Staffing Crisis Calls For Revised Immigration Laws

  1. Health Leaders Comment

    Staffing Crisis Calls For Revised Immigration Laws

    By Carl Shusterman, for, July 29, 2002
    Anyone who has examined the shortage of clinical healthcare professionals in America (including immigration attorneys such as myself) realizes that importing foreign workers is not a long-term solution to this pressing problem.

    Foreign nurses, physicians and other providers, however, are an important supplement to the clinical workforce, and many hospitals and other healthcare organizations depend upon them. Foreign-born nurses, many of them from the Philippines, played a vital role in filling staffing gaps during the nurse shortage of the late 1980s and early 1990s.

    For years, foreign-born physicians have provided care to many of the 20 million people who live in some 2000-plus Health Professional Shortage Areas (HPSAs). Clearly, an immigration policy that ensures reasonable access to foreign clinicians is important at a time when hundreds of thousands of job vacancies exist.

    Unfortunately, current U.S. immigration policy puts unnecessary and unfair restrictions on hospitals seeking to hire foreign-born health professionals.

    First, and most egregiously, there is no viable temporary visa category for foreign born nurses. While some 200,000 temporary "H-1B" visas are available each year to foreign computer professionals, scientists and even fashion models, only 500 temporary "H-1C" visas are available to foreign nurses. The H-1C is a special temporary work visa for foreign professionals, similar to the H-1B, but it is specifically reserved for registered nurses. However, due to a series of restrictions, less than 10 hospitals in the country are able to hire nurses on H-1C visas. The lack of a temporary visa category greatly compounds the difficulty of recruiting foreign nurses who must wait up to two years to qualify for permanent visas (known as green cards).

    Immigration policy is similarly restrictive on the physician side. At this writing, the U.S. Department of Agriculture is not accepting new petitions for physician "J waivers." These waivers allow foreign physicians who train in the U.S. on "J visas" to remain here and take jobs in patient care positions (physicians do not need wavers to perform medical research). If they cannot obtain a waiver through an "interested government agency" such as the USDA, these physicians must return to their home countries for at least two years.

    There are currently some 2,000 foreign physicians working in rural areas through the J-1 Visa waiver program - a very small number relative to the total physician population, but significant to the hundreds of communities they serve.

    In the recent past, many physicians in mostly rural, Midwestern states, obtained J waivers through the USDA. With this option closed, the ability of many rural hospitals to hire foreign physicians is greatly inhibited. The Department of Housing and Urban Development (HUD) also has dropped the J visa program, limiting options for urban facilities seeking physicians on J visas.

    Post 9/11, immigration processing in most visa categories has become more restrictive, as we rightly reevaluate immigration policies in light of security concerns. However, security is yet another reason to allow for the monitored admission of foreign health professionals. Foreign nurses and physicians have an established record for providing care to underserved populations, without any incidence of terror over a period of many years. Their presence will be seen by both the healthcare infrastructure and by potential victims as a tremendous asset should we experience further mass terrorist attacks. With the various licensing and background checks already in place, health professionals are more highly vetted than any of the dozens of foreign professionals who currently qualify for temporary work visas.

    The solution to these problems is straight-forward and is proposed in a common sense bill (Senate 1259) introduced by Sen. Sam Brownback (R-Kansas) last year. Senate 1259 would allow foreign nurses to qualify for temporary work visas, in the same way that foreign computer professionals and fashion models do. Hospitals then would be able to recruit licensed, qualified nurses in a matter of a few months.

    The bill also would double the number of J waivers available through the so-called "Conrad 20" program. Conrad 20, named for Sen. Kent Conrad of North Dakota, allows each state Department of Public Health to sponsor 20 physicians for J-waivers each year. That number would increase to 40 under S. 1259.

    The bill creates no new programs and would not require additional government expenditures. However, S. 1259 will only pass with the concerted support of the healthcare industry. The American Hospital Association has specifically endorsed S. 1259, but Congressional representatives will have to hear from healthcare professionals in their districts for the bill to gain momentum.

    Is immigration anything more than a bandage on what is a serious and long-term staffing problem? No. But even a bandage is good to have when you are bleeding.

    Carl Shusterman is a Los Angeles-based immigration attorney and serves as health professions liaison for the American Immigration Lawyers Association, Washington, D.C. He can be reached at

    Loved the following response @healthleaders site.

    Ease immigration laws for healthcare professionals by Leslie on July 30, 2002 at 5:56PM

    Do you want a loved one or yourself taken care of by nurses who can barely understand formal English, nevermind colloquial English? I don't. Let market forces work. I say let's ease immigration laws for attorneys and bring down the cost of litigation! Leslie Durr
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  3. by   fedupnurse
    We should have tougher restrictions for entry into this country. It use to be that you couldn't come to this country unless you had a sponsor to be responsible for you. I think we need to go back to that kind of system. In my neck of the woods these immigrants know how to manipluate the system before they even get off the boat and practically have their medicaid cards and welfare cards waiting for them. Enough already! I the days of the sponsor it was the sponsors responsibility to ensure that the immigrant could pay his way. Ah, the good old days.
  4. by   oramar
    This guy is in somebodies pocket. Somebody is crossing his palm. His reasonable statements are a subtrefuge to cover what he is really up to.
  5. by   Gomer
    Question...just how much does Carl make when he imports these bodies?

    I would suggest that instead of funding foreign interests, we use the monies to education our own citizens and improve the lot of those already working in the profession.
  6. by   midwestRN
    My hospital uses 20+ foreign doctors, some good, some bad. Most are difficult to understand. The patients rarely are able to talk to them about their care because their accents are very thick. I have to ask them to repeat T.O.'s several times, and still I am not sure what they are saying at times. The answer has to be to educate our own. We have a huge workforce out there that would be willing to be nurses if the pay, benefits and working conditions were enticing enough.
  7. by   mattsmom81
    I totally agree with you guys!

    Something stinks here....he's in the pocket of the AHA more than likely. "Let's just import do the work American nurses won't. Let's ignore the cultural and language barriers...a warm body will suffice.".

    Perhaps the future of healthcare/nurses does lie in the Phillipines, Mexico, Spain...whatever new country is jumping on the bandwagon.....but I don't have to like it nor endorse it.
  8. by   fedupnurse
    Let's recruit from countries where people are oppressed. Then they will think they have it good here. They won't make waves. The waves we are making is to improve the system. God knows the suits don't want to see that-might cut into their profits!
  9. by   NancyRN
    Better yet....let's recruit the nurses who are already HERE! It might take something really innovative like...paid lunch breaks..
  10. by   UKRNinUSA
    I am one of those imported nurses from the last nursing shortage (i came over here in 1991 from the UK ). I have not worked in acute care for a number of years due to the poor, and at times intolerable, working conditions. You are quite welcome to cite me as an example of how this so-called "solution" doesn't work. Just because we come from a different country doesn't mean that we don't know good working conditions from bad.
  11. by   fergus51
    It is already VERY difficult for immigrant nurses to come here. We just underwent a round of gov't cuts where a lot of nurses lost their jobs, so our union stopped allowing foreign recruitment until those displaced nurses have jobs. One of the upsides of a union. They were called racist for it, but I think it was just common sense. Aside from the fact that we should take care of the nurses we already have, it isn't fair to bring foreigners here when they might get bumped out of their job.
  12. by   rncountry
    The difference is though UK nurse is that you come from a country that has significant cultural similarities, at one time I recall a statisitic that 70% of American's could ultimately trace their roots back to Great Britian. Contrast that to a nurse coming from a country in which is unacceptable to talk back, whether it is to a male or to the boss. Nurses coming from say the Phillipines where the idea of a woman being strong and independent has yet to take root, are a very different situation than a nurse from the UK where it has been my impression that there are strong unions, and strong nurses. So what you see and I see as intolerable situations are likely to be ignored by those from third world countries, because it may very well be better than what they have came from. They may well be afraid to speak out as well, fearing they will not have what few protections that American nurses have.
    What it makes me think of is when millions of Irish Catholics came to this country during the potato famine. Know why there are so many cops and fireman of Irish descent in New York and Boston? When the Irish Catholics came here(as opposed to Ulster Irish or Scots Irish who were protestants) they were looked as the dregs of society, so the only jobs they could get was as cops and fireman, jobs in the late 1800's and early 1900's that certainly did not have the respect they carry now.
    The only way to make things different for nurses is for nurses to be outspoken, I don't see third world nurses being able to do that, and I believe that is the point.
  13. by   -jt
    <The only way to make things different for nurses is for nurses to be outspoken, I don't see third world nurses being able to do that, and I believe that is the point.>

    I think some of that is changing too. The first wave of imported Phillipine nurses have been working in my hospital for 20 - 30 yrs. Others have been here for less than 10 yrs. They do speak up. Maybe more politely than the rest of us. But they do fight for what is right & are not doormats or passive/permissive. They even have no qualms about going on strike when necessary.

    The president of the board of directors of the New York State Nurses Association (which is also our labor union) is a Phillipine staff nurse who is also the past president of the Phillipine Nurses Association in this country.

    Hospitals prefer to recruit from the Phillipines because their nursing school curriculums are based on & follow US nursing school curriculums. They use US textbooks & learn US standards of care. They are taught in English & graduate with a BSN. But I bet the hospitals didnt bank on these nurses actually standing up for themselves - which they are doing more & more.
    Last edit by -jt on Aug 6, '02
  14. by   -jt
    <<<107th Congress

    Immigration and the Nursing Workforce

    ANA's Message to Congress:

    ANA believes that the U. S. healthcare industry has failed to maintain a work environment that is conducive to safe, quality nursing practice and that retains experienced U. S. nurses within patient care. ANA supports continuation of the current certification process to apply to all foreign-educated health care workers regardless of their visa or other entry status. ANA opposes efforts to exempt foreign-educated nurses from current H-1B visa program requirements.

    The Issues Surrounding Immigration and the Nursing Workforce:

    The practice of changing immigration law to facilitate the use of foreign-educated nurses is a short-term solution that serves only the interests of the hospital industry, not the interests of patients, domestic nurses, or foreign-educated nurses[/I].

    ANA condemns the practice of recruiting nurses from countries with their own nursing shortage.

    The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 requires that all foreign health care professionals, except physicians, must be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or another independent, government-certified organization qualified to issue credentials. The certification process verifies that the foreign health care worker's education, training, or experience meets all applicable statutory and regulatory requirements for entry into the United States. In addition, any foreign license submitted must be validated as authentic and unencumbered. If the health care worker is a registered nurse (RN), the nurse must have passed an examination testing both nursing skill and English language proficiency. ANA opposes the proposal now being considered that would reduce these requirements.

    The cause of instability in the nursing workforce must be addressed.

    Over-reliance on foreign-educated nurses serves only to postpone efforts required to address the needs of the U.S. nursing workforce.

    Current laws limit the recruitment of nurses from overseas to 500 per year. The proposed Senate bill would [U]increase the number of nurses recruited from overseas from the current 500 per year to 195,000 per year. The House of Representatives proposed bill removes the cap entirely and calls for no limit on the number of foreign-educated nurses that could be recruited to the US. The proposed bills in both the House and the Senate are similar in reducing the current strict credential requirements for these nurses.

    Additionally, foreign-educated nurses brought into the United States tend to be placed in jobs with unacceptable working conditions with the expectation that these nurses, as temporary residents and foreigners, would not be in a position to complain.

    To view charts comparing current visa laws along with the changes that have been proposed to reduce credentialling requirements and allow for the recruitment of many more foreign-educated nurses from oversees, see:
    Last edit by -jt on Aug 6, '02