Reverse "out source" nursing? Can we call it that?????

Valerie Salva, BSN, RN · Mar 11, 2009

I've been calling it "insourcing."

And it's time for it to end.

Our nation's health - especially its' economic health- is put at risk by insourcing. Only health care corp CEOs and shareholders benefit.

I have also worked in the auto and manufacturing industries.

I just posted about this type of situation in another thread- here is the post-

Imo, there is no nursing shortage in the US. US employers do not want to pay nurses better, improve working conditions, or assign reasonable nurse to pt ratios. They do not want to treat us as professionals, respect us or deal with us, so they look for nurses elsewhere.

This can be compared to the auto industry and other US manufacturing-

There is no shortage of auto or factory workers- quite the opposite- but US companies moved their operations overseas and to Mexico in search of cheaper workers.

US hospitals can't be moved out of the country, so instead, nurses are brought in from other countries.

This way, both the manufacturing and health care industries spend less money on employee wages, and keep far more $$ for their own executives and shareholders.

When a foreign nurse is sponsered to come to the US, they usually have to sign a contract which states that if they quit their job within so many years they must pay the hospital tens of thousands of dollars. Employers have them over a barrel, so the sponsered nurse is under a lot of pressure to put up with very poor working conditions and impossible work loads.

If there is a surplus of nurses in the US, nurses must compete for jobs, instead of employers competing for nurses- this is what employers want.

hpygrl01 · Mar 11, 2009

I agree, but can there or is there a union for nurses country wide? Like what the UAW has? Oh forget it, I just remembered the UAW is now basically dead.

RNsRWe, ASN, RN · Mar 11, 2009

While I share your annoyance with the influx of predominantly cheaper staffing, I do have to let you know that they DO have to take a test: the NCLEX, the same one you do. So while they may indeed come from a different standard or a different culture or a different background in nursing, they DO have to pass the very same test that you and I must in order to practice nursing in the US.

APRN., DNP, RN, APRN, NP · Mar 11, 2009

I don't taste the flavor of anyone trying to put down the intelligence of "they" whom have to pass the same NCLEX as "we".

I understand that there are a LOT of angry new grads out there who grew up in the US, went to school in the US and intend upon working in the US, and will take NCLEX in the US, but cannot get a job in the US because someone who did not grow up in the US, or go to school in the US, but will take the same NCLEX as they do, will wind up with the job because it is more profitable to the hospital to give the job to the cheapest laborer.

While I share your annoyance with the influx of predominantly cheaper staffing, I do have to let you know that they DO have to take a test: the NCLEX, the same one you do. So while they may indeed come from a different standard or a different culture or a different background in nursing, they DO have to pass the very same test that you and I must in order to practice nursing in the US.

Neveranurseagain, RN · Mar 11, 2009

While I share your annoyance with the influx of predominantly cheaper staffing, I do have to let you know that they DO have to take a test: the NCLEX, the same one you do. So while they may indeed come from a different standard or a different culture or a different background in nursing, they DO have to pass the very same test that you and I must in order to practice nursing in the US.

The problem is not your skills or taking the same NCLEX, it's the fact that American citizens are being turned down for jobs so they can hire RN's from other countries. RN's who are bound by a contract, are less assertive when it comes to pt/Nurse ratio's and who do not rock the boat when there is a problem, It's allowing the wages to be lowered and more importantly, the working conditions to remain unsafe.

Xbox Live Addict · Mar 11, 2009

I've been calling it "insourcing."
And it's time for it to end.
When a foreign nurse is sponsered to come to the US, they usually have to sign a contract which states that if they quit their job within so many years they must pay the hospital tens of thousands of dollars. Employers have them over a barrel, so the sponsered nurse is under a lot of pressure to put up with very poor working conditions and impossible work loads.

In the history books, this was called "indentured servitude" and "bonded" employment (hence the term "bondage"), and amounted to slavery, since the wages indentured workers earned were always insufficient to pay back whatever loan or "bond" the employer held. These foreign workers are being exploited as well.

Henry Ford understood that putting Americans to work would create a built-in customer base for products. Once Americans stop buying products, who will buy them instead?

Ther

Roy Fokker, BSN, RN · Mar 11, 2009

This is an old, tired argument. One that has been discussed multiple times here on allnurses.com.

I'll refrain from answering save for a couple posts that bring up long discredited claims.

because it is more profitable to the hospital to give the job to the cheapest laborer.

Patently false.

Employers have to pay the SAME wages to foreign nurses as they do American nurses. It's Department of Labor laws. You can look it up....

Any employer violating this code is violating labor laws and can be sanctioned/booked/prosecuted.

The problem is not your skills or taking the same NCLEX, it's the fact that American citizens are being turned down for jobs so they can hire RN's from other countries. RN's who are bound by a contract, are less assertive when it comes to pt/Nurse ratio's and who do not rock the boat when there is a problem

This is a generalized - and quite frankly - an ignorant claim/opinion. Many of our immigrant nurses come not only from third world nations like India but also from countries such as Canada, the UK, Germany, Australia etc.

One could argue that US citizen nurses who are also "bound by a contract" are also "less likely to rock the boat" (especially given the current economic scenario) and be "less assertive" (especially new grads) when there is a problem.

It's allowing the wages to be lowered

Not a factual argument - labor laws dictate that employers are bound to pay any nurse qualified to work in the US by the going pay scale. Just because someone is an immigrant doesn't mean they work for lower wages.

and more importantly, the working conditions to remain unsafe.

Working conditions have deteriorated throughout the past couple of decades - despite the waxing and waning of nursing immigration.

These foreign workers are being exploited as well.

Can you prove that foreign nurses are being paid less than their American counterparts (given same jobs/experience/conditions etc.) ???

Because, if you can - said employer is violating labor law.

Once Americans stop buying products, who will buy them instead?

One only need to lose sleep over that question only if one assumes/thinks that supply-demand is a one way road.

Besides - Americans aren't the only inhabitants of this planet... there are more than 5.5 billion others around too. If Americans won't buy products - I'm sure those who are selling said products will find a more lucrative market for their wares...

I welcome one and all who wish to come to the United States for the betterment of their lives or the lives of their loved ones. Honest, productive individuals are what this nation needs right now.

cheers,

Roy

Neveranurseagain, RN · Mar 11, 2009

by oversaturating the market with rn's, it weakens the wages, and creates competition among job applicants. this drives down wages and encourages people to work under less than safe working conditions. if there is an unlimited supply of oversea rn's, this will continue. double the supply of nurses, then see what happens under a supply and demand system.

here is a statement from hrsa's website:in addition to graduates from u.s. nursing programs, the nsm assumes net immigration of 3,500 rns per year from foreign countries.

http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/2.htm

here is a quote from the professional journal of nursing: [color=#808080]often, nurse migrants are placed in vulnerable, inequitable work roles, and employing nurse migrants fails to address basic causes of nurse shortages in developed countries, such as dissatisfaction with work conditions and decreased funding for academic settings. ethical concerns in nurse migration

journal of professional nursing, volume 22, issue 4, pages 226-235

b. mcelmurry, k. solheim, r. kishi, m. coffia, w. woith, p. janepanish

the practice of hiring foreign nurses to address the crisis may be beneficial in the short term but may worsen the situation in the long term. foreign nurses willing to work for less pay and benefits falsely lower wages below what they would be in a fair market. driving down nursing wages will result in nurses leaving the profession to work in other occupations.http://citizeneconomists.com/blogs/2008/07/16/are-foreign-nurses-in-us-healthcares-future/

ana maintains that health care providers should not look overseas for nurses when the real problem is that the u.s. health care industry has failed to maintain a work environment that is conducive to safe, quality nursing practice and that retains experienced american nurses in patient care. 2003 online journal of issues in nursing

article published november 10, 2003

i too, feel america is a melting pot of diversity. i welcome people from different countries and realize that they have the goal that many of us have: a better life for ourselves and family. but in economic times such as we have now, it's time to look after ourselves first.

Roy Fokker, BSN, RN · Mar 11, 2009

by oversaturating the market with rn's, it weakens the wages, and creates competition among job applicants. this drives down wages and encourages people to work under less than safe working conditions.

ok - let us assume that tomorrow all nursing immigration were to stop [which is already the case since october 2006 but that's a different thread]. let us also assume that us nursing schools were to suddenly acquire the ability to turn out more nursing graduates.

wouldn't the same scenario apply then???

nurses in the us are screaming for better 'capacity' in their schools so that more rns can be turned out - but were such a scenario be successful, the net effect would ultimately be the same: 'more rns available for the jobs on hand'.

your "oversaturating the market with rns" scenario.... just no "foreign" nurses involved this time.

if there is an unlimited supply of oversea rn's, this will continue. double the supply of nurses, then see what happens under a supply and demand system.

that's a big, fat "if". reality is that since october of 2006, visas/green cards for immigrant nurses are no longer existant (check out the multiple threads dealing with "retrogression" in the international nursing forum).

there is no "unlimited supply of of overseas rns".

here is a quote from the professional journal of nursing: [color=#808080]often, nurse migrants are placed in vulnerable, inequitable work roles, and employing nurse migrants fails to address basic causes of nurse shortages in developed countries, such as dissatisfaction with work conditions and decreased funding for academic settings. ethical concerns in nurse migration
journal of professional nursing, volume 22, issue 4, pages 226-235
b. mcelmurry, k. solheim, r. kishi, m. coffia, w. woith, p. janepanish

this doesn't address the 'primary' focus of my argument vis a vis that "foreign nurses are brought in so that wages can be lowered".

i won't even bother to address the "vulnerable, inequitable work roles" part of it. not only does it smack of elitism, it also leads the reader to believe that immigrant nurses are dunces and will do anything so that they can secure a future here. that's a blanket generalization and a highly offensive one at that.

the practice of hiring foreign nurses to address the crisis may be beneficial in the short term but may worsen the situation in the long term. foreign nurses willing to work for less pay and benefits falsely lower wages below what they would be in a fair market. driving down nursing wages will result in nurses leaving the profession to work in other occupations.http://citizeneconomists.com/blogs/2008/07/16/are-foreign-nurses-in-us-healthcares-future/

(emphasis mine) again - it's against department of labor laws to pay "immigrant nurses" less wages than one would pay an "american nurse".

immigrant nurses are green card holders. they are 'resident permanent aliens' - sans citizenship and the right to vote for the president and run for national office; they enjoy all freedoms american citizens enjoy and are responsible for all the duties thereoff.

citizenship has nothing to do with employment - this is why it is also illegal during an interview to ask any potential applicant if they are a "citizen or not". employers are only allowed to verify if an applicant is "authorized to work" in the united states.

that's the law.

ana maintains that health care providers should not look overseas for nurses when the real problem is that the u.s. health care industry has failed to maintain a work environment that is conducive to safe, quality nursing practice and that retains experienced american nurses in patient care. 2003 online journal of issues in nursing
article published november 10, 2003

the ana also claims to "speak for all nurses" but refuses to represent lpns/lvns.

i don't disagree with anas position that working conditions in the us could be better... but i disagree with their argument that said problems will be solved if only more "american nurses" would be retained.

immigration has always been highly regulated in this country - this isn't a "new" issue for nursing.

i too, feel america is a melting pot of diversity. i welcome people from different countries and realize that they have the goal that many of us have: a better life for ourselves and family. but in economic times such as we have now, it's time to look after ourselves first.

"ourselves"? america is a nation of immigrants - baring the native indian folks; none of us got here ahead of anyone else.

the right person for the right job.

if it were me or my loved one on that er stretcher - that's all i care about.

my final :twocents:

cheers,

roy

lpnflorida · Mar 11, 2009

While I can be upset at the thought of any hospital bringing in Nurse from another country when Nurses in this country do not have a job. I somewhat understand that if a hospital feels they are not able to hire enough qualified Nurses they will look elsewhere. Hospitals have often filled positioned outside of their own current employees. Why ? They must have felt those candidates in house did not meet the qualification they were looking. Sometimes, they simply want a fresh perspective on things so they hire someone from elsewhere in United States.

The health care crisis is not about just not having enough Nurses. It is about having enough experienced qualified Nurses.

During economic up times. Money is flush for new grad training programs in our hospitals. During economic down turn. Money starts to dry up. It is cheaper to hire an experience Nurse from overseas as opposed to a new grad Nurse. I wish it were not so. It is what it is.

Valerie Salva, BSN, RN · Mar 11, 2009

Again, just because it is the law that nurses from overseas are to be paid the same wages as US nurses does not make it so.

Corporations do not have any qualms about breaking this (and many other) laws.