Hospitals looking to help ease a serious nurse shortage by
recruiting registered nurses (RNs) in the Philippines
the primary source of foreign RNs for U.S. hospitals may
soon need to look elsewhere.
Health care immigration experts warn that the number of
nurses from the Philippines and India another major RN
exporter will drop off significantly next year, because
those countries have exceeded their per-country quotas for
employment-based immigrant visas or green cards. "Processing
time for RN green cards could be extended by an additional two
to three years," said Greg Siskind, who specializes in health
care immigration issues as an attorney for the
Memphis-TN-based Siskind Susser law firm. "The recruitment of
foreign nurses to the U.S. will be dramatically curtailed as
health care employers no longer view this as a viable approach
to addressing the shortage of RNs in this country."
The Philippines is the number one exporter of nurses in the
world. More than 50,000 nurses have left the Philippines and
found employment in the U.S. in the past four years, according
to a study conducted last month by the University of the
Philippine's National Institute of Health in Manila. Health
care immigration expert Bruce Morrison, chairman of the
Bethesda, MD-based Morrison Public Affairs Group, predicts the
visa cutbacks will reduce by two-thirds the number of Filipino
nurses who are hired by U.S. hospitals and other health care
organizations.
"If there are 20,000 fewer foreign nurses entering the
marketplace over the next two years, then any hospital that is
dealing with a nursing shortage will be affected." said
Morrison, a former Democratic congressman from Connecticut who
was chairman of the House Immigration, Refugees and
International Law Subcommittee.
Hospitals for decades have sponsored foreign-born employees
for legal permanent residence. Over time, immigrants in the
U.S. from the Philippines, India, and China have filed more
visa petitions than those from any other country,
significantly outpacing the fixed quotas. The result: extra
long waiting times will begin in January for health care and
other professionals from those countries, according to the
U.S. Citizenship and Immigration Service. Charles Oppenheim,
chief of the State Department's Immigration Visa Control and
Reporting Division, said that, while there may not be an
immediate effect, hospitals should expect recruitment of
Filipino and Indian RNs to "take a hit ... they probably will
be seeing a crunch in supply."
Some hospitals could start feeling the crunch early next
year, said Los Angeles-based immigration attorney Carl
Shusterman. "Hospitals and other employers can expect a bad
situation to get even worse," said Shusterman, adding that
California hospitals will find it harder to meet mandated
nurse-to-patient ratios.
With the U.S. facing a projected shortage of 600,000 nurses
by 2020 a cutback in the supply of Filipino and Indian RNs
takes on added significance. And the cutback in visas follows
a recent report by prominent health care researcher Peter
Buerhaus that shows American hospitals increasingly rely on
foreign-born RNs. The number of foreign RNs working in the
U.S. rose by 12.5% during the past two, accounting for nearly
one-third of the total growth of RN employment in the U.S.
nurse labor market.
U.S. hospitals long have looked to Filipino RNs to help
address their nursing shortages because of the countries'
similar university health care curriculum and teaching
methods. "We decided to go with the Philippines because nurses
receive a four-year baccalaureate there, and their programs
and textbooks are all in English," said Trudy
Knoepke-Campbell, HealthEast Care System's director of
workforce planning in St. Paul, MN. "They take the same tests
that American nurses take, and the work ethic of the Filipinos
is exemplary."
Knoepke-Campbell traveled to the Philippines three times to
interview nurses. The hospital recruited 35 nurses, with the
last one arriving two weeks ago. When Knoepke-Campbell made
her first visit to the Philippines in 2000, her hospital had a
nurse vacancy rate of 10.7%. Today, it's 3.2%. "We took a
number of steps to lower the vacancy rate, but recruiting
Filipino nurses was definitely a part of the solution," she
said. "It's worked out well for us."
Knoepke-Campbell said a reduction in the number of Filipino
nurses permitted into the county could "pose significant
workforce problems for many hospitals. We all know the
demographics ... Right now, the nurses from the Philippines
and to a lesser extent nurses from India are helping to fill
the need. Hospitals should be concerned."
Andrew Downing, president of Indian nurse recruiter
GlobeMed Resources in Richmond, VA, has placed some 450 nurses
from India with 60 U.S. hospitals. "If you are adding two or
maybe three years to a process that can already take a couple
of years, that is going to make it more difficult for
hospitals to budget now for nurses who may be coming two,
three or four years from now," he said. "And it will have a
huge effect on nurses in India who are applying for a green
card to work here. A number of them will opt to go to the
United Kingdom or elsewhere."
The AHA also is raising serious concerns about "limiting
hospitals' options in addressing their workforce challenges
and responding to the needs of their patients and
communities," said Anne Ubl, the AHA's vice president for
legislative affairs. "Staff shortages are among the most
critical problems confronting hospitals, and we'll be calling
on Congress to fix a policy that doesn't make sense from a
health care perspective."
Some health care immigration specialists suggest Congress
lift the per-country quotas or reinstate the temporary visa
category for nurses, a program that expired in 1995. Others,
like ex-Rep. Morrison, recommend lawmakers carve out an
exception in the law, which would let the government take
visas from other countries that went unfilled and reassign
them to the Philippines and India. "There are plenty [of
visas] there to solve the problem," he said.
