‘matching’’mechanism) that can place a foreign healthcare worker in the context where theirascribed status traits are best matched.

To use ascribed status traits as an effective matching mechanism, US healthcareorganizations should assess cultural novelty difference/distance between the US andother countries as a means to identify pools of foreign healthcare workers. Thecultural novelty or distance is derived from Hofstede’s four dimensions of culture,which include: (1) power distance; (2) uncertainty avoidance; (3) individualism vs.collectivism; and (4) masculinity vs. femininity (Hofstede, 1980). Studies examiningcultural distance found support for the claim that when a worker is relocated into anew country, the greater the cultural novelty/ distance between the two countries, the


greater the difficulty the worker will have adjusting to the new culture (Church, 1982;Black, Mendenhall, & Oddou, 1991; Harvey, Novicevic, & Speier, 1999). Therefore,when examining the pool of potential foreign healthcare workers on the basis ofascribed status traits and cultural novelty, US healthcare organizations shouldattempt to predict the degree of status inconsistency that the foreign healthcareworker might perceive upon relocating to the US. The ultimate goal of the UShealthcare organizations is to limit the degree of the perceived status inconsistencyand the associated liabilities of foreignness that may result from inpatriation.

The matrix shown in Figure Three draws attention to the dimensions of ascribedand achieved status traits and high and low degrees of cultural novelty. If there is ahigh degree of cultural novelty coupled with an ascribed status trait, a higher degreeof status inconsistency may be expected to result when applied in a cross-culturalcontext (see Bandura (2002) for an analysis of cross-cultural application of theory).Conversely, if there is a low degree of cultural novelty coupled with an ascribedstatus trait, a moderate-to-low degree of status inconsistency may be expected toresult. For example, when comparing the ascribed status trait in terms of differencebetween two inpatriated RNs of different nationalities (e.g., from Canada and thePhilippines), it could be hypothesized that the RN from Canada would experience alower degree of status inconsistency than the RN from the Philippines, simplybecause Canada has lower cultural novelty compared to the United States than doesthe Philippines. By minimizing the degree of status inconsistency, a US healthcareorganization can minimize the likelihood of occupational stress and role strain toarise. The decreased stress/strain levels can minimize the need for copingmechanisms and behaviors and thus improve the person–organization fit. In turn,the better person–organization fit can lead to more effective and efficientorganizational integration.

It should be recognized, however, that the degree of status inconsistency is onlyone variable associated with inpatriation. If, on the one hand, the ascribed statustrait is not anticipated to cause a high level of stress in the foreign healthcareworker’s personal and/or professional environment, it will more than likely have aminimal effect on person–organization fit and organizational integration. If, on theother hand, the ascribed status trait is significant enough to cause a high level ofstress in the foreign healthcare worker’s personal and/or professional environment, acoping mechanism will be become salient and cause behavior(s) directed at rectifyingthe inconsistency. As a result, individuals perceiving a status inconsistency based onan ascribed status trait may have a greater tendency to try to change the environmentand/or context of their role or position in the organization in order to overcome thestatus inconsistency (Harvey et al., 2000a). As they may, however, never be able tofully rectify the inconsistency, they will likely ultimately become increasinglyunproductive and/or quit his/her position. Such an unfavorable outcome may occurbecause the attempts of changing the context of the organizational role or positionis, at best, a very slow and arduous process that can possibly lead to further statusinconsistencies. Therefore, it may be in the best interest of US healthcareorganizations to focus their selection process towards foreign healthcare workerswho come from countries low in cultural novelty in comparison to the United States.


To illustrate how US healthcare organizations can use ascribed status traits as amatching mechanism for recruiting and employing foreign healthcare workers, thefollowing two examples are provided. First, on a micro level, if a US healthcareorganization is planning on recruiting a number of foreign RNs, it should usedemographic statistics from their primary service area as a basis from which to targetRNs. Specifically, if a hospital located in Nashville, TN serves an increasing numberof Hispanics in its primary service area and the growth of this segment of thepopulation is increasing at a dramatic rate, the hospital may be well served to targetRNs from Hispanic countries (e.g., Mexico, Argentina, Spain, etc.) in lieu oftargeting Asian or Eastern European RNs.

Second, on a more macro level, if a US healthcare organization owns and operatesnumerous healthcare facilities throughout the United States and is recruiting varioushealthcare professionals for a number of their healthcare facilities, there may be anopportunity to selectively place healthcare workers in certain areas that best matchtheir cultural background. Thus, an Irish radiology technician may be bettermatched to a healthcare facility in Boston, MA, because of the large local Irishpopulation, in contrast to Portland, OR, where the relative share of the Irishpopulation is considerably smaller.

The status variable of a foreign worker (e.g., RN) interacts, however, with the levelof his/her self-efficacy (the definition and description of self-efficacy construct isprovided further below). Figure Four illustrates the ascribed and achieved statustraits and high and low degrees of self-efficacy. In brief, if there is a high degree ofself-efficacy coupled with an ascribed status trait, a moderate-to-low degree of statusinconsistency may be expected to result. Conversely, if there is a low degree of self-efficacy coupled with an ascribed status trait, a high degree of status inconsistencymay be expected to result. Understanding this relationship is important from theperspective of US healthcare organizations when they try to minimize the degree ofperceived status inconsistency and influence how inpatriate workers are integratedinto the organization.

Selective placements/matching of foreign healthcare workers based on ascribedstatus traits will probably not fully alleviate the status inconsistency that arisesduring the inpatriation of foreign healthcare workers. However, it appears to be animportant tool that US healthcare organizations can use to their advantage whenrecruiting and employing foreign healthcare workers.

4.2. Targeting foreign healthcare workers using achieved status traits

As described earlier, an individual perceiving a status inconsistency based on anachieved status trait could have a greater tendency to learn and try to change his/herbehavior in order to overcome the status inconsistency (Harvey et al., 2000a). Thistendency allows for targeting foreign healthcare workers with specific propensity toovercome the stress resulting from a status inconsistency. Harvey et al. (2000a)suggest that organizations planning the use of inpatriates should consider thefollowing candidate characteristics in their selection process: (1) self-efficacy, (2)cognitive, behavioral and emotional assets, (3) communication abilities, and


(4) strategic action capabilities for operationalizing job requirements. The moreprevalent these traits appear in an individual, the higher the likelihood that anindividual, facing with a high level of status inconsistency engendering stress, willexhibit a propensity to assess and change his/her attitude and behavior as a means tocoping and overcoming the stress.

Of the four characteristics suggested above, self-efficacy may be the most critical interms of status inconsistency theory (Harvey et al., 2000a, b, c; Gecas, 1989; Jones,1986). Bandura (1988) defines self-efficacy as the beliefs and/or capabilities that anindividual has in influencing events in a personal and professional context.Furthermore, the level of self-efficacy an individual possesses is largely dependenton the expectations and beliefs formed concerning challenges in the organization andmacro environment (i.e., culturally salient stereotypes) and their behavioralresponses to these challenges (Harvey et al., 2000a, b, c). When entering a newcultural environment before stereotypes are fully formed, individuals with high levelsof self-efficacy may be able to disconfirm certain tendencies specific to theenvironment. This propensity allows them time to create their own innovativeorientation to the new environment (Jones, 1986). In effect, individuals with highlevels of self-efficacy may be less apt to be influenced by organizational socializationmethods, but rather exhibit a tendency to develop their own innovative socializationsmethods (Jones, 1986). Therefore, a higher level of self-efficacy is a critical factor indiminishing the degree of status inconsistency perceived by foreign healthcareworkers as they interact and respond to challenges apparent in the new cultural andorganizational environment.

Figure Five illustrates how the level of self-efficacy interacts with achieved statustrait. If there is a high level of self-efficacy coupled with an achieved status trait, alower degree of status inconsistency may be expected to result. Conversely, if there isa low level of self-efficacy coupled with an achieved status trait, a moderate-to-lowdegree of status inconsistency may be expected to result. Following this matrix, alicensed practical nurse (LPN) with a high level of self-efficacy would be expected tohave a lower degree of status inconsistency, given the status inconsistency waspredicated on an achieved status trait (e.g., quality education).

A specific challenge that US healthcare organizations can expect to encounter ishow to encourage foreign healthcare workers to rely on their self-efficacy to increasetheir motivation (Harvey et al., 2000a, b, c). A foreign healthcare worker possessinghigh self-efficacy, yet activating none of his/her potential towards diminishing thestatus inconsistency, may develop coping mechanisms and behavioral reactionssimilar to a foreign healthcare worker with low self-efficacy. Thus, if an inpatriateLPN with high self-efficacy experiences status inconsistency based on the educationquality he/she has attained, yet not activating that self-efficacy towards increasinghis/her education quality (e.g., the coping mechanism and behavioral reaction usedto decrease the status inconsistency), the likelihood of overcoming the statusinconsistency and achieving organizational integration decreases.

Achieved status traits can also be assessed against high and low degrees of culturalnovelty. As Figure Five illustrates, if there is a high level of cultural novelty coupledwith an achieved status trait, a moderate-to-low degree of status inconsistency may


be expected to result. Conversely, if there is a low level of cultural novelty coupledwith an achieved status trait, a low degree of status inconsistency may be expected toresult. Furthermore, as achieved status traits may foreshadow coping mechanismsand behaviors that cause change in the individual (e.g., increasing education level),US healthcare organizations may be best served to seek out individuals who aremotivated through achieved status traits. Once again, understanding this relation-ship is what is most important from the perspective of US healthcare organizations.Any tool that can anticipate the effects of variables on the degree of statusinconsistency perceived may help toward the much larger goal of achieving effectiveand efficient organizational integration.

4.3. Targeting foreign healthcare workers using a combination of ascribed and

achieved status traits

The combination of Figs. 3 and 4 can lead to more strategic approaches torecruiting foreign healthcare workers for US healthcare organizations. As illustratedin Fig. 5, at low levels of cultural novelty and high self-efficacy coupled with anachieved status trait, a very low degree of status inconsistency may be expected toresult. Conversely, at high levels of cultural novelty and low-self-efficacy coupledwith an ascribed status trait, a very high degree of status inconsistency may beexpected to result.

The ability to capitalize on the opportunities presented by the combination ofascribed and achieved status traits may result in the organization’s ability todramatically minimize significantly the degree of status inconsistency perceived by aforeign healthcare worker. In turn, as the likelihood of stress to arise is furtherdiminished, this can lead to more accurate predictions of what coping mechanismsand behaviors individuals may exhibit as they integrate into the organization. Theformation of a strategic approach requires the efforts of exploring these and otherpossibilities within the realms of status inconsistency. US healthcare organizationsthat can attract foreign healthcare workers with low or very low degrees of perceivedstatus inconsistency may then be able to integrate them more quickly into the

ARTICLE IN PRESS

SI = Status Inconsistency

High Degree of SI

Moderate to Low Degree of SI

Low Degree of SI


Ascribed Status Traits

Low Cultural Novelty

High Cultural Novelty

Achieved Status Traits

Fig. 3. Assessment of the degree of status inconsistency perceived between ascribed and achieved status

traits and cultural novelty.

M. Harvey et al. / International Journal of Intercultural Relations 28 (2004) 127–150140

organization through proactive, structured and sequential organizational integrationprograms. A program such as this may be able to foster these personal changes in theindividual even more quickly so as to further limit or eliminate the statusinconsistency while speeding up the process of organizational integration.

5. The need for inpatriation programs for foreign healthcare workers

Merely selecting foreign healthcare workers who may have an increasedprobability of integrating into an organization does not ensure the US healthcareorganization will retain these employees. Rather, developing an effective inpatriation

ARTICLE IN PRESS



High Degree of SI


Low Degree of SI


Low Self-Efficacy

High Self-Efficacy


Fig. 4. Assessment of the degree of status inconsistency perceived among ascribed and achieved status

traits and self-efficacy.


Moderate to High Degree of SI

Low Degree of SI Very LowDegree of SI



Low Cultural Novelty & High

Self-Efficacy

High Cultural Novelty & High

Self-Efficacy


Very High Degree of SI

Moderate to High Degree of SI


High Degree of SI

Low Cultural Novelty & Low

Self-Efficacy

High Cultural Novelty & Low

Self-Efficacy

Fig. 5. Assessment of the degree of status inconsistency perceived between ascribed and achieved status

traits and combinations of cultural novelty and self-efficacy.


program may likely contribute to retention and successful integration of foreignhealthcare workers as the success component of the overall inpatriation process(Harvey, 1997b; Harvey & Buckley, 1997). US healthcare organizations, through thedevelopment of an integrative inpatriation plan, can further increase the effective-ness and efficiency of the organizational integration process. In this section, theskeleton of an inpatriation program is proposed. The program incorporates severalcritical aspects of the inpatriation process, such as: (1) identification of high potentialcandidates for inpatriation, (2) technical and educational training programs, (3)preparation tactics for living in the US culture, (4) acculturation tactics into theorganizational culture, and (5) evaluation and compensation approaches. The modelof this inpatriation program is shown in Fig. 6.

5.1. Planning the inpatriation process to maximize the organization’s opportunity set

to succeed

The goal of this stage of the inpatriation planning process is to conceptualizeand strategize the framework by which to target and recruit foreign healthcareworkers. Every step proposed in this stage of the inpatriation program is to be

ARTICLE IN PRESS

Planning the Inpatriation Process (Maximizing Organizational Chances)

Creation of “Inpatriation HR Policies” for foreign healthcare workers Targeting of specific countries from which to recruit foreign healthcare workers Identification of the “key attributes” a foreign healthcare worker will possess

Pre-Inpatriation Preparation (Inpatriation Program Development)

Development of social support programs and strategies

Inpatriation Logistics

Recruitment of foreign healthcare workers Review and adjustment of inpatriation process and programs

Fig. 6. Inpatriation framework.

M. Harvey et al. / International Journal of Intercultural Relations 28 (2004) 127–150142

completed well before the US healthcare organization proceeds down a recruit-ment path. The decision to recruit internationally will cause the HRM functionof the organization to change. US healthcare organizations will need toadapt appropriately their processes, polices and control mechanisms (Harvey et al.,2000a, b, c). The changes in the organization’s mindset reflecting inpatriationchallenges are imperative in order to assist in the organizational integrationprocess.

Another step involved with this initial phase of the inpatriation program is thetargeting of countries that have similar cultural novelty to the United States. The useof Hofstede’s (1980) ‘‘four dimensions of culture’’ may be the most accurate tool bywhich to ‘‘cluster’’ countries based on their comparative cultural novelty scores. TheUnited States is clustered with the following countries: Australia, Canada, GreatBritain, Ireland and New Zealand (Hofstede, 1980), and therefore have relatively lowdifferences in cultural novelty in comparison to the United States. Other countriesthat are in adjacent country clusters to the United States, but have slightly higherdifferences in cultural novelty, are Italy, Switzerland, Germany, Austria and Israel(Hofstede, 1980). Interestingly enough, when examining the member countries inwhich the United States is clustered, they all ‘‘Westernized’’ and they have relativelywell-respected healthcare systems. This comparison suggests that healthcare workersfrom these foreign countries may also have a positive country-of-origin effect on theUS healthcare systems (Harvey & Hartnell, 2003), which may correspond to lowerdegrees of perceived status inconsistency and increased effectiveness and efficiencyspecific to organizational integration.

Using the above-suggested country ‘‘clusters’’ proposed by Hofstede (1980), UShealthcare organizations can create a ‘‘matching’’ mechanism for the placement offoreign healthcare workers in areas that may best match certain ascribed status traitsof the candidates. Additionally, US healthcare organizations may be able to focus onand measure certain characteristics (e.g., self-efficacy) that may be correlated tosuccess in the organization. Both of these tactics can perhaps limit the degree ofstatus inconsistency perceived by foreign healthcare workers that can assist with theprocess of organizational integration.

Finally, the identification of certain ‘‘key attributes’’ in the inpatriation planningphase will help a US healthcare organization to maximize its chances for the successof recruiting foreign healthcare workers. Depending on the type of job being filled(e.g., RN, pharmacist, social worker, etc.) different skills sets will be necessaryto successfully accomplish the requirements of the job. Some of the different skillsets that may be applicable to various healthcare related-jobs are: (1) technicalcompetence, (2) organizational ability (especially for healthcare managementpositions), (3) sense of politics, (4) understanding and/or acceptance ofthe job and its importance to the organization, (5) objectivity and openmindedness, (6) interpersonal skills, and (7) cultural empathy, flexibility andawareness (Harvey, Speier, & Novicevic, 2001). These skill sets, while generallyimportant, are not equally important for all types of healthcare positions (e.g., a dataentry clerk will probably not need to have political skills in order to succeed at his/her job).


5.2. Pre-inpatriation preparation—inpatriation program development

This stage of the inpatriation program, the development of social supportprograms and strategies, progresses from the previously described conceptualizationstage. The main emphasis associated with pre-inpatriation preparation focuses onthe ‘‘change’’ aspect of HRM policies and procedures. As an example, relevant jobpreviews and mentoring programs, while seemingly costly, may be a critical factor indetermining the success of inpatriate candidates. It will take unique approaches tothe inpatriation program to increase the overall success of international recruiting.

The element of appropriate training cannot be overstated in terms of importanceto the success of the inpatriation program. Research has shown that pre-departuretraining and continuous post-arrival training after a worker becomes employed areimportant in achieving organizational integration (Black, Gregersen, Mendenhall, &Stroh, 1999; Black et al, 1991). The key components of successful training programs,designed to achieve organizational integration, are: (1) general cultural and factualinformation, (2) attribution awareness training (i.e., this is the way that an individualmay affect others around him/her), (3) cross-cultural training (i.e., this is the wayothers may affect the individual), (4) behavioral modification training, (5) training inexperiential learning, and (6) interaction training (Harvey, 1997a–c).

US healthcare organizations should also consider the development of supportprograms for the organization’s existing domestic workers. The development andimplementation of such programs is important as the organization has theresponsibility to create an absorptive capacity that is conducive for organizationallearning (i.e. beyond everyday activities/tasks to be carried out). Examples ofsupport programs are cultural awareness and sensitivity programs. These supportprograms serve to educate healthcare workers about the foreign healthcare workers’home countries, communication styles (especially if foreign healthcare workers arecoming from culturally distant countries) and celebration norms of foreign holidays(e.g., Cinqo de Mayo).

The development of social support programs and strategies for foreign healthcareworkers, particularly the programs focused on achieved status traits, is important fora US healthcare organization. The rationale for focusing on achieved status traitsposits that the presence of achieved status traits may motivate the candidate todevelop coping mechanisms and behaviors that will change him/herself when a statusinconsistency arises. For example, when incentives are structured and communicatedto foreign healthcare workers, an educational support program that will warrantpromotion after successful completion may motivate foreign healthcare workers topartake in the educational opportunities. This program may be sequenced as follows:(1) a foreign healthcare worker is officially hired as an LPN, a position with fewerresponsibilities and privileges in comparison to that of an RN, (2) the LPN enters aneducational/training program sponsored and paid for by the healthcare organiza-tion, whereby he/she upgrades his/her education and skills over a modest timeperiod, and (3) upon successful completion of the education/training program, theforeign healthcare worker is promoted from an LPN to an RN. While this programmay exist and be operational in many healthcare organizations, engaging proactively


foreign healthcare workers to consider and enroll in the program is crucial forovercoming status inconsistencies and achieving organizational integration.

As another example, the issue of salary and benefits has become an infamous toolfrom which to lure healthcare workers from one healthcare organization to another.By offering switching perks such as higher wages or signing bonuses, US healthcareorganizations are less actually addressing the supply shortage of healthcare workersin the United States, but more exacerbating the problem. In contrast, recruitmentand employment of foreign healthcare workers is actually an effort to increase thesupply of healthcare workers. However, not recognizing the differences in needs thatthis group of professionals requires when arriving in the United States will result in asimilar fate of being lured from one organization to another by higher salaries andbenefits.

Perhaps the best method to overcome this labor instability issue is to view theinpatriated foreign healthcare worker as a member of a ‘‘network organization,’’which ensures that this individual’s abilities and characteristics are reflected in theorganization and the organization’s values and beliefs are reflected in the individual.In other words, if the US healthcare organization treats the foreign healthcareworker in the organization as an asset, that asset cannot be separated from theorganization’s asset base because of their mutual dependency on each other.

As another form of support, if a US healthcare organization recruited andemployed a group of healthcare workers from the Philippines, it would be in the bestinterest of the healthcare organization to provide housing and transportation forthese workers and their families. Moreover, the healthcare organization may ensurethat these workers have access to their native food, religion and even entertainment.It may not be too far out of the question to provide even paid vacations back to thePhilippines. These types of benefits are an attempt to re-create or provide accessto some of the most critical aspects of the Philippino culture in the United States.In doing so, the healthcare organization is creating a mutual dependency; theorganization obviously depends on the professional capabilities of the Philippinohealthcare workers to deliver healthcare services and the Philippino healthcareworkers depend on the organization to balance the uncertainty of the US culturewith the comfort of the Philippino culture. This mutual dependency, in return, canfoster organizational integration.

Additionally, as organizational integration evolves, a ‘‘network branch’’ of the UShealthcare organization may be developed in the Philippines through positive word-of-mouth promotion. This is likely to result in a steady stream of foreign healthcareworkers into the network center in the United States. The US healthcareorganization may thus have solidified a comparative advantage in the Philippinesby effectively and efficiently integrating workers across borders into the organiza-tion. The comparative advantage may be translated into the competitive advantageby attaining lower vacancy and turnover rates in certain job positions, whichincreases competitive HRM leverage over competitors, while not only developing ofa pluralistic work environment that is appreciated by healthcare employees andconsumers, but also capitalizing on economies of scale and scope of the HRMfunction through the network formation in key markets.


Pre-departure training is another area of opportunity for US healthcareorganizations to develop a strategy that will assist in the organizational integrationof foreign healthcare workers. Fisher (1986) notes that the speed of adjustment into anew organization will be made easier if a more complete and accurate ‘‘anticipatorysocialization’’ process takes place.

5.3. Inpatriation logistics

This component of the inpatriation program is characterized by the successfulexecution of the recruitment, employment, and subsequently organizationalintegration goals. In the context of a strategy to limit the degree of statusinconsistency felt by a foreign healthcare worker, a US healthcare organization mayattempt to employ candidates who possess such characteristics as high of self-efficacy(as discussed earlier). Seeking out individuals with high self-efficacy may be achievedthrough: (1) observation of the level of mastery of an experience or functionalresponsibility, (2) witnessing how other individuals in various types of situationssucceed, (3) persuasion by respected individuals within the organizations that haveaccomplished the same goals, and (4) relying on psychological or emotional states toconvince the person that you are prepared (Harvey et al., 2000a).

Harvey et al. (2000a) also note several reasons why lower levels of self-efficacymay be salient with some individuals. The key reasons include: (1) low level ofacceptance into an organization and macro culture, (2) lack of recognition by theorganization for accomplishments, (3) less formal education and training achieved orexperienced, (4) lack of social capital with key decision makers within theorganization, (5) low language and technical abilities, and (6) increased stress levelsdue to family problems (i.e., adjustment) and (7) lack of social support to deal withthese challenges. A status inconsistency resulting from any of these reasons may beminimized because each one is connected to an ascribed status trait and/or trainingprogram. For example, providing access to cultural activities may be an effective wayto reduce increased stress levels in the family. Or, access to educational/trainingprograms to overcome a lack of recognition in the organization can assist withincreasing an individual’s self-efficacy.

In addition to self-efficacy of an individual, there are other characteristics thatrequire attention during the recruitment stage of the inpatriation program. Some ofthese characteristics include: (1) technical knowledge specific to the job in question,(2) independence (i.e., willingness to relocate to the United States), (3) sincerity andattitude, (4) motivation to partake in training, (5) adaptability to foreignenvironments, (6) proficiency in the English language, (7) knowledge of the UnitedStates’ culture, history, etc., (8) the candidate’s spouse’s attitude and opinion onrelocation to the United States, and (9) any previous relocation experience, even if itis within the candidate’s home country (Harvey, 1997b; Caligiuri, 2000). Accuratemeasurement of these characteristics can help the US healthcare organization forman opinion as to whether the individual may experience high or low degrees of statusinconsistency.


In general, the mere listing of the above candidate characteristics will not producea more qualified foreign healthcare candidate in and of itself. Rather, thesecharacteristics are to serve as the link between the macro and organizational cultureand the behavior that results when interacting with this macro and organizationalculture. If the self-structure/make-up of the individual reflects the characteristicslisted above, the degree of the status inconsistency may be reduced. The result maybe a better person–organization fit and a more effective and efficient organizationalintegration.

Given the availability of organizational resources and capacity, a more promisingmethod in the selection of foreign healthcare workers is the assessment of candidatemultiple IQs, learning styles and thinking styles (Harvey & Novicevic, 2001b). In thissituation, Harvey & Novicevic (2001b) suggest that several key personality attributesare be measured and used for the identification of potential inpatriates. Theseattributes are the candidate’s IQ level on various different levels (e.g., cognitive,emotional, innovative, intuitive, political, organizational, social/cultural, network),learning styles (e.g., accommodator, assimilator, diverger, converger) and thinkingstyles (e.g., monarchic, hierarchic, oligarchic, anarchic).

The final area to consider in the last step of this inpatriation program is the reviewand adaptation of the entire inpatriation process (and/or the social support strategiesand programs) in order to ensure a more effective and efficient organizationalintegration. The review and adaptation are particularly critical for creation of a‘‘network organization’’ in the home country of some foreign healthcare workers,which can help attain lower vacancy and turnover rates in certain job positions.Moreover, the review and adaptation practice can increase competitive HRMleverage over competitors, assist in the development of a diverse work environmentthat is appreciated by healthcare employees and consumers, and capitalize oneconomies of scale and scope of the HRM function through the network distributionin key markets.

6. Conclusion

It is anticipated that the supply shortage of various professions in the healthcareindustry will cause US healthcare organizations to increase their internationalrecruiting efforts. The mere increase in international recruiting efforts, however, willnot overcome the supply shortage of healthcare workers. Rather, the ability of theUS healthcare organization to successfully inpatriate and integrate foreignhealthcare workers will be the measure of international recruiting success (Harvey& Hartnell, 2003).

Using the framework of status inconsistency theory as a tool, US healthcareorganizations may be able to predict the degree of difficulty a foreign healthcareworker may experience when entering the organization. In facilitating the under-standing of this process, status inconsistency can then be used to develop aninpatriation program that will not only foster organizational integration, but alsoallow the organization to retain the foreign healthcare workers (i.e., not allow them


to be lured away by other competing hospitals). It is likely that the effects ofeffectively and efficiently inpatriating and integrating foreign healthcare workersinto the organization are lower vacancy and turnover rates in certain job positions(which increases competitive HRM leverage over rivals), a diverse work environment(that is appreciated by healthcare employees and consumers), and economies of scaleand scope of the HRM function (that is valued by top management).

The inpatriation program proposed here as a practice to help overcome statusinconsistency and increase organizational integration will be not only challenging toexecute from a strategic standpoint, but also difficult to justify from a coststandpoint, as significant resources and capacity need to be devoted to strategicinternational recruiting for US healthcare organizations. The main issues that theseorganizations must address are whether this upfront increased cost can yield a higherlong-term value than their current staffing processes and whether such value cangenerate a competitive advantage for the organization.

References

Advisory Board Company, The (2001). Competing for talent: Recovering America’s hospital workforce.

Washington, DC: The Advisory Board Company.

Autry, C. (2001). The person-organization fit of warehouse operations employees, Ph.D. Dissertation,

University of Michigan.

Bacharach, S., Bamberger, P., & Mundell, B. (1993). Status inconsistency in organizations: Form social

hierarchy to stress. Journal of Organizational Behavior, 14, 21–36.

Bandura, A. (1988). Reflections on nonability determinants of competence. In: R. Shernberg, &

J. Kolligan (Eds.), Competence considered: Perceptions competence and incompetence across the life

span. New Haven, CT: Yale University Press.

Bandura, A. (2002). Social cognition theory in cultural context. Applied Psychology: An International

Review, 51(2), 269–290.

Barney, S. (2002). The nursing shortage: Why is it happening. Journal of Healthcare Management, 47(3),

153–155.

Berry, J. (1990). Psychology of acculturation. In: J. Berman (Ed.) Nebraska symposium on motivation,

1989. Lincoln: University of Nebraska Press.

Berry, J. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International

Review, 46(1), 5–34.

Berry, J., Kim, U., Minde, T., & Mok, D. (1987). Acculturation attitudes in plural societies. Applied

Psychology: An International Review, 21(3), 491–511.

Black, S., Gregersen, H., Mendenhall, M., & Stroh, L. (1999). Globalizing people through international

assignments. Wesley, NY: Addison.

Black, S., Mendenhall, M., & Oddou, G. (1991). Toward a comprehensive model of international

adjustment: An integration of multiple theoretical perspectives. Academy of Management Review,

16(2), 291–317.

Burke, R., & Dezca, E. (1982). Preferred organizational climates of type A individuals. Journal of

Vocational Behavior, 21, 50–59.

Cable, D., & Judge, T. (1994). Pay preferences and job search decisions: A person–organization fit

perspective. Personnel Psychology, 47, 317–348.

Caligiuri, P. (2000). The big five personality characteristics as predictors of expatriate’s desire to terminate

the assignment and supervisor-rated performance. Personnel Psychology, 53, 67–88.

Chatman, J. (1991). Matching people and organizations: Selection and socialization in public accounting

firms. Administrative Science Quarterly, 36, 459–484.


Church, A. (1982). Sojourner adjustment. Psychological Bulletin, 9, 540–572.

Cohen, W., & Levinthal, D. (1990). Absorptive capacity: A new perspective on learning and innovation.

Administrative Science Quarterly, 35, 128–151.

Cox, T (2003). Meeting the nursing shortage head on. Healthcare Financial Management, December,

53–60.

Doverspike, D. (2000). Responding to the challenge of a changing workforce: Recruiting nontraditional

demographic groups. Public Personnel Management, 29(4), 445–458.

Erickson, J., Pugh, W., & Gunderson, E. (1972). Status congruency as a predictor of job satisfaction and

life stress. Journal of Applied Psychology, 56, 523–525.

Fisher, C. (1986). Organizational Socialization: an integrative review. In G. Ferris (Ed.), Research in

personnel and human resource management, Vol. 4 (pp. 101–145). Greenwich, CT: JAI Press.

Foladare, I. (1969). A clarification of ‘ascribed status’ and ‘achieved status’. The Sociological Quarterly,

10(1), 53–61.

Fong, T. (2003). Reinvestingyagain. Modern Healthcare, 33(7), 11.

Gecas, V. (1989). The social psychology of self-efficacy. Annual Review of Sociology, 15, 291–316.

Gering, J., & Conner, M. (2002). A strategic approach to employee retention. Healthcare Financial

Management, November, 40–41.

Geschwender, J. (1978). Racial stratification in america. Dubuque, IA: W.C. Brown Co.

Guisinger, S. (2002). Liability of foreignness to competitive advantage. Journal of International

Management, 8(3), 223–240.

Harvey, M. (1997a). Developing leaders rather than managers for the global marketplace. Human

Resource Management Review, 7(4), 76–85.

Harvey, M. (1997b). Inpatriation training: The next challenge for international human resource

management. International Journal of Intercultural Relations, 21(3), 87–98.

Harvey, M. (1997c). Dual-career expatriates: Expectations, adjustment and satisfaction with international

relocation. Journal of International Business Studies, 28(3), 627–659.

Harvey, M., & Buckley, R. (1997). Managing inpatriates: Building a global core competency. Journal of

World Business, 32(1), 35–52.

Harvey, M., Buckley, M., & Novicevic, M. (2000a). Strategic global human resource management: A

necessity when entering emerging markets. In G. Ferris (Ed.), Research in personnel and human

resources management (pp. 175–242). New York: Elsevier Science, Inc.

Harvey, M., & Hartnell, C. (2003). The liability of foreignness in healthcare organizations: A framework

for its reducing stakeholders’ Alienation. Working Paper Series, University Mississippi.

Harvey, M., & Novicevic, M. (2001a). The emergence of the pluralism construct and the inpatriation

process. International Journal of Human Resource Management, 12(3), 276–285.

Harvey, M., & Novicevic, M. (2001b). Selecting expatriates for increasingly complex global assignments.

Career Development International, 6(2), 69–87.

Harvey, M., Novicevic, M., & Speier, C. (1999). The impact of emerging markets on staffing the global

organization. Journal of International Management, 5(2), 76–89.

Harvey, M., Novicevic, M., & Speier, C. (2000b). Strategic global human resource management: The role

of inpatriate managers. Human Resource Management Review, 10(2), 234–246.

Harvey, M., Speier, C., & Novicevic, M. (2000c). An innovative global management staffing system: A

competency-based perspective. Human Resource Management Journal, 39(4), 78–93.

Harvey, M., Speier, C., & Novicevic, M. (2001). A theory-based framework for strategic global human

resource staffing policies and practices. International Journal of Human Resource Management, 12(6),

224–237.

Hofstede, G. (1980). Culture’s consequences. Thousand Oaks, CA: Sage Publications.

Homans, G. (1974). Social behavior: its elementary forms. New York: Harcourt, Brace, & Jovanovitch.

House, J., & Harkins, E. (1975). Why and when is status inconsistency stressful? American Journal of

Sociological Review, 81, 395–412.

Jasinskaja-Lahti, I., Liebkind, K., Horenczyk, D., & Schmitz, P. (2003). The interactive nature of

acculturation: Perceived discrimination, acculturation attitudes and stress among young ethnic

repatriates in finland, israel and germany. International Journal of Intercultural Relations, 27, 79–97.


Jones, G. (1986). Socialization tactics, self-efficacy, and newcomers’ adjustment to organizations. Academy

of Management Journal, 29(2), 262–279.

Koch, J. (1977). Status inconsistency and the technician’s work adjustment. Journal of Occupational

Psychology, 50(2), 121–128.

Kristof, A. (1996). Person–organization fit: An integrated view of its conceptualizations, measurements

and implications. Personnel Psychology, 49(1), 1–49.

Lenski, G. (1954). Status crystallization: A non-vertical dimension of social status. American Sociological

Association, 19, 405–413.

Lenski, G. (1956). Social participation and status crystallization. American Sociological Review, 21(4),

458–464.

Linton, R. (1936). The study of man. New York: Appleton-Century-Croft, Inc.

McDonald, L. (2002). Raising the bar on recruitment and retention. Healthcare Financial Management,

October, 58–61.

McGrath, J. (1976). Stress and behavior in organizations. In M. Dunnette (Ed.), Handbook of industrial

and organizational psychology (pp. 1351–1395). Chicago: Rand McNally.

Mee, C. (2002). Battling Burnout. Nursing, 32(8), 8–9.

Mee, C., & Robinson, E. (2003). What’s different about this nursing shortage? Nursing, 33(1), 51–55.

Mezias, J. (2002). Identifying liabilities of foreignness and strategies to minimize their effects: The case of

labor lawsuit judgments in the united states. Strategic Management Journal, 23, 229–244.

Muchinsky, P., & Monahan, C. (1987). What is person-environment congruence? Supplementary Versus

Complementary models of fit. Journal of Vocational Behavior, 31, 268–277.

Osland, J., & Bird, A. (2000). Beyond sophisticated stereotyping: Cultural sensemaking in context.

Academy of Management Executive, 14(1), 65–79.

Ratiu, I. (1983). Thinking internationally: A comparison of how international executives learn.

International Studies of Management and Organization, 13, 139–150.

Shusterman, C. (2002). Get to know immigration guidelines. Nursing Management, 33(9), 10–12.

Starr, P. (1977). Marginality, role conflict, and status inconsistency as forms of stressful interaction.

Human Relations, 30(10), 949–961.

Update (2002). Healthcare Financial Management. March 10.

Ward, C. (1996). Acculturation. In D. Landis, & R. Bhagat (Eds.), Handbook of Intercultural Training,

2nd Edn. Thousand Oaks, CA: Sage Publications.

Ward, C., & Kennedy, A. (2001). Coping with cross-cultural transition. Journal of Cross-Cultural

Psychology, 32(5), 636–642.

Welch, D., & Welch, L. (1997). Being flexible and accommodating diversity: The challenge for

multinational management. European Management Journal, 15(6), 677–685.


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