Emergency Nurse Relief Act 2009- Update

Ginger's Mom, MSN, RN · May 25, 2009

That is NOT at all why this bill is being introduced.
The bill is being introduced because there are not enough nurses working in the USA. There are many reasons for this, many factors. NONE of those has anything to do with a negative view on native-born and educated nurses.
The issue is that we have very low nurse to patient ratios in the USA and need nurses desperately, currently the projected graduating nurses for the next three years cannot satisfy the growing needs of nurses in the USA.
Nurses are not a shortage in major metro areas but in rural hospitals and smaller cities it is a crisis.
So many people on this blogsite talk about how there are hiring freezes and no jobs available yet staffing firms are hounded by requests from hospitals all over the country to find them qualified nurses from anywhere!

What agencies are recruiting and where?

Usually my daily mail would be full of letters asking me to join their agency? There would be job fair where Nurse Managers would interview people on site. Nursing Journals would be full of ads looking for nurses,

There use to be recruitment bonuses .

All these recruiting tools have gone away. I look at the stats in my local hospitals, no job openings.

As far as rural nursing, stats have shown that foreign trained nurses migrate to large cities and rarely to rural areas. I have not heard of many rural foreign employed nurses ( places like rural Maine or on Indian Reservations).

Ginger's Mom, MSN, RN · May 25, 2009

My goodness I can practically hear the US national anthem being hummed in the background while reading these posts.
How exactly are you defining American?
Why would a European country hire someone who is not fluent in their language? After all we require that people have excellent command of English (I should say American English).
Why would a foreign country hire a nurse with a two year degree? The UK is 3 years for a diploma and four for a degree. Also, they have a longer school year than us. Further, the entire degree or diploma or degree is related to nursing (no fun little history of art, or women's studies electives).
How precisely does someone benefit culturally from having an "American nurse"? Does that mean my Kenyan friend can get a Kenyan nurse? I have a Swedish neighbor what about him?My Irish mother had a Filipino nurse just a few weeks ago -- thank goodness she didn't suffer (by the way this nurse was possibly the best nurse I have EVER observed at that hospital).
Incidentally, I suspect your BONs, undoubtedly made up of American nurses, have the same white papers on this subject as mine. Please go educate yourselves before you start banging on about this anti-foreigner stuff and see why they are concerned about nursing numbers.
Aging population, aging nursing workforce, aging faculty with NOT enough qualified nurses in the pipeline to manage the numbers nor enough facilities to get them qualified.
Also, whoever judges the number of nurses needed by the number of available jobs in their area...well...it is just silly to extrapolate the nursing needs of these United States from your little corner of it.
Your lively-hood isn't going to be "taken away" by in-sourcing. What a load of xenophobic tosh.

American Nurses would need to be fluent in the local language and meet the educational requirement , yet that doesn't happen.

I am on weekly conference calls with US Hospitals and I hear that their is no nursing shortage due to the economy.

eriksoln, BSN, RN · May 25, 2009

That is NOT at all why this bill is being introduced.
The bill is being introduced because there are not enough nurses working in the USA. There are many reasons for this, many factors. NONE of those has anything to do with a negative view on native-born and educated nurses.
The issue is that we have very low nurse to patient ratios in the USA and need nurses desperately, currently the projected graduating nurses for the next three years cannot satisfy the growing needs of nurses in the USA.
Nurses are not a shortage in major metro areas but in rural hospitals and smaller cities it is a crisis.
So many people on this blogsite talk about how there are hiring freezes and no jobs available yet staffing firms are hounded by requests from hospitals all over the country to find them qualified nurses from anywhere!

Whatever agency your are speaking of is an exception, not the rule. The vast majority of my travel nurse comrades have left the field because of lack of jobs. Agency nursing is a thing of the past here where I live, there is no need for them.

And the hospitals who continue to have a staffing shortage despite the flux of new nurses looking for job opportunities........................what the heck kind of work conditions are they functioning with that even in today's economy, people still turn down their job offers? There is one nursing home semi-close to me that is still hiring, but no one who knows better even applies. Its a poorly managed facility to say the least. When the job market got bad, they stuck their chins in the air, fired a lot of their staff and refused to implement agency nurses. They also lowered wages, initiated mandatory scheduleing (in other words, you have no "shift" you work, you could be put anywhere at any time) and raised nurse/pt ratios. That lasted about 4 months, now they are back to square one, begging for nurses to join their "team". No one will, so they claim to be victims of a "nursing shortage". I think it is plain to see their problems have notta to do with a phantom shortage.

Ginger's Mom, MSN, RN · May 25, 2009

I have just read the whole blog you are referring to from the very start. It seems that you, using multiple usernames on that blog instigated the whole thing by calling foreign educated nurses as inferior.
And you cry when people try to defend them? What crap are your trying to pull?
It's also very easy to conclude that you are the same person who is trolling that site and instigating things like you do here at allnurses.com.
You keep using the same xenophobic, ignorant lines from the past year or so. It was very easy to conclude that you are the same person. What were you doing there anyway?
And how thick face can you get by bashing foreign educated nurses in such a thread and bashing the immigration lawyer (and therefore all immigration lawyers as well) who authored it on his own blog site.
Of course, he will defend himself because unlike you he uses his actual name and does not hide by a username or hide on being anonymous.
And by the way the debate/discussion that went there other commentators seems to be more knowledgeable than you are.
Furthermore, they back up what they say unlike you that can't even stick with one story (nor stick with one username).
P.S. Hope you don't make an excuse that it's not you there. It's very obvious, specially that you are obviously trying hard to bring it over here and trying to turn the tables on him and hope no one actually reads the whole comments from the beginning and just read the last few new ones.

Nurses should be educated in the country they wish to practice. That is time test way of education.

In my own family, my daughter thought of going to a foreign medical school, even they best foreign medical school (and there are many that are superior to US Medical Schools ) are viewed not equal - I don't think I have ever used the word inferior but the education from a foreign medical school even the best does not prepare a doctor for American Health care. Lucky for her she is attending an American Medical School.

That being said, my primary care physician is a foreign educate doctor and he is the best. His son is now in medical school, did he choose to send him to a his medical school, no he is attending an American Medical School since he felt that would be the best education.

My last point nursing shortage should be determined by nurses and health care experts, not immigration lawyers who bash US nurses (stating they are not able to cope, will leave patients during a pandemic, not as well educated as Foreign Educated Nurses). Nurses are not determining the number of US lawyers why should lawyers determine nursing shortage. According there previous posts, there would be a critical shortage and patients dying in 2009 due to the lack of nurses, so far that has not happened.

lindarn · May 25, 2009

There are 500, 000 American nurses not presently working actively in nursing. Most have left due to poor working conditions, low pay, and a lack of respect. I agree that many would come back to work if the working conditions were improved.

I recently applied to a local nursing home for a full time evening position. I would be responsible for passing meds for 30 patients on one side, and 14 on the other side. The 14 patients were all ventilator patients. There would be me and one Respiratory Therapist to care for these patients. The interviewer assured me that the work load was, "very do able".

I declined the job. If this is what is causing the "nursing shortage", I don't think it has anything to do with nurses not wanting to take care of patients, or being too lazy to do a good job. I asked the interviewer why they didn't hire another nurse for the evening shift, and she replied that "they were not allowed to because they did not think another nurse was necessary". I rest my case. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Lovely_RN, MSN · May 25, 2009

I can only write about my experiences. I work in a SNF and recently the DNS has hired 6 MORE foreign nurses via agency because we don't have enough staff. The DNS is from the same country as these foreign nurses and though they have been trained as RN/BSNs they are working as LPNs on permit. Meaning they haven't even passed the LPN boards much less the RN boards. The DNS and the administrator are crying to the union that the facility is desperate for nurses but is this really true?

One of our CNAs became an LPN recently and wanted a position at our facility. She had to go to the administrator with the union delegate and explain that she had worked in our facility as a CNA for 4 years with no problems and yet the DNS told her that there were no openings. Once the union delegate got involved and threatened to file a grievance because we were using so many agency nurses a position magically opened up for the new LPN. This LPN has also sent many of her friends, new grad LPNs, to the facility to apply for positions and not one of them has been hired. I have also sent LPNs that I know to my facility to apply for positions and they never get hired or even called in for an interview.

I have been told by the foreign nurses that they are working for an entire $8/hr LESS than what I as a union member am being paid. They have no health benefits and my employer justifies the wage by providing them with housing; if you can call living 5 to a 1 bedroom apt adequate housing. Why do they put up with it? They do it because there are NO jobs in their native country and most of them have left behind spouses, parents, and children in their home country and are grateful to be able to send money back home. The wage is not enough to live on with their families in the US but with the exchange rate they are able to live comfortably back home.

I don't give a damn if anyone thinks I am xenophobic this is inherently unfair. My children, parents, and spouse live in the U.S and $50 or $100 in US dollars per week isn't going to take care of the entire family the way it will in countries where the exchange rate is $1US to a hundred or more of the foreign dollar.

Another issue is the working conditions. The reason that many nursing positions are difficult to fill is because the conditions are absolutely horrendous. What I notice about the foreign nurses is that they do not complain about the ridiculous ratios or the impossible workload. Now this doesn't mean that they are getting the work done on anything but paper but it means that the residents continue to suffer because only a handful of us speak out and we are labeled as whiners.

Tell me that it's possible for one LPN to take care 41 skilled nursing home resident's and I will have no problem calling you the liar that you are. There is no way to pass out multiple meds for these residents, many requiring full sets of vital signs, within two hours to remain in compliance. There is no way for the same single nurse to provide trach care, wound care, blood glucose monitoring, dining room duty, and all of the paperwork that is required. Yet these foreign trained nurses manage to get it all done w/o complaint. Funny thing is that when I work behind these same nurse I see the clogged trachs/GTs, the vital signs that are just written in and the dressings that haven't been changed since the last time I worked. Yet these are the perfect nurses that are willing to work back to back to back double shifts and when the DNS says jump they say how high? Is it because they have such a great work ethic and I am a lazy American or is it because they are terrified of losing their positions and having to go back home? There is a good reason why I am not willing to cover as many shifts are the foreign nurses do. It's not because I don't like to make money or wear Coach purses (words from my DNS mouth) it's because when I go to work I actually bust my rear and DO the work. I can't work OT because I feel like collapsing after 4 weekly shifts and I know dang well that I would have to cut major corners if I worked the 8 or more that they do.

I admit and I am not ashamed to admit that once I take my RN boards I am running for the hills because of the working conditions. If there is a shortage of American nurses at my facility it's for a good reason. I don't hate the foreign nurses and I feel sorry that they are being brought to this country and are being made to work like people in a sweat shop rather than the professionals that they are. The bottom line is that the residents are suffering and importing foreign nurses is not the solution to providing better patient care. It's nothing more than a way for employers to undercut the wages of the nurses who are already here and to make us shut out mouths by saying that we are lazy whiners. I really hope that the people who think that this is a good idea end up with a family member in one of these facilities so that they can gain a first hand understanding of what really goes on in the nursing home/SNF business. Better yet I hope the people who are responsible for creating these conditions end up as a resident.

Anyone who thinks that bringing in foreign workers doesn't have an impact on the ability of U.S nurses to get jobs and fight for good working conditions is smoking that green stuff. Just look at what happened to the IT field and if you think it can't happen in nursing then maybe you are smoking something even stronger than that funky green stuff.

2BSure · May 25, 2009

Our version of fluency does not even come close to what Europe requires of us. In Germany, you have to speak German with practically no accent. Americans say that you either had to be raised by a German or spent your childhood living there.
You used the word "tosh" so my guess is you come from the British Isles and so does my mother. I am no fool on this subject. Europeans should be last in line to call anyone xenophobic when they think we should protect jobs for our own countrymen first. :angryfire
Please! Go sell that to someone else! :angryfire
My "little corner" of the US has the same problems that friends of mine in other parts of the country have and to be frank, it really doesn't take much to google and discover the plethora of articles talking about the lack of a nursing shortage in any part of the country.
I have no idea how you can defend the assertion that in-sourcing won't take away jobs from Americans. Unless every single American is employed, I see no reason to admit foreigners to do the job. Again, there are plenty of registered nurses. If employers were desperate, they would try harder to attract them back to the bedside. These folks simply refuse to work under those conditions or they are at home with their families or moved into another role that isn't at the bedside. They would come back under the right conditions. Plain and simple.
American hospitals and colleges would find enough American nurses to fill those jobs if they needed to but in-sourcing is easier and more cost effective. All of this assumes that there becomes a real need, as opposed to a predicted need for nurses. Who knows? They may reformat and we end up with fewer nurses working with more CNA/PCTs and EMTs. What should we say then? Should we say "oops"?
I didn't miss your sarcasm either. I am delighted your mother received excellent care but if your neighbor is dreadfully concerned about finding a Kenyan or Swedish nurse then they should return to the country where they are most likely to run into those nurses. Otherwise, I am afraid they are left with the folks we have here.
I define American broadly: people who are here now and are legally here.

First of all what does it matter if I am from the moon? Are you seeking to nullyfy my argument purely based on that you think I am a Brit? Also, having a British mommy neither makes you an authority on Britain nor its foreign policy. In fact, I guarantee you have no idea how many countries Britain has formal open immigration policies with. From your accusation, of them having a jingoistic immigration policy, you essentially think there are none. Wrong-o my little friend.

Any crackpot with internet access can post an article that would come up in a Google search. Try searching for one's that claim Elvis still lives or that alien abductions happen. Your sources are skewed. The information that this government gets is information based of census data and that which is supplied by our own profession (hence my suggestion that you look for your own BONs white paper on this subject). Now if you reject out of hand the reasoning for bringing nurses from abroad because don't trust our profession (BONs and similar) and you don't trust the government, fine. But your scope of data collection for your argument (uncited google sources and "friends of mine") hardly move me to even consider your opinion has merit.

You still did not address how American nurses better serve culturally. Serve who better, culturally? And how (specifically)?

Thank God for foreign nurses because they prevent us from having to hire some of the dross out there out of sheer desperation.

eriksoln, BSN, RN · May 25, 2009

First of all what does it matter if I am from the moon? Are you seeking to nullyfy my argument purely based on that you think I am a Brit? Also, having a British mommy neither makes you an authority on Britain nor its foreign policy. In fact, I guarantee you have no idea how many countries Britain has formal open immigration policies with. From your accusation, of them having a jingoistic immigration policy, you essentially think there are none. Wrong-o my little friend.
Any crackpot with internet access can post an article that would come up in a Google search. Try searching for one's that claim Elvis still lives or that alien abductions happen. Your sources are skewed. The information that this government gets is information based of census data and that which is supplied by our own profession (hence my suggestion that you look for your own BONs white paper on this subject). Now if you reject out of hand the reasoning for bringing nurses from abroad because don't trust our profession (BONs and similar) and you don't trust the government, fine. But your scope of data collection for your argument (uncited google sources and "friends of mine") hardly move me to even consider your opinion has merit.
You still did not address how American nurses better serve culturally. Serve who better, culturally? And how (specifically)?
Thank God for foreign nurses because they prevent us from having to hire some of the dross out there out of sheer desperation.

I agree, having foreign nurses helps improve the overall quality of the nursing field. I've worked with foreign nurses that I loved. Worked with a few that made me say........hmmmmmm. And there are a lot of people getting into nursing for survival, not because they want to do it. Cant tell you how many people I've talked to who tell me "I'm going to nursing school. Its better than what I do now. I know its stressful but, just to get through the next few years of bad economy, you cant beat it. I talked to a career counselor ( :down: ) who told me I'll find a job right away and get much better health benefits."

When I finish laughing at the thought of these people being nurses (lets just say, they dont have the tolerence for stress and pressure it requires, their view of nursing comes from Grey's Anatomy and ER), I tell them the truths about the job market for nurses. I direct them to some of the hopital sites that have completely deleted their job postings board. I also show them letters from friends who have had to take paycuts or had their insurace coverage changed to save the hospital money. I then show them the letters from my own hospital explaining how raises are "on hold for the time being".

After all of this, 90% of the people change their minds. One even pointed out to me that, as a short distance truck driver..............he has better health insurance. Not saying truck drivers shouldnt have the insurance they have, but if someone who works for the hospital should at the very least have good insurance (the current situation would be like...........an accountant not having access to any banks for personal use).

I would follow your debate with this though. Yes, foreign nurses improve the quality of the nursing field. And yes, there are MANY people going into it for survival instead of to contribute to the profession. On the other hand, how do you explain so many new grads being turned away at the door? They have not been given the change to prove if they belong or not. No telling which side of the fence they are on. The complaints about job opportunities has risen from "I only have two job interviews" to "I have no interviews and the HR told me quit calling". Yet, they will import foreign nurses who in the short term cost more to train and present more of a risk (in terms of retention.............what if they decide they dont like the U.S. or our way of delivering healthcare?).

I dont like the sudden popularity of bringing in foreign nurses because of why it is being done. It costs more than hiring a new grad, yet hospitals not hiring new grads state they dont have the money to do so..........and turn around and scout for nurses in the Phillipines. Administration is doing this to thumb their noses at the Profession of Nursing. They want to create an environment where sweat shop conditions are the norm and nothing can be done about it. Bringing in foreign nurses, chaining them down with contracts and diluteing the market is a major step towards achieving this.

2BSure · May 25, 2009

I can only write about my experiences. I work in a SNF and recently the DNS has hired 6 MORE foreign nurses via agency because we don't have enough staff. The DNS is from the same country as these foreign nurses and though they have been trained as RN/BSNs they are working as LPNs on permit. Meaning they haven't even passed the LPN boards much less the RN boards. The DNS and the administrator are crying to the union that the facility is desperate for nurses but is this really true?
One of our CNAs became an LPN recently and wanted a position at our facility. She had to go to the administrator with the union delegate and explain that she had worked in our facility as a CNA for 4 years with no problems and yet the DNS told her that there were no openings. Once the union delegate got involved and threatened to file a grievance because we were using so many agency nurses a position magically opened up for the new LPN. This LPN has also sent many of her friends, new grad LPNs, to the facility to apply for positions and not one of them has been hired. I have also sent LPNs that I know to my facility to apply for positions and they never get hired or even called in for an interview.
I have been told by the foreign nurses that they are working for an entire $8/hr LESS than what I as a union member am being paid. They have no health benefits and my employer justifies the wage by providing them with housing; if you can call living 5 to a 1 bedroom apt adequate housing. Why do they put up with it? They do it because there are NO jobs in their native country and most of them have left behind spouses, parents, and children in their home country and are grateful to be able to send money back home. The wage is not enough to live on with their families in the US but with the exchange rate they are able to live comfortably back home.
I don't give a damn if anyone thinks I am xenophobic this is inherently unfair. My children, parents, and spouse live in the U.S and $50 or $100 in US dollars per week isn't going to take care of the entire family the way it will in countries where the exchange rate is $1US to a hundred or more of the foreign dollar.
Another issue is the working conditions. The reason that many nursing positions are difficult to fill is because the conditions are absolutely horrendous. What I notice about the foreign nurses is that they do not complain about the ridiculous ratios or the impossible workload. Now this doesn't mean that they are getting the work done on anything but paper but it means that the residents continue to suffer because only a handful of us speak out and we are labeled as whiners.
Tell me that it's possible for one LPN to take care 41 skilled nursing home resident's and I will have no problem calling you the liar that you are. There is no way to pass out multiple meds for these residents, many requiring full sets of vital signs, within two hours to remain in compliance. There is no way for the same single nurse to provide trach care, wound care, blood glucose monitoring, dining room duty, and all of the paperwork that is required. Yet these foreign trained nurses manage to get it all done w/o complaint. Funny thing is that when I work behind these same nurse I see the clogged trachs/GTs, the vital signs that are just written in and the dressings that haven't been changed since the last time I worked. Yet these are the perfect nurses that are willing to work back to back to back double shifts and when the DNS says jump they say how high? Is it because they have such a great work ethic and I am a lazy American or is it because they are terrified of losing their positions and having to go back home? There is a good reason why I am not willing to cover as many shifts are the foreign nurses do. It's not because I don't like to make money or wear Coach purses (words from my DNS mouth) it's because when I go to work I actually bust my rear and DO the work. I can't work OT because I feel like collapsing after 4 weekly shifts and I know dang well that I would have to cut major corners if I worked the 8 or more that they do.
I admit and I am not ashamed to admit that once I take my RN boards I am running for the hills because of the working conditions. If there is a shortage of American nurses at my facility it's for a good reason. I don't hate the foreign nurses and I feel sorry that they are being brought to this country and are being made to work like people in a sweat shop rather than the professionals that they are. The bottom line is that the residents are suffering and importing foreign nurses is not the solution to providing better patient care. It's nothing more than a way for employers to undercut the wages of the nurses who are already here and to make us shut out mouths by saying that we are lazy whiners. I really hope that the people who think that this is a good idea end up with a family member in one of these facilities so that they can gain a first hand understanding of what really goes on in the nursing home/SNF business. Better yet I hope the people who are responsible for creating these conditions end up as a resident.
Anyone who thinks that bringing in foreign workers doesn't have an impact on the ability of U.S nurses to get jobs and fight for good working conditions is smoking that green stuff. Just look at what happened to the IT field and if you think it can't happen in nursing then maybe you are smoking something even stronger than that funky green stuff.

It is quite a standard of most every corporation world-wide to use temp-style workers, not just in American healthcare. This isn't anything to do with foreigners. Can you think why...? Think about why one can hire someone and keep them on weekly hours just below the point where the that company have to kick in benefits. Think about how the balance sheets of ANY company (non-profit or not) reflect salaries and benefits. Think about company's bottom lines (non-profits are no exception as they are responsible to donors).

As for this anecdotal stuff about trachs etc. I can give as many examples of dreadful care by true blue American nurses. Crappy nurses are everywhere from anywhere.

2BSure · May 25, 2009

I agree, having foreign nurses helps improve the overall quality of the nursing field. I've worked with foreign nurses that I loved. Worked with a few that made me say........hmmmmmm. And there are a lot of people getting into nursing for survival, not because they want to do it. Cant tell you how many people I've talked to who tell me "I'm going to nursing school. Its better than what I do now. I know its stressful but, just to get through the next few years of bad economy, you cant beat it. I talked to a career counselor () who told me I'll find a job right away and get much better health benefits."
When I finish laughing at the thought of these people being nurses (lets just say, they dont have the tolerence for stress and pressure it requires, their view of nursing comes from Grey's Anatomy and ER), I tell them the truths about the job market for nurses. I direct them to some of the hopital sites that have completely deleted their job postings board. I also show them letters from friends who have had to take paycuts or had their insurace coverage changed to save the hospital money. I then show them the letters from my own hospital explaining how raises are "on hold for the time being".
After all of this, 90% of the people change their minds. One even pointed out to me that, as a short distance truck driver..............he has better health insurance. Not saying truck drivers shouldnt have the insurance they have, but if someone who works for the hospital should at the very least have good insurance (the current situation would be like...........an accountant not having access to any banks for personal use).
I would follow your debate with this though. Yes, foreign nurses improve the quality of the nursing field. And yes, there are MANY people going into it for survival instead of to contribute to the profession. On the other hand, how do you explain so many new grads being turned away at the door? They have not been given the change to prove if they belong or not. No telling which side of the fence they are on. The complaints about job opportunities has risen from "I only have two job interviews" to "I have no interviews and the HR told me quit calling". Yet, they will import foreign nurses who in the short term cost more to train and present more of a risk (in terms of retention.............what if they decide they dont like the U.S. or our way of delivering healthcare?).
I dont like the sudden popularity of bringing in foreign nurses because of why it is being done. It costs more than hiring a new grad, yet hospitals not hiring new grads state they dont have the money to do so..........and turn around and scout for nurses in the Phillipines. Administration is doing this to thumb their noses at the Profession of Nursing. They want to create an environment where sweat shop conditions are the norm and nothing can be done about it. Bringing in foreign nurses, chaining them down with contracts and diluteing the market is a major step towards achieving this.

You mean when I watch ER or Grey's Anatomy it isn't how I am really supposed to behave at work? Darn it! Actually I am not sure I have seen nurses on any show but ER.

allnurses Guide · May 25, 2009

I love and admire the many foreign nurse graduates I've worked with over the years.

An amazing RN who oriented me when I was a new grad taught me organizational skilld that continue to help me. She is also a friend.

Most are now U.S. citizens now. and leaders in our patient and social advoacy work.

BUT we have a shortage of nurses willing to work under the unsafe conditions that place both our patients health and our licenses at risk.

I think we need to bring back those who left and educate more nurses to replace our soon to retire boomers (wherever they were born).

Lovely_RN, MSN · May 25, 2009

You're missing my point. I'm not calling the foreign nurses crappy nurses. If anything I'm calling them fearful nurses. They are afraid of losing their positions and being sent back home so they don't complain about the working conditions because they have no negotiating power to do so. Being a crappy nurse has nothing to do with my post. The DNS puts major pressure on the nurses to work OT. The union nurses can and do refuse with very little repercussions but the foreign nurses CANNOT. The most that might happen to a union nurse is that they won't be called when OT is available. For a nurse like me that is nothing because the money doesn't motivate me anymore. I will not for the love of money work more shifts that I can handle and give substandard care. I need to sleep at night knowing that I do the best job that I can and I can't do that working 60+ a week.

The foreign nurses on the other hand really have little to no choice in the matter. No matter how tired they are they are forced to work because if they don't they run the risk of being let go. There is no one to speak up for them and they know better than to complain. They don't have the choice so after being pressured to work 60+ hours per week they cut corners out of exhaustion. Management doesn't give a crap because they have a warm body in the house and if something really bad happens the tired over worked foreign nurse is going to take the blame for it. I don't care who believes it I have seen it happen with my own two eyes. Everything is fine until it isn't, kwim? I've been accused of being inflexible and too by the book and foreign nurse so and so has been thrown in my face as being an ideal worker. Well on more than one occasion when the crap hit the fan the management that loved and built up nurse so and so as the ideal nurse scapegoated that same nurse. A foreign agency nurse is a very easy target and I have seen them come and go. The attitude is who cares they are a dime a dozen and they're more where they came from. This so called shortage that is expected to grow as the baby boomers age is going to mostly be a nursing home/SNF/ALF shortage because these are the most undesirable places to work in. So scenarios like the ones I am describing will only become more common in the future.

Now my question to you is: Would you like to be a resident at my nursing home? Would you like your mom or dad to end their days at my facility?

It is quite a standard of most every corporation world-wide to use temp-style workers, not just in American healthcare. This isn't anything to do with foreigners. Can you think why...? Think about why one can hire someone and keep them on weekly hours just below the point where the that company have to kick in benefits. Think about how the balance sheets of ANY company (non-profit or not) reflect salaries and benefits. Think about company's bottom lines (non-profits are no exception as they are responsible to donors).
As for this anecdotal stuff about trachs etc. I can give as many examples of dreadful care by true blue American nurses. Crappy nurses are everywhere from anywhere.