Higher proportions of nurses educated outside of the United Kingdom significantly affected patient satisfaction scores at National Health Service (NHS) hospitals in England, a study published in the BMJ Open found.

The odds of patients reporting good or excellent care fell by 12 percent for every 10 percentage-point increase in non-UK educated nurses, the study by the University of Pennsylvania School of Nursing found. It also decreased the odds of patients agreeing they always had confidence and trust in nurses by 13 percent. Three out of six additional measures of patient satisfaction were similarly affected.

Researchers said lower patient satisfaction could not be explained by other features at the hospitals, including poorer nurse staffing or work environments. Location, size, technology and teaching status also were not observed to be factors.

The study noted that NHS hospitals have increasingly recruited from abroad because of national concern that low nurse staffing levels were putting patients at risk. They concluded that "importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care."

According to an announcement from the University of Pennsylvania, the study "was motivated by findings from a previously published U.S. study documenting higher mortality for patients in U.S. hospitals that employed more non-U.S. educated nurses" as well as increased NHS recruitment of nurses from abroad "despite public concerns about quality."

In the U.S., the increased production of U.S.-educated nurses appears to have caused a marked decrease in the number of foreign-educated nurses taking the National Council Licensure Examination, a standardized entry exam that nursing hopefuls must pass in order to practice in the United States, FierceHealthcare previously reported.

At the same time, FierceHealthcare previously noted that 40 percent of foreign-educated nurses reported discrimination in shift assignments, wages and benefits, and reported lower job satisfaction scores than their U.S.-trained counterparts.

To learn more:

- here's the study

- check out the abstract

- see the Penn announcement