OP-ED

Op-Ed: No Need for Alarm Over Need for Foreign Nurses

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
unfilled.”

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
following:

       An estimated
8.5% of U.S.
nursing positions go unfilled each year – a number expected to triple by
2020.

       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
nurses.

      Shortages
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?)

Other
challenges include an aging (and retiring) workforce, fewer students and
teachers, high turnover rates, and a lack of funding for U.S. nursing
schools.   

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
heal ourselves. 

 Mick Whitley is the Managing Director of
global healthcare staffing firm HCL International.

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22 replies »

  1. I completely agree. A large portion of the nurses and nursing aides employed by our home health agency are foreign-born–and there have never been more compassionate, competent and skilled people. When it comes to a patient’s health, skill and passion should trump birthplace or accent.

  2. I have an MN, tried for several years to find a teaching position. No dice. I have 22 years psych experience in locked units, ER triage ( plus M/S), and out patient services. I could not find a decent job, took a very low paid job, and finally gave it up. I had hoped to work for another 8-10 years, and I see that new grads can’t find jobs either. It seems like the only jobs are for the nurses with 2 -20 years experience, and forget the rest unless you stay with your job until you retire.

  3. I am a South African trained RN who went through the green card immigration process to come to the USA to work as an RN. I waited 4 years to actually get over here. It is by no means an easy procedure. Once here, I was given the equivalent of a new grad RN’s wage per hour and I have been an RN for 13 years back in South Africa. I had a lot of guilt about leaving my home country, but in retrospect how do those foreign governments expect to retain nurses when they are paid minimum wage after graduation? Although there are comments on this blog that the foreign countries pay for the nursing education, this is only partially true. Unlike here in the USA, nursing students go to school and work simultaneously. The student nurse is a member of the work force and does all the donkey work that none of the other nurses do. Also, the scope of practice for a nursing student is much wider in South Africa.
    Few RN’s in the USA are incentivized to go into Nursing Education because they can earn substantially more at a hospital with only an RN qualification. RN’s who want to do their Bachelors or Masters degrees have to pay for it themselves. There are no tuition forgiveness programs through the government for nurses doing higher education either, except if you are willing to serve 2 years in some remote community. Most degree-seeking RN’s already have established careers and do not want to move.

  4. 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 unfilled.”

  5. 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.

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  7. Now after the repercussions of OUTSOURCING many jobs that Americans held…they want to ‘INSOURCE’ nurses. I am an unemployed RN and I cannot find a job. It is probably ‘CHEAPER’ to bring in foreign trained nurses under contract. I have worked with imported nurses under contract to the sponsoring facility. They were willing to work for less and work off the clock. This is illegal and detrimental to nursing industry.

  8. if importing of nurses will be done from third world countries, i believe their health care system would crash.. most of those that would be left on us are novices..from schools with poor quality training..

  9. The first thing the Government should concentrate on is to create enough facilities for nursing degree programs adequately staffed with trainers. There are many people in the United States who want to pursue nursing studies, but they simply can not pursue their goal because of lack of training facilities/instructors.

  10. Now all we need to do is let in foreign doctors to increase supply as the AMA severely limits doctor numbers in virtually all specialties. Supply limitations help drive up prices and conserves monopoly/cartel powers for physicians.

  11. This article is deceptive. There is plenty to be alarmed of. They ought to know better.
    Importing nurses by using agencies that bribe governments into releasing their much needed nurses is complete folly. United States law enforcement is already in the process of exploring whether these organizations are engaging in international bribery, forbidden by American law.
    The people working for and leading these organizations if not intentionally malicious are ignorantly so, which is just as bad. Taking nurses away from countries in order to staff them in other countries only “borrows from Peter to save Paul” and transfers the problems of the 1st world to the 3rd world. This is a clear violation of what it means to be a health care organization because patients suffer. Let me say this again. These organizations are hurting patients. While they may be improving the quality of care for patients in the first world, they are harming the quality of care of patients in the third world. This is not only folly but unethical.
    If every hospital joined forces to donate money and resources and energy into Colleges and nursing education, we would have a quick solution to this problem. Don’t buy into the marketing of these organizations.

  12. hi My name is Jasdeep K. Samra.I am on H4 visa status.means thatI can legally live here in US ,study here but unfortunately i can’t work.I am doing Masters in Nursing as Clinical Nurse specialist.But the problrm is this I don’t have work permit.Though there is huge shortage of nurses in US ,but still I can’t work.Is there any special qota for nurses on H4 so that I can get work permit.Can anyone answer my question?

  13. Nurses are the United States’ largest health care profession. Currently, RN vacancy rates are estimated at 8.1 to 13%. The American Nurses Association (ANA) states that replacing a single nurse can cost as much as $64,000. Nursing will experience a 23.5% job growth rate by 2016, however, the shortage could be as high as 500,000 nurses by 2025. There are many factors that contribute to the nursing shortage: poor staffing, job
    dissatisfaction, poor work environments, an aging nurse population, and decrease numbers of faculty to educate new nurses.
    The nursing shortage is a health policy concern for everyone. A 2002 study in the Journal of the American Medical Association (JAMA), reported that patients having common surgeries had a 32% greater chance of dying in hospitals with decrease nursing staff levels.
    Although employment of foreign nurses could be a short term answer to the nursing shortage, many people are predicting that there is an emerging shortage of nurses worldwide (ANA, n.d.). Nurses and other health care professionals need to take a stand and lobby for increased federal funding to support nursing programs to increase the number of students and faculty and also to ask for support for the Nurse Reinvestment Act of 2002.

  14. My name is Sean and I am an ethical recruiter. The comments in response to the article are thoughtful and well intentioned. However, respectfully, they exemplify a short sighted view of both the nature of the American nursing shortage and the international healthcare recruitment solution.
    1) The nations with socialized healthcare in Western Europe have more efficient healthcare systems that we should learn from. However, they too are experiencing nursing shortages and represent the largest importers of nurses from third world countries in the world.
    2) Even if our nursing schools, hopefully gain the increased capacity to produce more nurses, they won’t come close to producing enough nurses to fill the 1 million vacancies that will exist in 4-10 years. Furthermore, even if they could, we would be innundated with new graduates and will still be in dire need of experienced nurses to oversee them. Still the education system cannot change over night (more classrooms, more teachers, subsidies from the federal government to make it lucrative to emphasize nursing education)
    3) The temporary alleviation of the nursing shortage does nothin to halt the looming nursing shortage which will exist once the baby boomers flood healthcare and nurses retire. While many people are “returning” to nursing and hence alleviating the nursing shortage, this is temporary as the average age of nurses is 53-58 years of age. They all will be retiring soon. The supply of nurses will decrease while the demand on healthcare will increase over the next several years.
    4) while it is true that there are many third world countries like India that are experiencing nursing shortages themselves, there are plenty of other third world countries that have an EXCESS of good nurses, eager to come to the US so that they can send money to their families in their home countries. Thus responsible international healthcare recruitment actually can BENEFIT the third world rather than harm it.
    5)This American tendency to fear importing smart people to drive our industries has existed since this nation was founded. Time and time again, we’ve seen that immigration policy that promotes the immigration of skilled and needed workers benefits our society rather than hurts it.
    6) The nurses coming to America are not replacing American nurses. There are just way too many vacancies for that too happen. Rather, the immigrant nurses are taking the staff level jobs that allow the American nurses to be promoted.

  15. Is nursing education across India, China, and the US equal? I don’t know.
    Greg has identified an important problem with nursing. If admissions could be increased, we could have a big influx of nurses in just a couple years. Part of the problem is with nursing itself, as for example a nursing school wouldn’t let a pharmacist teach a nursing pharmacology course.

  16. The countries that we steal the most doctors and nurses from give their health care workers free education at the expense of the state. Then, lured by higher wages and a higher standard of living, they come to the United States.
    Issuing more visas and opening up the borders to nurses might help our health system, sure, but at what cost? It isn’t as if India, South Africa, and South Africa a nursing surplus — buying off their nurses might help our system but it is at the expense of the sick in those countries.

  17. At my wife’s hosptial there is no nursing shortage because of the economy, and I suspect if this were looked into further other hospitals would show the same shift. Trained nurses are re-entering the field as their husbands loose jobs, existing nurses are staying in nursing longer and travelling nurses are locking into full time one hospital jobs. In fact it appears that there are few jobs for just graduated nurses.

  18. The real question is what is our “Healthcare Footprint” and what is the cost to other countries when our inefficient and outdated health care system consumes more then our fair share of health care resources?
    For decades we have imported far more then our share of energy resources and we are now seeing the same thing happen to health care resources. In Thailand for example their public health system is suffering as a result of medical tourism.
    The solution is to improve the efficiency and the effectiveness of our health care system to at least match that of the EU and not to find ways to import healthcare resources. This will become as unacceptable as driving an SUV is.

  19. Despite a growing nursing shortage, nursing schools continue to turn away more potential nurses. The number of applicants denied admission to nursing schools has increased six-fold since 2002 because of a lack of instructors, according to a report by Pricewaterhouse Coopers’ Health Research Institute. The report also found that half of all new nurses leave their first job within two years. The nurse work force in general is dissatisfied for three primary reasons: excessive paperwork, heavy workloads and inadequate staffing. They wonder why there is a nursing shortage?

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