From the January 3, 2003 print edition

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Open the country's doors to admit nurses

In your Dec. 20, 2002, article "Nursing Ills: Reinvestment Act Needs Funding to Clip Growing Nursing Shortage," you are very quick to dismiss using nurses trained abroad as a solution to this severe problem. Foreign nurses offer an immediate solution to the nursing shortage and can buy us the time needed to address the long-term shortage.

You mention at the outset that Norway is importing nurses from poor countries, enticing them with high pay and lush social services. Later in the article, you state that employing foreign nurses "raises concern" because some nurses come from countries with their own shortages and that we exacerbate problems in other countries when we recruit their nurses.

This is the argument being put forth by nursing unions seeking to prevent Congress from making it easier and faster for health care employers seeking to hire foreign nurses (it takes nearly two years to bring a nurse over under current procedures). Seven years ago, the nursing unions were successful in lobbying Congress to kill a visa category for nurses that made it possible to bring nurses quickly in to the U.S. They argued then that the nursing shortage was over. No one will take that argument seriously today, so they have invented a new justification for protectionism.

There are a number of problems with the unions' new argument. First, the vast majority of nurses are coming from countries with surpluses. Well over 90% of the foreign nurses now in the U.S. are coming from the Philippines. The next wave will come from India now that the foreign nurse certification exam started being administered in that country earlier this year. India, like the Philippines, educates many more nurses than it can employ. Both India and the Philippines consider their nursing education programs to be an export industry. They know that their overseas workers pour billions of dollars back into their countries.

Second, America's immigration policies should be designed around America's needs and not the needs of other countries. We are facing a 20-year nursing shortage and study after study is coming out showing that Americans are actually dying because there are too few nurses. Typically, people argue against liberal immigration rules in order to protect Americans. It is rather ironic that we now hear anti-immigration arguments coming from people claiming that we should be protecting those in other countries rather than our own.

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Third, the unions' argument assumes that if America says no to nurse immigration, then foreign nurses will simply choose to stay home. You correctly note in your article that there are many other countries facing shortages and nurses are being recruited for placements all over the globe.

If we say no, these nurses WILL still leave. And countries like Britain, Australia and Canada will be the beneficiaries. In fact, in many impoverished countries, people go into nursing because it represents a ticket out of the country. If emigration were not an option, they might very well choose a different career. America is the number one destination in the world for people looking to emigrate. This is a tremendous asset that we should be exploiting. If we don't, other countries will be happy to take advantage.

Fourth, even if the Nurse Reinvestment Act is fully funded, supporters of the legislation admit that it is merely a band-aid that will only modestly slow down the ever-worsening shortage in the U.S. It will take years before we start to see a payoff if, in fact, we ever do. The nurse shortage crisis is a here and now problem, but the Nurse Reinvestment Act only offers modest hope for a distant future.

Fifth, the article offers the advice that if an employer just focuses harder on keeping their nurses, then the problem will be solved. You quote Peggy Troy of Le Bonheur Children's Medical Center as saying that a strong retention program is enough for her facility and they would never consider a foreign nurse. Le Bonheur is very fortunate that this is enough for their facility. But they are a well-respected regional children's hospital and it is easier for them to recruit and keep nurses than other places. But ask the average nursing home administrator how easy it is to keep good nurses.

Venture over to The Med, the VA Hospital or go to a rural hospital in an impoverished and ask the same question. They'll tell you that things are not so simple.

Sixth, you state that foreign recruiters have a poor image because they are offering "what seems to a poor nurse like an extravagant income." Well, of course this is true. Employers are offering foreign nurses -- as they are required to do by law -- the same or higher salaries than their American counterparts. Are you actually suggesting we should pay nurses the pittance of a salary they could earn abroad? Is it immoral to pay a decent wage? The nurses coming to this country are grateful for the opportunity to earn a living wage and

Finally, one thing most Americans don't know (and the nursing unions don't volunteer) is that foreign nurses typically are much better educated than their American counterparts. Most American nurses receive two year associates degrees while foreign nurses almost universally possess bachelors degrees. These well-educated nurses here enjoy an excellent reputation with patients and physicians and we should be welcoming them with open arms.

I am, frankly, surprised that the Memphis Business Journal would be so quick to embrace a strategy that is focused on a fat new government spending program rather than letting market forces solve the problem. Allow employers to look globally to find nurses and we will all be better off.

Siskind, Susser, Haas & Devine, Immigration Lawyers, Memphis

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