Emergency Nurse Relief Act 2009- Update - page 8

Read what is being said by American Lawyers about US Nurses, basically we are uneducated, not dedicated, and need the help of foreign nurses to function. American nurses especially ADN prepared... Read More

  1. by   Hushdawg
    Quote from Silverdragon102
    We have many members posting in the International forum that they have no nursing experience and have employers in the US but stuck in retrogression. Agencies generally will ask for experience but reading the threads in the International section many especially in the Philippines are struggling to get this experience.
    Yes, I'm aware of the struggle that nurses have in getting this needed experience. However, the hospitals still need it in order to hire and saying that immigrant nurses are inexperienced when they come to work in the US is completely incorrect.

    That was my only point.

    Right now nurses have to go to US hospitals in the Middle east on short-term contracts to get the experience to move on to the USA, Europe or Australia and New Zealand. There are so few long-term contracts in Arab countries that nurses cannot seriously think of them as destination, only training grounds. I think the US hospitals actually like it that way, the recruiters seem to route nurses through this as a process although I cannot confirm any official or unofficial policy to do this, it is based on my observations.
  2. by   Hushdawg
    Quote from Alexk49
    I went to the search site and the positions I saw were for very seasoned nurses with a specialty. If a US born nurse is not available for these very specialized positions, I agree there is a need to bring in the nurses. I did see very few medical surgical nurses, so the foreign nurses will need specialty experience also.
    Currently the USA staff positions are like those in the UK and other European countries, the shortage is only in specialized positions. What we are looking at though in the trend projections for the next 2-3 years is shortages spiking in overall RN staff positions due to numerous factors. Factors such as the rising age of the average RN and normal turnover as well as the increased stress of the work environment and higher education requirements (since RNs typically in the USA are AS degrees while foreign graduates are BS degree holders and hospitals are starting to get pickier with hiring).

    I would suggest, based on the hiring trends we are seeing, that US nurses complete the BS degree so that they may be more competitive and have more opportunities to move into specialized positions for greater job security (and pay of course).

    Quote from Alexk49
    If the agencies are not paying for travel expenses, prep courses, housing, that is even better. This means the foreign nurses would be processed like the native nurses. If there is a bonus, the foreign nurse should be entitled to it ( just like a native nurse) after they have been successfully employed.
    I totally agree. I really like this trend because it is stopping the practice of looking at nurses as a commodity to be traded. This attitude among staffing and recruitment agencies, I think, is the greatest problem to hit immigrant nurse communities over the last 10-20 years.

    Quote from Alexk49
    If you look at the history of nurse immigration traditionally the nurses went to urban hospitals, if there is a need in rural lower paying jobs and the foreign nurses are willing work in these areas, I would see it as a good situation.
    But you also have to look at reasons behind this hiring trend. It was due to many factors that have changed over the years.
    1) Urban centers experinced massive population booms during the Baby Boomer and Generation X eras which were not equally experienced across rural areas

    2) Urban centers provided stability of immigrant communities which were established to help support newcomers to the USA.

    3) Racism and other bigoted ideologies from rural hospital administrators which prevented the hiring of non-white and non-native individuals.

    One of the things that we try to do is educate nurses about the fact that the USA is a very diverse place and that nurses who are from the provincial areas are probably going to be more comfortable in more rural and small city environments than being plopped down in the center of Times Square. I also illustrate that since many Asians have become indigenous to the USA that any immigrant can find communities to help them feel more comfortable even in a small city with a population of only 30,000.

    Quote from Alexk49
    Are the foreign nurses aware that the situation has changed? That you must have experience and pay your own way?
    What do you think I do every day?
  3. by   Hushdawg
    Quote from Alexk49
    Since there is not a "shortage" right now and this in anticipation of need, why is the bill be proposed now. Shouldn't it be proposed when there is a need.
    Absolutely not.
    This is like treating a patient that is already dead.
    Understand that when a bill is submitted then it goes through a long process before being voted on and then passed into a law. The absolute soonest that this measure could be approved would be 2010 which is when the beginning of the shortage spike is expected.

    If a bill is pushed through on an emergency measure, as what would happen if we waited for the shortage to occur first, typically it costs the taxpayer much more and is more sloppily written without appropriate provisions for control and mediation of the measure. Additionally, emergency measures are known to have riders attached which increase wasteful spending and they are not analyzed as they should because of the panic state of things.


    Quote from Alexk49
    My point about the outpatient and home nursing is the following.

    A. nursing education the progression of care is taught, that the nurse always needs to be thinking of the next level of care. My understanding is that many countries do not have levels of care ( Hospital, SNF, Home Care, Skilled Nursing care, and custodial care). If I am wrong please correct me.
    It varies from one nation to another, but this is why hospitals have orientation programs. In the Philippines, for example, the family is charged with a majority of care due to the culture. Nursing homes for the elderly are almost unheard of as they are in Arab nations.

    This is one of the reasons why many of us are proposing bridging instruction to be taught before the nurse is hired so that the hospital will see that he or she has passed a certified medical cultural orientation program. Obviously these must be certified by NCSBN and other bodies in the USA in order to be legitimate.

    However, I should point out as someone who has lived in various places of the USA that these levels of care are not always available in the US. The types of care one can access in a major city will be far greater than one can access in a small city or in rural America.

    Quote from Alexk49
    B. Many times third party payors are looking for defined information for payment, the concept of insurance is totally new foreign nurses, what needs to pre certification, what is covered by insurance, etc.
    I disagree. Insurance is well known here and most countries. Those countries without insurance are going to be extremely impoverished nations.

    By that token, wouldn't nurses who work in nations providing universal healthcare also be just as clueless about insurance and coverage? Yet these are nations where the nurses are trained at US level or higher already.

    Quote from Alexk49
    C. Since the outpatient systems don't exist in foreign countries the foreign nurses are not exposed to this type of care.
    You're generalizing again.
    It varies from one nation to another and, once again, this is what orientation courses are for.
  4. by   Ginger's Mom
    From my reading here, I think many of the IEN are expecting to come to the USA, with free housing, living in a city and working in a hospital. If you are preparing IEN for the realities of coming to the USA you are doing a good thing.

    As far an nurses retiring in the next 2-3 years, what I see and hear is that retirement age nurses are planning to work past retirement age due to their losses in 403(b) and 401 (k).

    Many of the Associate Degree nurses have a BS in another field, for them getting a BSN is useless, they can go on and get a MSN. I don't think this is the time to bring up the BSN debate either since the competitive hospitals in my area, would hire a native ASN over a IEN so I don't think your premise is valid.

    I don't think you can think of nursing as a secure occupation, as a nurse who has lived through several down cycles, nurses have to reinvent yourself every couple of years. Those older nurses I mentioned before have adaptable very well to new technology. My point, is that to stay active in nursing all nurses have to evolve to meet the job requirements.
  5. by   Hushdawg
    Quote from Alexk49
    From my reading here, I think many of the IEN are expecting to come to the USA, with free housing, living in a city and working in a hospital. If you are preparing IEN for the realities of coming to the USA you are doing a good thing.
    Not only that but we lessen the workload of the BONs because we handle screening and error-proofing and ensure that applications for licensure are complete with all requirements before BON recieves them.

    We also educate nurses about all opportunities so that they aren't just applying to CA, VT and NM anymore.

    Quote from Alexk49
    As far an nurses retiring in the next 2-3 years, what I see and hear is that retirement age nurses are planning to work past retirement age due to their losses in 403(b) and 401 (k).
    Bearing that in mind, how many of the 43% (roughly) of nurses reaching retirement age within 3 years are going to do that?
    Even if only half of those retire it still means a large shortage that the US is not prepared to fill.

    Quote from Alexk49
    Many of the Associate Degree nurses have a BS in another field, for them getting a BSN is useless, they can go on and get a MSN. I don't think this is the time to bring up the BSN debate either since the competitive hospitals in my area, would hire a native ASN over a IEN so I don't think your premise is valid.
    And many nurses from Asian countries are also doctors who second-course as nurses... so we're going in circles.
    What would you rather have? A physician with an AS in nursing or with a BS in nursing?

    Quote from Alexk49
    I don't think you can think of nursing as a secure occupation, as a nurse who has lived through several down cycles, nurses have to reinvent yourself every couple of years. Those older nurses I mentioned before have adaptable very well to new technology. My point, is that to stay active in nursing all nurses have to evolve to meet the job requirements.
    I agree, nursing is not always a secure occupation, that is why I suggest increasing the level of knowledge and education to make it more secure than with an AS alone.

    I wholeheartedly agree with your point of staying active, but understand that for foreign nurses in order to renew or reactivate licenses from abroad the BONs require ongoing education of specific hours if their employment does not meet certain qualifiers. There are all sorts of things that the BON does to ensure that foreign nurses with licenses only keep them if they are maintaining their level of practical knowledge.

    Trust the BONs a bit more; they do a lot of work to protect the US patients from poor quality immigrant nurses.
  6. by   Ginger's Mom
    Based on my non scientific very opinionated view point, I would rather have an AS degree nurse then a Doctor become nurse. Many of the doctors are using nursing to sit for the USMLE and then leave nursing. Why shouldn't they since medicine is their first choice. Also it is very difficult for a doctor to translate to the nurses role.

    In a perfect world, it would be great to transition the IEN into the American workforce, but with all the budget cuts who is going to pay for this. Every hospital is hurting and looking to reduce costs , I don't think any hospital is looking for innovation and looking to increase expenses. And if they do have the funds shouldn't the funds be going towards scholarship home based?

    Trust the BON, ( who are going through massive, massive budget cuts), I am going to try for a position on the board. Issues like this makes me want to volunteer my time. In my state I only have to pay my fees and take 15 CEUS, that is such a joke and doesn't keep a non working nurse current.

    I think you are a bit out of touch of what is going on here in the USA, health care administrators have stated that they will accept 1.5% across the board, hospital census is down. All capital improvements are on hold. People are loosing there insurance while the state and feds are cutting programs. This nursing "shortage" is on paper and there are no funded positions for the anticipated growth. Positions at all levels are frozen ( meaning they maybe posted but they are not hiring unless critical).

    We also educate nurses about all opportunities so that they aren't just applying to CA, VT and NM anymore

    Did nurses think they could find a job in Vermont? Didn't they look at the population in VT? I would say they were out of touch, I think VT processes the IENs to padded their state budget.
  7. by   rainbow11
    Yes, I did contact immigration attorneys, basically everyone is suggesting to KILL SOME TIME until there is NEW BILL. There are attorneys willing to do paperworks, and hospitals willing to sponsor, but they do not want to, or I should say CAN NOT HELP until there are VISAS AVAILABLE.

    Unfortunately, generally nurses with BSN degree do NOT qualify for work visa, H1B. In order to apply for work visa the position should require a BACHELOR'S degree MINIMUM. For someone to work as a RN in the States you do NOT NEED a bachelor's degree, associate degree is enough (even though they seem to prefer BSN.)

    When I find nursing positions that require BSN degree, they also ask for many years of experience. These are Nursing supervisor/manager positions. As a new grad. with a BSN, who is NOT ALLOWED to work how on earth am I supposed to have experience?

    I applied to several NP programs. It's not like I wanted to do master's in nursing. I'm running out of patience waiting for a stupid bill, so I thought I might as well go back to school instead of KILLING SOME TIME. I had all of their admissions requirements, even GRE and TOEFL tests were waived for me, but they are denying my applications because of the lack of nursing experience again (they should really say so in their requirements instead of saying "nursing experience is preferred"!! i guess it's their way of fooling you and making money)!

    I almost wish I never went to a nursing school in the US - WHAT A WASTE OF MONEY, TIME & EFFORT!!! - in a country that does NOT give credit to people like myself who went to their university to get education, and obeyed their immigration rules and regulations! All that effort, and my US RN license is WORTHLESS really! If I joined millions of illegals from the beginning, I probably would have been much happier, at least nothing to get frustrated about nursing. This country's immigration system is sooo screwed up. They do NOT seem to distinguish someone working hard, making all the effort to be LEGALLY here and someone who does not give a **** about being legal, and falls out of status immediately, works & don't even bother to pay taxes.

    Oh, I'm from a pretty peaceful & democratic country, so "I can't go home" probably won't work for me. I'm getting really disgusted about this nursing, immigration staff..

    Quote from Hushdawg
    You should contact an immigration attorney and see if there is an alternative for you.

    Some free advice: There are alternatives to retrogression; you need a lawyer and some patience but you can still immigrate legally and work if you fit certain qualifiers.

    I understand how you feel. When I was in Chicago I was working with a community of Arab nurse graduates who were struggling to get legal status to work; luckily we were able to find ways to get them to immigrate legally because of the state of war and their inability to return to their defined "home" country.
    So now there are a few dozen patriotic Arab-American nurses working happily in the greater Chicago metro area.

    I hope you can find a solution soon for your situation.
    Last edit by sirI on May 31, '09
  8. by   Ginger's Mom
    Moon906, you are in a unique class, I think you would benefit from the http://en.wikipedia.org/wiki/Compreh...rm_Act_of_2006

    Comprehensive Immigration and Reform Act, no the above bill.

    Also look into perioperative nursing, many programs do not require any professional experience.

    http://www.aorn.org/applications/cou...=1%3D1&byMode=[Mode]%3D'On-Site'&submit=Search

    It may help since you would have a specialty occupation.
  9. by   Silverdragon102
    Quote from Hushdawg
    Yes, I'm aware of the struggle that nurses have in getting this needed experience. However, the hospitals still need it in order to hire and saying that immigrant nurses are inexperienced when they come to work in the US is completely incorrect.

    That was my only point.

    Right now nurses have to go to US hospitals in the Middle east on short-term contracts to get the experience to move on to the USA, Europe or Australia and New Zealand. There are so few long-term contracts in Arab countries that nurses cannot seriously think of them as destination, only training grounds. I think the US hospitals actually like it that way, the recruiters seem to route nurses through this as a process although I cannot confirm any official or unofficial policy to do this, it is based on my observations.
    Hospitals can make it a requirement that experience is required but we have seen many post that have no experience and US employer. I can only go on what I am seeing in the International forum. Agencies do make it a requirement to have experience and many require 2 years but going direct hire well that is up to the hospital.
  10. by   Ginger's Mom
    http://www.nytimes.com/2009/05/31/op...nt&tntemail1=y

    Looks like not all the Senator is for this bill.

    "We must do two things: Expand our health care capacity by giving American nursing schools the resources they need to hire educators to train the next generation of nurses. And we must help the growth of health care in developing countries."
  11. by   rainbow11
    I'm giving more hope in this H.R.2536 "Emergency Nursing Supply Relief Act" than a Comprehensive Immigration Reform (CIR), which focuses on illegal immigration, borders etc. unless CIR will include a section about legal nursing immigration. In my opinion these politicians should discuss about legal immigration FIRST before illegal ones.

    I'm sure I'm not the only one in this ugly situation. There are hundreds and thousands of US-educated, but foreign-born RNs, who are in the same shoes as I am. They just CAN NOT work. Unlike other majors we can not just go to a grad. school (if we decide so) because of lack of nursing experience. It does not make any sense to me, this is just one example showing how screwed up the immigration system in the US.

    I'm not sure if getting a specialty in nursing will help at all. Personally I do not want to spend another cent for something, like my BSN degree, which later turn out to have no use at all! But thanks anyway!


    Quote from Alexk49
    Moon906, you are in a unique class, I think you would benefit from the http://en.wikipedia.org/wiki/Compreh...rm_Act_of_2006

    Comprehensive Immigration and Reform Act, no the above bill.

    Also look into perioperative nursing, many programs do not require any professional experience.

    http://www.aorn.org/applications/cou...=1%3D1&byMode=[Mode]%3D'On-Site'&submit=Search

    It may help since you would have a specialty occupation.
  12. by   Ginger's Mom
    I have to ask didn't your school inform you that you wouldn't be able to work after graduation without a SSN ? Why is this a surprise to you since retrogression has been ongoing for years ?

    I hear you pain and you would be a better fit for a US Hospital employment ( I say this as a nurse and a consumer) but is it fair to all the nurses who have been waiting patiently to come to the USA and playing by the rule ? On the other hand you have been contributing to the economy here.

    I guess I have lots of questions and no concrete answers and I don't have the wisdom to have a good answer that would be fair to everyone.
  13. by   rainbow11
    Do you think that I'm unable to work because I do not have a Social Security Number?? HA HA. That's funny. I'm sorry you made me laugh again (I see you have no idea). This has nothing to do with a SSN or the nursing school. This is an immigration issue (there is NO VISAS for RNs!!), I do not have a legal right to engage in employment! There used to be a Schedule A visa category for RNs and physical therapists to get a permanent visa, but that category ran out of visa about 2 years ago when I was in school. The problem is a new bill hasn't been approved since that!! NOBODY knows when another bill will pass, if it ever happens!!

    I think there is a big difference (in terms of the process to apply for a visa) between foreign-born RNs 1) who went to school in the US, passed NCLEX, and got US RN license vs. 2) who are non-US-educated and waiting abroad! The ones who didn't get their nursing education from the US, and do not have US RN license they have to take some kind of international Nursing licensure exam, TOEFL (Test of English as a Foreign Language), Spoken English Test etc etc. I'm sure it is a loooong process for them to prove that their education is equivalent to US system. http://www.cgfns.org/sections/programs/vs/ there might be some info about exams etc. here. Even I have to pay money to get a Visa Screen to prove that my US-education is US-equivalent (even though my BSN is from an accredited US university!). That's another nonsense! (There are many stupid rules that don't make sense at all). But I was told my Visa Screen processing will be much faster than of those who are educated abroad. Filing applications probably has more steps, and papers involved and takes soo much time for them too. Plus they are not physically in the States, thus everything has to go through an agency or something like that. I'm just saying things that I heard, I can't speak for them really. May be there are other reasons that makes the whole process for them soo long, and that's why they've been waiting for years...

    Are you trying to say that they (non-US educated RNs) have been playing by rules and I haven't? Pardon me! I hope you didn't mean it or you just don't know what you are talking about?! As I said above I know the rules and requirements are different based on where you earned your nursing education, and probably if you are in the States or not. I feel the pain of RNs waiting for years to come to the States!

    My point is I think there should an easier way that ALLOW US-EDUCATE RNs to be able to work legally after nursing school. We also played by the rules, worked soo hard in school, paid so much money to get the degree (in most cases when you are an international student your tuition is much higher than in-state residents', or even out-of-state residents'; and no there no such thing as "financial aid" when you are a foreigner!). The visa process should probably be handled differently than of those educated abroad. I also think that the Congress should discuss about LEGAL immigration prior to illegal ones! That's just NOT FAIR! Also, it is NOT FAIR for us, who went to the same school, got the same degree and license as our American classmates, UNABLE to work simply because we are foreign-born!

    If I knew what was going to happen, of course, I wouldn't have gone to a Nursing school here! Probably, I wouldn't have come to the States in the first place. Why waste money & time for something where the Government doesn't give any value and turns out to be WORTHLESS! I wanted to work here for a few years, because I went to school in the States. Hope that makes sense.

    I don't understand people who are opposing this bill. The stats say that there will be about ONE MILLION open nursing position by 2020. So, how much of a difference will 20,000 green card visas to foreign RNs will make? one million vs 20 thousand?! That 20,000 is a one time deal, and it's for only 3 years (probably the first year they'll ran out of visas again).


    Quote from Alexk49
    I have to ask didn't your school inform you that you wouldn't be able to work after graduation without a SSN ? Why is this a surprise to you since retrogression has been ongoing for years ?

    I hear you pain and you would be a better fit for a US Hospital employment ( I say this as a nurse and a consumer) but is it fair to all the nurses who have been waiting patiently to come to the USA and playing by the rule ? On the other hand you have been contributing to the economy here.

    I guess I have lots of questions and no concrete answers and I don't have the wisdom to have a good answer that would be fair to everyone.

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