Let me be clear there is NO nursing shortage!!!!!!!!! and now THIS????

barefootlady, ADN, RN · Aug 5, 2009

Sorry to have caused flak about the "gossip" remark, but we see ads for Pa, DC, and Md in a few of our state newspapers, so when they say "new grads welcome", I think they mean it.

Sensoria17 · Aug 6, 2009

I'd expect quite the opposite - providing insurance coverage to tens of millions of people should increase demand for services.

I disagree. Unless you have an increase in people receiving elective surgeries (which I'm sure the government won't cover) we will not have an increased need for nurses.

Ginger's Mom, MSN, RN · Aug 6, 2009

"So they say" and "from the gossip" pinpoint one of the issues -- the lack of hard data which clearly shows any area of the country that's hiring new grads in significant numbers.
The only hard data that I've seen comes out of California in which a July, 2009 report shows a statewide nursing vacancy rate of 5% and that nearly half of all graduates are and will continue to be unemployed.
I read the occasional "gossip" post on AN which says "we're hiring like crazy" but fail to list a state, city, or specific hospital.
Come on, folks -- if it's really not that bad out there then why don't we see any specifics?

Yes, when I ask where the open jobs are , the names of the hospitals or cities are never mentioned.

I see several posts here now citing areas......thanks all for posting

Ginger's Mom, MSN, RN · Aug 6, 2009

I'd expect quite the opposite - providing insurance coverage to tens of millions of people should increase demand for services.

I am basing this on my state's experience where we have mandatory health care with the last stat being around 97- 98% insured for the past 2 years.

Open nursing positions are rare, hospital admissions are down and several hospitals are about to be closed.

The state basically counts every bean ( well not literally but we had to hire a special computer programmer to send quality data and comply with ridiculous standards).

I have not read the whole National Health care Plan, but don't expect that services will be rendered as in the past.

There is death counseling every 5 years for seniors. The government will choose which procedures can be done. Don't expect that knee and hip replacements will be done at the rate they are being completed.

There is talk about new models of nursing care ( meaning do more with less resources). I envision more disease management and case management positions to open up, but these are usually lower paying nursing jobs.

Ginger's Mom, MSN, RN · Aug 6, 2009

I am sorry to hear about yours and everyone else's difficulty in finding jobs. I am also stunned that you are not getting called back about nursing assistant positions. Where I live (NJ), the nursing homes are usually in dire need of nursing assistants.

In my state a licensed nurse can't work as a nursing assistant.

Hushdawg · Aug 6, 2009

"SOME"... up to 20,000 per year as authorized by this bill?

The 20,000 per year is to alleviate the shortage that practically everyone involved with healthcare administration can see coming due to the advancing average age of the USRN and the combination of standard needs increases. Right now the recession has suppressed the shortage and is holding it off for another couple years.

Hospitals are not hiring a huge percentage of the people graduating. That undermines your assertion that US nursing schools can't provide them. Unless you mean that nursing schools can't provide experienced nurses. In that you're right. That's why we need hospitals to be hiring and training new grads and actively recruiting experienced nurses to step up to the more clinically advanced roles.[/quote']
I totally agree with you on that. However as long as health care is a private industry then the companies which own hospitals can decide their own requirements for hiring staff positions. I am with you on the idea that US hospitals should have entry level positions established for new graduates to merge into a more experienced position. Perhaps RN graduates could be permitted to enter as LPNs and then migrate to an RN position after 6 months to a year? Something has to be done, on that we agree. However as long as our economic infrastructure remains capitalist that cannot be enforced by the government and it must come from the hospitals themselves.
When a hospital hires overseas the nurse must be a BSN graduate as well as having 1-2 years of clinical hospital experience in a paid position... Therefore the demand of knowledge and experience is high on the foreign nurse just as it is with the US nurse.
If you consider that a foreign nurse must pass his or her local board, then proceed through all the layers of evaluations done for foreign nurses to be able to sit for NCLEX and then become licensed the US is only looking at a candidate pool of roughly 13% of all the nurses which graduate from the Philippines. The number is even lower for other countries.
Why Philippines? Because it is the only country in the world with a rolling surplus of nurses. The number of new enrollees among nursing schools in RPH is dropping rapidly but still it is a large pool to pluck resources from if you are an HR agent for a hospital or network of hospitals.

Hushdawg · Aug 6, 2009

This really upsets me!! Three years ago, our district brought a boat load of Filipino math and science teachers. I even helped them pass the teaching exams by letting them use my study guides.
Needless to say, with our economy this year, the district laid off many teachers. They couldn't return the Filipino ladies?
Many of us are now sitting home with science credentials, and without a job to return to in September. Thanks a lot!! Forget about teaching. I'm retaking my prereqs hoping this doesn't happen to me again, or I'm going to explode!!!!

The reason they can't "return" the Filipinos is because of a contract signed. When you are employed in another country the company must contractually guarantee a specific work period as part of the POEA (Philippine Overseas Employment Administration) requirements to ensure that foreigners are not exploited in other countries (which, unfortunately, happens a lot... even in the USA).

RE: Education positions; they are no longer short-listed and only Special Ed teachers are being considered for occupational visas and even those are retrogressed 3-5 years (depending on various factors).

Hushdawg · Aug 6, 2009

Check out these sites for job openings that you could apply to:

http://www.minoritynurse.com/currently-hiring-nurses

http://www.nursetogether.com/JobSearch.aspx (Almost every state has openings in either small practice clinics or hospitals)

Right now, according to the mappings done by my contacts in staffing firms, the shortages are more heavy in rural areas than in metro areas.

If you are willing to relocate, there are jobs to be had.

caroladybelle, BSN, RN · Aug 6, 2009

Sorry to have caused flak about the "gossip" remark, but we see ads for Pa, DC, and Md in a few of our state newspapers, so when they say "new grads welcome", I think they mean it.

I work now in Baltimore, Maryland (left Florida behind) and the new grads are having very serious problems getting jobs here and in Philly, PA. My facility is extremely large and had a total 10 positions open, mostly PRN, and few of those suitable for a new grad.

They may be advertising it, but it's not necessarily true.....much like those ads in northern nursing magazines about Florida hospitals having competative wages and good orientation programs.....by whose standards?

Ginger's Mom, MSN, RN · Aug 6, 2009

The 20,000 per year is to alleviate the shortage that practically everyone involved with healthcare administration can see coming due to the advancing average age of the USRN and the combination of standard needs increases. Right now the recession has suppressed the shortage and is holding it off for another couple years.
Response:
The US should be increasing student slots to meet the upcoming needs. Win/Win situation, keeps Americans employed !
Quote:
I totally agree with you on that. However as long as health care is a private industry then the companies which own hospitals can decide their own requirements for hiring staff positions. I am with you on the idea that US hospitals should have entry level positions established for new graduates to merge into a more experienced position. Perhaps RN graduates could be permitted to enter as LPNs and then migrate to an RN position after 6 months to a year? Something has to be done, on that we agree. However as long as our economic infrastructure remains capitalist that cannot be enforced by the government and it must come from the hospitals themselves.
Response:
Most US hospitals do not employ LPNs, most LPNs are hired in outpatient or nursing homes, so you suggestion will not work.
Also for legal reasons you can not be under employed. If you are a RN you are held to that standard.
It is cheaper to have a new RN program than pay for to import Foreign nurses which can be up to $40K per foreign nurse.
According to the Guide to Ethical recruitment, the agency has to provide support
IV. Support FENs' transition, after arrival in the United States, into the U.S. work force so that the FENs are free to concentrate on their work.
Practical Support for Daily Living
a. Make reasonable efforts to ensure that the "basic needs" of FENs (e.g., safe and clean housing, health care, and transportation when public services are not available) are available during an initial transition period as part of a negotiated employment package.
b. Provide or assist in the provision of orientation and placement policies and practices to educate FENs about basic facts regarding living and working (e.g., living arrangements, banking, post office, etc.) in the United States.
Professional Support
c. Provide or assist in the provision of clinical orientation to ensure appropriate delivery of care, particularly with regard to clinical practices and procedures that may not be familiar to FENs.
d. Provide or assist in the provision of sufficient training of FENs in cultural/linguistic appropriateness.
When a hospital hires overseas the nurse must be a BSN graduate as well as having 1-2 years of clinical hospital experience in a paid position... Therefore the demand of knowledge and experience is high on the foreign nurse just as it is with the US nurse.
A new US grad does not need the support listed above plus they have ties to the community they are working in. Most patients enjoy have local nurses participate in their care.
If you consider that a foreign nurse must pass his or her local board, then proceed through all the layers of evaluations done for foreign nurses to be able to sit for NCLEX and then become licensed the US is only looking at a candidate pool of roughly 13% of all the nurses which graduate from the Philippines. The number is even lower for other countries.
Response
Response:
A BSN from some countries equate to lower degree in the USA. Not all BSNs are equal. Many ASN grads in the USA have a BS or BA so they truly have the best of both. Sad that only 13 % meet the very basic NCLEX standard which is the bare minimum of care. I would be impressed if the foreign nurses held credentials like Certification exams that critical care nurses, emergency room nurses, and others nursing organizations provide. It is rare to see an international nurse pass these advanced tests prior coming to the USA.
Why Philippines? Because it is the only country in the world with a rolling surplus of nurses. The number of new enrollees among nursing schools in RPH is dropping rapidly but still it is a large pool to pluck resources from if you are an HR agent for a hospital or network of hospitals.

Why is it most of the Philippine nurses who post here subject to retrogression have no clinical experience yet have a US sponsor? When is all this pre qualification that you cite? Also many of foreign nurses who have no or very little clinical experience are coming to the USA on a H1B visa that is for advanced practical nurses or upper level managers.

The some of Philippine nurses recruited to Canada, had been pre-qualified to go to Canada taken extensive tests and rigorous interviews , but many of them were deemed to be equal to a practical nurse. New Zealand has also found this to have similar issues.

Where are all these qualified nurses?? Won't they deplete their country from the only working nurses , since it the majority of nurses in that country are unemployed?

Why should the USA seek importation as a solution ? It seems many of the current US problems have occurred because of the rapid outsourcing the US has done in the past.

Ginger's Mom, MSN, RN · Aug 6, 2009

Check out these sites for job openings that you could apply to:
http://www.minoritynurse.com/currently-hiring-nurses
http://www.nursetogether.com/JobSearch.aspx (Almost every state has openings in either small practice clinics or hospitals)
Right now, according to the mappings done by my contacts in staffing firms, the shortages are more heavy in rural areas than in metro areas.
If you are willing to relocate, there are jobs to be had.

I looked at the sites you listed, I see that the jobs posted in my area are not really jobs, due to hiring freezes. Are there jobs ? Yes, they are harder and harder to find even for the most qualified nurses.

Hushdawg · Aug 6, 2009

Response:
The US should be increasing student slots to meet the upcoming needs. Win/Win situation, keeps Americans employed!

This is the crux of the problem. The shortage increase is faster than the rate of graduation, it is logistically impossible for the US nursing schools to meet the demands as they are projected to rise more and more from the next 2-5 years and then in a near hyperbolic trend from 5-10 years.

Most US hospitals do not employ LPNs, most LPNs are hired in outpatient or nursing homes, so you suggestion will not work.

Yes, that is true, but most hospitals have affiliated outpatient centers where LPNs can work and migrate within the same "company" (for lack of a better term).

Also for legal reasons you can not be under employed. If you are a
RN
you are held to that standard.
It is cheaper to have a new
RN
program than pay for to import Foreign nurses which can be up to $40K per foreign nurse.

Yes and no... up to $40K is a little inflated... while it is true that it can get that high most are far lower. Yes, they do have to pay out a bit more for securing the nurses however from their perspective they are getting a more secure "transaction" than in hiring a US nurse that can go anywhere. The foreign nurse must sign contracts and they face stiff penalties for breaking those contracts.

The "initial period" that the services must be rendered by the hospital is typically one month and they have negotiated rates with facilities to make the overall cost impact low.

Additionally, they work through staffing agencies or overseas employment firms to more or less side-step many of these issues.

Direct Hiring and Indirect hiring are two different issues and many hospitals choose indirect hiring because of the kinds of expenses you have outlined.

A BSN from some countries equate to lower degree in the USA. Not all BSNs are equal. Many ASN grads in the USA have a BS or BA so they truly have the best of both. Sad that only 13 % meet the very basic NCLEX standard which is the bare minimum of care. I would be impressed if the foreign nurses held credentials like Certification exams that critical care nurses, emergency room nurses, and others nursing organizations provide. It is rare to see an international nurse pass these advanced tests prior coming to the USA.

You are generalizing and you are negating the fact that a nurse's credentials have already been evaluated. According to US Immigration law, in order to obtain an occupational visa the position and the applicant must match; meaning that if the position requires a BSN then the BSN must be at the appropriate level. This is what Visa Screen certification is for in conjunction with the evaluations done at the local state board of nursing. This is why foreign born and educated nurses will ALWAYS have to process evaluations as part of an endorsement from one state to another no matter how long they have been working in the USA.

Here's how I get 13%:

Total number of nurse graduates that pass the local board in Philippines: 48%

Total number of those nurses which go on to apply for licensure in the USA: 80%

Total number of those who sit for NCLEX that pass: 44%

Other countries are lower, Philippines has the highest passing average for NCLEX outside the USA.

Foreign nurses cannot have the certifications that you mention because those certifications must be done in the USA per each State Board's standards. There are training facilities that have attempted to provide those kinds of certified trainings in the past here in the Philippines but the problem is that they would have to be accredited by each state.

Currently there is only one training facility still functioning and while the courses are not recognized in the USA, they do well to educate nurses to US methods and standards of providing care.

Why is it most of the Philippine nurses who post here subject to retrogression have no clinical experience yet have a US sponsor? When is all this pre qualification that you cite? Also many of foreign nurses who have no or very little clinical experience are coming to the USA on a H1B visa that is for advanced practical nurses or upper level managers.

I don't see how that is possible based on the way visas are issued from the Embassy. They are tough in interviews and all the positions that my contacts in staffing firms and agencies have are for experienced nurses. One nice thing for Pinoy nurses is that some healthcare networks in the USA have begun to recognize the difference between volunteer positions here and in the USA and are permitting some to be counted as work experience (depending on the hospital and the nurse obviously) so that may be a part of it.

You have to understand that in the Philippines, a volunteer nurse is 100% responsible for his/her patient's care just as if he/she is in a paid staff position.

Again, according to my Immigration attourney friend, (just got off the phone to clarify this point) a visa will not be issued for a position that the applicant is not qualified for. The BSN degree must be at the same education level for the position that they are going to and the experience level must be the same.

Also, he shared with me that some of the US Sponsors have placed requirements on the nurses.. as in they will sponsor and work with them for immigration but that they must get clinical experience in the meantime.

The some of Philippine nurses recruited to Canada, had been pre-qualified to go to Canada taken extensive tests and rigorous interviews , but many of them were deemed to be equal to a practical nurse. New Zealand has also found this to have similar issues.

Because you cannot be an RN in CA, NZ or other countries without being educated in those countries. Immigrant nurses MUST enter as LPN/LVN positions and then build their way up to RN positions.

Once the USA adopts universal health care then perhaps the same program will be implemented by the government as is done in every other country that has universal health care.

Where are all these qualified nurses?? Won't they deplete their country from the only working nurses , since it the majority of nurses in that country are unemployed?

1. Not all want to work overseas, some are happy to remain here

2. many of the qualified nurses are Filipinos working in hospitals in Dubai, Oman, KSA and other countries.

3. Since the employed nurses will be migrating to the other countries to take positions then the unemployed nurses will be able to move into place... it flows that way.

Why should the USA seek importation as a solution ? It seems many of the current US problems have occurred because of the rapid outsourcing the US has done in the past.

This is not outsourcing.

Outsourcing is sending the jobs to other countries.

We would be bringing in skilled professionals to live and work in the USA and provide service in the USA.

These skilled professionals would be contributing back to the economy of the USA because at least half to 3/4 of the income would be spent to maintain their own lives in the USA.

Immigration is what has made the USA great and strong. Diversified ethnicities, cultures, languages have all added to the texture of the USA and made it the nation that so many aspire to belong to.

Why should we do it? It's the American way.