By Miriam Stickler, Senior Editor, Insurance Insider

The recent terrorist attacks on the United States could make a nationwide nursing shortage even worse. Legislative attempts to address the problem by increasing temporary work permits for nurses abroad have been put on hold, and it is expected that Congress won’t act on the matter until next year at the earliest.

But when Washington gets back to the matter, the pressing need for nurses may mean that it is seen as an issue of public health, not immigration.

“Since the nursing shortage is a critical problem for our public health system, and there are growing concerns about whether the system is adequate to deal with widescale bioterror attacks, I would imagine that the issue could be shaped as a way to address this,” says Greg Siskind, a partner with the immigration law firm Siskind, Susser, Haas & Devine in Memphis, Tenn. “I have not heard anyone say that this or other pro-immigration legislation will be torpedoed.”

The Bush administration has been very careful to limit its post-Sept. 11 immigration plans to better security screening and they have made it clear that they intend to continue to support most aspects of the immigration system, according to Siskind. Given this environment, the legislation has a decent chance of passing, he says.

The outcome isn’t likely to be decided until 2002. “The expectation is that we’ll get back to [non-terrorism] business after the New Year,” says Carol Wolchok, director of the American Bar Association’s Center for Immigration Law and Representation in Washington.

Hospitals nationwide have 168,000 job vacancies, and 126,000 of these unfilled spots are for nurses, according to the American Hospital Association (AHA). The shortage has become severe in the last 18 months, because the nursing workforce is getting older (the average age of nurses is 46). In addition, nursing is now considered a less attractive career than other professions for young people, so nursing school enrollment is declining, says Nancy Augustine, an audit manager in KPMG’s healthcare practice.

The number of U.S.-educated nursing school graduates who took the entry level national licensing exam for registered nurses decreased by 26 percent from 1995 to 2001 according to the National Council of State Boards of Nursing. There were 25,046 fewer test takers in this category in 2000 as compared with 1995.

Hospitals’ strategies for coping with the lack of staff vary from facility to facility, according to AHA spokesperson Amy Lee. Tactics include recruiting RNs who are working in administrative or other non-nursing jobs; increasing fellowship and intern programs; raising salaries and letting nurses do their own scheduling to accommodate their work/home needs, Lee says. In addition, more then two-thirds of nurses work some type of mandatory or unplanned overtime every month, according to a recent American Nurses Association (ANA) survey.

To help address the shortage, the legislation would allow hospitals nationwide to hire foreign nurses on H-1C temporary visas and allow the nurses to stay in the United States for as long as six years. Under the proposed bill, nurses could get their temporary visas in as little as two or three months, according to an article published by Sen. Sam Brownback, (R-Kan.), who sponsored the version of the legislation now making its way through the Senate. The House of Representatives is considering similar legislation, which would allow 195,000 temporary visas for foreign nurses each year.

Currently, hospitals must sponsor alien nurses for permanent residence with a “Schedule A” green card application. There is an existing H1-C temporary visa program, but it is so restrictive that few nurses have been able to use it, says Siskind. For example, when the current program regulations were introduced in 1999, only 14 hospitals nationwide even qualified to apply to employ H1-C nurses, according to Siskind. “H1-C is a theoretical visa,” he says.

The Schedule A application process can take one to two years, says Siskind, but the long wait hasn’t been a deterrent to employers, even though they need nurses right now, because the shortage shows no signs of easing. “We’re seeing [green card] proposals for huge numbers of nurses,” Siskind says. “Employers have decided that this isn’t a temporary problem.”

Despite the Sept. 11 attacks and the continuing threats of biological terrorism, foreign nurses are still interested in working in the U.S. “The nurses coming from overseas are concerned, but they’re not not coming,” says Mark Siegel, president of healthcare recruiting agency Gateway Nursing Solution in Holmdel, N.J., which works extensively with nurses from the Phillipines.

The terrorist attacks did serve to highlight the fact that the U.S. needs to strengthen its public health system, including its nursing workforce.

“Nurses make up the backbone of our health care system, said Rep. John Boehner, (R-Tex.), chairman of the House Committee on Education and the Workforce, at a hearing held Sept. 25 in Washington. “If the nursing shortage facing our country was in serious condition two weeks ago, its condition is critical today,” Boehner added.