Emergency Nurse Relief Act 2009- Update

madnurse2b · May 25, 2009

I know that there was an article recently in our local paper about some retraining in language being done with foreign nurses in our community. I did find a couple of pieces on this:

http://www.lvrj.com/news/8795217.html

http://news.bbc.co.uk/1/hi/health/2143680.stm

Now, I have actually talked with some of my instructors who are foreign born. Studying for their NCLEX was hard, they had to translate questions into their native language, and then back to answer. I can't imagine doing that!

So while there are language barriers, we are talking about men and women who know their stuff better than most because they've done the translation. I know there are efforts being made to improve not just English language skills in this town, but also diction, pronunciation and understanding of common slang/colloquial speech. Some patients have trouble understanding some nurses. But then again you try getting an ASL interpreter for a hospitalized patient at the right time!

I will say that I hope that, as a current nursing student, the jobs will be out there for us when we get out. With the amount that some hospitals have spent to recruit "experienced" foreign nurses, they could easily create a nurse grad program that is comprehensive, and beneficial to the facility and the nurse grad.

ImMrBill3, RN · May 25, 2009

I have read this whole thread and I am pleased to see some real discourse on a complex subject. I have to agree emphatically with those who say register, vote and contact your reps.

Beyond that what can be done to hold corporations and administrators accountable for the impact of their policies? As a CNA I have seen it many times and from many others I have heard about the pressure to accept unreasonable assignments (how is a single LPN really supposed to pass meds to 60 pts safely in an hour and a half?), overtime when exhausted, the pressure to have all the documentation done and done on time for more care than two nurses could have provided (as a CNA it took 2H to document pt care how do you give pt care every 2H?). What is to be done about the policy of hiring not quite full time? How with the system we have can you overcome cutting pay and benefits to increase shareholder profits?

In the current climate Unions are not very successful, legislation is apparently going the other way, desperation makes so many accept what they should not.

I urge everyone to join and become active in their professional organization and those who are in research to document the improved pt outcomes and satisfaction that good nursing policies foster.

Ginger's Mom, MSN, RN · 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?

No, I would not like anyone being treated in your facility.

Here is more information on communication

http://www.psnet.ahrq.gov/resource.aspx?resourceID=8251

Lovely_RN, MSN · May 25, 2009

Some of the comments from these lawyers are incredibly offensive. They really seem to believe that nurses are overpaid for what we do and that the solution is to bring in as many foreign nurses as possible and lower our wages to the minimum. They believe that this is the way to reduce the cost of health care.

http://blogs.ilw.com/gregsiskind/2009/05/nurse-bill-introduced-in-house.html

I challenge you to tell me any other occupation that only requires an associate degree that pays as well as nursing.
Posted by: Greg Siskind | May 25, 2009 at 01:30 PM

http://www.mysanantonio.com/news/local_news/45964682.html

Nurses are starting at salaries more than 50 to 75% higher than teachers for positions only requiring half the college. And jobs abound. Nurses pushing the notion that American nurses are out of work and there is no shortage did the same thing in the mid-90s when the H-2A bill was up for renewal and it was a huge mistake for which we are still paying. Shamefully, many nurses would rather perpetuate a shortage that is killing American patients rather than admit that we don't have enough nurses here and don't have the capacity to train enough in short order. And they want to kick Americans when they're down financially and already can't afford our health care by dramatically pushing up already high nursing salaries. Those costs get pushed on to the backs of Americans who already are having to shelf their health insurance because they can't feed their families. It only this were an exaggeration. Unfortunately, millions of Americans have their backs against the wall and members of one of the few occupations with healthy salaries and low unemployment want to make people with a whole lot less security subsidize their labor cartel.
Posted by: Greg Siskind | May 25, 2009 at 01:41 PM

American Nurses Association and California Nurses Association are protectionists that don't want foreign nurses because as more nurses coming in, wages will go down. Their bargaining power will lessen as well.
They kept a blind eye on the shortage by justifying that there's none. But if you look around, many hospitals and facilities are hiring, mostly night shifts and floating shifts.
A simple analogy is this. Joe the plumber would only like to work Monday to Friday from 8am to 5pm. Guess what, he can't find work because most households are empty during this period and won't allow Joe to work alone without their supervision. And here comes, Jose the immigrant...he's willing to work anytime of the day, any day of the week. He finds work because most household want their plumbing problem fixed while they're in the house, i.e. 6 pm. So Jose got a job, not Joe.
Jose adjusts to the schedule of the clients, while Joe doesn't want to get out of his comfort zone.
Posted by: Dan | May 25, 2009 at 08:48 AM

Ginger's Mom, MSN, RN · May 25, 2009

I am glad someone else thinks it is offensive, and the ones who are for it are foreign nurses who wish to work in the USA. I do believe the bill doesn't have a chance of passing.

And if I was trying to apply in a foreign country I would try to befriend them not alienate the nurses I plan to work with, but that is me.

Hushdawg · May 26, 2009

I know you are not a nurse and currently not living in the USA. I live in a community by choice where being white in the minority so I take issue with your name calling.

To be clear, I was not calling you a name, I was pointing out that YOUR COMMENT was xenophobic.

There are many times I find you intelligent and agreeable so I'm not name-calling; I'm trying to get you to realize how you sound when you talk so emphatically on this issue.

Yes, I do not live in the USA, guilty as charged. Yes, I am not a nurse, however I work with nurses on a daily basis. My job is to council nurses in a way and help them achieve personal and professional goals; therefore a large part of my job requires that I keep up with hiring trends in various parts of the world. While the USA is a primary focus for Pinoy nurses I do try to help them find alternatives.

What I am saying is that I feel more than qualified to speak on this topic because I am looking at it from multiple perspectives at once. I *CHOSE* this profession because I recognize the need for nurses and because of my sincere care for those who choose the path of nursing. You can bet when I return to the USA that I will continue along this vein of work.

After all that nurses have done for society; it's about damn time that someone helped nurses, don't you think?

I would hope some great nurses would rise to the top especially from the top schools. The Philippine nurses need to raise their standards so all nursing schools have the same basic program.

Easier said than done; the Philippines has a lot of problems which get in the way of that. What we CAN do right now is to educate prospective nurses as to what they need to look for in nursing schools so that they can choose the right ones.

Are you saying that there are no poor schools in the USA? I beg to differ.. There are many low-quality colleges and universities in the USA. In the USA they loose accreditation and thereby loose students. Something happened in the Philippines a few years ago which eliminates that system of checks meaning that now nurses have to research the institution for themselves.

I have always stated nurses should be trained for the country they choose to practice. If a nurse chooses to work in a certain country they should attend school there, that is the most rationale thing. My understanding is that if you were a fully qualified US nurse you would not be employable, shouldn't Americans enjoy the same right?

The best schools here in the Philippines *ARE* training by US standards; that is why Chinese, Korean and other Asian peoples are coming to the Philippines to get nursing education in these schools.

This is what NCLEX is for: To ensure that licensure is given based on the same testing of skill sets. This is why all nurse licenses are given from the same exam instead of the way it was done before with a different exam for foreign nurses than domestic nurses.

In short, it levels the playing field.

This is also why NCLEX review schools are so essential outside the USA. They not only review information that the nurse gained in college, they also bridge the gap of information/education between foreign and USA nursing education. There are also plans by private companies to do cultural orientation programs and other things which will bridge the gap even further.

The issue of medical tourism, these hospitals have made the choice of being accountable to US Health standards by being reviewed by Joint Commission.

And so have many of the schools. The point is that you are making sweeping claims that non-US nurses are inferior and that simply is not true.

Hushdawg · May 26, 2009

So Blacks who came to the USA via slavery have no right to speak on immigration? I thought on a day like today Memorial Day, we should be free to exercise our freedom of speech. I guess all the Americans who have given their lives for America only did that for Native Americans.

You are missing my point.

My point is that there are so many people who are anti-immigration when they would not be here if it were not for immigration.

Don't pull that "more-patriotic-than-thou" crap with me. I was raised by a military family so I know what our men and women of the armed forces suffered for; they struggled for the right of all people to be free.

Freedom also includes immigration to enjoy those rights and liberties.

The Declaration of Independence says that all are endowed by the Creator with certain rights. It does not say that only those born in the USA ... it says ALL.

Life, Liberty and the Pursuit of Happiness... that's exactly what these immigrant nurses want for themselves and their families.

Yes, I want to see Americans employed. Yes I believe that skilled labor positions should be filled by Americans first. However I cannot deny the statistics and the blatant fact that within a few years unless something is done to fix it our healthcare networks will start to collapse from lack of staff. People don't get younger and the average age of nurses employed are getting older and closer to retirement.

When I speak to groups of nurses I state plainly that as an American and a patriot I do not want retrogression lifted. But as a pragmatic person who can see the numbers and what they mean for our very near future I realize there must be a window inside retrogression for nurses and other medical professionals to come into the USA to take positions that quite frankly not enough Americans are capable of filling.

Hushdawg · May 26, 2009

What agencies are recruiting and where?

I thought it was against TOS to promote agencies?

I can tell you that I personally have spoken with four US-based recruitment/staffing firms and they have over 3,000 positions collectively all across the USA. Some in CA, IL, NY, most in rural areas.

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.

You are right, there are less recruiting tools. There is not as much money allocated to recruitment and promoting staff openings as there used to be. Yes, there are hiring freezes in certain areas of the USA where no people are coming in at all.

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).

Statistically you are correct, in the past foreign nurses migrate straight to large cities because that is where they can feel safer with an established community of their own people and culture as well as the fact that the pay is better there (usually) and there are more jobs open.

There are MANY nurses from abroad who end up working in rural areas. I can tell you that in my corner of NC there is a hospital which hired 15 nurses from the Philippines and Vietnam right before retrogression hit. This is a hospital in a city with a population of 35,000.

Now that retrogression is in place and the major cities are seeing hiring freezes, we are seeing a shift in applications from states of high volume to states of low volume. Nurses are getting smarter with their choices and I'm advising them to take up positions in rural hospitals in order to get jobs in the USA where there is always a critical need.

Too much of your post talks about what you see from your corner of the globe; try to look at the big picture and realize that while your POV is valid and accurate, that there is more than one correct answer to the given question.

Hushdawg · May 26, 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.

Thank you for stating this. I did not want to state this because, since I am not a nurse, it would be viewed as "nurse bashing" or something.

This is definitely a factor, I agree... and I don't feel that it is a negative on USRNs for refusing to work in certain conditions since we, in America, have been conditioned to expect better than this.

However, foreign nurses are used to far worse working conditions. Here in the Philippines there are some hospitals operating with 25 - 30 patients per nurse... some even as many as 100 patients per nurse. They are paid what amounts to minimum wage.

For a foreign nurse, these conditions and pay are a vast improvement.

So yes, technically the immigrant nurses are doing the jobs that US nurses will not do.

That's just the way the world turns.

Since I am a proponent of Universal Healthcare, I also view this kind of condition as a key problem with privatized healthcare because the companies which own the hospitals are looking at ways to increase the bottom line and reduced staffing is one of the most effective ways to increase profits.

Hushdawg · May 26, 2009

Now, I have actually talked with some of my instructors who are foreign born. Studying for their NCLEX was hard, they had to translate questions into their native language, and then back to answer. I can't imagine doing that!

WOW! that's crazy. No wonder there are such low NCLEX passing rates in other countries.

Philippine based nursing education is all taught in English so it is actually very easy for Pinoy nurses to pass IELTS and TOEFL as opposed to other countries. In fact the Philippines is the only Asian country where English is not a barrier to the ability to pass NCLEX (which is probably why the passing rate here is so much higher than other "non-English" countries).

NCLEX education here is also taught in English, although I've seen a few slip into one of the local languages during lectures.

Lovely_RN, MSN · May 26, 2009

So all is well as long as someone is O.K with working under these conditions? What about the patients? What kind of care do you think they are receiving? We are all aging and we are susceptible to illness or injury at any time in our lives. At some point in almost everyone's life they will need to be hospitalized or be in need of permanent care in a SNF/LTC. I ask over and over again....is this the kind of care that you want for yourself or your loved ones? I swear I would rather be dead than be a patient in a lot of places. I know that what we get here in the U.S is better than the 3rd world but what kind of standard is that for comparison?

Thank you for stating this. I did not want to state this because, since I am not a nurse, it would be viewed as "nurse bashing" or something.
This is definitely a factor, I agree... and I don't feel that it is a negative on USRNs for refusing to work in certain conditions since we, in America, have been conditioned to expect better than this.
However, foreign nurses are used to far worse working conditions. Here in the Philippines there are some hospitals operating with 25 - 30 patients per nurse... some even as many as 100 patients per nurse. They are paid what amounts to minimum wage.
For a foreign nurse, these conditions and pay are a vast improvement.
So yes, technically the immigrant nurses are doing the jobs that US nurses will not do.
That's just the way the world turns.
Since I am a proponent of Universal Healthcare, I also view this kind of condition as a key problem with privatized healthcare because the companies which own the hospitals are looking at ways to increase the bottom line and reduced staffing is one of the most effective ways to increase profits.

Hushdawg · May 26, 2009

Some of the comments from these lawyers are incredibly offensive. They really seem to believe that nurses are overpaid for what we do and that the solution is to bring in as many foreign nurses as possible and lower our wages to the minimum. They believe that this is the way to reduce the cost of health care.

The statments are offensive.

Saying "only an Associate's degree" is like saying that an associate's degree is garbage.

Actually, I can think of an associate's degree that pays very well: Photography.

Photography was my first degree and it was an associate's. Some of my classmates went on to become staff photographers earning 70-80K per year. I went freelance to supplement my income from another job while I was studying for another degree and could earn $1200 in one weekend.

So associates degrees are not garbage, they are simply concentrated courses on programs which can be taught in a shorter period of time.

That being said, however, let me illustrate a point.

Two people come to apply for a staff job in your hospital. Both are licensed in your state.

One has an Associate's degree in Nursing

One has a BA in Nursing

Which would you hire for one available slot?

Usually you go for someone more qualified.

Isn't someone with a BA more qualified than someone with an Associate's?

Almost all foreign nurses are BA holders.

Maybe this also makes a difference?