Recent news coverage (“Amid Nation’s Recession,
More Than 200,000 Nursing Jobs Go Unfilled,” Reuters, March 8th) validly
and vividly calls attention to a nursing shortage in the U.S. healthcare system that
“threatens the quality of patient care even as tens of thousands of
people are turned away from nursing schools, according to experts.”
That article adds, “The shortage has drawn the
attention of President Barack Obama. During a White House meeting on Thursday
to promote his promised healthcare system overhaul, Obama expressed alarm over
the notion that the United States
might have to import trained foreign nurses because so many U.S. nursing jobs are
Importing internationally-trained nurses is no cause for
alarm. The fact is, at least in the short term, the U.S.does have to
import these nurses, and plenty more of them, if we are to meet our rapidly
growing healthcare needs. Don’t understand why? Consider the
– An estimated
8.5% of U.S.
nursing positions go unfilled each year – a number expected to triple by
– 2007 U.S.
Dep’t of Health and Human Services research reported we will require
1.2 million new RNs by 2014 – 500,000 of these simply to replace retiring
are especially dire in critical care, cardiac, intensive care and operating
rooms, and it takes years to “build” nurses in these areas.
– The economy
is making recruitment even harder (and, I would ask, why are there freezes
for nurses when it is clear access to healthcare affects us all?)
challenges include an aging (and retiring) workforce, fewer students and
teachers, high turnover rates, and a lack of funding for U.S. nursing
There is no 'quick fix' – we must first recruit the nurse
educators and then train the nurses. We must learn from new graduate nurse
experiences that they feel unsupported and apprehensive about working
autonomously as healthcare professionals, by ensuring they have the support and
guidance of experienced nurses. But this process will take years — who
looks after us when we get sick until then?
Perhaps the greatest challenge to solving the
nursing shortage is the immigration/VISA process currently in place for
internationally-trained nurses. There are generally three non-immigrant
visa options for nurses: H-1C, TN, and H-1B, and two of these
are significantly limited by statutory and quantitative visa allotments, as
well as legal, regulatory and policy-based eligibility
requirements. The TN would be a solution if Canada didn't have its own nursing
crisis, and Mexican nurses are required to sit English examinations (which is
only correct, I add) but results in another set of barriers. The
other method for a foreign nurse to come to the U.S. is by applying for a green
card, but the current numbers of nurses succeeding through this Schedule A
procedure still do not come even close to approaching the levels needed to help
alleviate the nursing shortage. Problems include quantitative visa limits,
as well as inconsistencies in procedures and processing times.
What does all of this mean, in practical terms? It
means that, while patients in U.S. hospitals wait and suffer from a lack of
sufficient nursing case, experienced and caring internationally-trained nurses,
who have committed to come here to help care for us, are also waiting –
some of them, e.g., from India, for as long as seven years! And
it’s great that President Obama has committed more money to expanding healthcare,
but the nurses that will be necessary to staff any such expansions are nowhere
to be found – at least not here, not yet.
Internationally-trained nurses are not taking jobs away from
US works at all, but are in fact filling only a small percentage of the
critical nursing shortage in this country – and are needed in greater
numbers, to help address the problem now. Failure to recognize this very
important fact – and to include the nursing shortage in any conversation
about healthcare reform – could prove fatal to the public health system
in the coming years.
Hospitals, we cannot
Mick Whitley is the Managing Director of
global healthcare staffing firm HCL International.