Archive for the ‘General Nursing’ Category

Overcoming the Stigma of Employment-based Immigration

Wednesday, March 11th, 2009

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/”>

HR 5924-The nurse relief bill has even more co-sponsors

Friday, July 18th, 2008

The most recent update on the Emergency Nurse Relief bill is in the link I
have provided. Last month the bill HR 5924 had 10 bi-partisan co-sponsors,
now that number is up to 17. The support is mounting which is a very good
thing! This bill, when passed, will put an end retrogression for nurses. I
know people are hearing a lot of negative things, through blogs and the
internet especially in the Philippines, about how retrogression will never
end. Please know that rumors and misinformation are easy to spread and that
is exactly what those negative messages are. They are not based on fact!
The bill HR 5924 is a fact and it is counter to the rumor that retrogression
will never end. People involved in the Healthcare Industry know we have a
nursing shortage here in the U.S. Business leaders know that small business is negatively impacted by retrogressions as well. They, along with our government leaders,
are working hard to rectify the situation which is good reason for all of us
to be hopefull that these times will soon come to an end. if you have a specific question, seek proper legal advice, speak with an immigration specialist or send me a message here. Keep up the spirit!

“Hammond Law Group Blog”<

One sided solutions are a drop in the bucket, let’s think full circle!

Monday, May 19th, 2008

I am long overdue in giving you a retrogression/what’s-going-on-about-the-nursing-shortage-update. Some good things are happening out there. Back on March 1st the Dept. of State
(DOS)/National Visa Center (NVC) pushed the dates for Employment Based 3rd category (EB3) visa processing to January 1st 2005 in an attempt to utilize the visa quota for fiscal year 2008 before they go in the trash. The USCIS is processing petitions too slowly and as a result they don’t use all the visas available to them each year. They go unused even though we are neck
deep in retrogression. What this means is that any nurses with petitions that have a priority date on or before the processing date has a shot at getting a visa. It gets even better; the last I looked at the visa bulletin the processing dates jumped from Jan. 1, 2005 to March 1, 2006! I have started getting paperwork from the NVC for some of our nurses, let’s hope it jumps
forward even more so we can get some of our long awaited RNs in. This situation is volatile and could change at any time and the dates could go back again so pushing all the paperwork through quickly is required in order to get a shot at visas, and trust me, we are on top of it.

Now in regards to retrogression the song remains the same, we are waiting for the elections
to conclude, so attention can be directed back to the need for some kind of immigration change that will allow nurses to obtain visas and fill the ever growing shortage. This leads me to my next point. We are approximately 250,000 nurses short and this number will keep going up; statistics are saying that by 2020 we will be a million short (recent reports have reduced that estimate, but there will still be a massive shortage that threatens quality of care). There is a lot of noise about getting more nurses through increased enrollment in nursing programs and ways to make this happen. I agree that we need domestic solutions, but what stands out are the numbers I have seen for increased enrollment still only supplies a small quanity of nurses
compared to the hundreds of thousands of nurses we need. With an aging baby-boomer population, the health care systems will become even more strained, not to mention the baby boomer nurses who are retiring. More nursing programs and students is a good and important plan, but it will take 20+ years to fully reap the benefits. We need something that answers to
the crisis now. In my opinion, a good solution is one that is well-rounded; that includes a combination of domestic solutions such as more nursing schools, better working conditions for nurses, domestic recruitment, etc. and recruiting from abroad. We aren’t the only country that has a nurse shortage and we are losing out due to our restrictive visa program for nurses. Other countries are much more welcoming to foreign nurses and they are the ones getting them instead of us. I have attached an article that is about one domestic proposal for getting more RN Educators in order to increase enrollment through the military. It is very interesting. Please comment on your thoughts and reactions!
“RN Educators”

Hospitals Need a Business Approach to Nurse Management Training

Tuesday, February 26th, 2008

The number one reason nurses cite for leaving their jobs in exit interviews is their direct manager. This issue is not unique to nursing or healthcare by any stretch of the imagination. Most business people know that people don’t quit jobs; people quit people. Managers are any organization’s number one line of defense when it comes to maintaining morale and retaining good employees. If your managers have not been trained to do this, or if the organization has not made it clear that employee retention should be a priority for managers, then your organization is missing a significant opportunity. It is an opportunity that has serious strategic and financial repercussions.

Nurse managers have it tough. They have a lot on their metaphorical plates; patient care, managing teams of tired, stressed and potentially fried nurses, budgeting, managing schedules, to name just a few. Many nurse managers are not given formal training in core management skills when they make the transition from staff nurse to nurse manager. Nurse managers should not shoulder all the blame for for high turnover in hospitals. There are so many different reasons for high turnover rates that are beyond the immediate control of the nurse managers. However, it is still a legitimate reason for nurse turnover that hopsital administrators can and should address. They just need to look to the traditional business world for models and best practices.

By including specific training for nurse managers that focuses on retaining, rewarding and motivating their teams, hospitals can have a significant competitive advantage when it comes to attracting and retaining talented caregivers. Training in core management skills should take place upon promotion and be included over time as nurse managers develop in their roles.

Skilled nurse managers know that they need to continually recognize and reward their staff, even or especially, in ways that are not about money. Most people thrive on acknowledgement of their work. It is easier to do a tough job when you know someone else values that you are doing it. Being consistent and even-handed about recognition is not as easy or as intiutive as the simple idea of recognition. This is where training can help a nurse manager go from good to great.

Less intuitive are the skills needed to build a performance driven team. This is where continuous training and reinforcement becomes critical. Being able to build strong alliances with staff, and earn their loyalty and commitment to department goals has a significant impact on job satisfaction and retetnion.

Nurse managers also need support from administration so that they have the time and freedom to develop those strong alliances with their teams; so that they have enough interaction with staff to be able to identify those team members who are at risk for turnover; so that they can help employees with key skill or performance areas; and so they can spend enough time recognizing and rewarding good performance among team members.

Hospital administrators not only need to take the steps to provide training to nurse managers in these areas. They also need to seriously examine the nurse manager’s workload. How can that workload be creatively realigned so the nurse managers have more time to actually manage? And there’s the challenge. How can you lighten the workload for nurse managers in a sector already in crisis due to a shortage of workers? Is there a way to work in non-clinical support for the nurse managers? If a hospital found that administrative load/paperwork took up 30% of their nurse managers’ week, they could create an administrative support pool to provide the nurse managers with back up. With their administrative load lightened, nurse managers could recycle that time into retention and team building activities. This is a place where hospitals can get creative with solutions beyond training. And don’t forget, the best source for these creative solutions is going to be the folks they are aimed at helping; the nurse managers!

Pairing new nurse managers with a mentor, a seasoned nurse manager who exemplifies the best practices and success you’d like to see across your organization, gives them an informal resource for ideas, as well as, someone to challenge and help them grow.

There are a ton of resources out there for management training and, increasingly, resources specifically for nurse manager training that focuses of leadership. Ideally, find a vendor with core expertise in this area. Ask for and speak with client references. See if they can provide you with success stories and before and after snapshots of retention figures. See if they are willing to talk about when their program didn’t work. This is such an important initiative, finding a vendor that shares your organization’s values and has a track record of success is serious business.

Some of the folks in this space that I really like are:
“Health Care Performance Institute”
” ABP Training”
“Dale Carnegie”
“The Leaders Toolbox”

Addressing immigration reform and the presidential candidates

Tuesday, January 15th, 2008

Happy New Year! This is my first 2008 email update addressing the ever looming shadow of visa retrogression for nurses. I think the one thing I am fervently hoping for everyday is to hear media adress the nursing shortage and need for immigration reform. I have seen a few articles and briefs more recently, The National Foundation of American Policy published a couple of briefs last September and October and they continue to address the need for more legal immigration overall in the country and the nursing shortage. See these links for the articles. “deadly consequesnces” “nurses”

What I hope comes next is coverage of this issue from the more mainstream media and I am looking to see what the Presidential candidate’s stances are on the topic of more visas for nurses and immigration reform overall. It is too much to hope that they would even touch on the topic of the nursing shortage and the needs for visas but it is not too much to expect them to address their thoughts on making more visas available for employment based immigrants and reforming current immigration practices. Some seem to be only focusing on the border security and illegal alien problem and, in my opinion, that is not broad enough of a view. I hope for a President who understands the importance of changing the immigration system and removing visa caps for shortage occupations. Even if they don’t make this a campaign topic I am doing my research to see what their stance would be on passing legislation to help get nurses visas. Something good probably will happen before the election; I am hearing hopeful whispers that something may happen in the first quarter of 2008. Nevertheless, it is important to me, and probably all you affected by the current situation, to have a President who will work to change the system long term, so that this kind of situation never happens again. Hammond Law Group’s blog spot covers both the presidential candidates’ views and what is happening in the media among other immigration topics. I have included the link here for those who wish to read it through, I found it very informative. Thanks for your participation by reading my thoughts and let’s hope for some happy news in 2008.
“www.hammondlawgroup.blogspot.com”

Retrogression Update: Impact of visa limits on US health

Thursday, December 20th, 2007

I’ve been waiting a long time to write something so I’d have some good news to share. Unfortunately all the Retrogression updates I’ve read recently report that nothing much has been happening. There are still no visas available for nurses and health care workers, in fact the longer this goes on the more it will have negative effects on patient care. Some believe the reason for all of this is that there is a political war going on within our own government which is paralizing us and that there is a strong anit-immigration sentiment currently.

It is a fact that Bush vetoes many bills that Congress passes. Congress may gain some leverage to get something passed because there is a need for Congress to pass legislation giving more financial support for the war in Iraq, so there might be some compromise. It is a historic truth that legal, employment based, immigrants are an important factor in the U.S.’s economic growth. Not having enough people to fill jobs, ANY jobs, causes economic stagnation or worse. There is always hope, I have seen an increase of communication on this topic in the media and slowly it should start to reach the general American public who are for the most part unaware of the level this nursing crisis has reached. Once it is common knowledge, there will be a lot of noise that will be heard by our law makers. I have tacked on some articles for reference.

The first one gives us a glimmer of hope that the bill HHS Education Appropriation Act of 2008 which was passed by Congress and that Bush vetoed may be amended by Congress to add a provision for nurse visas and that with the Bush Administration’s need for Congress to work with him to get him war funding, it may pass. A point to note is this article on American policies and issues is written by a Filipino and published in a Filipino paper. The second piece is an example of how businesses, etc. are hurting because of lack of immigration reform which results in a lack of workers and thus reinforces the fact that we need a legal immigrant worker population and the current caps on visas hurts business and economy. The last article exemplifies the fact that the nursing shortage has deadly results and discusses the shortage in a manner that matches the conclusions I have come to from much reading and research on this topic.

You all can help with this cause by speaking out and raising people’s awareness of the personal impact this shortage can have and then perhaps it will drive us toward a positive change in immigration and help to lift retrogression.

“www.globalnation.inquirer.net”

“www.businessweek.com”

“www.foreignnurses.net”

Nursing Needs Better PR

Friday, September 14th, 2007

“N.C. faces nurse shortage of 30% by 2020”, Nurses’ time at bedside may be trade-off for IT efficiency”, “Globalized nursing market may suppress pay, exacerbate shortage”, Nurse turnover fueled by stress, poor management“. These are just a sampling of some of the headlines about nursing pulled over just 3 days. There are more, but they all have one thing in common; they’re all about how bad it is in nursing. They paint a negative picture of nursing as a career. This negative picture will impact anyone who is considering becoming a nurse. Who wants to invest time in becoming a nurse when the only rewards broadcast at us incessantly by the media etc. are a fast track to ulcers, bunions, an aching back and being under-paid? Sign me up!

Now, to qualify the above, I am NOT saying we should not be engaged in open honest discussion about the challenegs surrounding the nursing shortage and working conditions for nurses. All of those headlines are dead on, and to hide those issues or pretend like radical change is not required, would be foolish and short sighted in the extreme. What I AM saying is that collectively, anyone involved in nursing is part of the global nursing on boarding team. Everyone in, related to, who hires for, or who writes about nursing has a responsibility to present the good, now more than ever. (Remember the days when media policed its own photographers and wouldn’t let anyone photograph FDR in his wheelchair? The message:”We stand united. We stand together.” Ah, the good old days…) We need to engage future nurses before they even start thinking about becoming nurses. How have we, as a nation, branded nursing as a career option? What are the rewards? Why did you get in to nursing? What do you love about the work? Is it a job or is a calling? What was the last thing you felt proud about at work? When was the last time someone thanked you or offered a simple “Good job?” Some of the big rules of on boarding are to inspire pride and collect and tell your stories, help build a personal connection in those you are trying to reach.

We need more headlines like “Nurse Retires After Over 60 Years At Work” or “Grants to improve quality through nurse training in California” or “Ga. nurses take lead in reducing infection risks in children“. We need more coverage about the wins and about why nursing is a great, rewarding career. We need to work together, united, to solve the problem of pay and working conditions and push the rewards into the spotlight in order to get nursing back on the career A list.

Next entry: how hospitals can create roblox robux hack better environments for nurses…

Hello world!

Tuesday, August 21st, 2007

Welcome to Nursing blog! We’re excited to be here and pleased you’ve joined us. Here we’ll be providing insight, ideas and generally commenting on the world of nursing, work and career. Check back often for updates!