Emergency Nurse Relief Act 2009- Update

rainbow11 · Jun 8, 2009

I don't think 20,000 foreign-born RNs will be hired in place of American nurses. The stats say that there will be ONE MILLION open nursing position by 2020! I don't know the current stats, but I'm sure there are position that you just can't fill with American RNs.

Look at this bill http://www.govtrack.us/congress/billtext.xpd?bill=h111-2536

It talks a lot about how the fees from from foreign nurses will be spent etc.

Also, I'm not sure about the cost of recruiting, but I know NOT all 20,000 RNs will go through recruiting agencies. People like myself (US-educated Rns who are already in the States) will probably deal directly with the hospital, and there is no need for airfare etc. Thus, the idea of charging 30K from every one of 20,000 foreign-RNs is ridiculous.

Silverdragon102, BSN · Jun 8, 2009

If this is successful then allocation should go to the ones in the queue already and have been waiting.

Ginger's Mom, MSN, RN · Jun 8, 2009

It seems like there are three different camps.

A.Foreign nurses waiting for retrogression to be over, have played by the rules waiting patiently.

B. American educated foreign nurses who want to be employed and have not gone through the normal immigration channels.

C. And then their are the American nurses, who through their organizations ( ANA, California Nurses Association, and other professional nursing organizations who oppose this bill.

If there is truly an emergency ( which I personally don't believe there is ) I would support the American trained foreign nurses practicing. If there is a need for controlled immigration of foreign nurses the "A" group should be allowed in to work and live.

Typical US government propose a bill without asking the groups ( the nurses ) what they want and need. I do feel their will be an immigration bill passed this year but issues such as illegal immigrants and reuniting families will be passed not nurses.

Hushdawg · Jun 10, 2009

I'm totally bowing out of this discussion... I feel like I'm trying to convince a hamster to stop running in his wheel.

rainbow11 · Jun 16, 2009

It seems like there are three different camps.
A.Foreign nurses waiting for retrogression to be over, have played by the rules waiting patiently.
B. American educated foreign nurses who want to be employed and have not gone through the normal immigration channels.

It seems like some people think that US-trained foreign nurses are the ones who haven't played by the rules. That's so wrong!! As I said before, and I'm repeating myself again, we have been playing by the rules too!! It's just there are some steps in the application process that we are allowed to skip, such as

- TOEFL (Test of English as a Foreign Language), Spoken English Test --- I think it's a common sense that these exams are waived for us since we managed to successfully complete nursing programs (taught in English!) in the States;

- CGFNS certificate - we took NCLEX-RN, and have US RN licenses, thus we do not need to take international licensure exam (i think that what CGFNS certificate is, I just know I do not need that)

- since we are in the States we do not need to schedule a consular interview which seems like has a long wait period in many countries, instead we wil have to apply for an adjustment of status here in the US.

- there is also a Premium Processing fee. My understanding is that if you pay this optional fee (about $1,000 I think) you can have your application processed a bit faster. I think this Premium processing fee applies to all applicants whether your are US-trained or non-US-trained.

There are might be other steps US-trained RNs can skip. So, without knowing the details plese do not jump to a wrong conclusion!!

I agree with Hashdawg, it seems like i'm talking to a 'dead' wall!

Silverdragon102, BSN · Jun 16, 2009

It seems like some people think that US-trained foreign nurses are the ones who haven't played by the rules. That's so wrong!! As I said before, and I'm repeating myself again, we have been playing by the rules too!! It's just there are some steps in the application process that we are allowed to skip, such as
- TOEFL (Test of English as a Foreign Language), Spoken English Test --- I think it's a common sense that these exams are waived for us since we managed to successfully complete nursing programs (taught in English!) in the States;
- CGFNS certificate - we took NCLEX-RN, and have US RN licenses, thus we do not need to take international licensure exam (i think that what CGFNS certificate is, I just know I do not need that)
- since we are in the States we do not need to schedule a consular interview which seems like has a long wait period in many countries, instead we wil have to apply for an adjustment of status here in the US.
- there is also a Premium Processing fee. My understanding is that if you pay this optional fee (about $1,000 I think) you can have your application processed a bit faster. I think this Premium processing fee applies to all applicants whether your are US-trained or non-US-trained.
There are might be other steps US-trained RNs can skip. So, without knowing the details plese do not jump to a wrong conclusion!!
I agree with Hashdawg, it seems like i'm talking to a 'dead' wall!

CGFNS exam is now only required by approx 4 states, most you can just do a course eval by CGFNS. Premium processing was available for everyone regardless on where they trained and is no longer available as schedule A is no longer available.

It is also thought that when you train in the US on a F1 visa that you will be returning back to your home country to work. It isn't always seen as a dual intent visa.

The only steps a US trained foreign individual misses is taking English exams. Otherwise the process is the same, find employer, get vsc, file I140 and join the queue. When visas are available you can AOS but so can someone who trained outside the US as long as they have passed NCLEX have vsc and visas are current

Ginger's Mom, MSN, RN · Jun 17, 2009

I don't think this bill has a prayer. So the discussion is almost moot.

As a nurse I would prefer if I had a choice of working with a US trained foreign nurse or foreign nurse ( personality and experience the same) I would choose a US trained nurse.

But I do feel, the US has for years said to foreign nurses play by the rules and you will have a chance to immigrate to the USA. Then give foreign nurses who choose to come to the USA on a student visa the slot that US has made a foreign nurse who has waited patiently does not seem right. It gives the message break the rules and you will be rewarded. Just doesn't seem right. But allot of things the US government does is not right, because it looks like any reform will be geared toward illegal aliens.

Hushdawg · Jun 17, 2009

I don't think this bill has a prayer. So the discussion is almost moot.
As a nurse I would prefer if I had a choice of working with a US trained foreign nurse or foreign nurse ( personality and experience the same) I would choose a US trained nurse.
But I do feel, the US has for years said to foreign nurses play by the rules and you will have a chance to immigrate to the USA. Then give foreign nurses who choose to come to the USA on a student visa the slot that US has made a foreign nurse who has waited patiently does not seem right. It gives the message break the rules and you will be rewarded. Just doesn't seem right. But allot of things the US government does is not right, because it looks like any reform will be geared toward illegal aliens.

:nono:

It really ticks me off that people keep talking about this bill like it is inviting backwater nurse school rejects and illegal aliens who only know about injections from a heroin addiction.

:down:

This bill seeks to bring QUALIFIED MEDICAL PROFESSIONALS WHOSE CREDENTIALS MEET OR EXCEED US NURSING EXPECTATIONS ESTABLISHED BY THE STATE BOARD OF NURSING!

Foreign educated or born nurses have to pass several layers of screening and evalations within the State Boards. Insinuating that any nurse will come into the USA and practice with an illigetiate license, poor education or in any illegal way is a flat-out insult to the men and women who work in the BONs to maintain clean licensure.

It is also a hateful slap in the face to any foreign nurse who has worked hard for many years to get a job which will provide for his or her family.

Why is it that there is a perfectly acceptable standard to enter into ANY occupation besides nursing in order to provide for one's family yet so many want to pretend that nursing is a completely altruistic and self-sacrificing occupation.

Come on.

Get real.

Get over it.

If that were true then all nurse positions would be volunteer basis.

But they aren't; because nursing is just like any other profession. You work hard to gain professional level of skills to provide a valuable service and get compensated well for it.

Fair is fair.

Nursing is a hard occupation which demands a lot of emotional and psychological dedication to the patient in ways that other occupations do not; but that is no reason to say that foreign nurses who take up the occupation in order to take care of their families have any less right to practice than those who choose nursing for another reason.

casseiopia · Jun 18, 2009

The CGFNS or visa screen is required at the border when you enter the country to even be permitted to enter the USA.

Ginger's Mom, MSN, RN · Jun 19, 2009

It really ticks me off that people keep talking about this bill like it is inviting backwater nurse school rejects and illegal aliens who only know about injections from a heroin addiction.
This bill seeks to bring QUALIFIED MEDICAL PROFESSIONALS WHOSE CREDENTIALS MEET OR EXCEED US NURSING EXPECTATIONS ESTABLISHED BY THE STATE BOARD OF NURSING!
Foreign educated or born nurses have to pass several layers of screening and evalations within the State Boards. Insinuating that any nurse will come into the USA and practice with an illigetiate license, poor education or in any illegal way is a flat-out insult to the men and women who work in the BONs to maintain clean licensure.
It is also a hateful slap in the face to any foreign nurse who has worked hard for many years to get a job which will provide for his or her family.
Why is it that there is a perfectly acceptable standard to enter into ANY occupation besides nursing in order to provide for one's family yet so many want to pretend that nursing is a completely altruistic and self-sacrificing occupation.
Come on.
Get real.
Get over it.
If that were true then all nurse positions would be volunteer basis.
But they aren't; because nursing is just like any other profession. You work hard to gain professional level of skills to provide a valuable service and get compensated well for it.
Fair is fair.
Nursing is a hard occupation which demands a lot of emotional and psychological dedication to the patient in ways that other occupations do not; but that is no reason to say that foreign nurses who take up the occupation in order to take care of their families have any less right to practice than those who choose nursing for another reason.

First of all you are not a nurse, so how can you know what a nurse's life is like? All you know is second hand information. It is a personal gripe, it is like a man who tells his wife giving birth it isn't painful. I believe you have to walk in a nurse's shoes to understand what a nurse does.

It has been my experience any nurse who enters nursing as a paycheck do not make great nurses, this holds true for any nurse regardless of where they are from. It takes more than a desire to support your family ( doesn't everyone want that) to be a good nurse. And the journey for US nurses to get into and maintain good status is very difficult much sacrifice US Nurse make is taking out loans and their families have to alter their lifestyles.

When looking into migrating to another country, why don't they ask about the community ( how are the schools, how are the people, what is the climate like, what are the conditions a nurse works in ), the only question I see is how much do I get paid. Or worse yet, I want to go to the USA but there are no openings so how do I get into Canada?

Secondly, I don't think the NCLEX reflects a nurse's true understanding of the nursing profession. I have seen excellent nurses fail and terrible nurses who pass. What acts as counter balance is having a common education ( not transcripts translated) and the ability to interact with the educators. There is no way for a US hospital to know what school is good internationally and no way a hospital can call a local school and state we need the new graduates to have more experience doing XYZ ( this is done all the time). There is no opportunity to call and speak to the nursing educator personally an agency just like head hunting agencies here in the USA will paint the most positive review of the candidate the represent. This is not an objective reference.

Most of the international nurses who post here have zero nursing experience and sadly many of them have graduate numerous years ago which makes their knowledge soon to be outdated. Yet they have a currently passed the NCLEX. Experienced and highly qualified nurses can presently apply for an H1B visa.

Last Point, the state board is the lowest minimum standard for a nurse to practice, it is not a very high standard. New US Graduates have a steep learning curve, many of them have taken it upon themselves to work as nursing techs and CNAs, unfortunately foreign nurses don't have the opportunity to get this extra clinical input. I personally believe the the standard to become a RN is too low.

Hushdawg · Jun 19, 2009

First of all you are not a nurse, so how can you know what a nurse's life is like? All you know is second hand information. It is a personal gripe, it is like a man who tells his wife giving birth it isn't painful. I believe you have to walk in a nurse's shoes to understand what a nurse does.

1) Should I apologize for not being a nurse? You often bring it up in discussion as though I should not even have an opinion because of that fact. Yet you are not a lawyer and I see you frequently criticize lawyers. Should not the same rules apply?

2) I'm not stupid enough to say that giving birth isn't painful. Just because I am not a nurse does not mean that I am incapable of empathizing and comprehending the life of a nurse and what he or she must go through for his/her profession.

3) I believe if you walked in a foreign nurse's shoes that you would not be so hypercritical of them.

It has been my experience any nurse who enters nursing as a paycheck do not make great nurses, this holds true for any nurse regardless of where they are from. It takes more than a desire to support your family ( doesn't everyone want that) to be a good nurse. And the journey for US nurses to get into and maintain good status is very difficult much sacrifice US Nurse make is taking out loans and their families have to alter their lifestyles.

Let's not get into a comparison of the kinds of sacrifices US nurses go through versus the sacrifices of foreign nurses. My bets are on foreign nurses for the level of family sacrifice.

Why can't a nurse be good at his/her profession if it is entered into for a good source of income? Are you saying that an overwhelming majority of nurses currently working would be willing to do nursing for free if they had housing and needs taken care of? I think not.

Plenty of people in plenty of professions choose the occupation choice because of income opportunities.

Engineers, lawyers, doctors, etc... why is it THOSE people are not judged for choosing a profession to make a good income and yet foreign nurses are? Seems a bit uneven if you ask me.

I don't care WHY a nurse has chosen his/her profession so long as they work as professionals and provide the services with passion and dignity.

When looking into migrating to another country, why don't they ask about the community ( how are the schools, how are the people, what is the climate like, what are the conditions a nurse works in ), the only question I see is how much do I get paid. Or worse yet, I want to go to the USA but there are no openings so how do I get into Canada?

1) The USA has a reputation of having the best overall so the "American Dream" propoganda that the government has been selling for more than a century is very effective. Don't blame foreign nurses for that.

2) if they are going to another country while waiting for the "American Dream" then of course they want to make sure that they will earn enough money so they won't get stuck into an indentured servitude setup.

3) cultures in other countries are not the same as the USA. In many countries working overseas and then returing to the home country is a common way of life.

Secondly, I don't think the NCLEX reflects a nurse's true understanding of the nursing profession.

Take that up with NCSBN, not foreign nurses. It seems to be good enough for American nursing graduates.

I have seen excellent nurses fail and terrible nurses who pass.

If they have not passed NCLEX and they are US nursing school graduates then technically they are not nurses at all when they take; so how can they be "Excellent nurses"

Also, since NCLEX tests the ability to apply knowledge into a clinical/practical setting then I fail to see how a "terrible" nurse CANDIDATE could pass.

What acts as counter balance is having a common education ( not transcripts translated) and the ability to interact with the educators. There is no way for a US hospital to know what school is good internationally and no way a hospital can call a local school and state we need the new graduates to have more experience doing XYZ ( this is done all the time). There is no opportunity to call and speak to the nursing educator personally an agency just like head hunting agencies here in the USA will paint the most positive review of the candidate the represent. This is not an objective reference.

Which is exactly why there is a credential evaluation portion of the application for licensure for foreign nurses.

You have no idea (obviously) what foreign nurses have to do in order to be licensed in the USA.

The entire licensure process ensures that the school is accredited and has provided sufficient information to the nurse to make her eligible to take NCLEX as the final stage of licensure evaluation.

I feel like a broken record.. I keep saying this and it keeps getting ignored, like I'm just making it up or something.

Most of the international nurses who post here have zero nursing experience and sadly many of them have graduate numerous years ago which makes their knowledge soon to be outdated. Yet they have a currently passed the NCLEX. Experienced and highly qualified nurses can presently apply for an H1B visa.

You are in luck. If they haven't gotten licensure after a certain period of time the US nursing boards require proof of employment or continuing education in order to gain licensure in the USA.

Again, you show a sore lack of knowledge with what it takes to become licensed in the USA for a foreign nurse.

Last Point, the state board is the lowest minimum standard for a nurse to practice, it is not a very high standard. New US Graduates have a steep learning curve, many of them have taken it upon themselves to work as nursing techs and CNAs, unfortunately foreign nurses don't have the opportunity to get this extra clinical input. I personally believe the the standard to become a RN is too low.

Then you need to take that up with NCSBN. But the fact that only 16% of licensed nurses remain employed after 3-4 years is proof that those nurses are filtered out through atrition.

Foreign nurses who migrate to the USA to work as nurse, however, have a much greater staying power (70-80% remain nurses after 4 years) which may explain why hospitals like to look overseas for staff positions.

Ginger's Mom, MSN, RN · Jun 19, 2009

"Let's not get into a comparison of the kinds of sacrifices US nurses go through versus the sacrifices of foreign nurses. My bets are on foreign nurses for the level of family sacrifice."

Alexk49 response:

My students I know are hungry, they had to choose between tuition or supper. They are proud and won't take money from me. I often buy extra food and share with them . Some of my students are so tired since they are working full time and going to school at the same time they fall asleep when standing up. Many of my students don't have phones or internet access. Some don't have money to buy books and share with other students. Many students couldn't afford to buy an extra uniform when the school changed uniforms. They often wash the uniform by hand so they could wear it the next day.

The have to take public transportation and many of their zip codes are in very high crime areas. Some live in homes where they don't have a bed. Yet they never complain, they are grateful to be in school. And their family members are working overtime in low paying positions to get the student through school.

Alexk49 response:

SO if you can tell me the foreign students go to bed hungry often, work long hours and attend school, have no phones, live in very poor conditions, and don't have proper clothes. I apologize, I read on the boards here, most live in homes often with maids. Do not work while going to school and must have computer access since they post here.

"Should I apologize for not being a nurse? You often bring it up in discussion as though I should not even have an opinion because of that fact. Yet you are not a lawyer and I see you frequently criticize lawyers. Should not the same rules apply?"

Alexk49 Response

I don't believe I have ever been critical of lawyers on this forum and I don't know what you are talking about . I believe I have advised nurses to seek legal counsel when needed. But I don't think I would be qualified to go on ALL LAWYERS and give legal advice. Or try to recruit foreign lawyers to come to another country.

"1) The USA has a reputation of having the best overall so the "American Dream" propoganda that the government has been selling for more than a century is very effective. Don't blame foreign nurses for that.

2) if they are going to another country while waiting for the "American Dream" then of course they want to make sure that they will earn enough money so they won't get stuck into an indentured servitude setup.

3) cultures in other countries are not the same as the USA. In many countries working overseas and then returing to the home country is a common way of life."

Alexk49 Response:

Shame on the Americans peddling this to poor people to spend more money they don't have. American Immigration has been successful when the immigrate embraces America as there home like my Dad did when he escaped communism. He was so proud to be an American and did everything to advance the American cause. What makes the US great is immigrants who desire to make this there home, not a place to work.

"Take that up with NCSBN, not foreign nurses. It seems to be good enough for American nursing graduates."

Alexk49 response:

You missed my points, there are checks when employing a US nurse, you can contact the school, instructors and previous employers. And I am taking this up with my state board. US students have an big advantage working in the field while going to nursing school. I also believe all new grads should have an extensive new nurse program to ready them for there career. I am basing this as a Mastered Prepared Nurse educator, do you have an education background at all ? Have you worked in the healthcare industry as a manager?

"If they have not passed NCLEX and they are US nursing school graduates then technically they are not nurses at all when they take; so how can they be "Excellent nurses"

Also, since NCLEX tests the ability to apply knowledge into a clinical/practical setting then I fail to see how a "terrible" nurse CANDIDATE could pass."

Alexk49 Reponse:

I am basing this on my experience where nurses could work at the Graduate nurse status. A terrible nurse is a nurse who passed the boards, but is unresponsive to patient care needs, not medicating their patients is a timely fashion, giving patient education, giving good hand off communication.

"Which is exactly why there is a credential evaluation portion of the application for licensure for foreign nurses.

You have no idea (obviously) what foreign nurses have to do in order to be licensed in the USA.

The entire licensure process ensures that the school is accredited and has provided sufficient information to the nurse to make her eligible to take NCLEX as the final stage of licensure evaluation.

I feel like a broken record.. I keep saying this and it keeps getting ignored, like I'm just making it up or something." I think you lack of understand about education is leading to this misunderstanding.

Alexkrn Response:

The credentalling maybe grueling but is not an ONSITE review, the foreign nurses instructors resume do not have to be filed with the board of nursing. The foreign schools are not accredited not by the BON or the NLN, or the CCE the process is not equal.

"You are in luck. If they haven't gotten licensure after a certain period of time the US nursing boards require proof of employment or continuing education in order to gain licensure in the USA."

Alexk49 Response:

Oh you have got to be kidding CEUs are so easy to get, I often get them on my lunch break, no testing involved" They are better then nothing but the CEUS do not prepare you for current nursing practices. This is not accepted as keeping skills up for any nurse American or Foreign.

Then you need to take that up with NCSBN. But the fact that only 16% of licensed nurses remain employed after 3-4 years is proof that those nurses are filtered out through atrition.

Foreign nurses who migrate to the USA to work as nurse, however, have a much greater staying power (70-80% remain nurses after 4 years) which may explain why hospitals like to look overseas for staff positions.

Alexk49 Response

The hospitals I have been in contact with and I belong to a large nation wide network of hospitals which I have weekly conference calls do not share what you are saying. I think you are referring to for profit hospitals that don't invest resources in keeping the nurses engaged. I wonder what their CMS scores are, every hospital that I have researched that have large foreign nurse population score very low in these CMS scores. Many of the hospitals that the foreign nurses worked in have closed in the northeast.

I personally feel nursing issues should be made by nurses not recruiters or lawyers.