Overcoming the Stigma of Employment-based Immigration

How Supporting International Employment- based Immigration, and Expanding Access to Visas for Nurses, Can Improve US Health and Economy

As an employee of an international nurse staffing company struggling with the roadblocks of retrogression, I often run into people who believe that hiring foreign workers to fill vacant US positions is borderline treason. The facts are clear; there are millions of jobs in the United States (especially in the health care field) that simply cannot be filled due to the lack of qualified candidates. According to a U.S. Department of Health and Human Services 2007 study, the United States will require 1.2 million new Registered Nurses by 2014 to meet nursing demand: approximately 500,000 RNs to replace nurses leaving the field, and an additional 700,000 to meet growing demand.

The Stigma
There needs to be clarification between the different types of immigration. Employment-based immigration often gets lumped together with illegal and family-based immigration and thus is seen as a burden to our economic systems. Such was the problem with the comprehensive immigration reform that the Bush Administration proposed in 2007/ 2008. They can’t and shouldn’t be lumped together. The issue of illegal aliens, immigration from Mexico and Canada vs. other countries, family-based immigration, and employment-based immigration are all separate and distinctly different issues. The White House web site on comprehensive immigration has specific plans and action for addressing illegal immigration but only briefly addresses the guest-worker programs :

“The Administration Is Streamlining Existing Guest-Worker Programs To Help Keep Our Economy Well-Supplied With Vital Workers.

The Department of Labor (DOL) and DHS are prepared to unveil a rule that would modernize the H-2A agricultural seasonal worker program to better provide farmers with an orderly and timely flow of legal workers, while protecting the rights of laborers. No sector of the American economy requires a legal flow of foreign workers more than agriculture, which is experiencing labor shortages.

DOL is also working on regulations streamlining the H-2B Program for non-agricultural seasonal workers.

DHS and DOL are studying potential administrative reforms to visa programs for highly skilled workers.”

Let’s be clear on one important point; the issue of illegal aliens holds no relevance to the problems we are facing with the nursing shortage and retrogression. Employment-based immigration does not threaten our national security, does not stretch our social programs, and does not take jobs away from American citizens, especially when there are no Americans to fill the open positions. Employment-based immigration was created to attract international talent to participate in the advancement of the United States economy, technology, education, and the overall welfare of our population. Our country doesn’t allow for immigrants to come in and take jobs away from Americans, the Department of Labor sees to that by requiring employers to post notices, show recruitment efforts, and jump through hoops when filing for a foreign worker. In addition, employment-based immigration is encouraged for shortage occupations in high tech industries such as, healthcare, science, and engineering.

Offset The Burden
The reasons for the nursing shortage are many and may take years to address domestically. Part of the solution is to hire foreign workers to help offset the burden. Unfortunately there is a strict limit on the amount of foreign workers allowed to enter the U.S. The government currently limits visas for skilled foreign workers to 65,000 a year, while the number of green cards, required for permanent resident status is limited to 140,000 a year. When the vacant nursing positions are expected to reach into the millions, you realize how small a number this is. To add insult to injury, in 2007, the H1B cap for 2008 visas was reached, through a random selection process, in only 2 days . And the applicants for 2009 H1-B visas are expected to exceed 163,000.

Happy Nurses = Happy Patients
I talk to hospitals and health systems daily that express concern for the ever-growing gap in nurse-to- patient ratios that threaten patient care, clinical outcomes, and long-term patient health. In addition, the outreach calls we make to current nurse employees, show increased levels of burn-out and frustration with the increase in patient work-load due to the lack of nursing staff to provide care. Of the 250 nurses polled in a recent outreach program, over 60% stated nurse-to-patient ratios as a leading factor in whether a nurse would consider quitting his/ her job.

In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).

Hospitals are desperate to stop the hemorrhaging of existing nurses by supporting them with additional qualified help. In addition, patient care begins to decline when nurses are stretched to their limits.
Looking at the impact of nurse staffing and how it relates to patient care, the American Association of Colleges of Nurses reported that an increase in RNs contributed to a decrease in hospital-related mortality and reduced lengths of patient stays, whereas inadequate staffing was reported to compromise patient safety.

Cause of The Shortage
Part of the reason why there are no American nurses to fill open positions stems from the availability of nursing education programs. Although the programs exist, there are often not enough educators and classes to meet demand. In 2007, AACN (American Association of Colleges of Nursing) found that 3,048 qualified applicants were turned away from master’s programs, and 313 qualified applicants were turned away from doctoral programs. The primary reason for not accepting all qualified students was a shortage of faculty. Lack of faculty is a direct result of the retiring population and the financial lure of in clinical and private-sector settings. According to the 2007 salary survey by ADVANCE for Nurse Practitioners, the average salary of a master’s prepared nurse practitioner is $81,517. By contrast, AACN recently reported that master’s prepared faculty earned an annual average salary of $66,588.

The same factors creating an increase in demand for health care services, an aging population, is also exerting shortage pressures on the nursing population. According to a 2006 study conducted by the Bernard Hodes Group, 55% of nurses plan to retire between 2011 and 2020. Fewer nurses are entering the profession and the average age of nurses is increasing, with less than 9% of nurses under the age of 30.

High wage compression in nursing means that most nurses experience salary growth early in their career that then tapers off as they advance. Wage compression, along with poor working conditions and high nurse-to-patient ratios serve to encourage experienced nurses to seek advancement outside of nursing, taking their skills and valuable experience with them.

In these challenging times, hospitals are looking to foreign workers to step in where American workers cannot. This is a necessary, short-term approach that will maintain or improve quality of work life and patient care, while larger issues in the healthcare arena are addressed and adjusted.

The Question of Qualification
When I talk to people about what I do, inevitably someone will express concern for the level of training a foreign nurse will have compared to domestic nurses. Our international nurses are from the Philippines and are fully trained and tested according to the same standards as American nurses. We conduct extensive background checks, verify all licensing, check references, conduct pre-employment interviews, and assist in acculturation and immigration paperwork. It is our job to make sure the nurses who care for American citizens are talented, passionate, and capable. We firmly believe that a blend of international and domestic talent creates a balanced solution for healthcare facilities and patients especially in these difficult times. Filipino nurses also have financial incentives to excel and perform in US Hospitals; average salaries for new nurses are $48,000 versus the $2,400 per year a nurse would receive in the Philippines.
Health Care is Good for the Economy
Research shows that this kind of employment-based immigration, especially nursing, is good for the economy and keeps the United States as a world leader in the fields of science, research, healthcare, and technology among others.

Hospitals and nurses especially have a huge impact on the economy:
· RNs work in several different markets, including public health facilities, long-term care facilities, and hospitals.
· The American Hospital Association (AHA) reported on the impact that hospitals alone have on the United States’ health care and economy: there are over 35 million people admitted, nearly 118 million people treated in emergency rooms, over 4 million babies delivered, and over 481 million outpatients treated each year.
· Hospitals are one of the largest private sector employers, employing more than five million people, and stimulating economic productivity.
· Nurses in many cases are the primary caregivers for the aging U.S. population.
· When accounting for hospital purchases of goods and services from other businesses, hospitals support one of every 10 jobs in the U.S. and $1.9 trillion dollars of economic activity.
· RNs are a significant factor in the success of hospitals and the health care industry. The Bureau of Labor Statistics reported that RNs held approximately 2.5 million jobs in 2006 with the majority of RN positions filled in hospitals.

Immigration for jobs that Americans can’t fill should continue.

Bill Gates Supports Employment-based Immigration
Even Bill Gates has argued in front of the U.S. Senate Committee saying he can’t get the talent he needs in the U.S. because there aren’t enough H-1B visas for him to attract qualified foreign workers. In March 2007 Mr Gates said that tighter U.S. immigration policies – governed partly by concerns over terrorism – were “driving away the world’s best and brightest precisely when we need them most”.

Adding, “It makes no sense to tell well-trained, highly skilled individuals, many of whom are educated at our top colleges and universities, that the United States does not welcome or value them. America will find it infinitely more difficult to maintain its technological leadership if it shuts out the very people who are most able to help us compete.” Mr Gates said that other countries were taking advantage of restrictive U.S. policies by catering to highly skilled workers who would otherwise choose to study, live and work in the U.S.

Mr Gates called on Congress to loosen rules that prevent many foreign students from settling once their studies in the U.S. are complete. He also suggested that Congress speed the process of obtaining permanent resident status for highly skilled workers.
Mr Gates even acknowledged concerns over U.S. job losses resulting from immigration but sought to distinguish between the need to encourage more highly skilled workers to enter the U.S. and the broader debate on immigration reform. “These reforms do not pit U.S. workers against those foreign born,” he said. “Far from displacing U.S. workers, highly skilled foreign-born workers will continue to function as they always have: as job creators.”

Next Steps
There are many ways to address the nursing shortage but the only way to ensure that there will be enough domestic nurses to fill positions is to have a long-term plan that mixes foreign help with an extensive domestic training program. Why not offset the burden until new domestic nurses can be trained to step in? Faculty nurses also need to be attracted to teaching positions by making private and clinical salaries competitive. We can only take these steps if the U.S. government increases the number of visas available to foreign workers and the American population overcomes the fear associated with immigration as detrimental to our culture.

Adding foreign trained nurses to help decrease nurse-to-patient ratios and improve working conditions overall for nurses, can make positive changes in the nursing career’s reputation attracting more Americans to nursing in the future and keeping current nurses happy and engaged.

Hospitals and organizations such as AHA (American Hospital Association) are currently paying lobbyists to go to Washington to fight for additional work visas for nurses. It is because of the efforts of the hospitals, Congress (who put together legislation such as HR-5924 the Emergency Nurse Relief bill), immigration law firms, and international staffing firms, that we saw the U.S. Homeland Security report “Improving the Processing of ‘Schedule A’ Nurse Visas” released December 5, 2008. This comprehensive report makes a compelling argument for the need to increase the number of U.S. visas available to nurses.

If we make enough noise, we can be confidently optimistic that reforms for employment-based immigration will occur.

You can go to White House web site and see what President Obama plans to do about these immigration issues. http://www.whitehouse.gov/agenda/immigration/

Contributors:

Jennifer Oullaf
Director Intl. Operations -MedX
Direct: 610-684-1274
Mobile: 484-431-4947
Joullaf@medxcorp.com

Jessica Parker-Smith
VP Marketing and PR
Direct: 610-684-6719

Barbara Grundy Evans
Talent Management
bevans@koposbaker.com

U.S. Department of Health and Human Services, “Toward a Method for Identifying Facilities and Communities with Shortages of Nurses, Summary Report” (Feb. 2007).

“www.whitehouse.gov/infocus/immigration/”>
“http://www.kateraynor.com/articles/h1b-visa-cap-2008.html”>
“http://www.uscis.gov/portal/site/uscis/menuitem.5af9bb95919f35e66f614176543f”>
“www.medscape.com/viewpublication/785_index”>

“www.aacn.nche.edu/IDS”>
“http://nurse-practitioners.advanceweb.com and www.aacn.nche.edu/IDS”>
“http://www.amnhealthcare.com/News.aspx?id=15444″>
“http://bhpr.hrsa.gov/healthworkforce/rnsurvey04″>
“http://journal.heinz.cmu.edu/articles/unbalanced-care/”>

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