What will become of this testiomy?

nightingale, RN · Mar 24, 2002

Thank you for this posting! I hope you do not mind but I will cut and paste it here. I will write to the advocacy groupof the information posted. Here is the article:

Testimony submitted to Congressional

committees and federal agencies in 2001

Testimony

of the

American Hospital Association

before the

Immigration Subcommittee

of the

Judiciary Committee

of the

United States Senate

on

Rural and Urban Health Care Needs

May 22, 2001

Mr. Chairman, I am Bradley D. LeBaron, president and chief executive officer of the Uintah Basin Medical Center (UBMC), in Roosevelt, Utah, and chairman of the Utah Hospital Association. I am here today on behalf of the American Hospital Association's (AHA) nearly 5,000 hospital, health system, network and other health care provider members. We are pleased to have the opportunity to testify on the health care worker shortage crisis, an issue of great concern to the health care community and the general public.

UBMC is a rural 42-bed health care, 501c3, not-for-profit, independent facility in northeastern Utah. We employ over 300 health care personnel, and care for more than 2,100 inpatients per year, serving a population of 25,000. We are a sole community provider with a broad range of health care services including general acute medical services, home health and hospice.

Mr. Chairman, health care is at a critical juncture. Along with increased regulation and decreased reimbursement, a shortage of qualified workers greatly affects our ability to care for the nation's men, women and children. If nurses, physicians, respiratory therapists, pharmacists and scores of others who take care of the nation's ill and injured are not available, the collective mission of health care providers will be threatened.

This crisis affects every aspect of health care delivery, from direct patient care given by a nurse or respiratory therapist to prescriptions filled by a pharmacist and home health care visits from a nurse's assistant. The most visible of these, though, is a lack of nurses to provide the critical bedside care needed in the inpatient setting for today's patients, as well as those who require care in the future. The average age of our nation's nurses providing care today is 45, and the average age of our nursing faculty continues to rise. As these caregivers, teachers and mentors retire from the workforce, fewer health care workers are in training to take their places, as evidenced by the continuing nationwide decline in nursing school enrollment. Factor in the 78 million baby boomers who will begin retiring in the next 10 years, and our resources will be stressed even further. Demand for health care will exceed capacity.

Over the years, hospitals and health systems have repeatedly experienced temporary shortages of personnel, such as during the nursing shortages of the 1960s, 1970s and 1980s. Following a redesign of work place and personnel policies in response to these shortages - and often a recession in the general economy - the situation improved in most communities as previously-trained nurses were re-employed in hospitals and health facilities.

Our current and daunting shortage is unlike any we have seen in the past. While traditional factors such as an expanding national economy, overall low unemployment rates and competitive compensation packages are contributing to the current shortage, new demographics and other factors are exacerbating the situation.

Most nurses work in hospitals, but many are turning away from this traditional health care setting. Hospital patients are now older, sicker and require a greater intensity of care from nurses and other personnel. Nurses, and everyone involved in health care delivery, are spending an increasing amount of time on paperwork and less time on patient care. Women, who traditionally comprise the majority of nursing personnel, are finding other career options that are less physically demanding, less stressful and come with a higher rate of pay. Baby boomers, who make up a large part of the health care workforce, are approaching retirement. Nursing school and training programs are experiencing annual declines in enrollment, and some have even closed. Even if more students could be recruited into nursing schools, there is now a shortage in qualified nursing faculty, and the average age of nursing school professors is 52.

Over the past several years it has become increasingly difficult for hospitals to attract and recruit qualified nurses. Rural hospitals face this dilemma every day. At UBMC, we have 58 registered nurses (RN) and 38 licensed practical nurses (LPN) on staff; however, our current vacancy rate is at 7 percent among RNs, and 6 percent among LPNs. Three years ago, we had virtually no nursing vacancies. Our current vacancy rate is the worst it has been in my eight-year tenure with the hospital. In fact, earlier this month, we just barely averted losing three nurses to urban centers for better pay.

Along with other health care facilities around the country, we are looking at a variety of options to retain our current nursing staff and attract new nurses. In the last 18 months alone, we have increased RN wages by 17 percent, in an effort to compete with larger health care facilities in other areas of our state.

UBMC is one of the few rural institutions with a nurse's education program in our town. We have partnerships with the baccalaureate nursing programs at Utah State University branch campus and Weaver State University, as well as with the LPN training at Uintah Basin Applied Technology Center. We graduate 20 nurses a year from these programs. But even last year, 14 nurses left the area to work in other areas of the state and country.

The public's demand for the highest quality patient care at the lowest possible cost has come face to face with the tightest labor market in the past 30 years. For example, government projections state that by 2020 we will face a shortfall of about 300,000 registered nurses.

Mr. Chairman, your colleagues in the Senate and the House, along with health care leaders, are working to find long-term solutions to the challenges we face. Hospitals and health care provider institutions across the nation are looking at retooling their retention and recruitment strategies, offering bonuses and providing other incentives, such as tuition reimbursement and child care, to attract and retain qualified health care workers to their facilities. The AHA formed the Commission on Workforce for Hospitals and Health Systems, asking a diverse population of stakeholders to work together and craft recommendations and bold solutions for this national dilemma. The commission represents hospital administrators, caregivers, academia, business leaders, frontline nurses, organized labor and many others. In addition, the Utah Hospital Association has formed the UHA Workforce Taskforce, to address what is becoming a critical shortage of nurses - and other health care staff - in Utah.

Yet even as we develop long-term strategies to expand our workforce, we face immediate shortages across the country. It takes a minimum of two years for a student to complete a professional nursing program with an associate's degree. Unfortunately, even if we were able to recruit scores of men and women into our nursing education programs, we still face daunting shortages. Using foreign nurses on a temporary basis is one of the few options that may help us address this need. According to Peter Buerhaus et al. (Implications of an Aging Registered Nurse Workforce, JAMA, June 2000), "immigration of RNs educated outside of the United States may provide the most feasible strategy." We would be able to fill many critical clinical nursing positions in an expedited manner.

Until 1995, temporary visa programs existed to help address episodic nursing shortages. For example, the now defunct H-1A visa program was used specifically to allow RNs licensed in their own countries to enter the U.S. temporarily. However, the current shortage we are facing is dramatically different, and we need both short- and long-term approaches. Currently, only one temporary program exists, the H-1C visa program for nurses. While I am certainly not an expert on immigration law, I can tell you that even this option is woefully inadequate, and fraught with complicated conditions, making it almost impossible for hospitals to use this as a remedy for their current troubles.

In 1999, Congress created the temporary three-year H-1C visa program, a narrowly crafted measure to enable health care facilities in underserved communities to recruit critically needed health care staff, specifically nurses, from foreign countries. Under this program, 500 foreign nurses per year may enter the country. But this program is almost useless. In order for a hospital to take advantage of this program and sponsor a foreign nurse into our country, the facility must have a minimum of 190 beds; their patient population must be comprised of at least 35 percent Medicare and 28 percent Medicaid recipients; their geographic location must have been designated as a Health Professional Shortage Area as of March 30, 1997; and the facility must meet strict labor certification requirements. Currently, given these rigid criteria only 14 out of our country's more than 5,000 hospitals even qualify for this program. And to my knowledge, not one registered nurse has entered the U.S. under the H-1C program.

The H-1B visa program is another program that, on paper, would appear to assist hospitals in bringing in foreign nurses on a temporary basis. Unfortunately, this is not the case. Last year, Congress amended the H-1B visa program, enabling skilled professionals with an employer-sponsored job in the U.S. to enter the country and work for up to six years. The requirements also state that in order to qualify for an H-1B visa, the individual must have a college degree and the job must require a bachelor's degree as a minimum level of entry. RNs generally do not qualify under the H-1B program since most hospitals and other employers who hire nurses do not require nurses to hold baccalaureate degrees. Another disadvantage is that these visas are limited in number each year, and the quota is generally reached early in the year. This illustrates the crucial need to reform our current immigration policies as it relates to nurses.

Some of my colleagues in Utah have attempted to work through these complex and nonsensical immigration rules, in order to fill critical positions in their facilities. It took one hospital almost 18 months to obtain a foreign nurse to care for their patients using the EB-3 (green card) visa program. Another facility in southeastern Utah is having a difficult time obtaining approvals to immigrate a foreign medical technician. But most rural facilities cannot afford the cost or time delay to obtain foreign nurses or other foreign health care workers.

Conclusion

To pretend that we can take care of the nursing shortage domestically is a disservice to patients. This is a problem that cannot be solved by hospitals or any one group alone. And it cannot be solved solely by the federal government. It demands a multi-tiered, collaborative approach among all affected parties to develop short- and long-term effective strategies and solutions to meet the health care needs of today and tomorrow. Revising our immigration policies toward foreign-born nurses is one way to apply a salve to this growing wound afflicting our health care system.

We have a critical shortage of women and men who are willing to serve in health care. This will only get worse, unless we work together to craft solutions that will allow us to continue our calling of providing compassionate care to all.

Thank you, Mr. Chairman.

Brownms46 · Mar 24, 2002

Thanks nightngale....no...I have no objection over your doing as you see fit...I bow to your expertise here.... :cool:

Lillith · Mar 24, 2002

Having read the article in its entirety, I don't think imported nurses are the solution, even if there were enough to solve the problem.

The solution is better pay, better pay, and better pay, for a start. Then, go on to GOOD insurance, incentives, bonuses, and how about q 3rd weekend work?

The facility where I work has dealt with the problem of call-ins by implementing a policy so punitive that we must use our hard-earned vacation time for sick days. Only after an extended illness of 4 days or more does our sick pay kick in. If one is 8 minutes late for work, you're classified as a no-call, no-show and can be terminated, even if you've ended up in the ditch in a blizzard, and, having been towed out, continue on to work. I could go on and on, but you get the drift....

It seems to me that in the face of an undoable work load that requires the patience of a saint and the muscle of a rhinosoraus, no errors, and an endlessly cheerful and caring demeanor, far too many institutions have chosen to punish us into compliance instead of paying and staffing appropriately. And, as long as there are discussions as to whether or not nurses should be concerned about compensation vs job satisfaction, (as if the two are not related or perhaps it's inappropriate for nurses to be concerned about money) it'll all just go on as it is.

My solution is to educated myself into a stupid Mon - Fri desk job that'll pay $10,000 more a year. Makes sense?

Well, within the system of health care, that's my only option if I want to avoid running by a$$ off for 9 hours a shift trying to do the undoable, and, incidently, earn a living wage.

And that's the way it is in 2002.

I end with no signature. Only Registered Nurses are may have signatures.

nightingale, RN · Mar 24, 2002

Well.... I do not consider myself an expert... I am in a high learning mode of all this data. I feel like a sponge and feel rather dry and needy of this type of information. Of interest was the conclusion of this article:

We have a critical shortage of women and men who are willing to serve in health care. This will only get worse, unless we work together to craft solutions that will allow us to continue our calling of providing compassionate care to all.

Certainly, the solution of importing nurses is not the key for me of this article. It is the recognition that continued attempts to recruit nurses are failing.

Yes, there is not a bottomless supply of quality health care workers to import. I find it amazing that AHA knows of this delema of nurses not wanting to do health care here in the US and the minimal efforts that are being made to change the work conditions. That is what I addressed when I wrote a commentary to this article through the advocacy site where the article is posted.

Lillith: I do not know what you are referring to when you state:

I end with no signature. Only Registered Nurses are may have signatures

What is up with that? Is that a sign on thing or what?

I felt your remarks were appropriate and you sound like a nurse. The RN thing is not the only type of nurse who posts here. I happen to be one but it does not make me an expert. We are all in this together.

B.

scrappy · Mar 24, 2002

He forgot to add in his letter that this would help the hospitals keep nursing pay low, patient acuity high,and keep nurse to patient ratios at a dangerous level thereby saving the hospitals money.

Not to long ago, I was working and as usual, was very busy. When I got to one patient's room, I was litteraly out of breath. The patient looked at me and said, "poor dear, this nursing shortage is really hard on you isn't it". I thought to myself, what nursing shortage, we are staffed by census and we have all the nurses they will allow us to have, they even cancelled one. This, of course, is not an isolated incident. Most places around here are staffed by census, and hey, they do occasionally cancel a nurse, sometimes even two. But when the patients see us running around too busy to even use the restroom, the hospital/health care system does not get the blame. It is blamed on the nursing shortage. :cool:

scrappy · Mar 24, 2002

He forgot to add in his letter that this would help the hospitals keep nursing pay low, patient acuity high,and keep nurse to patient ratios at a dangerous level thereby saving the hospitals money.

Not to long ago, I was working and as usual, was very busy. When I got to one patient's room, I was litteraly out of breath. The patient looked at me and said, "poor dear, this nursing shortage is really hard on you isn't it". I thought to myself, what nursing shortage, we are staffed by census and we have all the nurses they will allow us to have, they even cancelled one. This, of course, is not an isolated incident. Most places around here are staffed by census, and hey, they do occasionally cancel a nurse, sometimes even two. But when the patients see us running around too busy to even use the restroom, the hospital/health care system does not get the blame. It is blamed on the nursing shortage.

nightingale, RN · Mar 24, 2002

Good point Scrappy... ditto from my perspective as well... thank you for putting it into words....

B.

-jt · Mar 25, 2002

Bonnie, the key point of that entire article was that that is how the AHA is lobbying Congress to change the current laws so to allow an increase in importation of foreign nurses. Everything else was a prelude to the punchline - "let us import more nurses from overseas so we dont have to spend any money on making any workplace improvements to get our own nurses back".

The "recruitment/retention" tools he mentions arent working because they dont address the problem. The question is at what point will they stop playing this game & admit that they have to repair the working environment before people will want to take these jobs. People will not work in hospitals nowadays because of the poor salaries & WORKING CONDITIONS. Offering one-time bonuses & child care is not going to fix that. This is a stand off between healthcare workers & the AHA. The AHA will blame everything under the sun for the "shortage" (which is really a REFUSAL to work in these conditions). It will even admit that people arent taking the jobs it offers but it will not answer the question "WHY?" It will come up with every reason it can think of, as you see in that article, than the REAL one for why they cant find staff. Theyre avoiding the issue to avoid spending the money on the needed improvements. The AHA is trying to take the cheapest, easiest way out & the nurses of America are trying to prevent the legislators from being duped by it.........

OPPOSE increasing importation of RNs

Immigration and the Nursing Workforce:

"ANA believes that the U. S. healthcare industry has FAILED TO MAINTAIN a work environment that is conducive to safe, quality nursing practice and that retains experienced U. S. nurses within patient care.

ANA supports continuation of the CURRENT certification process to apply to all foreign-educated health care workers regardless of their visa or other entry status. ANA OPPOSES efforts to exempt foreign-educated nurses from current H-1B visa program requirements........

The Issues Surrounding Immigration and the Nursing Workforce:

The practice of changing immigration law to facilitate the use of foreign-educated nurses is a short-term solution that serves only the interests of the HOSPITAL INDUSTRY, not the interests of patients, domestic nurses, or foreign-educated nurses.

ANA condemns the practice of recruiting nurses from countries with their own nursing shortage......

The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 requires that all foreign health care professionals, except physicians, must be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or another independent, government-certified organization qualified to issue

credentials. The certification process verifies that the foreign health care worker's education, training, or experience meets all applicable statutory and regulatory requirements for entry into the United States. In addition, any foreign license submitted must be validated as authentic and unencumbered. If the health care worker is a registered nurse (RN), the nurse must have passed an examination testing both nursing skill and English language

proficiency........

The CAUSE of the instability in the nursing workforce must be addressed ......

Over-reliance on foreign-educated nurses serves only to POSTPONE efforts required to address the needs of the U.S. nursing workforce........

Foreign-educated nurses brought into the United States tend to be placed in jobs with unacceptable working conditions with the expectation that these nurses, as temporary residents and foreigners, would not be in a position to complain......

ANA OPPOSES this legislation that would change the regulations and certification process and OPPOSES legislation that will allow for increasing the numbers of nurses healthcare facilities may recruit from over-seas. All US nurses are asked to contact their elected federal legislators and urge them to do the same.

http://www.ana.org/gova/federal/legis/107/rnltc.htm

Further ANA testimony to Congress regarding the Nursing Crisis can be read on the Governmental Affairs webpage at the ANA website

For a comparison chart of current regulations versus the new proposed legislation that would change these regulations, reduce the certification process, and increase the number of nurses that can be recruited from overseas,

See http://www.ana.org/gova/federal/gachrt97.htm

The AHA must focus on improving the working environment for nurses - not on bringing in foreign nurses who do not have a choice on whether to work under those conditions.

Tell your Congressman and US Senator to vote NO on the AHA proposed legislation to increase importation of nurses.

>>>>>>>

nightingale, RN · Mar 25, 2002

Writing to them is like handing a cup of water in a blazing storm... geech!

B.

Jenny P · Mar 25, 2002

Nightingale, what do you mean by

"Writing to them is like handing a cup of water in a blazing storm... geech!"

Whom are you talking about writing to: 1. your congressmen; 2. the AHA; or 3. the ANA?

I write to my congressmen frequently; have NEVER written to the AHA, and have called the ANA, but am active at my state Assoc. level and am known there. Because I do write and email my congressmen, I am on their survey lists. I haven't made it to recent MNA-sponsored "Meet Your Legislators" days at the capital (working nights doesn't work with daytime meetings like that); but when I used to do that; I was recognized by my legislators back then. And I do believe that your voice (and vote) DOES carry weight--IF you use it!

nightingale, RN · Mar 26, 2002

I was referring to writing to the AHA.. which I did not get the jist of the story (with the first reading) .. to be honest....

You are right Jenny.... I should be concentrating on writing to my Legislative Rep. . I did go to Legislative Day in Cheyenne in February. I have written some emails but not in a while.

B.