Emergency Nurse Relief Act 2009- Update

Ginger's Mom, MSN, RN · May 29, 2009

http://www.bls.gov/oco/ocos083.htm#Employment change. Employment of registered nurses is expected to grow 23 percent from 2006 to 2016, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.

However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are:

Percent

Offices of physicians39

Home health care services39

Outpatient care centers, except mental health and substance abuse34

Employment services27

General medical and surgical hospitals, public and private22

Nursing care facilities20

Employment is expected to grow more slowly in hospitals--health care's largest industry--than in most other health care industries. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to grow by much. Patients are being discharged earlier, and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy.

My point is hospitals are not where the nursing shortage is going to be. Currently in 2009, I don't see many hospitals recruiting any one.

Could someone point me to the hospitals that have a shortage? I am assuming this is a perceived shortage and not real.

The need will be in less desirable ( and lower paying positions) in home health and out patient centers. Why are they not actively recruiting it seems odd since they are a biggest risk.

Ginger's Mom, MSN, RN · May 29, 2009

Yes Ma'am! Thank you for the gentle reminder.
I'd like to suggest that we stop using arguments of substandard education and healthcare facilities as a reason not to bring nurses in from outside the USA.
It is very demeaning to non-US nurses who do not fit into the stereotype that is being perpetuated.
Non-US nurses who are passing NCLEX and have been accepted as potential hires by US Hospitals are already going through massive screening processes at the BON level as well as the hospital administration level to ensure that only quality care providing nurses are being hired to work in the USA.
Let's focus on the real issue at hand which is NOT the imporation of nurses in general; but rather the extension of 20,000 green cards annually with adjustments as needed (under review each year) for RNs to fill the impending (not current) nurse shortage.
This of course will overlap issues of nurse employment in general in the USA and nurse working environments/conditions/treatment by hospitals/etc.
Fair enough?

The jobs that need to filled need experienced nurses. Many of the nurses who wish to come to the USA have no experience.

As an experienced outpatient nurse, you have to be aware of community resources.

The positions in the hospitals are non existent ( at least my observation), could you show me a web site of a hospital that is actively looking for new graduates? Not an agency or a temporary work agency. Are these hospitals advertising in our states where jobs are plenty?

My last point is hospitals have told our president they will reduce health care costs by 1.5%, recruiting our of area is very expensive. How are hospitals planning on making up the costs of recruitment ?

Hushdawg · May 30, 2009

My point is hospitals are not where the nursing shortage is going to be. Currently in 2009, I don't see many hospitals recruiting any one.
Could someone point me to the hospitals that have a shortage? I am assuming this is a perceived shortage and not real.

You've double-spoken here.

Your word choice in the first statement is "where the nursing shortage is going to be." Then you follow up with "Currently" and "have a shortage" instead of "will have."

That's the whole point. There are hospitals hiring in small cities and rural areas all across the USA at standard or below standard rates.

The purpose of this bill is the projection based on statistics and numbers of impending retiring nurses that we will be facing a major shortage of nurses working within just a few years. This is why the emergency nurse relief act only has a few years of time to be in effect. It is NOT a permanent addition to the number of green cards each year, rather it is an adjusted addition to facilitate the needed growth in the short term while the nursing schools work to fill the gap in long term.

Hushdawg · May 30, 2009

The jobs that need to filled need experienced nurses. Many of the nurses who wish to come to the USA have no experience.
As an experienced outpatient nurse, you have to be aware of community resources.

Your first argument is irrelevant. Hospitals in the USA do not hire foreign nurses without experience. Almost all of them require 2 years in clinical setting.

Let's focus on realities of who will actually be working in US hospitals rather than those who WISH to come.

I had a conversation this morning with a nurse who spoke fluent English (better than some Americans I went to High school with, that's for sure!) and has worked for 3 years in a US hospital in Saudi Arabia. This is the caliber of nurse that will end up working in US hospitals. One of the best things that comes out of retrogression is the backup supply of nurse is going to allow hospitals to be very choosy over who they hire so that they really get the best of the best.

Your second argument is highly irrelevant. If you follow that logic then no nurse could ever work in a hospital outside an area that she has lived. Therefore no nurse from New York City should ever work in a small city hospital in North Carolina since the communities are completely different.

The positions in the hospitals are non existent ( at least my observation), could you show me a web site of a hospital that is actively looking for new graduates? Not an agency or a temporary work agency. Are these hospitals advertising in our states where jobs are plenty?
My last point is hospitals have told our president they will reduce health care costs by 1.5%, recruiting our of area is very expensive. How are hospitals planning on making up the costs of recruitment ?

I just did a quick search here: http://www.nursetogether.com/JobSearch/tabid/98/Default.aspx

There are 6+ pages of results in various places.

Again, you miss the point. This isn't about a nurse shortage RIGHT NOW. It is about a nurse shortage within the next few years because of the advancing age of currently working RNs.

Recruitment is being cut in the following ways:

agencies and hospitals are no longer paying for NCLEX registration or exams, they are no longer paying for review courses or visa applications.

Agencies are seeking out "ready-to-go" nurses.

That cuts out a TON of money being spent.

Silverdragon102, BSN · May 30, 2009

Your first argument is irrelevant. Hospitals in the USA do not hire foreign nurses without experience. Almost all of them require 2 years in clinical setting.

We have many members posting in the International forum that they have no nursing experience and have employers in the US but stuck in retrogression. Agencies generally will ask for experience but reading the threads in the International section many especially in the Philippines are struggling to get this experience.

Ginger's Mom, MSN, RN · May 30, 2009

Your first argument is irrelevant. Hospitals in the USA do not hire foreign nurses without experience. Almost all of them require 2 years in clinical setting.
Let's focus on realities of who will actually be working in US hospitals rather than those who WISH to come.
I had a conversation this morning with a nurse who spoke fluent English (better than some Americans I went to High school with, that's for sure!) and has worked for 3 years in a US hospital in Saudi Arabia. This is the caliber of nurse that will end up working in US hospitals. One of the best things that comes out of retrogression is the backup supply of nurse is going to allow hospitals to be very choosy over who they hire so that they really get the best of the best.
Your second argument is highly irrelevant. If you follow that logic then no nurse could ever work in a hospital outside an area that she has lived. Therefore no nurse from New York City should ever work in a small city hospital in North Carolina since the communities are completely different.
I just did a quick search here: http://www.nursetogether.com/JobSearch/tabid/98/Default.aspx
There are 6+ pages of results in various places.
Again, you miss the point. This isn't about a nurse shortage RIGHT NOW. It is about a nurse shortage within the next few years because of the advancing age of currently working RNs.
Recruitment is being cut in the following ways:
agencies and hospitals are no longer paying for NCLEX registration or exams, they are no longer paying for review courses or visa applications.
Agencies are seeking out "ready-to-go" nurses.
That cuts out a TON of money being spent.

I went to the search site and the positions I saw were for very seasoned nurses with a specialty. If a US born nurse is not available for these very specialized positions, I agree there is a need to bring in the nurses. I did see very few medical surgical nurses, so the foreign nurses will need specialty experience also.

If the agencies are not paying for travel expenses, prep courses, housing, that is even better. This means the foreign nurses would be processed like the native nurses. If there is a bonus, the foreign nurse should be entitled to it ( just like a native nurse) after they have been successfully employed.

If you look at the history of nurse immigration traditionally the nurses went to urban hospitals, if there is a need in rural lower paying jobs and the foreign nurses are willing work in these areas, I would see it as a good situation.

Are the foreign nurses aware that the situation has changed? That you must have experience and pay your own way?

Ginger's Mom, MSN, RN · May 30, 2009

You've double-spoken here.
Your word choice in the first statement is "where the nursing shortage is going to be." Then you follow up with "Currently" and "have a shortage" instead of "will have."
That's the whole point. There are hospitals hiring in small cities and rural areas all across the USA at standard or below standard rates.
The purpose of this bill is the projection based on statistics and numbers of impending retiring nurses that we will be facing a major shortage of nurses working within just a few years. This is why the emergency nurse relief act only has a few years of time to be in effect. It is NOT a permanent addition to the number of green cards each year, rather it is an adjusted addition to facilitate the needed growth in the short term while the nursing schools work to fill the gap in long term.

Since there is not a "shortage" right now and this in anticipation of need, why is the bill be proposed now. Shouldn't it be proposed when there is a need.

My point about the outpatient and home nursing is the following.

A. nursing education the progression of care is taught, that the nurse always needs to be thinking of the next level of care. My understanding is that many countries do not have levels of care ( Hospital, SNF, Home Care, Skilled Nursing care, and custodial care). If I am wrong please correct me.

B. Many times third party payors are looking for defined information for payment, the concept of insurance is totally new foreign nurses, what needs to pre certification, what is covered by insurance, etc.

C. Since the outpatient systems don't exist in foreign countries the foreign nurses are not exposed to this type of care.

If you read all the white papers about the upcoming nursing shortage, this is where the growth area for nurses is going to be.

Hushdawg · May 31, 2009

We have many members posting in the International forum that they have no nursing experience and have employers in the US but stuck in retrogression. Agencies generally will ask for experience but reading the threads in the International section many especially in the Philippines are struggling to get this experience.

Yes, I'm aware of the struggle that nurses have in getting this needed experience. However, the hospitals still need it in order to hire and saying that immigrant nurses are inexperienced when they come to work in the US is completely incorrect.

That was my only point.

Right now nurses have to go to US hospitals in the Middle east on short-term contracts to get the experience to move on to the USA, Europe or Australia and New Zealand. There are so few long-term contracts in Arab countries that nurses cannot seriously think of them as destination, only training grounds. I think the US hospitals actually like it that way, the recruiters seem to route nurses through this as a process although I cannot confirm any official or unofficial policy to do this, it is based on my observations.

Hushdawg · May 31, 2009

I went to the search site and the positions I saw were for very seasoned nurses with a specialty. If a US born nurse is not available for these very specialized positions, I agree there is a need to bring in the nurses. I did see very few medical surgical nurses, so the foreign nurses will need specialty experience also.

Currently the USA staff positions are like those in the UK and other European countries, the shortage is only in specialized positions. What we are looking at though in the trend projections for the next 2-3 years is shortages spiking in overall RN staff positions due to numerous factors. Factors such as the rising age of the average RN and normal turnover as well as the increased stress of the work environment and higher education requirements (since RNs typically in the USA are AS degrees while foreign graduates are BS degree holders and hospitals are starting to get pickier with hiring).

I would suggest, based on the hiring trends we are seeing, that US nurses complete the BS degree so that they may be more competitive and have more opportunities to move into specialized positions for greater job security (and pay of course).

If the agencies are not paying for travel expenses, prep courses, housing, that is even better. This means the foreign nurses would be processed like the native nurses. If there is a bonus, the foreign nurse should be entitled to it ( just like a native nurse) after they have been successfully employed.

I totally agree. I really like this trend because it is stopping the practice of looking at nurses as a commodity to be traded. This attitude among staffing and recruitment agencies, I think, is the greatest problem to hit immigrant nurse communities over the last 10-20 years.

If you look at the history of nurse immigration traditionally the nurses went to urban hospitals, if there is a need in rural lower paying jobs and the foreign nurses are willing work in these areas, I would see it as a good situation.

But you also have to look at reasons behind this hiring trend. It was due to many factors that have changed over the years.

1) Urban centers experinced massive population booms during the Baby Boomer and Generation X eras which were not equally experienced across rural areas

2) Urban centers provided stability of immigrant communities which were established to help support newcomers to the USA.

3) Racism and other bigoted ideologies from rural hospital administrators which prevented the hiring of non-white and non-native individuals.

One of the things that we try to do is educate nurses about the fact that the USA is a very diverse place and that nurses who are from the provincial areas are probably going to be more comfortable in more rural and small city environments than being plopped down in the center of Times Square. I also illustrate that since many Asians have become indigenous to the USA that any immigrant can find communities to help them feel more comfortable even in a small city with a population of only 30,000.

Are the foreign nurses aware that the situation has changed? That you must have experience and pay your own way?

What do you think I do every day?

Hushdawg · May 31, 2009

Since there is not a "shortage" right now and this in anticipation of need, why is the bill be proposed now. Shouldn't it be proposed when there is a need.

Absolutely not.

This is like treating a patient that is already dead.

Understand that when a bill is submitted then it goes through a long process before being voted on and then passed into a law. The absolute soonest that this measure could be approved would be 2010 which is when the beginning of the shortage spike is expected.

If a bill is pushed through on an emergency measure, as what would happen if we waited for the shortage to occur first, typically it costs the taxpayer much more and is more sloppily written without appropriate provisions for control and mediation of the measure. Additionally, emergency measures are known to have riders attached which increase wasteful spending and they are not analyzed as they should because of the panic state of things.

My point about the outpatient and home nursing is the following.
A. nursing education the progression of care is taught, that the nurse always needs to be thinking of the next level of care. My understanding is that many countries do not have levels of care ( Hospital, SNF, Home Care, Skilled Nursing care, and custodial care). If I am wrong please correct me.

It varies from one nation to another, but this is why hospitals have orientation programs. In the Philippines, for example, the family is charged with a majority of care due to the culture. Nursing homes for the elderly are almost unheard of as they are in Arab nations.

This is one of the reasons why many of us are proposing bridging instruction to be taught before the nurse is hired so that the hospital will see that he or she has passed a certified medical cultural orientation program. Obviously these must be certified by NCSBN and other bodies in the USA in order to be legitimate.

However, I should point out as someone who has lived in various places of the USA that these levels of care are not always available in the US. The types of care one can access in a major city will be far greater than one can access in a small city or in rural America.

B. Many times third party payors are looking for defined information for payment, the concept of insurance is totally new foreign nurses, what needs to pre certification, what is covered by insurance, etc.

I disagree. Insurance is well known here and most countries. Those countries without insurance are going to be extremely impoverished nations.

By that token, wouldn't nurses who work in nations providing universal healthcare also be just as clueless about insurance and coverage? Yet these are nations where the nurses are trained at US level or higher already.

C. Since the outpatient systems don't exist in foreign countries the foreign nurses are not exposed to this type of care.

You're generalizing again.

It varies from one nation to another and, once again, this is what orientation courses are for.

Ginger's Mom, MSN, RN · May 31, 2009

From my reading here, I think many of the IEN are expecting to come to the USA, with free housing, living in a city and working in a hospital. If you are preparing IEN for the realities of coming to the USA you are doing a good thing.

As far an nurses retiring in the next 2-3 years, what I see and hear is that retirement age nurses are planning to work past retirement age due to their losses in 403(b) and 401 (k).

Many of the Associate Degree nurses have a BS in another field, for them getting a BSN is useless, they can go on and get a MSN. I don't think this is the time to bring up the BSN debate either since the competitive hospitals in my area, would hire a native ASN over a IEN so I don't think your premise is valid.

I don't think you can think of nursing as a secure occupation, as a nurse who has lived through several down cycles, nurses have to reinvent yourself every couple of years. Those older nurses I mentioned before have adaptable very well to new technology. My point, is that to stay active in nursing all nurses have to evolve to meet the job requirements.

Hushdawg · May 31, 2009

From my reading here, I think many of the IEN are expecting to come to the USA, with free housing, living in a city and working in a hospital. If you are preparing IEN for the realities of coming to the USA you are doing a good thing.

Not only that but we lessen the workload of the BONs because we handle screening and error-proofing and ensure that applications for licensure are complete with all requirements before BON recieves them.

We also educate nurses about all opportunities so that they aren't just applying to CA, VT and NM anymore.

As far an nurses retiring in the next 2-3 years, what I see and hear is that retirement age nurses are planning to work past retirement age due to their losses in 403(b) and 401 (k).

Bearing that in mind, how many of the 43% (roughly) of nurses reaching retirement age within 3 years are going to do that?

Even if only half of those retire it still means a large shortage that the US is not prepared to fill.

Many of the Associate Degree nurses have a BS in another field, for them getting a BSN is useless, they can go on and get a MSN. I don't think this is the time to bring up the BSN debate either since the competitive hospitals in my area, would hire a native ASN over a IEN so I don't think your premise is valid.

And many nurses from Asian countries are also doctors who second-course as nurses... so we're going in circles.

What would you rather have? A physician with an AS in nursing or with a BS in nursing?

I don't think you can think of nursing as a secure occupation, as a nurse who has lived through several down cycles, nurses have to reinvent yourself every couple of years. Those older nurses I mentioned before have adaptable very well to new technology. My point, is that to stay active in nursing all nurses have to evolve to meet the job requirements.

I agree, nursing is not always a secure occupation, that is why I suggest increasing the level of knowledge and education to make it more secure than with an AS alone.

I wholeheartedly agree with your point of staying active, but understand that for foreign nurses in order to renew or reactivate licenses from abroad the BONs require ongoing education of specific hours if their employment does not meet certain qualifiers. There are all sorts of things that the BON does to ensure that foreign nurses with licenses only keep them if they are maintaining their level of practical knowledge.

Trust the BONs a bit more; they do a lot of work to protect the US patients from poor quality immigrant nurses.