Thank you for this posting! I hope you do not mind but I will cut and paste it here. I will write to the advocacy groupof the information posted. Here is the article:
Testimony submitted to Congressional
committees and federal agencies in 2001
American Hospital Association
United States Senate
Rural and Urban Health Care Needs
May 22, 2001
Mr. Chairman, I am Bradley D. LeBaron, president and chief executive officer of the Uintah Basin Medical Center (UBMC), in Roosevelt, Utah, and chairman of the Utah Hospital Association. I am here today on behalf of the American Hospital Association's (AHA) nearly 5,000 hospital, health system, network and other health care provider members. We are pleased to have the opportunity to testify on the health care worker shortage crisis, an issue of great concern to the health care community and the general public.
UBMC is a rural 42-bed health care, 501c3, not-for-profit, independent facility in northeastern Utah. We employ over 300 health care personnel, and care for more than 2,100 inpatients per year, serving a population of 25,000. We are a sole community provider with a broad range of health care services including general acute medical services, home health and hospice.
Mr. Chairman, health care is at a critical juncture. Along with increased regulation and decreased reimbursement, a shortage of qualified workers greatly affects our ability to care for the nation's men, women and children. If nurses, physicians, respiratory therapists, pharmacists and scores of others who take care of the nation's ill and injured are not available, the collective mission of health care providers will be threatened.
This crisis affects every aspect of health care delivery, from direct patient care given by a nurse or respiratory therapist to prescriptions filled by a pharmacist and home health care visits from a nurse's assistant. The most visible of these, though, is a lack of nurses to provide the critical bedside care needed in the inpatient setting for today's patients, as well as those who require care in the future. The average age of our nation's nurses providing care today is 45, and the average age of our nursing faculty continues to rise. As these caregivers, teachers and mentors retire from the workforce, fewer health care workers are in training to take their places, as evidenced by the continuing nationwide decline in nursing school enrollment. Factor in the 78 million baby boomers who will begin retiring in the next 10 years, and our resources will be stressed even further. Demand for health care will exceed capacity.
Over the years, hospitals and health systems have repeatedly experienced temporary shortages of personnel, such as during the nursing shortages of the 1960s, 1970s and 1980s. Following a redesign of work place and personnel policies in response to these shortages - and often a recession in the general economy - the situation improved in most communities as previously-trained nurses were re-employed in hospitals and health facilities.
Our current and daunting shortage is unlike any we have seen in the past. While traditional factors such as an expanding national economy, overall low unemployment rates and competitive compensation packages are contributing to the current shortage, new demographics and other factors are exacerbating the situation.
Most nurses work in hospitals, but many are turning away from this traditional health care setting. Hospital patients are now older, sicker and require a greater intensity of care from nurses and other personnel. Nurses, and everyone involved in health care delivery, are spending an increasing amount of time on paperwork and less time on patient care. Women, who traditionally comprise the majority of nursing personnel, are finding other career options that are less physically demanding, less stressful and come with a higher rate of pay. Baby boomers, who make up a large part of the health care workforce, are approaching retirement. Nursing school and training programs are experiencing annual declines in enrollment, and some have even closed. Even if more students could be recruited into nursing schools, there is now a shortage in qualified nursing faculty, and the average age of nursing school professors is 52.
Over the past several years it has become increasingly difficult for hospitals to attract and recruit qualified nurses. Rural hospitals face this dilemma every day. At UBMC, we have 58 registered nurses (RN) and 38 licensed practical nurses (LPN) on staff; however, our current vacancy rate is at 7 percent among RNs, and 6 percent among LPNs. Three years ago, we had virtually no nursing vacancies. Our current vacancy rate is the worst it has been in my eight-year tenure with the hospital. In fact, earlier this month, we just barely averted losing three nurses to urban centers for better pay.
Along with other health care facilities around the country, we are looking at a variety of options to retain our current nursing staff and attract new nurses. In the last 18 months alone, we have increased RN wages by 17 percent, in an effort to compete with larger health care facilities in other areas of our state.
UBMC is one of the few rural institutions with a nurse's education program in our town. We have partnerships with the baccalaureate nursing programs at Utah State University branch campus and Weaver State University, as well as with the LPN training at Uintah Basin Applied Technology Center. We graduate 20 nurses a year from these programs. But even last year, 14 nurses left the area to work in other areas of the state and country.
The public's demand for the highest quality patient care at the lowest possible cost has come face to face with the tightest labor market in the past 30 years. For example, government projections state that by 2020 we will face a shortfall of about 300,000 registered nurses.
Mr. Chairman, your colleagues in the Senate and the House, along with health care leaders, are working to find long-term solutions to the challenges we face. Hospitals and health care provider institutions across the nation are looking at retooling their retention and recruitment strategies, offering bonuses and providing other incentives, such as tuition reimbursement and child care, to attract and retain qualified health care workers to their facilities. The AHA formed the Commission on Workforce for Hospitals and Health Systems, asking a diverse population of stakeholders to work together and craft recommendations and bold solutions for this national dilemma. The commission represents hospital administrators, caregivers, academia, business leaders, frontline nurses, organized labor and many others. In addition, the Utah Hospital Association has formed the UHA Workforce Taskforce, to address what is becoming a critical shortage of nurses - and other health care staff - in Utah.
Yet even as we develop long-term strategies to expand our workforce, we face immediate shortages across the country. It takes a minimum of two years for a student to complete a professional nursing program with an associate's degree. Unfortunately, even if we were able to recruit scores of men and women into our nursing education programs, we still face daunting shortages. Using foreign nurses on a temporary basis is one of the few options that may help us address this need. According to Peter Buerhaus et al. (Implications of an Aging Registered Nurse Workforce, JAMA, June 2000), "immigration of RNs educated outside of the United States may provide the most feasible strategy." We would be able to fill many critical clinical nursing positions in an expedited manner.
Until 1995, temporary visa programs existed to help address episodic nursing shortages. For example, the now defunct H-1A visa program was used specifically to allow RNs licensed in their own countries to enter the U.S. temporarily. However, the current shortage we are facing is dramatically different, and we need both short- and long-term approaches. Currently, only one temporary program exists, the H-1C visa program for nurses. While I am certainly not an expert on immigration law, I can tell you that even this option is woefully inadequate, and fraught with complicated conditions, making it almost impossible for hospitals to use this as a remedy for their current troubles.
In 1999, Congress created the temporary three-year H-1C visa program, a narrowly crafted measure to enable health care facilities in underserved communities to recruit critically needed health care staff, specifically nurses, from foreign countries. Under this program, 500 foreign nurses per year may enter the country. But this program is almost useless. In order for a hospital to take advantage of this program and sponsor a foreign nurse into our country, the facility must have a minimum of 190 beds; their patient population must be comprised of at least 35 percent Medicare and 28 percent Medicaid recipients; their geographic location must have been designated as a Health Professional Shortage Area as of March 30, 1997; and the facility must meet strict labor certification requirements. Currently, given these rigid criteria only 14 out of our country's more than 5,000 hospitals even qualify for this program. And to my knowledge, not one registered nurse has entered the U.S. under the H-1C program.
The H-1B visa program is another program that, on paper, would appear to assist hospitals in bringing in foreign nurses on a temporary basis. Unfortunately, this is not the case. Last year, Congress amended the H-1B visa program, enabling skilled professionals with an employer-sponsored job in the U.S. to enter the country and work for up to six years. The requirements also state that in order to qualify for an H-1B visa, the individual must have a college degree and the job must require a bachelor's degree as a minimum level of entry. RNs generally do not qualify under the H-1B program since most hospitals and other employers who hire nurses do not require nurses to hold baccalaureate degrees. Another disadvantage is that these visas are limited in number each year, and the quota is generally reached early in the year. This illustrates the crucial need to reform our current immigration policies as it relates to nurses.
Some of my colleagues in Utah have attempted to work through these complex and nonsensical immigration rules, in order to fill critical positions in their facilities. It took one hospital almost 18 months to obtain a foreign nurse to care for their patients using the EB-3 (green card) visa program. Another facility in southeastern Utah is having a difficult time obtaining approvals to immigrate a foreign medical technician. But most rural facilities cannot afford the cost or time delay to obtain foreign nurses or other foreign health care workers.
To pretend that we can take care of the nursing shortage domestically is a disservice to patients. This is a problem that cannot be solved by hospitals or any one group alone. And it cannot be solved solely by the federal government. It demands a multi-tiered, collaborative approach among all affected parties to develop short- and long-term effective strategies and solutions to meet the health care needs of today and tomorrow. Revising our immigration policies toward foreign-born nurses is one way to apply a salve to this growing wound afflicting our health care system.
We have a critical shortage of women and men who are willing to serve in health care. This will only get worse, unless we work together to craft solutions that will allow us to continue our calling of providing compassionate care to all.
Thank you, Mr. Chairman.
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